Most Americans say that, when the time comes, they'd prefer to die at home. No surprise, then, that an increasing number are doing just that. But is that really the best route? And is dying at home what people—regardless of what they say on opinion surveys—really want? Not necessarily, a new commentary argues, but whatever the answer is, it's time for hospitals to put more thought—and money—into caring for those who sadly aren't going to get any better.
"Public surveys commonly report that around two thirds of respondents express a preference to die at home," writes Kristian Pollock, a principal research fellow at the University of Nottingham School of Health Sciences, in the BMJ. Indeed, recent studies have highlighted concerns about poor quality of care in hospitals, where many people in the industrialized world spend their final days. But even if the health care is good, some people simply might not want to die in an unfamiliar place, hooked up to monitors and IVs.
Focusing on where we die could be a distraction from the more important question of how we die.
Despite that, the place of death doesn't appear to be a particularly high priority for many people, Pollock argues. For example, the same studies that find around two-thirds of people prefer to die at home also rank place of death relatively low on the list of concerns. A survey conducted by Sue Ryder, a hospice provider and research center in England, found that people were generally more concerned about being free from pain, being with loved ones, and dying with dignity.
That means focusing on where we die could be a distraction from the more important question of how we die, Pollock argues. "Just because a death occurred at home does not mean that it was good. The person may have been alone, inadequately supported, in pain, distressed, and fearful," she writes. The experience is hard on families, too, if they serve as the primary caretakers. Hospitals, Pollock argues, might be able to manage pain more efficiently and shift some of the burden off of families, making the process of death a bit easier for everyone involved.
"When patients wish to die at home, every effort should be made to achieve this outcome," Pollock writes. But at the same time, doctors and policymakers should be careful not to push a home death as somehow better. Meanwhile, "the hospital needs to be reinvented as a viable alternative and place of excellent care for dying patients and their families."
"Far from neglecting and disregarding the hospital as a site of terminal care," Pollock writes, "much greater thought and adequate resources must be directed to enabling hospitals to provide excellent support for dying patients and their families."
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