Hospice Patients Alliance: Patient Advocates

Getting It Right

(Contrary to Wesley J Smith, JD and Ira Byock, MD who get it So wrong)

Part One - Evaluating Wesley J Smith, JD's Position on the Hospice Industry

by Ron Panzer

March 7, 2015

There is a way which seems right to a man,
but the end thereof are the ways of death. - Proverbs 14:12

There are some that would say it is "uncharitable" to critique the work of someone like Ira Byock, MD or Wesley J Smith, JD. Yet, along with some of the good work they have done, each in his own way, both Byock and Smith contribute to the misinformation that the public has about the realities of healthcare within a hospice or palliative care setting.

While extolling the many benefits of such care, they both routinely deny that there are egregious problems permeating the industry and, contrary to readily available data, they even suggest that such problems are quite rare.

However dedicated they or any one of us may be, no one is incapable of error, and all of us need to listen to others at times. As we are told:

The way of a fool is right in his own eyes,
But a wise man is he who listens to counsel. -- Proverbs 12:15

Byock is one of the "faces" of hospice & palliative care in the United States. Wesley is a long-time volunteer for hospice and an ardent true believer in the hospice industry. It is very clear from his many articles that he actually is an active cheerleader for the secular hospice industry! He tells us that he has been fortunate to have had very positive experiences with hospices.1

Smith writes:

"I have been a hospice volunteer, and my research into hospice ..., as well as personal experiences with family and friends, have made me a hospice enthusiast."

Wesley J Smith, JD's Misunderstandings About Hospice

Well, I also am an enthusiast for hospice as it is meant to be: a merciful expression of love in action and an affirmation of the value of a patient's life even when they are nearing the end of their life. Yet, many hospices have abandoned the reverence for life that was part of the original mission and is essential to the delivery of care that is both safe and truly clinically professional.

There are hundreds of individuals working within the healthcare industry who see quite clearly what Wesley J Smith obviously cannot! One physician, E. Nicole Cooper, MD responded as recently as Feb 9, 2015 to Wesley Smith's article, "Hospice Defend Yourself" and wrote:

"Please see hospicepatients.org [Hospice Patients Alliance] for the original purpose and methods used in hospice in the 1980s before Medicare began to impact finances and incentivize neglect of true palliative care in the 1990s. Please use that site to try to find a hospice which honors the original purpose for patient and family.

As a physician who trained in hospice in the 1980s as a volunteer before going to a Catholic medical school, and now an Eastern Orthodox physician, I would only say that tragically in my office, medical society, and personal life I have learned it is a rare hospice which deals with patients as originally envisioned or as consistent with the Eastern Orthodox or Roman Catholic way much less the Hippocratic Oath.

Please read the cautionary tales on the website under Euthanasia. Please learn on the site what questions to ask to understand what your loved one will actually go through and why. The goal of original hospice was to keep a person as comfortable and fully present and him/herself as possible by whatever means was appropriate so he or she could with dignity and a clear mind reconcile with family, oneself and with God.

That was "palliative care" then and as it should be. Now starvation and dehydration (which are quite painful) may be masked by heavy pain med sedation so that the person is quiet while being killed early essentially.

You may see a family joking with staff in a party atmosphere and not "with" the immobile and unresponsive patient at all. It is all quite bizarre, deceptive, and not loving, respectful and filled with dignity as intended.

Our goal is to restore hospice to its rightful function. Not to have truly comforting medications denied due to expense and called "extraordinary measures" when previously it would have simply been part of good care to optimize how the patient feels and can function. I am always grateful when someone has had a good experience with hospice recently; they are blessed.

Please see this website and fight for your loved one to receive the "original" hospice care, hospicepatients.org. I have no involvement with it, just somber appreciation.2

This physician (who has never been in contact with HPA) is just one of many, many physicians and nurses as well as other healthcare professionals who independently confirm there are very serious problems in the hospice industry. Yet, even knowing about these and many other reports, Smith defends hospice as if it is some vulnerable entity being battered by slanderers. He writes,

"Don't be scared off hospice by horror stories. Rather, before entering a hospice or placing a loved one in a program, have a long talk with administration about their policies regarding treating conditions such as gangrene, bed sores, pain controlling radiation, and tube feeding. And then, hold them to it."3

The naiveté of such advice, "hold them to it," is astounding! If a hospice agency has integrity, then yes, you can "hold them to it." But in the case of a hospice run by administrators and staff with integrity, there usually aren't as many problems in the first place and you won't often need to "hold them to it."

When a hospice is disrespecting patients' rights, unwilling to provide basic care and medications that will improve the comfort of the patient, willing to practice stealth euthanasia, committing fraud, or other violations, they don't care what patients or families say or request. They ignore the patient and family or individual with the medical power-of-attorney. They bully them. They call adult protective services on the family members who object to the abuse, neglect and harmful activities occurring. They lie, saying that the family members are a "danger" to the patient or staff. They ban the caring family members from visiting with the patient.

They call the police if they raise a fuss. They do some or all of these things and more. I wish you could speak with the anguished family members that have called us for many years and reported how terribly they have been treated, and these reports come from all over the country, having had terrible experiences in large and small hospices, and nonprofit as well as for-profit hospices.

I am not one to label all hospices as bad or all hospices as good, but having realistic objective information is necessary to properly advocate for our patients or to protect our own loved ones who enter the healthcare system. I love the mission and reality of authentic pro-life hospice! It has been a major part of my life's work to restore the culture of life that makes such pro-life healthcare possible.

But we must realize that just as problems in hospitals or nursing homes can be horrendous, problems in hospice can be even worse because they are required to comply with much less stringent regulations and they know that the enforcement of the standards of care in hospice is almost nil.

Whistleblowers have presented information detailing how standards of care were being violated and how patients were consequently suffering, yet little significant reform of the industry has occurred. It appears that adherence to the standards of care within hospice has even gotten worse over time!

When hospice corporate leaders intentionally violate the standards of care (as contrasted with financial fraud), there is little effort by government to correct them. About all that might happen is State inspectors, responding to a complaint, might require that the hospice submit a "plan of correction" indicating that the hospice agency administrators promise to "be good!" Why should anyone trust them?

When it comes to financial fraud and the federal effort to stop hospice corporations from defrauding the government to the tune of many hundreds of millions of dollars overall, Wesley J Smith, JD complains:

... the Clinton Administration launched "Operation Restore Trust," [in 1995] which went after hospices in a cruel and chilling way by demanding tens of millions in refunds by presuming that patients who didn't die within six months were receiving hospice fraudulently. It was then up to the hospices to prove otherwise.4

The feds apparently were going after "poor, vulnerable" hospices in a "cruel and chilling way?" Incredible! The only problem with Smith's retort is that hospice corporations actually were and continue to steal millions from the federal Medicare program! The U.S. Department of Justice has documented innumerable cases of fraud committed by hospices resulting in the theft of several hundreds of millions of dollars since the Medicare Hospice Benefit was created in 1982.

It is true that there are serious problems that arise out of how the federal government reimburses hospice agencies, and there are very good suggestions readily available that delineate how to reform the Medicare Hospice Benefit and how agencies are reimbursed.5

Reg Hislop, III, a major healthcare industry consultant has written,

The incentives provided within the present [hospice] Conditions of Participation and the benefit and reimbursement language, are so misaligned with how patients utilize and access hospice services that providers seeking volume and revenue growth have teased and breached, the False Claims Act line.6

Note that he specifies "providers seeking volume and revenue growth" as having violated federal law, not those who are there out of the goodness of their heart to provide hospice services for the sake of the mission — while they of course receive reasonable reimbursement for their work! Even though there are problems with the government's reimbursement criteria, there is no doubt that there actually are corporate leaders willing to use hospice as a vehicle to plunder Medicare. They don't care about the mission of hospice; they care about huge increases in revenue even at the expense of the patients' well-being.7

Smith's abysmal ignorance of the criminality existing within the hospice industry is appalling! Regarding one of the most notorious perpetrators of major fraud in the hospice industry, and one of the largest, Vitas Hospice, Hislop writes:

On May 5, the U.S. Department of Justice released its most recent complaint (legal suit filed in Federal court) against Chemed, the corporate parent of Vitas [Hospice]. The complaint is a False Claims Act suit....

In the case against Chemed/Vitas, the Federal government is alleging that Vitas intentionally over-billed Medicare for higher reimbursement amounts by "up-coding" patient needs absent any real need and, admitted patients for care and billed for services where there was no definitional or certifiable need on the part of the patient. In this case, each violation is alleged against Vitas as a hospice provider organization....

Reading the complaint, I was struck with a number of thoughts. First, the magnitude of the complaint is huge. It encapsulates the entirety of Chemed's hospice holdings, collectively Vitas. The majority of False Claims Act complaints are against a single provider or geographically and agency limited. Additionally, the time period referenced encompasses over a decade of claims.

As I have followed False Claims Act cases in health care for years and paid close attention to the hospice activity, a reasonable estimate of the dollar amount (Vitas) involved is hundreds of millions of actual claims that are exposed to treble damages before the imposition of Civil Monetary Penalties. There is also the shadow of criminal prosecution for certain Vitas actors and management looming. Finally, this complaint is in the midst of other complaints against Vitas, open or soon to be open. A significant False Claims Act case is open against them in Texas and a newly opened complaint with a physician whistleblower in Los Angeles just broke and is today, wrapped in the broader complaint....

The complaints current and yet forthcoming, paint an overall picture of a business model [of Vitas Hospice] that is grossly non-compliant and steeped in fraud at the core ....

Their [US Justice Dept and Centers for Medicare and Medicaid Services] words in various locations, tell me straight-forward that the industry has a fraud pandemic and the day of reckoning has arrived. [emphasis added].8

Does that sound like the "poor, victimized" hospice industry that Smith portrays? When (on March 2, 2015) I searched for the terms "hospice" and "Medicare fraud" at Google.com, there were 49,100 results! If there is so little hospice Medicare fraud occurring as Wesley Smith, JD asserts, why would there be 49,100 results? Try it and read some of the numerous articles about such fraud.

As a nurse working in hospice, I directly witnessed how a large nonprofit hospice could have nurses chart care that was not provided in order to bill for care that was never delivered and realized that tens of millions of dollars could have wrongly been billed by that hospice in one year alone! It was quite amusing when I saw that a hospice CEO I knew had been involved in hospice fraud was later slated to give a major regional seminar on "How to avoid Hospice Fraud" — something like bank robbers teaching other bank robbers how not to rob banks (or maybe behind closed doors they discussed how not to get caught). Astounding!

Smith is and was not privy to the bookkeeping and billing records of hospice corporations, nor was he privy to the medical records that were used to justify billings. Some hospices even have "double books" where they provide one falsified set to the government and another set of records that record the actual data. Smith has no idea what hospices were billing for around the country and how they were committing fraud. I and many others who are focused on this niche of healthcare do know.9

Smith complains that hospices were accused of fraud when patients didn't die soon enough. He doesn't realize that many hospices do pad their revenue stream by taking in completely non-terminal patients who are actually stable, chronically-ill patients who might live many years. Aside from year-after-year federal convictions of hospices for exactly this type of fraud, hospice administrators and nurses I have known have also confirmed that some other hospices they know are actually doing this!

These hospice agencies then bill for hospice services while providing almost no services. That is fraud! How do many hospices today cover up their crime? They end the lives of the non-terminal but chronically-ill patients and purportedly prove that the patients actually were "terminal," because they obviously did die! Therefore, the reasoning goes, "They must have been terminal!"

CEOs of the criminal hospice agencies are regularly quoted in news articles bemoaning the "unfairness" of the federal government — the same line that Wesley J Smith spits out on a regular basis.

I ask Mr. Smith: What about the intentional criminal activity occurring in hospice?10

What about Compassionate Care Hospice of New York that agreed to repay $4.0 million to the U.S. and $1.6 million to New York State in 2015?
What about Good Shepherd Hospice that repaid 4 million just this year, 2015?
What about Hospice Compassus that repaid $3.92 Million in 2014?
What about Alex Pugman, former director of Home Care Hospice in Philadelphia who in 2014 was sent to jail for two years, nine months for his involvement in defrauding $16.2 million from the government?
What about Hospice of Arizona that repaid $12 Million in 2013?
What about Hernando-Pasco Hospice, d/b/a HPH Hospice, that repaid $1 million in 2013?
What about Hospice of the Comforter Inc. (HOTCI) that repaid $3 million in 2013?
What about Harmony Hospice Care that repaid $1.287 Million in 2013?
What about Odyssey Hospice that repaid $25 million in 2012?
What about Hospice Care of Kansas - Voyager HospiceCare that repaid $6.1 Million in 2012?
What about Hospice Home Care that repaid $2.7 million in 2011?
What about Diakon Lutheran Social Ministries d/b/a Diakon Hospice Saint John that repaid $10.56 million in 2011?
What about Kaiser Permanente's Oregon hospice unit that repaid $1.8 million in 2009?
What about Southern Care hospice that repaid $24.7 million in 2009?
What about the Hospice of Michigan that repaid $1.5 million back in 1997?

These are just a very few more notorious cases among hundreds of cases of fraud being perpetrated by hospices around the country. Articles like "How Dying Became A Multibillion-Dollar Industry" and "Dying and profits: The evolution of hospice,"11 describe what is really going on. Secular humanism and the devaluation of human life is just one part of the degradation of hospice. The other is plain greed!

Those hospice administrators with integrity that I know do not complain about being accused of fraud, because they are not accused of fraud. They provide care for truly terminally-ill patients and don't go looking for stable, non-terminal patients that they label terminal in order to bilk the system. They may encourage greater reimbursement and reform of the reimbursement criteria, just as any businessman would, but they don't complain about the government going after hospice agencies that do commit crimes and are later convicted.

Smith cites the case of a long-term ALS (Lou Gehrig's Disease) patient who was discharged from hospice because he was staying on hospice too long, suggesting that this is the typical scenario for patients the US Justice Dept labels as non hospice appropriate. That is not the case! Every hospice is going to have some patients that live much longer than expected and that is expected.

If a hospice had just a few cases like that, they can and do justify keeping the patient longer so long as the physician re-certifies the patient as being hospice appropriate. However, when they have a large percentage of non-hospice-appropriate patients, they discharge many when they think they're going to get caught, and then patients who really need the service are harmed.

It's only when a hospice agency has an unusually large percentage of patients who live much, much longer than might be expected that the red flags go up for the Justice Department investigators who are responding to reports from whistleblowers inside the hospice who know fraud is occurring, or for the Medicare fiscal intermediaries who monitor hospice billings and statistics and are tasked with making sure patients are appropriate for hospice according to the current law.

Smith reveals his bias toward regarding hospice as a relatively unblemished industry when he astoundingly intentionally omits any mention at all of hospice when discussing the dehydration deaths of patients. He writes:

Twenty years ago, for instance, it would have been unthinkable to dehydrate people to death by removing their feeding tubes because they were cognitively disabled. It might even have been criminal. Today, due in large part to vigorous advocacy by bioethicists, which in turn has led to court cases and then to new laws permitting the practice, it is routine in nursing homes and hospitals throughout the country.12

Where does Wesley J Smith think Terri Schiavo was executed through dehydration? She was in the Hospice of the Florida Suncoast Woodside Hospice facility where the CEO, Mary Labyak was busy making sure the non-terminal and disabled woman, Terri Schiavo, died and set a legal precedent for dehydration killing through withdrawal of tube feedings in a hospice setting. Labyak was a corporate officer, friend, and fellow board member at Ira Byock's Partnership for Caring organization.

Why does Smith specifically not mention hospice where the practice of dehydrating people to death has been first widely practiced for years (largely through Byock's efforts) and then spread to hospitals and nursing homes through palliative care programs there! Before hospice and palliative care were introduced, hospitals and nursing homes would be extremely unlikely to dehydrate a person to death, and they still are if a hospice or palliative care dept is not formally involved.

Hospice and palliative care settings give the practitioners a kind of permission to end the patients' lives because supposedly "death is expected." No county district attorney will prosecute such medical killings and few if any attorneys will take such cases to court. For that reason, hospices have a license to kill. They know they can get away with it!

Smith is sadly making hospice his idol, embraces a faith in hospice stating that it has done, and can do, little wrong, except in extremely rare instances. He demonstrates the "sacred cow" mentality many have about hospice. I've written many times about how hospice as an industry is treated like such a "sacred cow."

At least cows are revered in India with good reason: they provide milk, butter, and cheese, and the cow dung is dried and burned when used for cooking and fuel. However, there is no justification for treating hospice like a "sacred cow" — as an industry that should never be and cannot be objectively evaluated and critiqued. Placing the hospice industry on a pedestal has resulted in the proliferation of much misinformation. When reality hits, patients and family members who expect good end-of-life care are shocked.

In biblical terms, I would say that some have actually made an idol out of hospice, just as some have made a quasi-religion out of the bogus "man-made" global warming in order to bolster globalist and socialist agendas that would create regulations forcing capitalist Western nations to stifle their economy while allowing communist China and increasingly totalitarian Russia to spew pollution without end.

For anyone who cares to look, more and more details have emerged how politicized "scientists" have admitted in emails and reports that they fabricated data outright or falsified the temperature data available in order to bolster its sky-is-falling alarmism and the consequent anti-capitalist agenda. Sorry, socialist global warmists, the end of the world predicted 20 years ago to occur "in 20 years" from then, i.e, now, has not occurred! And for those who remember the 1970s and 1980s as I do, the global cooling predicted (and covered by Time Magazine and other media outlets) has also not occurred!13

For decades, anyone who has raised issues with hospice has often been lambasted with fierce vitriol. Anyone questioning hospice is attacked just as much as those who question man-made global warming. True-believers have called or written and stated that many of the violations we know are occurring, never happen!

They just can't believe it, they say. It is interesting to note that these types of calls or notes have become fewer and fewer through the years. It is clear that many are coming to the realization that they can no longer deny that there are widespread imposed deaths in hospice and palliative care settings, as well as other major problems. Wesley J Smith excepted.

One reason for the assertions of "hospice can do no wrongers" is that these healthcare professionals and volunteers may project their own integrity and good practice on all others, never suspecting that many in the industry do not share their respect for patients' lives. They also are profoundly naive not only about human nature, but about how the euthanasia movement has intentionally and successfully, in fact, infiltrated and actually taken control of the industry.14

A third major reason many assert that hospice doesn't do these things, is that they are actual practitioners of active euthanasia and/or stealth euthanasia within hospice and palliative care settings! They do not wish to have others know what they are doing until the time is right for announcing to the world how widespread these practices are, and then have them legalized with the rationale that "society has changed" and "the people approve."15

Getting back to Wesley J Smith, JD, the long-time hospice volunteer — and I certainly applaud his good works — hospice volunteers who have no medical training and do not actually administer medications or perform medical or nursing procedures, really do not know what is going on or could be going on. Even nurses or physicians who are working a case can be mistaken or misled about a patient's condition!

I know of hospice medical directors whose patients were not in pain, but were misled by calls from nurses stating the patient was in extreme pain and needed high doses of morphine. Sometimes, the physician made actual house calls to check on these surprising developments (since she knew the patients were not in pain) only to find that there was no pain issue at all! The nurses were falsifying their report of patients' clinical conditions in order to justify physician orders for opioids, so they could hasten the patients' deaths!

In some cases where a relative or physician seeks to justify a patient's admission into hospice, they may communicate to the hospice team that the patient has "cancer" when there actually is no cancer. A medical director interested in bolstering the hospice agency's census of patients will eagerly admit the patient with a "cancer" admitting diagnosis. The nurses will then assume in many cases that there is pain (when there is none) and administer opioids that result in a hastened death — since such opioids like morphine are unneeded. This is only one way that adult children who seek to inherit their parents' estate sooner have manipulated the hospice staff into doing the killing for them.

It is noteworthy that in reports we receive from families, later autopsy results showed no cancer at all. What do these patients die from then? If no autopsy had been done, many would still have believed the patient died from an actually nonexistent cancer.

In the case where a stealth euthanasia practitioner is working in a hospice or palliative care setting, it is quite easy to mislead other nurses and the physician. They can lie about the patient's pain level, or simply state that the patient was "agitated" and receive orders for sedation. Other nurses who come along to work with the patient assume that the report of such agitation is truthful, and therefore, keep up the medications for agitation, often sedating the patient permanently till they die of dehydration, not from their terminal illness!

A hospice volunteer like Wesley J Smith, JD, or any other observer, would see in any of these scenarios a patient who was sleeping peacefully with nurses who appeared quite dedicated. Imposing death can appear to be a "perfect death" to those who do not know the detailed truth.

There is no way for a hospice volunteer or other observer to know the truth in such circumstances. Just as I don't pretend to know the intricacies of complex law, a hospice volunteer, no matter how well-intentioned and lengthy his involvement in hospice, does not know what nurses and physicians know!

It is possible for anyone, even a physician who has not independently assessed the patient's actual condition, to believe a patient is being well-cared for, when death is actually being imposed right in front of their eyes! This is why it is termed stealth euthanasia and not openly declared active euthanasia. A "pretty" death may actually be an involuntary imposed death!

The only way to actually determine the patient's real clinical condition would be to back off of opioid and/or sedative medications so that the patient could recover wakefulness (if possible by that time) and then reassess the patient's actual status.

I have done exactly that at patients' family requests and seen that sometimes, pain medications were not needed or were being overprescribed, thereby placing the patient into an unwanted coma when the patient wished to be awake at the end-of-life period. Of course, if you back off medication levels and pain or agitation actually re-emerges, you have confirmation that the medications actually are needed, are being given appropriately, and need to be re-established at the previous levels.

Secular humanists who work within hospice support euthanasia and assisted-suicide openly or privately, or, they support stealth euthanasia while publicly condemning euthanasia and assisted-suicide. Once they have decided that a patient should die soon, they regularly tell family members who care for the patient and seek to continue to provide basic care, "You are being selfish by keeping him or her alive!" or "The good and merciful thing is to let him go," really meaning that we should impose death one way or another, so that his suffering is ended permanently.

Even when the patient is truly not terminal, pressure is brought to bear so that an elderly, disabled, chronically-ill or otherwise vulnerable patient's life may be ended and a death protocol begun, usually by withholding food and fluids and sedating the patient. The pressure placed on patients and their loving family members to have life ended (often with the opportunity to plunder organs if the patient is younger and in a hospital setting) is incredibly forceful, intimidating, and often accompanied by outright lies, misinformation, and manipulations.

In secular humanist thinking, ending life is considered good because suffering will therefore be ended! Secular humanist physicians like Ira Byock, MD, endorsed without reserve by Wesley J Smith and many at the National Right to Life Committee, regularly impose terminal sedation and hasten death within hospice and palliative care settings. Caring and affirming life under these circumstances is considered evil and selfish by secular humanists!

Smith even misadvises readers about what can or cannot be treated after a patient has enrolled in hospice. He writes that a patient's admission to hospice "could preclude a hospitalization ... [for] pneumonia."16

Well, if a patient is not in the pre-active or active phase of dying17 in the progression of the terminal illness, it is quite reasonable to have the patient treated for pneumonia. What if the patient had cancer but was nowhere near death? Why shouldn't that patient be treated for pneumonia?

A choice not to treat a urinary tract infection or even pneumonia is a choice to assure death from the infection in a few days or weeks, rather than having the patient live till his terminal illness naturally takes him. Is this what hospice is supposed to be like according to Smith?

What if a patient who is in the early stages of a terminal lung cancer falls and breaks a leg? Should that be treated? Of course! In some cases, it is appropriate for the patient to temporarily revoke the Medicare hospice benefit, get treated for non hospice-related conditions, and then go back on the hospice benefit. Smith may not realize it, but this is commonly done by many hospices in these circumstances, even for the treatment of pneumonia when the patient is not close to dying already.

Yes, Dame Cicely Saunders was the founder of the modern hospice movement. Smith admiringly describes the beginning of her vision for the work (also quoting herein from David Clark, one of Saunders' associates):

So strong was Saunders's faith in what she perceived as her divine calling, she began volunteering as a nurse at homes for the dying after work. Urged on by her deep desire to help dying people, she went to medical school at the age of 33, this at a time when there were few women doctors.

Saunders focused her medical practice on helping dying people and alleviating pain. She obtained a fellowship in palliative research and began work in a hospice run by nuns, where pain control was unevenly applied, a nearly universal problem at the time, causing much unnecessary misery. Saunders conceived of putting patients on a regular pain control schedule, which, in her words, "was like waving a wand over the situation."

Believing firmly that "the St. Christopher's project [was] divinely guided and inspired," she became an activist, energetically raising money for the new project, and in the process, raising the consciousness of the medical establishment. Saunders' initial idea was for St. Christopher's hospice to be a "sequestered religious community solely concerned with caring for the dying."18

But the idea soon expanded from a strictly religious vision into a broader secular application, ....[emphasis added]19

Smith describes her work as having expanded into a "broader secular application?" This is a completely false and very serious misunderstanding of Dame Cicely Saunders approach!

Dr. Saunders was a devout pro-life Christian and saw her vision of hospice as a fulfillment of her call to serve the dear Lord Jesus Christ. For her, hospice work embodied her Christian mission to all, just as Christians openly serve individuals of any religious persuasion or none.

Objectively, it would be impossible to view her work as "secular" by any stretch of the imagination, as Smith mistakenly asserts. Just because she didn't push her religion at every step doesn't mean that it wasn't the most basic thing about everything she did!

Dr. Saunders and her staff prayed each and every new morning and her work was whole-heartedly Christian in inspiration and practice. Throughout her career, she openly dedicated all of her work to the dear Lord Jesus Christ. In fact, Dr. Saunders sprinkles biblical references into her many letters and writings. Confirming her Christian faith, she has written,

If we are Christians, our vision is of God's sharing with us all in a deeper way still, with all the solidarity of His sacrificial and forgiving love and the strength of His powerlessness. As Bishop Taylor wrote in a Christmas poem, "I am the undefeated heart of weakness." That loving power will outlast all else and holds out an ultimate hope of life through death.

Sometimes we can speak of this, more often we have to stay silent beside this silent God, whose ways of meeting each person's need will often be known to them alone. In our turn, we have to trust in the often perplexing anonymous Spirit. Many Hospices have chosen a free-flying bird as their symbol. For many, this represents the Holy Spirit, but I believe this also echoes the many religions that have spoken of some form of inner guide or Wayshower....20

I could quote dozens of other references from her writings to demonstrate that her mission in hospice was absolutely faith-based and never secular at all. Can it be any clearer that Dr. Saunders' application of hospice was never "secular?"

Nevertheless, it is not surprising that Smith views Saunders' mission as secular. He has been mis-educated over time by some who promote a secular American version of hospice that is not faith-based at all. It is striking to note that even though he believes her mission and the mission of hospice today actually is secular, he still whole-heartedly endorses the present secular and tainted approach to hospice!

Through decades and continued choices to ignore the realities of the hospice and palliative care industry, and many misleading statements to the public about them, Wesley J Smith, JD, along with many at the National Right to Life Committee21 have sadly disqualified themselves to serve as an objective guide to what people should know about hospice or what is right or wrong about the hospice industry! They have lost their credibility on the issue.

We do not condemn all hospice and palliative care and have never done so. Whatever name end-of-life care is given, it will always continue in one form or another. We simply encourage end-of-life care practitioners to affirm the sacred value of human life and hope that they revere the God who gives that life. If they do not, they are certain to go astray!

We demand that end-of-life care practitioners never hasten or impose death in any way, even by the deceptive stealth euthanasia methods regularly practiced by physicians like Ira Byock, MD! This was Dr. Cicely Saunders mission, not some tainted counterfeit that victimizes the most vulnerable among us.

Yes, we see that like Smith and Byock, many hospice administrators, leaders and staff love to claim Saunders as their own and claim that they are following in her footsteps, even when they violate her most basic guidance about how the mission should be accomplished and her cautions about what is to be avoided.

Human history is filled with accounts of individuals who trusted those who betrayed them (Genesis 4). When hospice professionals impose death upon patients in any manner, it is no different.

A large segment of the hospice and palliative care industry currently approaches the mission from an entirely different worldview than Dr. Saunders: a secular humanist and utilitarian worldview!

The Christian worldview and the secular humanist worldview — with its secular bioethical approach22 — are diametrically opposed to each other. The conclusions reached, the goals held, and the methods used by those of such disparate worldviews can never be the same!

How bizarre and tragic it is that Wesley J Smith — who tells us he has adopted the Eastern Orthodox Christian faith — embraces the secular hospice movement personified by Ira Byock, MD? How does he not see the betrayal of the mission involved in the secular version of hospice?

How is it that he doesn't even recognize that it is the dear Lord Jesus Christ who inspired Dr. Saunders to follow Him as a Christian, as well as to begin and continue to devote the rest of her life to this merciful loving work He called her to do in order to give glory to His name?

Those who remain faithful to the Hippocratic Oath and to God remain faithful to her mission. There are very dedicated hospice professionals working to truly serve those nearing the end of their lives. However, Ira Byock, MD and those like him are not faithful to the mission. They have tainted it and taught others to follow in their footsteps, causing terrible anguish for far too many!

(Part Two on Dr. Byock)


  1. Wesley J. Smith, J.D., The Problems With Hospice, July 25, 2011, The Center for Bioethics and Culture. Back

  2. E. Nicole Cooper, M.D., Feb 6, 2015 Comment on article by Wesley J Smith, "Hospice Defend Yourself," Feb 6, 2015, First Things. Back

  3. Wesley J. Smith, J.D., The Problems With Hospice, July 25, 2011, The Center for Bioethics and Culture. Back

  4. Wesley J. Smith, J.D., The Problems With Hospice, July 25, 2011, The Center for Bioethics and Culture.
        Why Does Our Government Keep Attacking Hospice?, May 4, 2008, First Things. Back

  5. Reg Hislop, III, Reforming the Medicare Hospice Benefit, May 16, 2013, Reg's Blog. Back

  6. Reg Hislop, III, Hospice Tumult: The Begining of the End?, May 14, 2013, Reg's Blog. Back

  7. Ron Panzer, Stealth Euthanasia: Health Care Tyranny in America (Hospice, Palliative Care and Health Care Reform), 2011, p. 70, Hospice Patients Alliance. Back

  8. Reg Hislop, III, United States v. Vitas: The Impact and What Next, May 15, 2013, Reg's Blog. Back

  9. Ron Panzer, Hospice Fraud & Scams You May Encounter: (How to Avoid Them), Hospice Patients Alliance. Back

10. U.S. Dept of Justice, Many articles found on the website of the United States Department of Justice website searching for "false claims act" and "hospice", U.S. Dept of Justice website. Back

11. Ben Hallman, How Dying Became A Multibillion-Dollar Industry, June 19, 2014, Huffington Post.
      Peter Whoriskey and Dan Keating, Dying and profits: The evolution of hospice, Dec 26, 2014, Washington Post. Back

12. Wesley J. Smith, J.D., Harsh Medicine, from the book Culture of Death, Ch One, Encounter Books, 2002, posted online at Catholic Education Resource Center. Back

13. Staff, Another Ice Age?, June 24, 1974, Time Magazine.
      Julia A Seymour, And That's the Way It Was: In 1972, Cronkite Warned of "New Ice Age", March 5, 2015, Newsbusters. Back

14. Ron Panzer, From Euthanasia Society of America to the National Hospice & Palliative Care Organization (1938-Present), Hospice Patients Alliance. Back

15. Ron Panzer, Stealth Euthanasia: Health Care Tyranny in America (Hospice, Palliative Care and Health Care Reform), 2011, Hospice Patients Alliance. Back

16. Wesley J. Smith, J.D., The Problems With Hospice, July 25, 2011, The Center for Bioethics and Culture. Back

17. Ron Panzer, Signs and Symptoms of Approaching Death, Hospice Patients Alliance. Back

18. David Clark, Cicely Saunders Selected writings 1958-2004, Quotes here from David Clark, archivist for the collection, Feb 2006, Oxford University Press. Back

19. Wesley J. Smith, J.D., Dame Cicely Saunders, The mother of modern hospice care passes on, July 19, 2005, The Weekly Standard. Back

20. Dr. Cicely Saunders, Spiritual Pain, The Journal of Palliative Care, vol. 4, no. 3, 1988, pp. 29-32;
        reproduced in the book, Cicely Saunders Selected writings 1958-2004, Feb 2006, Oxford University Press. Back

21. Ron Panzer, What is Really Wrong with the National Right to Life Committee, Nov 25, 2011, Hospice Patients Alliance. Back

22. Dianne Irving, PhD, What is Bioethics?, June 3, 2000, LifeIssues.net. Back

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