Hospices began in England as small, non- profit, community- based organisations, meant to provide compassionate palliative care to the terminally ill.  When I ran my company my fellow director’s wife, a dedicated nurse, worked (and died of cancer)  in the very first hospice.

Because hospice care is funded in America, quite generously, by Medicare, this civilised approach to imminent death has been traduced by commercial, profit- making companies, some of them large corporations, which may put profit ahead of compassion, the so-called “industrialised” model of hospices.

Evidence continues to accumulate that modern industrialized hospices, especially those owned and run by large for-profit corporations and private equity firms may enroll patients who are not terminally ill to increase revenue , and often expose patients to the morepowerful pain- killers that are routinely used in hospitals.  The regulatory response to such behavior continues to be spotty, and seems focused on enrollment of non-terminal patients as a form of fraud, not as a danger to patients.   So far in 2015 two commercial hospice chains settled charges that they enrolled patients who were not terminally ill, thus defrauding the taxpayer. Patients are given inappropriate psychoactive drugs and narcotics, and forego the medical care that could help cure their illnesses.  Hospices and profit do not mix.

Allowing vulnerable people, close to death, to be exploited and treated as if they were profit centers suggests a society with serious ethical problems. Liberty ( to start an enterprise and make money) should not equate to license.  In an Epicurean world such behaviour would be banned.  But then health care, along with end of life care, would not be run for private profit.