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Selling hospice.

¹Associate Professor at the University of Tulsa College of Law and a Scholar at the O'Neill Institute for National and Global Health Law at Georgetown University.

The Journal of Law, Medicine & Ethics : a Journal of the American Society of Law, Medicine & Ethics

|January 8, 2015

Summary

Americans are increasingly using hospice care for end-of-life support. However, the commercialization of hospice services, particularly by for-profit providers like Vitas, raises concerns about patient autonomy and medically unnecessary treatments.

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Area of Science:

Health Services Research
Medical Ethics
Sociology of Health

Background:

Hospice utilization in the U.S. has risen due to the
hospice movement
Medicare coverage
and governmental reimbursement.
The growth of hospice care aligns with the
death-with-dignity
movement, empowering end-of-life decision-making.

Purpose of the Study:

To examine the complex relationship between the
death-with-dignity
movement and the commercialization driving hospice utilization.
To investigate allegations of financial incentives influencing patient care decisions within a major for-profit hospice provider.

Main Methods:

Analysis of the corporate, investment, and regulatory history of Vitas Innovative Hospice Care.
Examination of a lawsuit alleging incentives for patient intake nurses, physicians, and marketers.
Review of the impact on patient and family decisions regarding treatment and crisis care.

Main Results:

The largest for-profit hospice provider, Vitas, faced allegations of a system incentivizing the use of expensive, medically unnecessary crisis care.
Financial incentives may have influenced patient and family choices to discontinue curative treatments.
The commercialization of hospice care presents potential risks to patient autonomy and health.

Conclusions:

The increasing embrace of hospice care by Americans is intertwined with market realities and commercial interests.
The commercialization of hospice services raises ethical concerns regarding patient autonomy and the quality of end-of-life care.
Further understanding is needed on the balance between compassionate end-of-life care and profit-driven motives in the hospice industry.

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