Today I had the opportunity to attend a “Values, Ethics, and Culture at End-of-Life” conference.  Presentation topics dealt with both the system wide and interpersonal aspects of working with hospice patients and their families.

For example, Joanne Lynn MD., MA, MS. discussed the fact that the priorities reflected in current policies (such as Medicare or other insurance) don’t match the needs of the frail or elderly.  There is a focus on medical interventions (medicines, procedures, etc.) but it’s incredibly difficult to navigate the process of having in-home care.  She argued that restructuring the system to integrate both the medical and social needs of a patient is important, and that evaluating these needs on a community by community basis will help to resolve gaps in services. A “monitor manager” would ensure that their assigned community has services in place to meet both the medical and social needs of the residents living within that community. The main themes from the presenters relating to the interpersonal aspects of care can be applied in almost any health care setting. Dr. Richard Payne M.D. discussed the importance of meeting the patient where they are and understanding that pain is not always physical; it can also be emotional pain as they move through their end-of-life journey. Helping these patients work through these emotions can improve their quality of life and physical pain levels. A panel of experts representing Jewish, Christian, Eastern Religions and Islamic cultural identities highlighted a few major themes when working with patients and families:

• Empathy is important.
• Don’t make assumptions about their faith, beliefs, traditions based upon how they identify themselves. For example, there are over 200 different types of Christianity.
• Ask them to teach you about their faith/beliefs and what is important to them.
• Go with the flow.

Finally, Arthur Caplan, PHD ended the conference with a presentation about how rationing in health care occurs today based on income and resource disparities among different individuals. He argued that more awareness is needed related to hospice, perhaps even a national day to talk about Death and Dying. He said something very important as well; something that those in the field understand: “hospice doesn’t save anybody’s life; it makes it a better life.”