In the Business of Dying: Questioning the Commercialization of Hospice

This article critically questions the commercialization of hospice care and the ethical concerns associated with the industry's movement toward “market‐driven medicine” at the end of life. For example, the article examines issues raised by an influx of for‐profit hospice providers whose busines...

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Bibliographic Details
Published in:	The Journal of law, medicine & ethics medicine & ethics, 2011-06, Vol.39 (2), p.224-234
Main Authors:	Perry, Joshua E., Stone, Robert C.
Format:	Article
Language:	eng
Subjects:	Bioethics Blood & organ donations Business Commercialization Corporations, Nonprofit Death Dying Economic aspects Family Gifts Grass roots movement Health care costs Health care expenditures Health care policy Health Expenditures Health Facilities, Proprietary - economics Health services Health technology assessment Hospice care Hospice Care - economics Hospices Hospices (Terminal care) Humans Industry Juries Law Laws, regulations and rules Medical care, Cost of Medical ethics Medical service Medicare Medicine Nonprofit organizations Organizations, Nonprofit Palliative care Palliative treatment Patients Quality of care Terminal Care Terminal illnesses United States Wives
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Summary:	This article critically questions the commercialization of hospice care and the ethical concerns associated with the industry's movement toward “market‐driven medicine” at the end of life. For example, the article examines issues raised by an influx of for‐profit hospice providers whose business model appears at its core to have an ethical conflict of interest between shareholders doing well and terminal patients dying well. Yet, empirical data analyzing the experience of patients across the hospice industry are limited, and general claims that end‐of‐life patient care is inferior among for‐profit providers or even that their business practices are somehow unseemly when compared to nonprofit providers cannot be substantiated. In fact, non‐profit providers are not immune to potentially conflicting concerns regarding financial viability (i.e., “no margin, no mission”). Given the limitations of existing empirical data and contrasting ideological commitments of for‐profit versus non‐profit providers, the questions raised by this article highlight important areas for reflection and further study. Policymakers and regulators are cautioned to keep ethical concerns in the fore as an increasingly commercialized hospice industry continues to emerge as a dominant component of the U.S. health care system. Both practitioners and researchers are encouraged to expand their efforts to better understand how business practices and commercial interests may compromise the death process of the patient and patient's family — a process premised upon a philosophy and ethical tradition that earlier generations of hospice providers and proponents established as a trusted, end‐of‐life alternative.
ISSN:	1073-1105 1748-720X