Logan Reid
Hospitals are designed to cure people and prolong life, so death is often regarded as a failure. However, dying in a hospital is common, and hospitals must balance vigorous efforts to cure patients with providing a good death for those who cannot be saved. People who die in hospitals undergo more procedures, tests, and costs than those who die elsewhere, and their final days may be spent in an unfamiliar place surrounded by strangers. While most people would prefer to die peacefully at home, this is not always possible or realistic, and hospitals must navigate the complex preferences and needs of patients and their families at the end of life.
| Characteristics | Values |
|---|---|
| Percentage of people dying in hospitals in the US | 35.1% |
| Percentage of people dying at home in the US | 31% |
| Percentage of people dying in long-term care facilities in the US | 26.8% |
| Percentage of people who survive "Code Blue" resuscitation attempts and leave the hospital | 2% |
| Percentage of patients who experienced at least one "severe" symptom | 75% |
| Percentage of nurses who judged patients' global care as "good" or "very good" | 76% |
| Percentage of deaths that occurred in a hospital in 2000 | 48.0% |
| Percentage of deaths that occurred at home in 2000 | 22.7% |
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What You'll Learn
Hospital deaths are more expensive and intrusive than deaths at home
Reasons for Hospital Deaths Being More Expensive
An analysis by Arcadia Healthcare Solutions revealed that spending on individuals who die in a hospital is about seven times higher than on those who die at home. This is because hospitals perform more intensive services and procedures, resulting in higher costs. Furthermore, Medicare or private insurance often pay doctors and hospitals more for their services, further increasing the overall cost.
Intrusiveness of Hospital Deaths
Hospital deaths can be more intrusive due to the nature of the hospital setting. Hospitals are focused on curing illnesses and prolonging life, which may result in aggressive and invasive treatments, even when death is imminent. This can delay or prevent palliative care and cause unnecessary physical and emotional harm to patients. Additionally, patients may be subjected to more intense tests and procedures, which can be distressing and uncomfortable.
Preference for Dying at Home
Many people express a preference for dying at home rather than in a hospital. This is because individuals would rather spend their final days in a familiar and comfortable environment, surrounded by their loved ones. However, these wishes may not always be realized if clear instructions are not provided to doctors and family members.
Challenges in End-of-Life Care in Hospitals
Hospitals face challenges in providing adequate end-of-life care. The culture of curing diseases and prolonging life can conflict with the needs of dying patients. Additionally, symptom control may be inadequate, and palliative care may be delayed or neglected. This can result in unnecessary suffering and a lower quality of life for patients during their final days.
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Most people want to die at home
Despite the fact that more deaths occur in hospitals than in other settings, most people would prefer to die at home. This preference is reflected in the fact that doctors, who are aware of this desire, tend to die at home themselves (72%). Hospice care is usually intended to help people die comfortably at home, although inpatient hospice programs also exist. In the US, more than 31% of people pass away at home, a percentage that has increased in recent years.
However, dying at home can place a burden on family members, who may not realize that they will be responsible for most of the physical and emotional work involved in hospice care. This burden has even been given a name: caregiver syndrome. As a result, some people who have experienced home hospice care with a loved one decide that they do not want the same for themselves.
In some cases, people who would prefer to die at home end up dying in a hospital, where they may be subjected to overmedication and unwanted treatments. This can be due to prognostic uncertainty, patients' poor conditions, prolonged hospital stays, and the high percentage of patients incapable of making decisions. Additionally, life-prolonging interventions may be suggested by families who are not adequately informed but want to guarantee their loved ones every option.
To ensure that people's end-of-life wishes are respected, it is important to have conversations about their preferences and express them in writing. This can help prevent situations where individuals are swayed by a physician's recommendation or receive unwanted care.
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Hospitals are designed to cure people, not let them die peacefully
Hospitals are designed to cure people and prolong their lives, not let them die peacefully. While the situation is changing, most people with serious illnesses receive some form of hospital care, and hospitals are often the place of death for many. However, this does not mean that hospitals are designed to let people die peacefully.
The culture of modern medicine and hospitals is to treat patients and attempt to cure them, regardless of the quality of life that may result. This can lead to aggressive, invasive, and futile treatments that prolong dying rather than life. For example, in the case of ""Code Blue" resuscitation attempts in older patients with chronic illnesses, very few survive beyond six months, and those who do are often in a worse physical and mental state. Additionally, patients are not always informed about the realities of these procedures, which can be traumatic for both the patient and their families.
Furthermore, hospitals tend to focus on curing diseases rather than providing palliative care, which can result in inadequate symptom management for dying patients. A study in Italy found that 75% of dying patients experienced at least one "severe" symptom, yet nurses still judged the overall care as "good" or "very good". This indicates a disconnect between the care provided and the actual needs of patients at the end of their lives.
The shift towards dying at home or in long-term care facilities reflects a change in societal beliefs about death and dying. People are increasingly opting for hospice care, which provides comprehensive end-of-life comfort care, allowing most individuals to die peacefully at home. While hospitals are not primarily designed to let people die peacefully, they are still responsible for providing good end-of-life care that respects the patient's wishes and minimizes needless harm. This includes respecting patients' choices for withholding or withdrawing treatments and providing adequate palliative care when appropriate.
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Dying inpatients may receive inadequate care
Hospitals are primarily focused on curing diseases and prolonging life. As such, dying inpatients may receive inadequate care because their needs do not align with the culture of care of large hospitals. For example, in a study of 370 patients who died on the general wards of 40 Italian hospitals, symptom control was inadequate for the most severely ill patients: 75% experienced at at least one "severe" symptom (42% pain and 45% dyspnea). Despite some encouraging signs of sensitivity to end-of-life problems, acute inpatient institutions in Italy still deal inadequately with the needs of dying persons. Similarly, in Italian hospitals, patients' choices for withholding or withdrawing treatments are not asked for nor recorded, even when patients are fully competent, and advanced directives are not acknowledged. This is also the case in the US, where hospice care is intended to help people die comfortably at home. However, inpatient care and inpatient hospice programs do exist and can provide palliative care for dying patients.
Palliative care is an approach that improves the quality of life for patients and their families facing life-threatening illnesses. It aims to prevent and relieve suffering by identifying, assessing, and treating pain and other problems, whether physical, psychosocial, or spiritual. Palliative care involves a range of services delivered by a variety of professionals, including physicians, nurses, support workers, paramedics, pharmacists, physiotherapists, and volunteers. It is required for a wide range of diseases, with the majority of adults needing palliative care for chronic diseases such as cardiovascular diseases, cancer, chronic respiratory diseases, AIDS, and diabetes. Other conditions that may require palliative care include kidney failure, chronic liver disease, multiple sclerosis, Parkinson's disease, rheumatoid arthritis, neurological disease, dementia, congenital anomalies, and drug-resistant tuberculosis.
However, training on palliative care for health professionals is often limited or non-existent, and population access to opioid pain relief is inadequate and fails to meet international conventions on access to essential medicines. For example, unnecessarily restrictive regulations for morphine and other essential controlled palliative medicines deny access to adequate palliative care. As a result, only about 14% of people worldwide who need palliative care currently receive it. Adequate national policies, programs, resources, and training on palliative care among health professionals are urgently needed to improve access.
Furthermore, dying inpatients may experience inadequate care due to the challenges of transitioning from curative to palliative care. For example, in a case study, a patient with cancer was offered options for life-prolonging but invasive treatment, which he declined. However, he was not referred to social work staff or given the opportunity to discuss palliative care options and concerns with his family. Unfortunately, this is not an isolated incident, as hospitals often regard death as a failure and strive to cure illnesses and prolong life. While curing diseases and prolonging life are important, hospitals should also aim to provide a good death for patients and their families, respecting their wishes and providing adequate palliative care when necessary.
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Procedures after death in a hospital
When a person dies in a hospital, there are several procedures that are typically followed. Here are the steps that occur after a death in a hospital setting:
Pronouncement and Identification:
The first step is for hospital staff to pronounce the death and verify the identity of the deceased. This involves physically examining the person, checking for vital signs, and recording the time of death. Hospital staff must follow specific protocols to ensure the pronouncement is accurate and properly documented.
Notification of Next of Kin:
If the deceased has passed away in a hospital, the staff will inform the named next of kin. It is common for family members to want to view the body, and this is usually allowed shortly after death before the body is moved. However, if the death occurred in a surgical room or if the person had a communicable disease, viewing the body may not be possible, or there may be a waiting period.
Preparation and Transportation:
Hospital staff will make preparations before moving the body. They will clean the body, remove any medical devices, and ensure the body is properly covered and clothed. The body is then transported to the hospital morgue, a temporary holding facility where bodies are kept at low temperatures to delay decomposition.
Death Certificate and Autopsy:
An official declaration of death is required to obtain a death certificate, which is necessary for various legal and financial matters. A doctor or authorised person in the hospital will fill out forms certifying the cause, time, and place of death. Funeral directors or hospital social workers will assist in completing the death certificate and making arrangements for the removal of the body from the hospital, which typically must be done within three days to three weeks. If an autopsy is requested, it is usually performed at a different facility and not in the hospital morgue.
Organ Donation and Bereavement Support:
If the deceased had registered for organ or tissue donation, a transplant coordinator will discuss the process with the next of kin, as organs need to be removed soon after death. Hospitals often have bereavement staff who can provide support and coordinate documentation. This includes helping with decisions regarding autopsy, organ donation, or body donation for medical science.
Funeral Arrangements and Notifications:
The family will work with a funeral home to make arrangements for the funeral or burial. It is important to notify relevant parties, such as employers, social groups, and the deceased's contacts, using various means such as social media or personal phone calls.
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Frequently asked questions
Hospitals do not "let people die". Their central mission is to cure diseases and prolong life. However, in the pursuit of this mission, patients may undergo more intense tests and procedures, which can be distressing and traumatic for the patient and their family.
The first step is pronouncing the death, which involves verifying the identity of the deceased, examining them for any vital signs, and recording the time of death. After this, the body is typically moved to the hospital morgue, where it is kept cold to delay decomposition. The family may be able to view the body at the morgue. If the cause of death is unclear, the body may be released to the medical examiner's office for further analysis.
Hospital staff will provide information on the next steps, such as registering the death and choosing an undertaker. The Bereavement Services team can offer additional support and answer any questions. Hospital chaplains can also provide spiritual and non-religious support to the family.
