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GOING GENTLY:
No antiseptic wards // No long-shot measures // No eleventh-hour heroics // Simply, at the end, a decision to choose quality over quantity.

At Home in Hospice

By Linda Keslar // Photographs by Annabel Clark // Spring 2007
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Franklin Wyman

When Franklin Wyman, 85, was diagnosed with acute leukemia in December, he thought about how he wanted to die. He could stay in the hospital and perhaps gain a year of life with aggressive treatment. Or he could return to his suburban home outside Boston, where he and his wife could get whatever help they needed, medical and nonmedical, from a nearby hospice. “I’ve had a very good life,” says Wyman, a retired investment banker. “What would be the point of making drastic efforts that might, or might not, keep me alive for another year?”

For now, Wyman doesn’t need much help from Partners Hospice in Waltham, Mass. A nurse stops by to see how he’s doing and to make sure he has medication to relieve his arthritis pain. A walker, a wheelchair and a portable oxygen generator have been delivered for future use, and the members of his clinical team—a physician, nurses and home-health aides—stand ready to address any discomfort he experiences. There’s also a pastoral counselor and a medical social worker to help Wyman and his family deal with depression, anxiety and spiritual issues.

What Wyman won’t receive is treatment to extend his life. “Hospice recognizes dying as part of the normal process of living and focuses on maintaining the quality of the life one has left,” says Marcia Reissig, former president of Partners Home Care, which owns the hospice. Wyman appreciates having that opportunity, and spends his days reading, surfing the Internet and visiting with family and friends. “It’s important to me to maintain my dignity until the very end and to be a good example for my family,” he says.

Given a choice, it’s likely that most people would prefer to end their lives in much the same way. But that’s not how the final weeks usually play out. Most Americans spend their last days in acute-care hospitals and nursing homes, often amid a flurry of desperate though futile medical measures. Half of those who die in hospitals endure pain at least half the time, while almost 40% spend 10 days or more on a ventilator.

By 2030, one-fifth of the U.S. population will be older than 65, and by 2040, the death rate is expected to nearly double from current levels to about 4.1 million deaths annually. Those demographic shifts add urgency to the debate over the American way of dying, and hospice has become an important part of the conversation. Increasing numbers of terminally ill patients have come to view hospice not as a plan for giving up the fight but as a way to emphasize the quality of life during their remaining days. Already, one in three deaths in the United States takes place in hospice, and the aging of the baby boom generation is likely to accelerate that trend.

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One Man’s Journey

Franklin Wyman

When Franklin Wyman thought about how he wanted to die, he chose hospice.

Hospice’s Growing Pains

Judging by the numbers, this type of care is still underrecognized.

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hed-dossier

1. Last Rights: Rescuing the End of Life From the Medical System, by Stephen P. Kiernan (St. Martin’s Press, 2006). Informed by both scientific research and intimate portraits of the dying, Kiernan takes a hard look at how the medical system, including hospice, deals with end-of-life issues and offers some alternatives.

2. Unplugged: Reclaiming Our Right to Die in America, by William H. Colby (American Management Association, 2007). Colby, a legal expert, uses poignant case studies to examine some of the perplexing legal, ethical, medical and personal issues at the heart of the right-to-die debate.

3. “Operational and Financial Performance of Publicly Traded Hospice Companies,” by Michael J. McCue and Jon M. Thompson, Journal of Palliative Medicine, Vol. 8, No. 6, 2005. Insightful study that compares the performance of hospices owned by publicly traded companies with nonprofit hospices, and examines why public companies are able to earn substantially higher profits.

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