Saturday, June 12, 2010

Curative Medical Care vs. Non-Curative Hospice Care: Two Men in Love with the Same Woman

Curative medical care and non-curative hospice care are like two men in love with the same woman. The curative man, who has enjoyed many wonderful years with her, is reluctant to let her go. But their joy together has declined with time. While she appreciates the fulfillment they shared in the past, she now feels a lack of commitment to him and an urgency to move on with her life. The hospice man, the new love in her life, fills the void she is experiencing and brings an essential enhancement to her well being. He longs to stay with her because their relationship has reached a mutually meaningful level. The woman he loves embraces the happiness his hospice presence brings.

Unfortunately, many experience this love triangle in varied ways. Patients may resist the prediction of death within months and the prospect of involving outsiders as caregivers. Some doctors and caregivers may be reluctant to admit that a patient cannot be saved. Medical staff focused on curing all patients may not totally commit to the hospice philosophy of non-curative care when working with hospice patients.

Love triangles like this that exist in nursing homes and other institutions must be resolved with focus on the best interests of patients. In order to improve treatment of the terminally ill, institutions that have hospice programs must be dedicated to promoting staff expertise in hospice practices. This commitment must include clear administrative support with ongoing education and monitoring of staff practices. This will ensure that hospice patients receive services appropriate to their non-curative condition. 

What’s love got to do with it? Everything. In some institutions where these positive partnerships have been implemented, hospice practices such as better pain management have naturally become part of the care given to terminally ill patients who are not in hospice programs. True love can be contagious like that.

Can two men be in love with the same woman? Sure, if they respect each other’s boundaries, strive for a healthy relationship including the woman’s needs, and understand that, when lovers lose their mutual joy and loyalty, moving on can be love’s greatest expression.

Frances Shani Parker, Author


  1. Excellent message Frances! There were two items that jumped out at me while I was reading.

    First, the idea of mutal respect. As a volunteer for a hospice organization I have always been taught that I should always be mindful that when I go into a facility it is like going into a home. Not only for the patient, but for the staff as well. In many cases the staff have been part of a patient's "extended family" and care deeply for the person. As a result we need to be sensitive to that and understand that they may also have a difficult time with letting go.

    This brings me to the second item - the fact that in many assisted living facilities and nursing homes, the staff are there to "treat" the patient. I have witnessed many times where the staff are overwhelmed with the idea of allowing a person to die as opposed to taking heroic efforts to keep them alive.

    Yet, when coached, they often provide some of the most compassionate and caring support I have ever witnessed. It isn't that they can't do it but rather that they are wired not to do it. Once they get over the mental obstacle and buy into the effort of making an individuals passing as comfortable and peaceful as possible it can be a beautiful site to witness.

    Keep up the great work Frances - your words provide validation and inspiration to those of us in the trenches.

    Jeff Hoffman
    Hospice Vigil Volunteer

  2. Jeff, thank you for commenting. If I validate those in the trenches, it's because I served there many years. Your words mirror some of my thoughts over the years exactly. I also witnessed staff members who meant well, but who just couldn't deal with the guilt and finality of letting someone die in peace, even when the patient resisted their efforts.

    Making that necessary change from curative to non-curative care requires a major paradigm shift in thinking that is underestimated in institutions with hospice programs too often. Regular staff turnover only makes matters worse. I just can't emphasize enough the importance of ongoing education and monitoring of staff practices for meeting patients' needs.

    I believe one person can make a positive difference. My written words (book, articles, poems, etc.) are my ways of promoting improvements in hospice, nursing homes and eldercare in general. While some would rather not have certain issues mentioned, facing them is the only way they will be addressed. Thanks for validating my efforts. Knowing that we share a common vision inspires me. I wish you the best.

  3. Loved the post. I agree that there needs to be a shift in thinking, in order to recognize the need for change from curative to palliative care. I also recognize that the reason for the hesitancy to accept change is rooted in our society's unwillingness to discuss death and dying. I was very fortunate that as a young girl I stumbled across a book by Elizabeth Kubler-Ross so the idea that death as a natural part of life came relatively early. I cannot help but wonder why these issues are not more aggressivley addressed in nursing school, medical school, etc. We do a huge disservice to those we serve by not being equipped to assist someone through that which is inevitable for all of us.