I really appreciated Jerry Dincin’s thoughtful commentary “Uphold the right to die” (Aug. 5) but have just one correction: Though it is assumed most people want to die at home, this is not always the case. I’ve worked in health care for many years and have seen some home deaths that weren’t so nice. If the home environment is not respectful of the dying person, if their family is in denial, if they don’t have adequate care and adequate pain management, then home is not the best place to be.
I’ve seen people who prefer the hospital, where they get round-the-clock care, compassion, and respect, and lots of drugs to ease pain. Unfortunately, with insurance companies setting standards and managed care having to follow their guidelines, patients often don’t have the choice: They are forced to go home to die.
I had a friend who kept going to the ER because she had no one at home to help her and the IV drugs at the hospital worked better than the pills and patches she had to make do with at home. A pattern developed—go to the ER, get admitted, get care for a couple of days, then be discharged home. At the very end, the firemen had to bring her home; she couldn’t walk anymore. She really just wanted to remain in the hospital but kept getting sent home.
Unfortunately, this is often the scenario for dying people. Home-care nurses come only for an hour, maybe three times per week. It’s not round-the-clock unless the family is rich enough to afford private nursing care.
Another friend who was caring for her dying father found the PCA device (IV that is controlled by the patient to give continuous pain medication; called a Patient Controlled Anesthesia or PCA) malfunctioned the night her father died. He died in horrendous pain, the daughter staying with him and struggling to get the darn thing working in the middle of the night. I can tell you, she was quite traumatized by what she witnessed. This wouldn’t have happened if the patient was in the hospital or nursing home.
Thanks for publishing the commentary and bringing light on a subject most people don’t want to think about.