Harbor Hospice, a hospice organization primarily based in Texas, aims to provide comfort and dignity to terminally ill patients in accordance with their values and needs. Harbor Hospice’s Central Houston location provides inpatient and outpatient hospice services to patients at the end-of-life in Houston and surrounding areas.
end of life care, spiritual plurality, patient autonomy
As the aging population rises and costs for specialized medical procedures increase in the United States, the need for hospice care is growing. A branch of palliative medicine, hospice provides symptom relief and begins when the patient no longer pursues treatment. In such a setting where medical cure is no longer the primary objective, the care team focuses on providing comfort to terminally ill patients and addressing their spiritual and emotional needs at the end of life.
At Harbor Hospice in Central Houston, providers strive to make the transitional period at the end-of-life as comfortable as possible for patients. Dr. Rebecca Lee, a hospice and palliative care physician at Harbor Hospice in Houston, emphasizes that “everything [the care team and I] do is to provide comfort and maintain quality of life.” Patient autonomy is honored in each decision as she seeks to understand what it means for each patient to live their fullest possible lives. For example, patients at Harbor are able to eat whatever they desire and are allowed to refuse pain medications as they wish. Special requests, such as desires to take cross-country trips, are fulfilled.
Dr. Lee also emphasizes the challenging ethical dilemmas that arise from the ambiguity over the meaning of a “good death.” One common source of issues is the “Do Not Resuscitate”(DNR) Form, a medical order that permits providers to not perform CPR if a patient’s breathing stops. Although CPR can resuscitate a patient, the procedure can be extremely taxing, especially on very sick individuals, and does not guarantee a state of consciousness. While the patient holds the final autonomy in signing the form, Dr. Lee notes that “my job is to provide informed consent” and lay out what each option looks like. Other issues arise when family members disagree over medical decisions, particularly when a patient is no longer lucid. To mitigate these problems, Dr. Lee strongly suggests that families hold important conversations about end-of-life care before a patient is unable to communicate, especially concerning medical power of attorney and DNR orders. In Being Mortal: Medicine and What Happens in the End, surgeon Atul Gawande echoes this sentiment, writing about the importance of having such conversations with family members about the end-of-life if a loved one is facing a terminal illness (Gawande 2014). While they are tough, these discussions are necessary in helping caregivers and providers understand how the patient views a meaningful life.
At Harbor, patients often grapple with existential questions and turn toward spirituality as a way to make meaning at the end-of-life. To provide an avenue for patients to discuss these thoughts, Harbor provides a chaplain on-staff who offers spiritual guidance to patients. If a patient is of a different religious denomination, the chaplain arranges for other religious leaders to come in, such as priests, monks, imans, and rabbis. Certain rituals, such as last rites by priests and bell performances by Buddhist monks, can be performed at the hospice center according to the patient’s request. These services are geared toward the beliefs of each patient and emphasize the hospice philosophy that patients should be cared for in all aspects, including their spirituality.
Facing abstract experiences and spiritual questions at the end of life, patients also turn to artistic forms of expression. In Life at the End of Life: Finding Words Beyond Words, Marcia Brennan, who is an artist and professor of art history and religion at Rice University, presents poems, short stories, and visual arts pieces created by patients and their loved ones at the end of life. Through these pieces, patients express uncertainties and suffering, find hope, and make meaning of this transitional period. Some patients at Harbor indeed turn toward these art forms, writing poetry and creating art through which they can hold onto their dignity and find a language to articulate metaphysical and existential questions.
Harbor Hospice’s philosophy embodies the belief that health is not just the absence of a disease, but the maintenance of mental and social well-being. By honoring patient wishes, Harbor advocates for the idea that health should encompass one’s values, fears, goals, and needs or what makes life significant for each individual.
Brennan, Marcia. Life at the End of Life. Chicago: The University of Chicago Press, 2017.
Gawande, Atul. Being Mortal: Medicine and What Matters in the End. New York: Metropolitan Books, Henry Holt and Company, 2014.
Lee, Rebecca. Interview by Anney Tuo. March 18, 2022.