Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Purpose: A key component of the hospice philosophy is patient autonomy. Rather than giving over control to medical experts to cure disease, the dying person is empowered by the interdisciplinary team of hospice practitioners to guide and direct the time that remains. Another tenet of the hospice philosophy is to neither hasten nor postpone death. A serious challenge faces hospice practitioners with the legal option of choosing death. A lethal dose of medication can be obtained (within guidelines) by a terminally ill person in Oregon in order to hasten death. Hospice providers across all disciplines have found that this choice has posed a serious challenge to the underpinnings of their work. Method: The data are based on interviews with interdisciplinary hospice providers from eastern and western regions of the U.S. A total of 12 hospices were visited and 60 hospice professionals engaged in a semi-structured interview. The responses to six open-ended questions were taped and then transcribed. Both the construction of the interview instrument and analysis of the transcriptions were extensions of the constant comparative method of analysis. The themes were conceptualized by the statements made during the interviews about the hospice philosophy and its relation to hastened death. Results: Three interconnected themes emerged from 60 hospice providers: 1) whether hospice can provide sufficient comfort to eliminate requests for a hastened death; 2) whether an inherent value of life should preclude choice; and 3) if an individual's freedom of choice should preclude the value of life. The responses of the social workers to hastened death within the hospice philosophy were also examined as a subset of the larger data set. The three themes for this group were: 1) the challenges to the role of the social worker within the hospice philosophy when a person chooses to die; 2) how hastened death modified practice principles and professional values; and 3) the emergence of personal struggles with the choice. Implications: The voices represented here are unique in that they are open and free to discuss the dilemmas and challenges that a hastened death poses to hospice care. Co-workers thoughts and feelings differed from one another and also with the official policies of their workplaces, pointing to perceived conflict among hospice providers. Social workers in particular found challenges within their role, their practice principles, and their personal reactions when a terminal person chooses to die. The hospice philosophy of 30 years, coupled with the apparent desire of some U.S. citizens to control the time of their death, may drive interdisciplinary adaptation to care of the dying. The Supreme Court recently decided that Oregon's law did not violate the Controlled Substances Act, therefore other states may move to legalize the option through legislative process or ballot initiative. The interdisciplinary challenges brought about by this choice will require further study and discussion.