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HEARTS of the CITY | Navigating the Real World

A rotating panel of experts from the worlds of philosophy, psychology and religion offer their perspective on the dilemmas that come with living in Southern California.

March 26, 1997

Today's question: More than 400,000 dying people each year participate in hospice programs. Federal auditors are conducting a special review of the nation's hospice programs because too many people live longer than the six months federal rules provide for. The Department of Health and Human Services has notified numerous hospice programs that they have improperly spent more than $80 million caring for people who have lived longer than 210 days after enrolling for hospice care. Is it ethical to have regulations requiring physicians to certify that their dying patients will not live more than six months in order to qualify for hospice service?

Thomas P. Rausch

Chairman, department of theological studies, Loyola Marymount University

Caring for the sick and the dying is a work of mercy, and whatever mitigates the impersonality of hospitalization should be encouraged. The hospice program is one of the most creative government-sponsored health care programs we have; it is both cost-effective, providing an alternative to costly hospital care for the dying, and compassionate, enabling families to care for a dying loved one in the privacy of their home. Physicians need to make a prudential judgment in assigning a patient to hospice care. Though some parameters are required, determining precisely when a person will die is not always possible and should not be required.

Herb Robinson

Director, Munger Center for Psychological Services

Ours is a push-and-shove world where a traffic dispute can escalate into a gun battle. Panicked over limited resources, we become easily impatient with anyone in the way. Now even our government seems to be playing the bully, impatiently counting the days the terminally ill take to die, and threatening hospice workers with the bill if those in their care get off schedule and linger too long. It seems to be misplaced zeal to save a few dollars and deny the last best gift we can give our dying. At the very least they deserve our patience as they let go of this rushing world and slip into a place of endless time.

Miriyam Glazer

Director, Dortort Writers Institute, University of Judaism

In Orwellian fashion, the government calls its hospice auditing campaign "Operation Restore Trust." Does it really imagine that its macabre assault on those hapless souls lingering in this life longer than Medicare protocols permit will restore trust in government? Rather, rivaling the "catsup is a vegetable" scandal, this latest maneuver of budget-knife bureaucrats suggests an even more grotesque disdain for the most vulnerable among us. Why not rename the campaign "Hurry Up, Please, It's Time!," dress physicians as Carroll's white rabbit ("You're late, you're late") and demand that, like medieval churches, American hospices have huge clocks in their halls as prodding reminders to the dying of the now government-required Hour of Death?

Compiled by K. CONNIE KANG, Times staff writer

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