Are Euthanasia Advocates Taking Over America’s Hospice Industry?

Bioethics   |   Steven Ertelt   |   Dec 19, 2003   |   9:00AM   |   WASHINGTON, DC

Are Euthanasia Advocates Taking Over America’s Hospice Industry?

by Kathy Dial Staff Writer
December 19, 2003

Washington, DC ( — Imagine for a moment that a close relative—your father, a sister, a grandparent—is suffering from a terminal illness. It’s past the point where your loved one can care for himself—and beyond your capabilities to help him. Time is running out, but you want to make his last days as comfortable as possible before death comes to claim him.

If you’re like 10 percent of Americans, you find a hospice to take him in. Since hospice care is covered by Medicare, you know the financial burdens of his final weeks will be eased—and you can rest comfortably in knowing that the hospice staff will do all it can to ease your loved one’s pain while allowing nature to take its course.

It’s a peaceful thing to think about. Or is it?

Ron Panzer, president of the pro-life Hospice Patients Alliance (HPA), says there’s a hidden threat inside the hospice industry that’s been growing like a cancer for decades—and most people don’t realize it until it’s too late:

Hospice workers all over the country are routinely killing patients.

"Families who report in to HPA tell us they’ve overheard nurses say things like, ‘I’m just like Jack Kevorkian, only I do it with morphine,’ " Panzer, whose organization receives thousands of calls like that a year, told "And they get away with it week after week after week, because ‘it’s hospice!’ "

Panzer has heard it all through the years: Family members describing their relative as terminally ill, but functional and not in unmanageable pain—until a visit from a hospice nurse left the patient dead within an hour. Family members who have been told by hospice workers how to administer pain medication—only to realize afterward that it was a lethal dose. And honest hospice workers who have been threatened or fired after finding out about cases of euthanasia and Medicare fraud. It’s all taking place, he says, in a competitive industry that’s favored by the federal government and making millions with little accountability.

"No government agency listens to these families," he said. "Absolutely no agency responds appropriately. From the local and state to the federal levels, these families are ignored—tens of thousands of them every year. Local district attorneys will refuse to prosecute reports of hospice killings because they’re so-called ‘expected deaths.’"

As the seed is planted …

Not every hospice in America is out kill patients before their time in order to make a buck, Panzer said. The industry, which began in England in the late 1960s before the first American hospice was founded in 1974, has done much to deserve its golden reputation as the best end-of-life care option available.

In the beginning, Panzer said, "they were mostly nonprofit hospices, and before that, they were volunteer hospices set up by doctors, social workers and nurses. They might take donations, but they weren’t getting paid in the early 1960s. "It wasn’t a business—it was a labor of love."

But by the time Florence Wald, MSN, established Connecticut Hospice in 1974, a dark seed was already taking root in the fledgling industry.

"I’ll tell you the way I see it, and I know that I differ from [British hospice founder Dame] Cicely Saunders, who is very much against assisted suicide," Wald told the Journal of the American Medical Association (JAMA) in 1999. "I disagree with her view on the basis that there are cases in which either the pain or the debilitation the patient is experiencing is more than can be borne, whether it be economically, physically, emotionally or socially. For this reason, I feel a range of options should be available to the patient, and this should include assisted suicide."

That mindset attracted the attention of euthanasia advocates. Since 1938, the right-to-die movement has existed in the United States—first calling itself the Euthanasia Society of America, most recently changing its name to Choice in Dying.

"They did it as a public-relations move to make their agenda more palatable to the gullible public," Panzer said, "representing a hastened death as a ‘choice,’ just as abortion has been represented as a ‘choice’ and a ‘right.’ "

Choice in Dying has led the charge to promote advance directives and living wills—viewing them, Panzer said, as a stepping stone to assisted suicide and then euthanasia in a country that needed time to get acclimated to that kind of thinking. And the United States needed a lot of time: The concept of euthanasia has its roots in the eugenics movement that spawned the Nazi death camps of Hitler’s Germany. That wasn’t palatable to Americans who fought in World War II.

… so grows the tree.

But Panzer believes that the idea, which lay nearly dormant for half a century, found the crack it needed to break through to the surface in the 1980s.

"Medicare was looking at how to cut costs when providing very complex and intensive care to patients who were terminal. Statistics show the greatest expenditures for a patient are in the last months of life," he explained. "The hospice benefit was started in the early 1980s and was found to successfully reduce the costs of Medicare. So it was officially approved by Congress as a Medicare benefit."

Dr. Linda Peeno spent years in the managed-care industry, witnessing firsthand the kind of mindset it introduced to patient care. She left the field to become a patient advocate 10 years ago, unable to deal with the cost-containment attitude that shortchanged patients out of good—sometimes life-saving—care.

"This troubled me even when I was directing a nonprofit HMO," she told "We entered an agreement with a hospice, and immediately I saw our nurses trying to shift patients to hospice as quickly as possible. Once you get a family member to acknowledge that the condition is terminal and hospice is a resource, there was this belief they’d stop seeking other resources [and treatments]. So our costs were limited dramatically."

In the meantime, the euthanasia movement was finding inroads into the hospice industry: In the late 1990s, Choice in Dying was absorbed by a new organization called Partnership for Caring—founded by Dr. Ira Byock, a hospice physician.

Why did they merge?" Panzer asked. "Any organization that was pro-life would never in any way be associated with Choice in Dying, which is a front for the euthanasia movement."

When the cost-containment practices of managed care spilled over into all forms of health care—turning physicians more into gatekeepers than caregivers, Panzer said—the euthanasia movement saw a ripe opportunity: Right-to-die advocates began to infiltrate the top levels of the policy-making organizations in the hospice industry.

In other words," Panzer said, "hospice as we knew it is not hospice as it is today."

Medical literature has documented those inroads: JAMA reported in 1999 that physician-assisted suicide and the hastening of death is not "unheard of" or "rare" in medicine. A survey of 355 oncologists revealed that 15.8 percent reported having participated in euthanasia or assisted suicide—and of those, six patients did not "participate in the decision for euthanasia or assisted suicide." That means they were killed because the doctors wanted them dead, not because they chose it.

The industry’s top policy-making bodies are the National Hospice and Palliative Care Organization, Last Acts Partnership, and the Hospice Foundation of America. Though none of those organizations maintains publicly accessible position papers on assisted suicide on their respective Web sites, Partnership for Caring does: It says it "takes no position."

"The Partnership for Caring Board of Directors has taken legalization of physician-assisted suicide off the table as an issue for policy development and political action," says the document, titled "Leaving Our Differences at the Door," found on a page last updated in April 2002. "Partnership for Caring will not join the debate about physician-assisted suicide, and will take no position for or against its legalization because to do so would divert energy from Partnership for Caring’s mission to eliminate the suffering of dying Americans."

That’s just the sort of nebulous language Panzer has come to expect from the industry.

"They are not up-front about the euthanasia agenda, but you will not find one word mentioning the sanctity of life or the pro-life movement [on their sites]," he told "On their Web sites, they post articles from doctors who are right-to-die people."

For example, Panzer points to Byock co-writing an article with Dr. Timothy Quill—who promotes terminal sedation for patients, even if they are not suffering from the uncontrollable agitation that’s often found in the final stages of life.

"If you expand the utilization of terminal sedation to other patients, it becomes the preferred method of euthanasia and is currently being implemented in hospices across the U.S. in that way—even though it’s illegal," he said.

The road to abuse

That’s a system that’s ripe for abuse by family members with ulterior motives. It’s what many believe has happened in the case of Terri Schiavo—the disabled Florida woman whose husband has kept her in a hospice for years while seeking the court’s permission to remove the feeding tube on which she depends so she can starve to death. Michael Schiavo lives with and has fathered two children with another woman and stands to inherit Terri’s estate if she dies—the reason her parents believe he’s never divorced her.

"The Terri Schiavo case cannot be understood without … the background of hospice and the right-to-die movement," Panzer said. "She was placed [in hospice care] as a test case for the right-to-die movement to establish a legal precedent to end the lives of the disabled using hearsay evidence [about her end-of-life wishes], which is very common in hospice settings and in cases where one family member wishes to end the life of the patient.

"The Schiavo case represents the railroading of the disabled into death, using hospice as the vehicle to implement their dark agenda. Hospice is the preferred killing field, because no prosecutor will go after a hospice killing. It’s a sacred cow."

Because of the savings hospice care can net the federal government through Medicare, Panzer believes the government doesn’t want to hear any bad news about the industry—even news of murder. It would tarnish the image, turn people away who would otherwise use the industry for their relatives—maybe even make some stock prices tumble. It’s also easy to falsify patient records—to make it look as though every effort was made to manage their pain for as long as they needed to die naturally, as the government requires hospices to do under the per-diem payment basis (for every day a patient is enrolled, not for each service rendered)—even if those efforts weren’t made.

"I can see how that would be the line of thinking," Peeno said. "It’s much like what happens in psychiatry sometimes with patients who are negligently treated—[the legal system] says they were mentally ill to begin with. So you shut down any attempt to understand how the system hastened the process.

"We’re all going to die—but there’s a legitimacy to the process. It shouldn’t be accelerated for an economic goal."

That’s a story that’s caught journalists’ attention before, but has never really made it past them to the public. Panzer and some of the families that have lost members to abusive hospice systems have all been interviewed over the last few years by some of the top news magazines in the nation—include PrimeTime Live and 20/20. But after the producers and reporters have done all the legwork, they return to New York—where, so far, their editors have always killed the story.

So the industry remains unchecked—even by the mainstream media.

"If all the dead bodies from this hospice homicides were piled in one place, it would resemble a Nazi death camp—because the Holocaust is already here in America," Panzer said. "You don’t see it because they’ve figured out if they kill one at a time, they can get away with it."

"And they are."

Related web sites:
Hospice Patients Alliance –