Honouring the age-old commitment to "the patient's good": the promise--and peril--of hospice

In this article, the rise of hospice in the United States is examined and some of its important strengths and weaknesses are described. It is suggested that, despite the tendency to believe otherwise, hospice is not immune to a kind of alienation between patients and clinicians based on the absorption of doctors with biomedical conditions and their possible technological remedies, thus overlooking or ignoring the patient's good. To protect the age-old fiduciary or "trust" relationship between patients and clinicians requires a re-adjustment of current attitudes and practices--not just in the current cure-oriented health care of conventional medicine, but in the palliation-oriented health care of hospice as well. That is, it requires the development of attitudes and practices that foster a democratic, multidisciplinary process of shared decision-making and the adoption of a genuinely bio/psycho/social understanding and articulation of "the patient's good"--irrespective of where along the continuum of care patients and clinicians find themselves (5, 13).