What is "Open Access"

Traditional Hospices have had a well earned reputation for not being willing to encourage sustaining life when they can. The mantra has been, "we do not lengthen or shorten" life. But the issues have been complex since often, infections have been not treated as "not a hospice philosophy" to extend life.

At the same time - specialists have often prescribed continuation of treatments with horrific side effects and horrific costs, when the methods are not working. After all, chemotherapy is effectively "poison" with a goal of hitting the cancer harder than the host, so when it is not effectively hitting the cancer, how does continuing chemotherapy "give someone hope."

The twin pillars of "new age hospice" are to use those methods that allow someone to live longer (as long as they want to and in the patient's terms longer is better), but, when "high tech" becomes medically ineffective to use spiritual techniques so that we continue to care and support the patient and family when we cannot cure.

We do not need to utilize "medically ineffective" and harmful methods to "Offer Hope," since we offer hope by accepting the Spiritual Creator that connects us all - and - by testifying (depending on your comfort level without reference to any specific religion, or - if you are comfortable, "in the voice" of the religion of the patient, since, for me, i am serving God in the moment through the voice of the patient who i am treating. The simple statement, "we know as doctors we can't do anything to cure your illness, but if the Lord wants to heal you, you can get better, we will pray with you" ..... has great power.

Not everyone is comfortable with this approach, but here are two points: a) in a cancer patient who has broken through chemo, and is worsening in the face of chemo, the patient will live longer if we use prayer for "Hope" than if we continue "chemo for Hope." (there is an evidence based study on this from March 2007 that is a 3 year lookback of 5% of the Medicare population base).

and

I have been asked in referencing God, "what about the atheist" - and i need to testify that in 30 years of doing end of life care, it has NEVER been the atheist who is struggling with the ethical dilemma on whether to use "heroic measures" at this point. When i take a spiritual history (and we always need to take a spiritual history), the atheist identifies himself to me BEFORE i start a "God" discussion, and asks "please keep me comfortable."

"Open Access" tends to be discussed as a Hospice's willingness to provide expensive care, not usually provided by "Traditional Hospice." But i prefer to understand it in more patient centered terms, in that, the specialists often are unable or unwilling to have the discussions that will educate the patients to the situation that is their reality, and that by compromising for a time, we have an opportunity to help the patient, first by offering education, and also, by offering the spiritual support that they need.

The difficulty with acceptance is part of the heart of what we do in Hospice, sometimes, we have to be ourselves in acceptance that we are not in control or making the choices (are we ever?)

My prayer for all those who work in this difficult and very human mission.