Hospice was meant to offer dignity in death - but it fails the most marginalized. We need hospice programs that go to the streets, into shelters, behind bars

Hospice was meant to offer dignity in death - but it fails the most marginalized. We need hospice programs that go to the streets, into shelters, behind bars
STAT; by Christopher M. Smith; 8/26/25
I’ve spent more than a decade in hospice care, sitting at the bedsides of people facing the final days of their lives. I’ve held hands in hospital rooms, in tents, in prison cells, and in homes that barely qualify as such. And over time, I’ve come to see that dying in America is not just a medical event - it’s a mirror. It reflects everything we’ve failed to do for the living. Hospice was created to bring dignity to the dying - to manage pain, provide emotional and spiritual support, and ease the final passage for people with terminal illness. But the systems surrounding hospice care are riddled with inequity. The very people most in need of compassion - the unhoused, the incarcerated, people of color, LGBTQ+ individuals, and people with disabilities - are systematically excluded, underserved, or erased. Access to a good death is too often reserved for the privileged, while everyone else is left to navigate a system that wasn’t built for them - or worse, actively works against them... The truth is, hospice care cannot achieve its mission unless it actively addresses the inequities built into the structures around it. We need hospice programs that go to the streets, into shelters, behind bars. We need training rooted in cultural humility, in antiracism, in trauma-informed care. We need to reimagine what it means to offer dignity to someone whose life has been defined by abandonment. That work won’t come from quarterly board meetings or compliance audits. It will come from listening - really listening - to those most affected. It will come from rethinking how we define “home,” “caregiver,” and “worthy.” It will come from a shift in focus: from profits to people, from efficiency to empathy, from “standard of care” to standard of justice... Because dying is universal. But justice, even at the end of life, is still not.
Publisher's note: STAT also references Dr. Ira Byock's article "The hospice industry needs major reforms. It should start with apologies, 8/22/23".