Reply #123: not really. [View All]

There are prescribing laws that oncologists and urologists have to obey, and they include monthly limits on narcotics. Hospice, hospitals and freestanding nursing facilities are exempt from those laws. Home use without hospice is not exempt. With his doctors' hands tied, D was offered hospitalization first. He didn't want to be in a hospital for various reasons, and he didn't want to be in a hospital more than he didn't want to die.

When D first got sick, he knew he couldn't make rational decisions about his health care - far too emotionally distressed about it - so he signed his MPOA over to my mother, who is capable of keeping a cool head in the middle of chaos. (D could never do that, and to his credit, he recognized it as maladaptive.) Mom was able to look at the amount of pain D was in, look at the options for recovery (none) and make the decision with him that he was likely to live longer and better if he had effective pain management. His other options were to go into a nursing facility or to the VA hospital, neither of which he wanted at all, most of all because it would mean he wouldn't see my mother as often (the available centers being on the other side of the Valley from where my mother lived and worked, and she was supporting them at the time).

Choosing hospice is a difficult decision at the best of times, but a terminal dx with no hope of recovery, a very painful, metastasizing cancer that moved incredibly fast, and psychological issues (he had a complex file, don't doubt it) beyond his thanatophobia and separation anxieties meant that he accepted hospice when my mother told him it was for the best.

I can't give you the whole rationale in 5 paragraphs on a message board because it took D, my mother, his medical team, and the rest of his support system a good six months to come to the decision that hospice was right. It wasn't a snap decision, and it wasn't made unethically or on the spur of the moment. But legal realities did figure into the process.