Medical experts speak on the intrigues of dying at home or in hospital

A recent article in BMJ examined the idea of whether people prefer to die at home or in the hospital under the attention of caregivers, but then a number of medical experts weigh the intrigues and issues behind the choice to die at home or in the hospital, vis-à-vis the end-of-life palliative care that the patient is given in the face of age-related illnesses and pains.

Kristian Pollock of Nottingham University in England noted that several people do not indicate where they prefer to die because many patients believe this depends on individual factors and others simply think where they die does not matter. She added that most patients are more concerned about where they pain will be best managed rather than thinking of where they will die.

“Normalizing home as the best and natural place to die promotes a sense of guilt and failure if death occurs elsewhere,” Pollock said. “The cultural script about death and dying risks being rewritten to support ostensive choice as a de facto obligation. Given the projected increase in institutional deaths, the hospital needs to be reinvented as a viable alternative and place of excellent care for dying patients and their families.”

She added that the emotional value of dying at home is best seen when patients believe they can receive hospital care at home – having access to all medical equipment and nursing care at home, then they prefer to die at home. But then, the idea that family members could associate their pains and suffering and death with the place of their death at home tends to contaminate dying at home.

The director of the ethics programs and the palliative care programs at Beth Israel Deaconess Medical Center in Boston, Dr. Lachlan Forrow insists many patients do not like the notion of dying at home even when they say they do with their mouths.

The Director of adult neuro-oncology, hospice, and palliative medicine at Montefiore-Einstein Medical Center in New York City, Dr. Jerome Graber, noted that it is clear that many families can and will provide home hospice care at an exceptionally skilled level when given appropriate training, assistance, and resources, and that some families find it an incredibly fulfilling and rewarding experience.

Then Graber raised the concern of caring for a loved one at home while the caregiver himself is grieving and in emotional distress. He said home hospice programs may be useful in this instance, but then a 24-hour care is not often assured and could be disrupted when urgent symptoms or unpredictable situations arise to the mortally ill.