2020_010_A
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70% of Americans want to die at home

70% of Americans want to die at home

Covid-19 is denying persons a death surrounded by loved ones.

When we know death is inevitable, most of us want to die at home. Should those dying of Covid-19 have that choice?

Your thoughts?

What follows is not an endorsement:

Charles Camosy, a professor of theological and social ethics at Fordham University, makes the case that hospice should be an option for those dying of Covid-19:

It is now clear that ventilators can save the lives of only a minority of patients with advanced cases of the disease. At the same time we are beginning to absorb how often those who die spend their last moments isolated in ICUs, with no family to tell them they are loved and no religious presence to administer last rites or pray with them.

Dying of severe respiratory disease can be a grim experience without the proper care. Happily, home hospice staff are practiced at helping patients die well in these situations. These skilled practitioners are trained to use the right amount of morphine and concentrated oxygen to relieve the need to gasp for air, while also employing muscle relaxants and anti-anxiety medications to keep the patient at ease.

Protections can be implemented for families who consider the admittedly higher risk worth it. “Suppose the risk level is raised a small percentage,” said Banach [CEO of the National Hospice and Palliative Care Association]. “That has to be weighed against the very good chance of dropping a loved one off at the hospital and their dying without being able to say goodbye. That’s a very personal decision that family members ought to be able to make.”

Simply put, there are values that trump the singular goal of lowering COVID-19 infection rates. One of those is the compassion to accompany loved ones as they pass away and provide them with clergy.

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Steven Wilson

One of the ethical issues that we must always consider is “what are probable unintended results of the action(s) we’re about to undertake,” and then to weigh those probabilities into the equation before taking an action. I’m afraid we’re doing a fairly poor job, in this moment of justifiable anxiety, at thinking through probable unintended consequences of decisions like isolating the dying from their loved ones, or shuttering churches in a time of great social anxiety. I know, I know, risk minimization. And I’m taking that seriously. But we need to take a good hard look, after this is past, at how we did things and how we could do them better–because while a pandemic doesn’t happen every year, HIV/ West Nile/ Zika/ H1N1/ MERS/ SARS/ Ebola could all have gone that way.

Eric Bonetti

People tend to be frightened of death and dying, but may miss out as a result on some very beautiful experiences.

When my mom’s long battle with COPD came to an end, I was lucky enough to be able to sit with her; hold her soft, frail, still warm hand; smooth her hair; sing the lullabies to her that she sang to me when I was small, and tell her that I love her.

Due to black ice on the roads, it took several hours for someone to come out and declare her dead. But our final hours together were beautiful and very positive, even through the grief.

I hope all persons have an opportunity at least once in life to have such a beautiful and profound experience.

Helen Kromm

I assume the 70% number comes from the Kaiser Foundation survey, which pre-dates the Covid19 pandemic. I don’t doubt that percentage as a preference, and actually would think the number might have been higher. The reality here though is that doesn’t take into account our current situation, and specifically those infected with this disease.

Maybe a more appropriate question to ask would be if you were infected with a highly contagious disease, would you prefer to die at home even if it put your family, friends, and clergy at increased risk? My answer would be no, and I think most people would answer no if the desire to be at home placed those left behind at risk.

There’s also the practical consideration that most home care programs for the terminally ill provide less intensive care and place an immense burden on untrained people to take up that slack. This article provides a very good viewpoint: https://www.advisory.com/daily-briefing/2020/01/28/hospice-care The skilled hospice staff Camosy references are on average on site with each patient 30 minutes a day.

And of course there is this: “Protections can be implemented for families who consider the admittedly higher risk worth it.”

That’s true I’m sure. But the key part of that is “higher risk”. While some and probably most families are willing to take that risk, what about those they come into contact with during the up to fourteen day incubation period where they can unknowingly transmit this disease to complete strangers? Those strangers don’t seem to have a voice in this.

James Pratt

For those who do not live alone, chances are that their household members are already infected, and thus remaining at home rather than going to the hospital does not increase the risk to those family members. Under current protocols, those who come into unprotected contact with an infected person are supposed to self-isolate; if those protocols are enforced, further spread is minimized. Also, it is better for one family member to be present and link in others by FaceTime or other means, than to burden overworked nursing staff with that responsibility.

Clergy would need to have access to proper protective equipment

Catriaa

(Catriaa – In the future, take note of policy requiring first and last names. – eds.)

So the option is to coldly drop your frightened and tired loved one off at a cold hospital and not be able to comfort them I. Their last moments upon this Earth? “Goodbye. It was fun while you were well. Now that you are ill, probably scared we will put you into the hands of strangers and let you suffer and die alone. You had a good run now, goodbye.” I’m sorry. If it was my loved one I would be banging down the walls to sit with them until they leave this world By your theory, doctors and nurses should not show up for work. After all, they are not sitting by one person holding their hand until they pass a probably scary and painful last hours, they are touching and caring for tens of people on any given day. If anyone is going to catch it in a hospital, surely it would be them

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