Literature Review

Less wealth at death linked to more end-of-life symptoms McKnights Long-Term Care News; by Kristen Fischer; 3/10/25 Older people with less wealth showed a higher burden of symptoms when they approached the end of their lives compared with those who had more wealth, a study found. The report was published in JAMA Network Open on March 6. Investigators looked at data from 8,976 older adults. The team evaluated 12 end-of-life symptoms including difficulty breathing, frequent vomiting, low appetite, difficulty controlling arms and legs, depression, and severe fatigue or exhaustion.Then they correlated symptoms to individuals’ wealth. Wealth was broken into three categories: low wealth was having less than $6,000; medium wealth was having between $6,000 and $120,000; and high wealth was considered having more than $120,000 at the time of death. Of respondents, 22.5% had low wealth, 50.5% had medium wealth and 27.1% had higher wealth. People who had less wealth were more likely to have a higher burden of symptoms compared to those who had more money. Functional impairment, multimorbidity and dementia were factors that affected the association, data revealed.Editor's note: Click here for this important JAMA article, posted in our Saturday Research issue 3/15/25, "Wealth disparities in end-of-life symptom burden among older adults."

At the end of life, doctors’ actions and patients’ wishes may be misaligned, according to a Rutgers Health study Rutgers; by Greg Bruno; 2/28/25 For terminally ill cancer patients, the final days of life are immensely personal, having the choice to continue cancer treatments, or to stop treatments and prioritize a more comfortable passing. What a patient wants, however, isn’t always what they receive, according to a Rutgers Health study published in the journal Cancer. “A patient's end of life is often not a reflection of what they want, but rather, who their oncologist happens to be,” said Login S. George, a health services researcher at the Rutgers Institute for Health, Health Care Policy and Aging Research, and lead author of the national study. “The data doesn’t indicate patient-centered treatment decisions, but rather, more habitual or default ways of treating patients,” says George, who is also a member of the Cancer Prevention and Control Program at Rutgers Cancer Institute, the state’s only National Cancer Institute-designated Comprehensive Cancer Center. ... [Click on the title's link for more statistics, insights, and recommendations.]

Patient put in hospice at 52 celebrates life years after admission, thanks to heart surgery KCTV-5, Kansas City, MO; by Morgan Riddell; 2/27/25 A local man with heart failure who was told numerous times he only had months to live now has a new outlook on life two years later. ... It started in 2023. Sam Edwards, who was diagnosed with ALS after serving in the military, started experiencing new pains. He went to doctors who all determined Sam was just experiencing issues related to ALS. Then, a doctor at the VA Hospital noticed some tests were off and found Sam was experiencing heart failure. What he needed was open heart surgery, but doctors determined the risk of putting Sam on the operation table was too high. Not only was he at risk of having a stroke and dying on the operating table, but his recovery would also be months long and painful. They declined to do the surgery at the VA and suggested Sam go get a second opinion. This is when he was connected with Dr. Michael Gibson.Editor's note: While we in the palliative and hospice field promote earlier admissions to care and elimination of overtreatment, another side of the coin exists. Click on the title's link to read more about this hospice patient who sought out a second opinion. Imagine: the hospice patient is you (at age 52); or a family member; or a best friend. Especially as AI becomes more prevalent in assessing palliative and hospice referrals, we must see the bigger picture and retain human element. 

Charges dismissed against chef accused of trying to kill his Monterey county mother KSBW Action News-8, Monterey, CA; by Felix Cortez; 2/28/25 A popular San Francisco area chef who was arrested along with his sister and charged with trying to kill their mother more than two years ago has had attempted murder charges dismissed against him. “In over 30 years of practice, this was one of the saddest cases I have ever seen and one of the most incompetent investigations by the Monterey County Sheriff’s Department that I have ever seen,” said Juliet Peck, the attorney for James Stolich. ... The mother was terminally ill and lived on a ranch off Highway 68 outside Salinas. “James’ mother’s only wish was to die at home without pain, surrounded by her daughter, son, and pets,” Peck said. But that never happened; Tinker died about a week later in a hospice facility, never to see her children again, because an emergency protective order obtained by the sheriff’s office prevented the children from visiting their dying mother. ... According to court documents, the daughter, Whitney, was the “agent designated to make all health care decisions for her mother,” which included administering medication to help alleviate her mother’s pain. ...The original criminal complaint alleging attempted murder charges said Whitney or a co-conspirator “crushed up pills with a mallet.” A close friend of Tinker was willing to testify that Whitney had no intent to kill her mother but was simply following her mother’s “directive to provide effective and sufficient palliative care even if it hastened her death.”Editor's note: This case raises numerous issues, including but not limited to community education (including law enforcement), Advance Directives, patient and caregiver education and support, MAiD (Medical Aid in Dying) or the End Of Life Option Act (EOLOA) in California, ethics, and the dying process (note that "the mother died about a week later in a hospice facility). 

Leading early conversations about ICD [implantable cardioverter defibrillator] use in end-of-life cancer care  Cancer Network; by Megan Mullins, PhD, MPH; 2/21/25 Earlier and more frequent talks about disabling ICDs with patients receiving end-of-life care and their families may help avoid excessive pain. ... Regarding implantable cardioverter defibrillators (ICDs) in those with fatal cancers, it is critical that patients know what having a device means and how it impacts end-of-life care, according to Megan Mullins, PhD, MPH. CancerNetwork® spoke with Mullins, assistant professor in the Peter O’Donnell Jr. School of Public Health, the Harold C. Simmons Comprehensive Cancer Center, and the Department of Internal Medicine at UT Southwestern Medical Center, about how ICD deactivation prior to end-of-life care could impact clinical practice in patients with advanced cancers. ... She emphasized that device deactivation would allow the body to undergo the natural dying process without unnecessary painful shocks associated with the use of the device.

Daughter indicted for killing mother with morphine in Evans The Augusta Press, Augusta, GA; by Greg Rickabaugh; 2/25/25The daughter of a woman who died in an Evans assisted living home from a fatal dose of morphine has been indicted for malice murder. Rachel Elaine Waters, 41, is expected to surrender this week on murder charges in the death of 74-year-old Marsha Sprayberry Foster, according to Columbia County authorities.An indictment says that Waters administered a lethal dose of morphine on July 12, 2023, while her mother was at the Marshall Pines assisted living on North Belair Road. The cause of death was determined in an autopsy, showing that excessive use of the unprescribed morphine was the reason for her death. Foster had Alzheimer’s disease, and the morphine was reportedly left behind by hospice workers and used by the daughter without authorization.

As hospitalists’ role grows, so do the ethical dilemmas Medscape; by Donavyn Coffey; 2/17/25 Margot Eves, JD, clinical ethicist for Cleveland Clinic, was called in for an emergency consult: A man in his early 50s was asking doctors to take him off the ventilator. Just 24 hours before, the man with chronic obstructive pulmonary disease (COPD) okayed the life-saving treatment. The hospitalist over his care expected him to come off the ventilator in a few days, but 24 hours was too soon. He wouldn’t survive. With head nods and in writing the patient signaled that he was fully aware — he understood this would end his life. Eves was called in to help weigh the options: Honor the patient’s wishes or help him survive. These kinds of ethical dilemmas have become common to the burgeoning hospitalist profession. ....

A CEO’s strategic guide to leading people facing cancer CEO World Magazine; by Joelle Kaufman; 2/10/25 Cancer doesn’t just affect individuals – it impacts entire organizations. As leaders, we must anticipate and prepare for the moment when cancer touches our teams. With over 18 million cancer survivors currently in the U.S. workforce and over 2 million new diagnoses annually, the question isn’t if cancer will affect your organization but when and how you’ll respond. ... The first step will be how you respond when an employee shares that cancer is impacting their life. The second step is how you will manage while cancer is having its impact. ... When we get this right, we build more than just protocols – we build resilient organizations that demonstrate our values through action. In doing so, we create the kind of workplace where people can bring their whole selves, face life’s challenges with dignity, and continue contributing meaningfully to our shared mission. Editor's note: Getting this "right" matters especially for hospice and palliative care organizations. Read this article for both strategic professional guidelines and a personal story from a CMO/business owner.

End-of-life-care option bill in New Hampshire stirs conversation on deathMonadnock Ledger-Transcript, Peterborough, NH; by Sruthi Gopalakrishnan; 2/4/25 At age 75, Rep Bob Lynn says he loves life. But he knows he’s no “spring chicken” and his days are finite. The former chief justice of the state Supreme Court is the prime sponsor of House Bill 254, known as “The New Hampshire End of Life Freedom Act,” which gives terminally ill adults the choice to take control of their final days and end their own life with a dose of lethal medication. ... If the legislation passes, terminally ill individuals aged 18 and over with a prognosis of less than six months to live will be able to receive medications to end their lives on their own terms. It comes with a long list of requirements that two health care providers must verify, including that they have healthy mental capacity, are aware of alternative options and are competent to self-administer the drugs. Opponents warned it could encourage suicide, be misused and send a harmful message that people with disabilities are a burden. ... Michelle Flynn, a retired internal medicine physician from Bedford, said allowing terminally ill patients to end their lives opens the door to death as a treatment option. ... Lisa Beaudoin of Temple, founder of Strategies for Disability Equity, worries it would worsen the discrimination disabled people already face in health care. 

Truth-telling, and ethical considerations in terminal care: an Eastern perspectiveNursing Ethics; Qing Ma; Yi Wu; Ronghua Fang; 1/25 Truth-telling for terminally ill patients is a challenging ethical and social issue for Chinese health care professionals. However, despite the existence of ethical and moral standards for nurses, they frequently encounter moral dilemmas when making decisions about truth-telling to patients with end-stage diseases in China. This article focuses on nursing morality, ethics, norms, and philosophy in health care and discusses countermeasures taken by nurses in truth-telling decision-making in combination with Chinese Confucian culture. The analysis identifies key ethical strategies tailored to Chinese nurses’ practices, emphasizing individual autonomy, cultural sensitivity, and family dynamics in truth-telling decisions.

Hospice rationale should be reassessed, says ethicist Medscape; by Arthur L. Caplan, PhD, Medical Ethics at NYU’s Grossman School of Medicine; 1/23/25 ... Decades ago, I first found out about the idea that came from England and a nurse, Cicely Saunders, to change the setting in which people die. ... I think that was a wonderful idea, and it has revolutionized end-of-life care. We have many excellent, superb hospice programs. ... The hospice institution is decades old, and it’s time to take another look at what’s going on there.  ... Private equity is all over this area, buying up hospice chains and home care hospice — looking to make big profits but not looking to maintain the quality requirements that ought to be there or to do more than is minimally required to set up and staff hospice. ... ... For reasons of serving the best interests of hospice patients, we should be rechecking the fairness of reimbursement, not overburdening families with care that ought to be provided by hospice programs, and making sure that those who are dying are monitored adequately and receiving checkups regularly. ...

Free Death Cafés provide a venue for difficult conversations The Northern Virginia Daily. Stephens City, VA; by Brian Brehm; 1/20/25... Blue Ridge Hospice, in partnership with Bowman Library, wants to spark the death-related conversations that many people want to have but are comfortable initiating. Starting this month, the two organizations will be hosting a Death Café on the fourth Thursday of every other month. ... According to a media release from Blue Ridge Hospice, “Death Café is not a grief support group or a counseling session, but rather a casual and welcoming space for people to reflect on death-related topics, with the aim of helping us live life more fully. Whether you’re curious, thoughtful or seeking meaningful conversation, come as you are and engage in this judgment-free, agenda-free discussion.”