Does Hospice Care Hasten Death?
No, hospice care does not hasten death—in fact, evidence demonstrates that patients enrolled in hospice live longer than those who are not, with mean survival extended by 29 days for patients with lung cancer, heart failure, and pancreatic cancer. 1
Evidence That Hospice Extends Survival
The misconception that hospice hastens death is directly contradicted by clinical data:
A retrospective analysis of 4,493 Medicare patients with terminal illnesses found that those referred to hospice had a mean survival time 29 days longer than those not referred, particularly for patients with congestive heart failure, lung cancer, and pancreatic cancer. 1
There was a positive correlation between length of hospice stay and survival days, with an estimated longer survival of 0.8 times the number of days actually in hospice. 1
The American College of Chest Physicians explicitly states that talking frankly about death and dying in conjunction with hospice referral may be misconstrued as "taking away hope," but this conclusion is based on fear, not fact—patients receiving hospice tend to have a better sense of hopefulness and a longer survival. 1
Why This Survival Benefit Occurs
The survival advantage from hospice enrollment likely stems from several mechanisms:
Hospice provides intensive symptom management that reduces the physiologic stress of uncontrolled pain, dyspnea, and other distressing symptoms, which can otherwise accelerate decline. 2
Patients avoid the complications and burdens of futile aggressive treatments that may actually shorten life through adverse effects, infections, and treatment-related morbidity. 1
The interdisciplinary hospice team approach addresses medical, psychosocial, and spiritual needs comprehensively, optimizing overall patient well-being. 3
The Goal of Hospice Care
Understanding hospice's actual intent clarifies why it doesn't hasten death:
The explicit goal of hospice is neither to prolong life nor hasten death, but rather to provide total care that maximizes quality of life. 4
Hospice recognizes that a peaceful and comfortable death is an essential goal of health care when cure is no longer possible, focusing on pain relief, comfort, and enhanced quality of life. 3
Palliative sedation at the end of life, when employed, uses the "doctrine of double effect"—the intent is symptom relief, not to produce death, which differentiates it from euthanasia. 1
Common Misconceptions That Fuel This Fear
Several misunderstandings perpetuate the false belief that hospice hastens death:
Many incorrectly believe hospice care is only for the last hours to days of life, when in fact earlier referral (at 80-90 days) is associated with better outcomes and allows hospice to reach its full impact. 1, 2
There's a misconception that hospice requires withdrawing all treatments or having a "do not attempt resuscitation" order, which is not true—patients can continue comfort-oriented medications and interventions. 1, 2
The belief that treating symptoms of discomfort at the end of life hastens death is contradicted by evidence showing the opposite effect. 1
Clinical Implications
The evidence supports early hospice referral:
Optimal timing for hospice referral is when prognosis is months to weeks, not days, as the average hospice stay is only 17-19 days with one-third dying within 7 days of enrollment—indicating failure to refer early enough. 2
Delay in referral until death is near reduces the potential value of hospice services at consolidating grief preparation and acceptance, providing only death care rather than comprehensive end-of-life support. 1
Physicians should counsel patients and families that hospice enrollment is associated with longer survival, not shorter, directly addressing this barrier to timely referral. 1