To be, or not to be, that is the question:
Whether ’tis nobler in the mind to suffer
The slings and arrows of outrageous fortune,
Or to take arms against a sea of troubles
And by opposing end them. To die—to sleep,
No more; and by a sleep to say we end
The heart-ache and the thousand natural shocks
That flesh is heir to: ’tis a consummation
Devoutly to be wish’d. – Hamlet
Shakespeare’s brooding prince contemplated death in the face of heartbreak. However, today many people who are coming to the end of their lives are considering legalized suicide. They are doing so to avoid prolonged suffering and indignities.
Currently, 10 states allow physician-assisted suicide. However, measures to legalizing the practice are being considered in 19 other states. The trend is an effort to add another option to end-of-life decisions that include hospice and palliative care.
Death With Dignity
Advocates of physician-assisted suicide prefer to call it death with dignity. That is because they feel the action is a humane way for terminally ill people to end their lives with minimal pain and humiliation.
Although death with dignity gives you the right to choose when to die, it is not without legal requirements. As mentioned earlier, death with dignity is only legal in 10 states. It can only be performed with the assistance of a licensed medical professional. In addition, patients must be terminally ill and a resident of a state that sanctions death with dignity.
Each state lays out the procedures for obtaining lethal medications. The patient must request the medications. It is up to the physician to determine if the request is valid and if the patient is a resident of the state.
Advanced Directives Not Covered
An increasing number of seniors and those with life-threatening diseases draft advanced directives. These documents go into effect when you can not make decisions for yourself. They instruct family and medical staff as to what medical treatment you want or do not want.
Death with dignity laws require you to be lucid and able to make your own decisions. For that reason, advance directives can not be used to apply for physician-assisted suicide.
Impact on Life Insurance Coverage
Life insurance policies vary – sometimes greatly. For example, one policy may allow for coverage of assisted suicide while another may not.
In addition, a policy that pays beneficiaries in the case of death with dignity may not pay if the medication is taken in a state that does not sanction the practice.
Furthermore, private life insurance policies rarely pay when a suicide is committed within the first two years of issuance. However, group policies handle the matter differently. If your coverage is paid entirely by your employer, it may not have a two-year elimination period for suicide coverage.
Notice the use of the word “may” in the preceding paragraphs. That is a red flag indicating that you should read your policies carefully as part of any end-of-life decisions.
Cost of End of Life Care
According to the Medicare Trustees Report for 2023, the Centers for Medicare & Medicare Services (CMS) paid $23.9 billion for hospice care in 2022. That figure is expected to increase by more than $54 billion by 2032.
Medicare and Medicaid payments for hospice care are expected to increase four times more than private insurance by 2031. Part of the reason for that is the large number of seniors enrolled in Medicare.
Medicare contributions are projected to climb by 7.5 percent. In addition, Medicaid payments are expected to rise by 3.2 percent. Conversely, private insurance is only anticipated to increase by 2.5 percent.
End-of-life Care
There are three options for end-of-life care.
- Go it alone with no medical care.
- Hospice Care
- Palliative Care.
Going It Alone
This may be preferred, but it is the hardest to pull off. In most cases, we lose the ability to care for ourselves as we near death. That means family, friends or, most often, medical staff will need to be called in.
One consequence is relying on family or friends to care for you is the physical and emotional wear on the caregiver(s). The Cleveland Clinic calls this “caregiver burnout”.
“Caregiver burnout is a state of physical, emotional, and mental exhaustion that can happen when you dedicate time and energy to manage the health and safety of someone else,” According to the clinic. “Caregivers who experience burnout may feel tired, stressed, withdrawn, anxious and depressed.”
Hospice Care vs Palliative Care
Both Hospice and Palliative care emphasize easing pain and providing the highest quality of life possible for patients.
The primary difference between these two approaches is that hospice care is employed when a patient is terminally ill with a life expectancy under six months. Hospice care does not provide curative care. On the other hand, palliative care seeks to manage pain and enhance the quality of life while a patient is undergoing curative treatment.
A team of medical professionals, which may include your doctor and spiritual advisors, is involved in both hospice and palliative care.
In the vast majority of cases, hospice and palliative care is not provided 24 hours a day.
Usually, it entails regular visits from a medical professional who coordinates care with your caregiver. That is usually a family member if you stay at home.
However, according to the Hospice Foundation of America, care can be given anywhere you live. That includes private residents, nursing homes, or other residences. The same is true for palliative care, which can also be received at an outpatient clinic.
Who Pays
Both palliative and hospice care can be paid by Medicare, Medicaid, and private insurance plans. In addition, veterans may be eligible for palliative care through the Veterans Administration.
Length of Treatment
Palliative care is designed to be provided as long as needed. In contrast, hospice care is expected to last six months or less. However, hospice care can be extended.
You are authorized two 90-day hospice care extensions. After that, care can be extended every 60 days for as long as you live. In addition, you can leave hospice care to resume curative treatment or if your condition improves. However, you can return to hospice care any time.
If you have Part A Medicare (hospital coverage) the Medicare website states – “you pay nothing for hospice care”. To qualify for care, Medicare requires that:
- Your hospice doctor and your regular doctor (if you have one) certify that you’re terminally ill (with a life expectancy of 6 months or less).
- You accept comfort care instead of care to cure your illness.
- You sign a statement choosing hospice care instead of other Medicare-covered treatments for your terminal illness and related conditions.
Private insurers that offer hospice coverage tend to follow Medicare guidelines.
Last Words
To say that end-of-life decisions are gut-wrenching is a colossal understatement. Fortunately, laws in states that allow assisted suicide provide regulations to ensure the practice is not abused.
However, some feel these regulations are too restrictive. They argue that long-term debilitating diseases, such as Alzheimer’s, should be exempt from a six-month life expectancy restriction.
Most of us hope for ourselves and our loved ones to have long lives. We also hope for a high quality of life. For many, cutting out indignities and suffering in their final days is part of living a quality life.
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