Expos Research PaperEvan Ketner

by 2001 there were approximately 2283 Medicare-certified hospice agencies that cared for 579,801 patients with an ALOS of 49.9 days at a cost to Medicare of $6228 per patient, well below the Medicare beneficiary cap of $16,650. During this period, hospice services were also expanded to include patients with noncancer terminal illnesses.

The upward trend in the number of hospice programs reflects a better consumer understanding of choice when it comes to end-of-life options and a growing public demand for the availability of hospice as an additional medical option. Data from the National Hospice and Palliative Care Organization (NHPCO), from 1974 to 2004, illustrates the increasing number of hospice programs in the United States (Figure 1).

Career

According to his lawyer Geoffrey Fieger, Kevorkian assisted in the deaths of 130 terminally ill people between 1990 and 1998. In each of these cases, the individuals themselves allegedly took the final action which resulted in their own deaths. Kevorkian allegedly assisted only by attaching the individual to a euthanasia device that he had devised and constructed. The individual then pushed a button which released the drugs or chemicals that would end his or her own life. Two deaths were assisted by means of a device which delivered the euthanizing drugs intravenously. Kevorkian called the device a "Thanatron" ("Death machine", from the Greek thanatos meaning "death").[19] Other people were assisted by a device which employed a gas mask fed by a canister of carbon monoxide, which Kevorkian called the "Mercitron" ("Mercy machine").[20]

According to a report by the Detroit Free Press, 60% of the patients who committed suicide with Kevorkian's help were not terminally ill, and at least 13 had not complained of pain. The report further asserted that Kevorkian's counseling was too brief (with at least 19 patients dying less than 24 hours after first meeting Kevorkian) and lacked a psychiatric exam in at least 19 cases, 5 of which involved people with histories of depression, though Kevorkian was sometimes alerted that the patient was unhappy for reasons other than their medical condition. (In 1992, Kevorkian himself wrote that it is always necessary to consult a psychiatrist when performing assisted suicides because a person's "mental state is ... of paramount importance."[22]) The report also stated that Kevorkian failed to refer at least 17 patients to a pain specialist after they complained of chronic pain, and sometimes failed to obtain a complete medical record for his patients, with at least three autopsies of suicides Kevorkian had assisted with showing the person who committed suicide to have no physical sign of disease. Rebecca Badger, a patient of Kevorkian's and a mentally troubled drug abuser, had been mistakenly diagnosed with multiple sclerosis. The report also stated that Janet Adkins, Kevorkian's first patient, had been chosen without Kevorkian ever speaking to her, only with her husband, and that when Kevorkian first met Adkins two days before her assisted suicide he "made no real effort to discover whether Ms. Adkins wished to end her life," as the Michigan Court of Appeals put it in a 1995 ruling upholding an order against Kevorkian's activity.[22] According to The Economist: "Studies of those who sought out Dr. Kevorkian, however, suggest that though many had a worsening illness ... it was not usually terminal. Autopsies showed five people had no disease at all. ... Little over a third were in pain. Some presumably suffered from no more than hypochondria or depression."[23]

Services provided under the hospice benefit for the patient and family include: Physician care Professional nursing services Personalized home health aide care Social worker counseling and supportive care Spiritual consultation Caregiver support and training Pharmaceutical services for the management of symptoms and pain control related to the terminal diagnosis Durable medical equipment service to assure maximal comfort and assistance related to the terminal diagnosis Physical, occupational, speech, and nutritional consultation for symptom control related to the terminal diagnosis Respite care Bereavement support for both patient and family Volunteer services

he determination of which level is most appropriate for the needs of the patient is made by the members of the IDT with input from the patient and family. Standards of care to ensure quality are identified by Medicare, which certifies the majority of hospices nationwide. In addition, many hospice organizations are members of the NHPCO, which also endorses and encourages a sharing of ideas and solutions for hospice at the national level. Many hospices also attain and maintain accreditation by either the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) or the Community Health Accreditation Program (CHAP) to further guarantee quality of services and care.

pported assisted suicide but still argued that it falls outside the domain of moral medical practice: they argue there ought to be others (non-physicians) who assist in death of this kind. Other commentators note that there is a plurality of views within the medical profession, and the goals of the profession ought to respect that diversity. The profession tolerates differences of opinion about, for example, the practice of abortion. Why should it not, goes the argument, also tolerate diversity in respect of physician-assisted suicide? Terminology

Ethics has drawn up a specific vocabulary in order to clarify different kinds of action. A physician's involvement in the death of patients can fall into the following categories: active, involuntary: the physician intentionally kills a patient contrary to the wishes of the patient active, voluntary: the physician intentionally kills the patient in accordance with the wishes of the patient passive, involuntary: the physician lets the patient die by refraining from interventions, contrary to the wishes of the patient passive, voluntary: the physician lets the patient die by refraining from interventions which would be useless in any case, in accordance with the wishes of the patient

Standard Arguments against Physician-Assisted Suicide There are a number of arguments that are repeated in the argument against physician-assisted suicide: suicide is wrong in and of itself even for the ill it is incompatible with the healing goals of medicine given appropriate palliative care, it is unnecessary requests for death are induced by poor care and/or unrecognized psychological needs the practice damages physicians by desensitizing them to human needs it leads down a slippery slope to indiscriminate killing of the ill, weak, and disabled, among others

To estimate how often physicians receive requests for physician-assisted suicide and euthanasia