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The National Hospice and Palliative Care Organization (NHPCO) in Alexandria, VA, has issued a list of talking points hospices can use when discussing the New England Journal of Medicine-published study on Oregon patients who died after refusing food and water. The NHPCO talking points include the following:
• Hospice supports a patient’s right to choose care or refuse unwanted medical treatment.
• A patient who elects hospice care may often stop curative treatments and allow the illness to follow a natural progression leading to death.
• Hospice is committed to honoring patient autonomy and places the wishes of the patient at the center of care.
• Through proper education and support, hospices prepare patients and families for the journey they can expect to experience. An understanding that hospice will address fears and concerns brings comfort to all those whom hospice serves.
• Hospice utilizes an interdisciplinary team of health care professionals and trained volunteers to address symptom control, pain management, and emotional and spiritual support tailored to the patient’s needs and wishes.
• More than 885,000 patients were served by the nation’s 3,200 hospice providers in 2002.
• A very, very small number of hospice patients actually make the choice to stop food and fluids to hasten their own death.
• Every year, more than 10,000 people die with hospice care in Oregon. The study revealed only 102 hospice patients who made the choice to stop eating and drinking.
• The nutritional and hydration needs of patients actively dying are different from the needs of persons in good health. As death nears, the body begins to "shut down," and food and fluid requirements decrease.
• In discussing nutritional needs of patients, NHPCO’s Standards of Practice for Hospice Programs say, "the interdisciplinary team assesses the patient’s nutritional needs and implements nutritional care as desired by the patient and family." The nutritional and hydration needs of a patient are carefully assessed and discussed with each patient and adjusted according to each patient’s preference and needs.