Do patients in hospice care have to withdraw all medical treatment?

Patients in Hospice Care Do Not Have to Withdraw All Medical Treatment

Patients in hospice care are not required to withdraw all medical treatments, but Medicare requires that they agree to focus on comfort-oriented care rather than curative treatments for their terminal illness. 1

Understanding Hospice Care Requirements

• Hospice care is defined as support and care for patients and their families in the last phase of an incurable disease, allowing them to live as fully and comfortably as possible 1
• Medicare and other insurers require certification that the patient has a terminal prognosis (likely less than 6 months of life) for hospice eligibility 1
• Medicare requires patients to agree in writing that hospice care (not other Medicare services like curative care) will be used to treat their terminal illness 1
• Despite this requirement, patients can still receive treatments that provide comfort and symptom management 1

What Treatments Can Continue in Hospice

• Palliative treatments aimed at managing symptoms such as pain, dyspnea, anxiety, and other distressing symptoms continue and are often enhanced 1
• Medications for symptom management, including opioids, benzodiazepines, and even certain antidepressants may be continued or initiated as needed for comfort 2
• Supplemental oxygen, medications for symptom control, and other interventions that improve quality of life can be maintained 1
• Some hospices offer "open-access" programs that provide hospice services alongside selected aggressive treatments, depending on the financial resources of the hospice 1

Important Distinctions in End-of-Life Care

• Withdrawing or withholding life-sustaining treatments is ethically and legally different from physician-assisted suicide or euthanasia 1
• Discontinuing ineffective, futile, or burdensome treatments is not intended to hasten death but acknowledges the natural progression of disease 1
• Patients can refuse specific treatments while continuing to receive others based on their goals of care 1
• Hospice focuses on quality of life rather than extending life at all costs 1

Common Misconceptions About Hospice

• Many incorrectly believe hospice care is only for the last hours to days of life, when in fact earlier referral is associated with better outcomes 1
• There's a misconception that hospice requires patients to have a "do not attempt resuscitation" order, which is not true 1
• Some believe that treating symptoms at the end of life hastens death, but research shows hospice patients often live longer than those not enrolled in hospice 1
• Many patients and families don't understand that hospice can be provided in multiple settings, including home, nursing facilities, or dedicated hospice units 1, 3

Decision-Making Process

• Decisions about which treatments to continue or discontinue should be guided by the patient's goals of care and what provides more benefit than burden 1
• The process of forgoing life-sustaining treatment often occurs sequentially over time rather than as a single decision 4
• Patients can be withdrawn from hospice programs if their condition unexpectedly improves 1
• Discussions should emphasize not only what treatments will be discontinued but also what care will be continued to ensure comfort and well-being 1

Clinical Considerations

• Patients with non-cancer diagnoses (like COPD or heart failure) often receive less timely referrals to hospice despite potential benefits 1
• If a patient survives beyond the initial 6-month prognosis, Medicare will continue to cover hospice care as long as they still meet eligibility criteria 1
• The hospice team approach addresses not only physical symptoms but also psychological, social, and spiritual needs of both patient and family 5
• Hospice care continues after the patient's death with bereavement support for the family 5