Quiz: hospice philosophy and patient self-determination

How well do you understand hospice philosophy? How ready are you respect patient and family wishes?

Take the following quiz, based on real-life situations, to find out. And share your thoughts in the comments section below.

What's the best approach when a patient says she doesn’t want a DNR?

Correct! Wrong!

Patients have the right to choose whether or not to get a DNR, even if they choose hospice care. Hospice team members are responsible to respect and support their decisions, and not try to change their minds.

A patient’s family member declines the support of the chaplain/spiritual care coordinator. What is the best response?

Correct! Wrong!

Everyone has the right to decisions about their own spirituality, and this includes the decision whether or not to engage in what they perceive as spiritual practices. Good hospice spiritual care coordinators are capable of being supportive of people who do not identify as spiritual, but this is not a reason to impose a spiritual care coordinator onto a patient or family. If we respect the needs of spiritual clients while imposing our preferences onto non-spiritual clients, this amounts to religious discrimination.

Whose responsibility is it to make sure each patient has a funeral home selected before dying?

Correct! Wrong!

The hospice team--and most often this is the social worker--can support end-of-life planning by inquiring about funeral home arrangements and offering to support patients or family members in choosing a funeral home that will meet their needs. And it is up to the patient and family what they do with that support. If a family member says they haven't gotten around to planning, but will eventually, the team can check in with them about how it's going down the road. But if a family member still doesn't engage in planning, it could mean they are not emotionally ready to, and pressuring them to do it would not be supportive. Planning ahead can reduce the stress the family feels when the patient passes away, and we can educate about that. But whatever decision they make--even if it's a decision to make no decision--we are responsible to support them.

You are concerned about the safety of a fully oriented, bed-bound patient who lives alone. You educate her about the risks to her safety and the options available, to include hired caregivers, state-funded caregivers, residing with family and placement in a facility. She rejects all of these options and says she doesn’t want to talk about it. What is the best approach?

Correct! Wrong!

Fully oriented patients have an ethical right to choose to live at home, alone, even when it's not safe to do so. We are correct to be concerned about their safety, but the adult protective service agencies of many states will not force mentally competent patients to live in nursing homes or accept help.

A fully oriented patient states he doesn’t want hospice team members to communicate with his family members, including his wife who is his MPOA. Instead, he wants hospice to communicate with him and his friend Brian. What do you do?

Correct! Wrong!

An alert and oriented patient, who has not been deemed incompetent, has the right to decide who will speak for him or her. A person appointed as power of attorney gains decision making responsibility when the patient is no longer fully oriented or able to express wishes. Therefore it may be a good idea for this patient to see if he wants Brian to be appointed as power of attorney, because otherwise when he's not able to communicate, the hospice team will likely follow the power of attorney paperwork that's already in place.

Quiz: Hospice philosophy and patient self-determination

Do you agree with these answers? Any disagreement? Share your thoughts in the comments section below.

Turn the page to

Funeral homes: Where hospice workers forget patient self-determination

Go back to

An open letter to those who work with the Texas OOHDNR

8 comments

  1. Disagree with funeral planning question. The absolute worst time to plan a funeral is at the time of death. It may also be that the patient has some thoughts or wishes in regard to their arrangements to be communicated. What if a patient or family wants to donate the deceased for medical research or science? This requires pre registration. Most families are unaware of the cost of funerals and pre planning may help them tap into resources to help.

    1. I appreciate your feedback and I welcome good discussion over differences of prospective like this.

      Can you please tell me more about how you disagree? I agree with you that after the patient dies is the worst time to make the arrangements. And I agree with you that the team, especially social workers, should offer to support the family in this planning.

      But despite the hospice team’s best efforts, sometimes family members don’t engage the topic ahead of time. In that situation, it is entirely out of the hospice team’s power to make sure a funeral home is chosen.

      We can assess and educate and advocate, but we can’t force a decision. And we should not apply pressure in order to. A lot of times the hesitation has to do with their own grieving process. Grief cannot be rushed. It needs to be allowed and supported.

      What answer did you believe was the correct one to the quiz question about funeral homes? Can you explain why?

  2. I was hesitant about the safety of a fully oriented, bed-bound patient who lives alone Question. Wouldn’t it be considered self-neglect ?

    1. You’re absolutely right! I’m learning some specifics about how laws and attitudes can differ from state to state.

      Specifically, self-neglect is something that we would need to report in a state like California, but not Texas.

      Thank you for pointing this out.

    2. You’re right. It depends on the state. Self-neglect isn’t a thing in Texas in this context. I recently learned that it is in California.

  3. I Agree with most of the answers although as a hospice social worker it is my responsibility to have a funeral home listed in their chart. If there is not one and the patient dies believe me I’m going to hear about it.

    1. You said a lot just now. Let’s start with the fact that you’re going to hear about it.

      Who are you going to hear about it from? I’m going to wager that you are not going to hear about it from a social worker. I could be wrong. some hospices do have social workers in leadership positions. But most leadership positions in most hospices are filled by nurses.

      Regardless, the fact that your supervisor would be unhappy with you because a patient dies without a funeral home does not mean that you are at fault if that happens.

      I used to pride myself on how effective I was at getting families to choose funeral homes. I thought I was being persuasive for a good cause and I felt like a hero.

      But our job is not to persuade, especially when it’s a matter that they have a right to choose.

      They have the right to choose whether or not they make those plans ahead of time. if they do not want to make those plans ahead of time, or if they are internally not ready, it is not your job to change them. It is your job to support them.

      It is not our job to encourage patients or their family members to change their decisions. It is our job to advocate on behalf of their decisions as much as we can.

      specifically when it comes to funeral homes, our job is to assess their planning, educate that we can help with choosing a funeral home, and then however they respond, we support them.

      if you have inquired about a funeral home, and educated that you are able and willing to support, and then they ask for more time, then give them more time. A month later, you can check in with them.

      But why keep at it? By then, they don’t need any more education about your willingness to support with funeral Home arrangements.

      if you have inquired about a funeral home, and educated that you can help, and then follow it up once, and then left the ball is in their court, then you have done your job. And then if the patient dies and a funeral home is not chosen, that is because you respected them as adults to follow their own process instead of harassing them, as your supervisor probably wants you to do.

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