Place and Dying: Home Versus Hospital

Subject: Medical Ethics
Pages: 6
Words: 1670
Reading time:
7 min
Study level: Master

In this work, the advantages and disadvantages of places for the dying of ill people, precisely a home and a hospital, are considered. Dying is a physically and psychologically stressful process that significantly affects both a terminally ill person and his or her family and loved ones. In addition, the body of a dying person requires care and support with medicines to reduce the pain caused by the symptoms of the disease. However, relatives without qualifications and medical facilities cannot provide such care. For this reason, they face severe stress due to the inability to alleviate the suffering of a loved one and the need to be near him or her constantly. Consequently, the hospital is a more suitable place for dying as the patient can receive palliative care that will give him or her comfort, and at the same time decrease the stress of his or her loved ones.

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Death is an integral part of the life cycle; however, often, it is not quick and painless as people die from chronic and dangerous diseases. For this reason, medicine offers palliative care to make the last days of a person less painful and more comfortable. For the same reason, many patients prefer dying at home, since they believe their own place will bring them more psychological comfort. However, at the same time, patients shift the responsibility for their care to their family and loved ones, causing them physical discomfort and increasing the moral burden.

In addition, home care cannot provide a high level of palliative help because the family does not have the means and qualifications; hence, the condition of the patient can significantly deteriorate and become unbearable. Consequently, the hospital is a more favourable place for dying as the patient is under the constant supervision of specialists, but at the same time, he or she can remain close to the family.

The main factors in choosing a patient’s place for dying are his or her health state and the presence of family caregivers at home. Gágyor, Himmel, Pierau, and Chenot (2016) argue that the role of a carer is much higher in choosing the place of death than the condition of the disease, and dying at home increases the quality of the last days of life. However, scientists only take into account the last 48 hours before death, which significantly affects the result of the studies.

No one can tell with accuracy the date of a patient’s death; thus, he or she may die during transportation home, or live a few more years. In both cases, such unexpected events reduce the quality of care as the family cannot provide them with it properly. For example, a cancer patient lived four years after he decided to die at home, and all this time his wife took care of him, but the inability to provide him full treatment caused him unnecessary pain in the last four days (Kolata, 2019). In addition, his wife notes, “The model of care wasn’t designed to give me any respite. It was absolutely exhausting.” (Kolata, 2019, par. 20). Consequently, all efforts to ensure comfortable dying were in vain as the state of the man’s health brought only more suffering to him and his wife.

Moreover, the choice of dying at home can also be difficult or impossible if a person does not have the ability to receive proper care. According to Costa et al. (2016) such factors as the presence of a caregiver, lack of loneliness, and visits by medical staff increase the likelihood of home dying; however, not all people have these factors. Even if a nurse often visits the patient, as well as his children or spouse, to help him out after their work, he or she does not have constant care.

In addition, dying at home imposes a physical, psychological, and financial burden on family members, which can make the patient feel guilty about his condition. The cancer patient’s wife says, “I can’t bear the thought of him dying in the kitchen. I mean, how will I ever be able to eat there again?” (Srivastava, 2017, par. 8). Besides, hiring a private caregiver also incurs financial costs that not every family can afford. Constant care for the dying also often requires taking unpaid weekends, which causes significant stress.

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At the same time, hospitals can take some of the responsibility that family members have to bear. People need strength to remain moral support for the dying person and at the same time, relieve stress and grief. In addition, as Srivastava (2017) notes, patients and their families feel more secure in the hospital, since they know that they will receive the help of professionals in critical situations.

It is also sometimes difficult to predict what complications a particular disease can cause and what kind of specialist help a patient will need. The proximity of various technical equipment, medicines, and medical personnel allows relatives to provide a person with quality care and save him or her from discomfort and pain. At the same time, the patient’s family can spend most of the time with him or her as hospitals do not prohibit this. In other words, the moral support of loved ones can remain as significant and vital as with home care.

However, modern hospitals and the healthcare system of many countries still have drawbacks that force patients and their families to choose their homes for dying. Witkamp, ​​Droger, Janssens, Zuylen, and van der Heide (2016) note a series of factors that influence the patient’s family choice and satisfaction with the quality of care for him or her. Among them are clear communication, participation in decision making, acknowledgment of their position, trust to health care staff, rest and privacy (Witkamp et al., 2016).

The first aspect is related to the fact that relatives would like to know everything about the conditions of their family members to be prepared for changes. In addition, this approach helps families to be informed about the deterioration even if they are not in the hospital so that they can say goodbye. It is also easier for the family to experience the fact that the dying person is not at home if they are involved in decision-making and trust the work of medical staff (Witkamp et al., 2016). In other words, the family does everything possible to ensure the comfort of the dying person.

Recognition of the patient’s position or desires also plays a significant role in the patient’s comfort and the satisfaction of caring for his or her loved ones. It is essential for the family to know that the patient has everything necessary except treatment, which makes the last days of life more enjoyable. For example, it can be either food preferences or your favourite program on television. In addition, one of the most common problems for relatives is the lack of privacy as well as convenient places to rest (Witkamp et al., 2016).

This aspect makes it almost impossible to stay in the hospital and make long visits because relatives do not have the opportunity to sleep a bit or be alone to grieve. Most of these factors can be achieved by a more attentive and sensitive attitude towards patients, which force people to change their mind about hospitals.

However, there is another problem of hospitals dying for the healthcare system. This issue is the ability to keep the patient during his or her last days. The first factor is the availability of places and wards as patients who require immediate treatment and have a high chance of recovery also need the space and attention of doctors. Secondly, hospitals and the state need resources to maintain the dying person’s comfortable state and at the same time treat people who can be saved. U.S. doctors point out that hospitals have long had financial incentives to do not keep patients for a long time (Kolata, 2019).

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Srivastava (2017) also says, “There is ample evidence to show that palliative care is beneficial and cost-effective but unfortunately, it’s also true that despite its proven benefits, it is usually ill-funded, sometimes misunderstood and always overstretched” (par.31). Thus, the more people choose hospitals for dying, the more overloaded the financing of the medical system.

On the other hand, each person deserves comfortable last days of his or her life, and the health care system must provide people with decent conditions. It is essential to understand that limited funding means the need to increase it but not a growth in the number of people dying at home, where they cannot be provided with proper care. The state, insurance companies, and ordinary citizens need to pay attention to this problem and make efforts to solve it.

For example, to provide free palliative care for low-income socially vulnerable people, but to make partially paid these services for the population that can afford it. Thus, if people understand the importance of hospital care for the dying and respect the right of others, then a partial reduction in government spending will reduce the burden on the budget. Consequently, people will be more responsible about their own process of dying and its impact on their loved ones, choosing hospitals instead of their own homes.

In conclusion, multiple factors indicate that the hospital is a more comfortable place for the last days of a person’s life. Medical care and nursing will reduce the discomfort and pain caused by diseases and at the same time, allow the patient’s close people to cope with stress. This topic is especially important because people often do not understand how difficult and painful the last days can be for a dying person and his relatives. In addition, more research is needed to determine how people can be convinced of the need for hospital care for terminally ill patients. However, it is necessary to carry out some reforms and make sure that the hospital staff treats each patient with understanding and sympathy to create the perception in people’s minds about hospitals as their preferred place for dying.

References

Costa, V., Earle, C. C., Esplen, M. J., Fowler, R., Goldman, R., Grossman, D., … You, J. J. (2016). The determinants of home and nursing home death: a systematic review and meta-analysis. BMC Palliative Care, 15(8), 1–15.

Gágyor, I., Himmel, W., Pierau, A., & Chenot, J.-F. (2016). Dying at home or in the hospital? An observational study in German general practice. European Journal of General Practice, 22(1), 9–15.

Kolata, G. (2019). More Americans are dying at home than in hospitals. The New York Times. Web.

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Srivastava, R. (2017). Dying at home might sound preferable. But I’ve seen the reality. The Guardian. Web.

Witkamp, E., Droger, M., Janssens, R., Zuylen, L. V., & Heide, A. V. D. (2016). How to deal with relatives of patients dying in the hospital? Qualitative Content Analysis of Relatives Experiences. Journal of Pain and Symptom Management, 52(2), 235–242.