California Hospice Network Affiliate CEO pens opening chapter for End-of-Life Ethics in a Changing World
By: Gia Martucci, Marketing and Communications Specialist
April 7, 2023 – The Hospice Foundation of America’s (HFA) newest book, End-of-Life Ethics in a Changing World, begins with a rather provocative opening chapter written by Sacramentan Craig Dresang of the California Hospice Network (CHN).
This newest release from HFA explores a diversity of issues and ethical challenges related to end-of-life care and was written and edited by some of the nation’s leading ethicists, healthcare professionals, and grief experts. Dresang, who serves as CEO of YoloCares (a founding affiliate of CHN) has tapped into his 20 plus years in palliative care to discuss the growing divide between hospice’s history and philosophy and the current landscape of end-of-life care.
In this volume of scholarly and personal work, end-of-life care professionals and those with an interest in medical ethics will find perspectives that both inform best practice and challenge current approaches to care for those with life-threatening illnesses.
Chapters explore topics including the limitations of the Medicare Hospice Benefit (MHB); equitable access to care; use of telehealth in end-of-life care and bereavement support; medical aid in dying; voluntarily stopping eating and drinking; guiding surrogate decision makers; pain management; pediatric hospice care; and developing and training hospice ethics committees. (View the full table of contents here.)
A prominent theme addressed by book authors and editors is whether hospice, a comprehensive service that answered a collective public cry for non-medicalized death decades ago, has lost its ethical footing and moral compass as a result of its dramatic shift to a largely for-profit business model.
“As more and more for-profit entities, funded by private equity dollars, enter the field, it is imperative that legacy non-profit hospice agencies make their voices heard on the national stage. As the founders of the hospice movement, we must take action to protect our market shares so that our communities, the ones who birthed the hospice model of care, can continue to access excellent community-grounded care,” says Dresang.
Since the 1983 enactment of the MHB, Americans have benefitted from hospices’ team-based, patient-and-family centered approach to care for the dying, and today, more than a million people in the US die in the care of hospice each year. The benefit has allowed patients with a prognosis of six months or less to die in their homes, where most want to die, and it has enabled (and required) people to die without life-prolonging or futile medical interventions. Yet after 40 years, several authors agree, it is time to revisit the strict benefit structure of hospice within the context of its founding principles, the needs of terminally ill patients, and modern medicine.
“Medical care has greatly evolved over the last 40 years, leading patients to live longer with life-limiting illnesses and necessitating the need for a different take on the rigid structure of the MHB which relies on determination guidelines that were established decades ago,” says Dresang. “It’s time for non-profit hospices to come to the table to bring the MHB into the 21st century so that patients and hospice agencies are not suffering from inadequate care or costly audits.”
Dresang says that CHN, an affiliation of like-minded non-profits that serve ten counties between the Santa Cruz Coast to the Sacramento Foothills, is looking to lead the charge of protecting the legacy of non-profit hospices in California and beyond. “We are working directly with legislators and are building an ethics committee to advance our mission of protecting an industry that we helped create—one that is now poor quality and private equity investors,” says Dresang.
The CHN encompasses YoloCares in Davis; Hospice of the Foothills in Nevada County; Mission Hospice in San Mateo; and Hospice of Santa Cruz County, representing a collective workforce of 700 employees and census of over 1,000 patients.
End-of-Life Ethics in a Changing World is available to order on, www.hospicefoundation.org, or by calling 800-854-3402. Out now, the book is part of HFA’s ongoing educational initiative to increase awareness of hospice and care for the bereaved.