As a hospice admission nurse, I get this question a lot.  Family members want to know whether we can hide the fact that the patient is on hospice care and dying.  They'll ask if we can turn our badges around (my company's name has the word "hospice" in the title) and say we are visiting nurses helping the patient get better.  They request that we don't use the words "death" or "dying" around the patient.   They worry that their loved one, armed with this knowledge, will give up and die faster.

Ask any hospice worker and you'll discover how uncomfortable this makes us.  We want to honor cultural, religious, and personal beliefs but we know that ignoring the elephant in the room is never a good thing.  We've seen the amazing work that can be done at the end of life by patients who know their time is short.  We've witnessed the peaceful death of so many who had time to plan and prepare for the end and we've seen the flip side too.  We've seen patients who didn't have the chance to complete important tasks at the end of life struggle through the dying process.  We also know that just as you can't hide the fact that a woman in labor is going to have a baby, you can't hide the inevitability of death from a person who is dying.

So, do you have to tell your dying loved one that they are dying?  No, of course not.  Should you consider doing it anyway?  Read ahead....

My Loved One is Dying.  Do I Have to Tell Him?

A U.K study found that a physician's religious belief influenced how they treated patients near the end of life.  Doctors who described themselves as "extremely non-religious" or "very non-religious" were nearly twice as likely to practice ethically controversial end-of-life practices that could hasten a patient's death.

Dr. Clive Seale, a professor at Barts and the London School of Medicine and Dentistry, conducted the study -- a random mail survey of more than 3,700 doctors across Britain.  Doctors included neurologists, palliative care specialists, geriatricians, and other specialists and 2,923 physicians responded to the survey to report on how they took care of their last terminal patient.  Doctors who were atheist or agnostic were more likely to practice things like continuous deep sedation (a form of palliative sedation) and other practices that may hasten patient death.

The study also found that doctors who were religious were less likely to discuss end-of-life wishes with their patients.

Religion, or lack of it, deeply influences the decisions we make.  It's no surprise that religion influences how physicians practice medicine -- but should it?  I was having this conversation a couple weeks ago with friends of mine (who happen to be friends from church).  They were troubled about a graduate student in counseling who was asked to leave the university after she refused to council homosexuals due to religious convictions.  Despite my own religious convictions, I believed the university had made a necessary decision to remove the counseling student.  My argument was that there are certain professions that require the professional to set aside personal and religious beliefs to best serve others.  Medicine is certainly one of these professions.  I've taken a professional oath to act in the best interest of my patients; doctors take the hippocratic oath and vow to do the same.  Additionally, the British Medical Association specifically states that doctors cannot allow religious belief to interfere with their treatment of patients.

Health care professionals must set aside our own beliefs and find out what the patient wants.   It's not only what is required of doctors and nurses (and counselors, and social workers, etc...) but it is what's right for the patient.  Does the patient have religious convictions that would oppose treatments such as palliative sedation?  Does the patient have their end-of-life wishes written in a document?  Are there family members who can make decisions on behalf of the patient so the doctor doesn't have to bear the responsibility?  The answers might take a little digging but I think it's well worth the time.

A study, released by the New England Journal of Medicine, found that patients on hospice/palliative care lived longer than those who received standard care.  This study followed patients with non-small-cell lung cancer and found that those receiving palliative care lived, on average, two months longer than those receiving traditional cancer care and they reported a higher quality of life.

This isn't the first study of it's kind.  The Journal of Pain and Symptom Management published a similar report in 2004 that showed that patients with 16 of the most common terminal diagnoses who received hospice care lived several weeks to two months longer than patients who did not received hospice care.

Unfortunately, the perception that hospice means "giving up" prevents many patients from seeking it sooner.  These studies are proof that the sooner a patient receives palliative care or hospice, the better their quality of life will be.  Patients should never wait to elect hospice or palliative care simply because they think they are giving up and will die sooner.  We now know the opposite is often true.  Patients live longer and fuller lives if they receive quality palliative care and hospice services.

Learn more about hospice and palliative care:

What is Palliative Care?

What is Hospice Care?

Am I Ready for Hospice Care?

Does Choosing Hospice Mean I'm Giving Up Hope?

I couldn't resist sharing this story with you.  Ron Sveden of Cape Cod was rushed to the hospital with a collapsed lung and pneumonia.  On an X-ray taken at the hospital, doctors found a spot on Sveden's lung.  Sveden already suffered from emphysema and feared that cancer would take his life in six months or less (in which case, he would have qualified for hospice care).  Doctors did a biopsy and instead of finding a tumor, they removed a pea sprout.  Yes, a pea that had actually sprouted in his lung!

Thankfully, Sveden won't be a hospice patient just yet.  Another piece of good news -- he hasn't lost his appetite for peas.