The Crisis of US Hospice Care: Family and Freedom at the End of Life explores the complicated history of hospice care in the US and how it has come to be. Wrought with political strife and decades of inadequate government support for end of life care, the book brings to light the human aspects as well as the policy shortcomings. Braswell’s book is extremely accessible for audiences of any level while raising important questions.
The first chapter of the book opens with the discussion about the right to die. The question about freedom of choice versus who is eligible for Physician Assisted Suicide (PAS) is not as simple as it seems. Currently, only those that have end stage diseases or extenuating circumstances can opt for PAS in a limited number of states. The second chapter delves into the family situation. Many families are not equipped to provide long-term, end of life care simply due to financial hardship and having their families and their own lives to live. The existence of inadequate home care and patchwork healthcare networks of assisted living homes are a result of patients and families being unable to make ends meet. The third chapter recounts some of the political and ideological disagreements that have plagued the progress to improve support for those at the end of life, as well as systemic racism that is found in end of life care facilities. The fourth chapter provides examples of situations where the patient has lost the ability to choose what they actually want out of their last days due to lack of adequate familial support and lack of a safety net in nursing home systems. These can lead to abandonment or suffering caused by fragmented healthcare institutions lacking continuity. The fifth chapter describes the current schools of thought when it comes to PAS; pro-life versus pro-choice. By framing the argument for or against PAS as such, the political leanings of people in each party will continue to shape how the patient choice landscape will look. The final chapter talks about when the end of life stage begins and how it is perceived differently by medical professionals, the patients, their families, and the political system.
Braswell does an excellent job of weaving personal anecdotes and story-telling elements with a topic that can be muddled by politically or medically driven arguments. The book integrates personal anecdotes, the experiences of families from different backgrounds, and politically relevant history. The fight to end the crisis that is the inadequate US hospice care is one that will continue to be influenced by the evolving definition of patient rights, family support, and government-based support. It would be a valuable reading for medical professionals, public health professionals, and anyone else interested in healthcare that is provided at a vulnerable time of peoples’ lives.