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J Pain Symptom Manage. 2011 Oct;42(4):643-8. doi: 10.1016/j.jpainsymman.2011.07.001. Epub 2011 Sep 1.

No place like the hospital.

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  • 1Harvard Pilgrim Health Care Institute, Boston, Massachusetts 02215, USA.


The gold standard for end-of-life care is home hospice. A case is presented in which a patient dying of irreversible small bowel obstruction from metastatic cancer insisted on remaining in the acute care hospital for care when alternative sites of care, including a skilled nursing facility and residential hospice, were available to her and covered by her health insurance plan. The ethical issues raised by this case are discussed from the perspective of the patient, the clinical team, the hospital, and the insurance company. Over the past decade, hospital-based palliative care consultation and general inpatient hospice care have sought to improve the quality of dying in the hospital. To the extent that such efforts have been successful, they may result in increasing demand for the hospital as the site for terminal care in the future.

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