by Rebecca Gagne-Henderson PhD, APRN, ACHPN Who is your customer? Your company, a hospital you work for, the consulting physician? Another way to ask this is: Where does your allegiance lie?  Palliative care has changed. When I started, it was a wild and woolly new frontier. You had to put your holster on your hip and stand between Western Medicine and the vulnerable dying patient. Sometimes you had to stand between the unreachable hopes of the family for a cure and the dying patient. It was all about culture change.  Strangely, it has metamorphosed into “a service”. The question is ..read more

By Rebecca Gagne-Henderson PhD APRN ACHPN Over the years of caring for dying patients, it bothers me when I can remember a patient’s face in my mind’s eye but cannot recall their name.  I have a physician friend who, since the beginning of his practice of 40 years has a series of notebooks where he has recorded the name of each patient who died in his care. I wish I had thought to do that. There are some patients and families I will never forget. I am going to share one of my favorite hospice stories with you now. Louie was my patient.  He lived in a dementia facility that ..read more

by Rebecca Gagne Henderson PhD APRN ACHPN The Original Schism In 1054 AD a Roman Catholic Cardinal was sent to the Metropolitan of the Eastern Orthodox Church and excommunicated the entire Eastern church. The Eastern Bishop declared anathema on the Roman Catholic church. Oh, the Irony amongst these fine men who carried the mantle of the original apostles fighting over who is the greatest. Whatever happened to the “Last shall be first”? The Palliative Schism I bore witness to such a schismatic proclamation this year whilst watching a European Palliative Care webinar. It included a pan ..read more

by Rebecca Gagne-Henderson PhD APRN ACHPN What is the Death Rattle? In the early 2000’s I noted many hospice physicians began to refer to the death rattle as hypersecretions. The secretions may at some point become copious, but the term “hypersecretions” indicates a disorder which produces an excessive amount of secretions. In addition to hypersecretions, other terms have been suggested such as “terminal congestion” and “retained secretions” to diverge from death rattle which some find distasteful (1). These are terms are inaccurate and pathologize a natural process.  It is fort ..read more

By Rebecca Gagne-Henderson PhD, APRN, ACHPN, FNP Wherever we call home, most of us long to be there.  No matter the condition of the floors, or the quality of the curtains–perhaps no curtains, that is the place we want to be at the end of the day. But what about at the end of our lives?   Home may look different from the traditional images in our mind’s eye.  In the 90s I had a hospice patient whose address changed every fortnight.  She would call me and give me her new location.  The law in Los Angeles was that you could not park a vehicle for ..read more

by Rebecca Gagne-Henderson PhD, APRN, ACHPN We find ourselves in an era of frequent and normalized overtreatment of the very old and very ill. This overtreatment contributes to frailty and debility, which leads to the institutionalization of those unfortunates to lay and wait for death to come. Overtreatment includes interventions that have little to no benefit to the patient. It is also associated with treatments which are performed without the patient’s fully informed consent (1). We all, clinicians and patients alike, need to recognize when it is appropriate to stop overtreatment and ..read more

by Rebecca Gagne-Henderson PhD, APRN, ACHPN This Sunday is Easter.  There is no better time to tell this story.  It is a story of a patient our team cared for when I was director of a hospice.  Easter is an appropriate time as this is the story of a young woman’s resurrection experience. This experience occurs during her stay on hospice before her untimely death. Her experience is an illustration of Remoralization reached on her path to grace and redemption. I know all who read this blog are not Christian, Jewish, Muslim or even believers.  Whatever one’s beliefs, this was ..read more

by Rebecca Gagne-Henderson PhD, APRN, ACHPN This Sunday is Easter.  There is no better time to tell this story.  It is a story of a patient our team cared for when I was director of a hospice.  Easter is an appropriate time as this is the story of a young woman’s resurrection experience. This experience occurs during her stay on hospice before her untimely death. Her experience is an illustration of Remoralization reached on her path to grace and redemption. I know all who read this blog are not Christian, Jewish, Muslim or even believers.  Whatever one’s beliefs, this was ..read more

Originally posted March 15, 2022 by Rebecca Gagne-Henderson PhD, APRN, ACHPN This will be the first in a series of blogs regarding assisted dying.  It is a much more complicated issue than can be discussed in 280 characters tweets.  The issue goes far beyond the principle of autonomy and involves more than the individual purporting this said autonomy. This post will discuss the ethical principles and the laws which are relevant to assisted death. Palliative sedation is the act of instituting complete or partial, continuous or intermittent sedation using a “cocktail” of intravenous me ..read more

by Rebecca Gagne-Henderson PhD APRN ACHPN Those who argue for assisted death do so without a thorough examination of all the ethical implications associated with this practice, and the ramifications it will have for the individual, the clinician, and society. The most frequently cited ethical principle in the argument for assisted death is Autonomy. According to Beauchamp and Childress “Personal autonomy is, at minimum, self-rule that is free from both controlling interference by others and from limitations, such as inadequate understanding, that prevent meaningful choice” (1).  This def ..read more