Unreconcilable Differences?(Letters) (Letter to the Editor‪)‬

To the Editor: The sensitive discussion by Courtney Campbell and Jessica Cox on hospice care and physician-assisted death ("Hospice and Physician-Assisted Death: Collaboration, Compliance, and Complicity," September-October 2010) is a model blend of ethical analysis, empirical study, and policy assessment in bioethics. The legalization of physician aid in dying has raised important ethical issues for hospice that go to the broader question of its evolving mission and its place in the landscape of end-of-life care in our society. Hospice began, one might say, as a philosophy of care of the dying that formed a countercultural movement. It offered a systematic and holistic approach to care involving not only the dying person but surrounding family and friends. It aimed to make living while dying meaningful and to heal and strengthen relationships even in the face of grief and loss. Over time, Medicare funding and other developments led hospice to grow to the point where today it cannot be considered counter-cultural, even though it is still under-appreciated and underutilized. But it is no longer a "movement"; it is a well-established form of health care delivery. As such, hospice has now entered the domain of our autonomy-focused ethic of health care.