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This past April, following a series of hospitalizations for chronic lung disease, and after consulting with her family and doctors, it was announced that Former First Lady, Barbara Bush decided not to seek additional medical treatment and focus on comfort care. She died peacefully and comfortably, surrounded by her loved ones, on her own terms.

Senator John McCain’s openness in sharing his journey with brain cancer and his final decision to end treatment highlights the importance and value of talking with family members about our final wishes before the end of  life.  He died, surrounded by family, peacefully and comfortably, on his own terms.

The words “no longer receiving medical treatment” are actually incorrect. What both of these memorable, public figures had announced is what the medical profession calls, a change in “Goals of Care.” What it means when a person changes their Goals of Care is that instead of continuing with treatments that can cure and prolong one’s life, they transition to Hospice and Palliative Care that helps alleviate suffering. It is not a discontinuation of medical treatment. It focuses on the actual problem of being terminally ill and of dying even if we wish the problems were different.

As a person ages, or disease progresses, Goals of Care and treatments may change. Hospice care can become the focus of treatment for comfort care. The goals for Hospice and Palliative Care is to improve quality of life for the patient and family.

Advance Care Planning is a lifelong process and should start with a conversation with family or a healthcare provider. It’s important that these wishes be documented with a Goals of Care note, or an Advanced Directive, Fives Wishes or POLST form. By knowing and following a patient’s Goals of Care, healthcare providers care for the patient in a way that is timely, medically appropriate, and meets the patient’s values and wishes. It is also an organized way for care teams to communicate as a patient move between locations of care. Goals of Care are created just for the patient and their situation. They can change if the patient’s situation changes or if the patient would like to change something that they had decided earlier.

Having influential figures like Barbara Bush and John McCain make public their decision to transition to Hospice and Palliative Care continues to drive discussion around the importance of Advance Care Planning. They died with the dignity they were owed. It was not because they discontinued medical care, but because they accepted a kind of medical care that was appropriate for their condition.

Hospice is not about dying, it’s about living, and the Stein Hospice team helps our patients live their lives to their fullest.

To find out more about Stein Hospice, please visit our website at or call 732-227-1212.

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