#palliative care

[dvoeverie-stitches]

Still stable numbers. We are heading back down to Little Rock after coming home to sleep last night.

They’ve moved her from ICU to a private room for family to more comfortably keep vigil.

[sanctuary-angel]

Whatever It Takes was such an emotional rollercoaster of a journey, that I felt help me cope somewhat with my life at that point. Seeing my father - whom I had poor relationship with prior - deteriorate daily for three years with the cancer that ultimately spread, echoed the emotions Harry was feeling as he watched Severus' health decline each day.

The anger of the prognosis. The grief of lost time. The sadness of wishing you didn't have the relationship you did before he got sick.

Now feeling like the least you could do was push the past away so you could be there for their present. And because of the limited time they had.

Harry watching Severus fade away from him, mirrored what was happening in my life at the time. But unlike Severus, my father never carried the guilt of how he treated me growing up. There was so many words I wished that were said, but instead, I pushed it away just to deal with the grief of losing a parent and support my family during those final days.

Harry and Severus had the time to mend things, and deal with that guilt and pain of the past. And knowing Severus may eventually lose his life, made Harry even more heartbroken of losing yet another pivotal adult figure. Amongst the pain of survivors guilt after the war.

Their story - I made sure it was a beautiful journey. With all of its aches and pains, but also, a well-needed reconciliation ❤️‍🩹✨️

[umbra-life]

According to mortality records from the Department of Health Statistics and Information (DEIS) and official figures released in 2024 and 2025, the country recorded around 1,984 deaths by suicide over the past year, compared with 1,207 victims of completed homicides, according to the National Report on Homicide Victims compiled by the Under-Secretariat for Crime Prevention and the National Public Prosecutor’s Office.

Chile’s silent crisis: more people die by suicide than from homicides, and mental health is already having an impact on the country’s economy. Revista Tierra Bella (21th may 2026)

The Pharmacy Fund for Chronic Non-Communicable Diseases (FOFAR), one of the main programmes supporting patients with high blood pressure, diabetes and high cholesterol treated within the public healthcare system, is listed in the Ministry of Treasury's proposal for discontinuation as part of a government-led review of public spending. The measure forms part of a document drawn up by the Budget Directorate (Dipres), which identifies hundreds of state programmes subject to evaluation for the 2027 Budget. Among these are various initiatives by the Ministry of Health, including FOFAR. What is FOFAR? FOFAR funds the procurement and free provision of medicines for people with chronic conditions who are treated within the primary healthcare system. Thanks to this fund, Family Health Centres (CESFAMs) are able to maintain a supply of treatments for patients with highly prevalent conditions such as high blood pressure, type 2 diabetes mellitus and dyslipidaemia. In many municipalities, these resources have also made it possible to supplement local authority programmes providing home delivery of medicines to older people and those with reduced mobility.

Kast’s government is considering discontinuing Fofar in the 2017 budget: the programme benefits thousands of patients with chronic illnesses. Revista Tierra Bella (2nd july 2026)

Hacienda propone desfinanciar programas de cuidados paliativos y prevención del suicidio ⋆

El Ministerio de Hacienda solicitó al Ministerio de Salud descontinuar al menos 24 programas sanitarios de cara al presupuesto 2027, como pa

[religion-is-a-mental-illness]

Caring for Each Other’s Sons

In this narrative medicine essay, a palliative care physician composes letters in her head to the mothers of aging veterans and to the physi

By: Jessi Humphreys, MD

Published: Apr 30, 2026

Sometimes, when I care for older veterans, I write a letter to their mother in my head. It goes something like this.

Dearest Mother of My Patient:

You are no longer with us, but I want you to know that I will take care of your little boy. He is 79 now, dying of a similar heart condition that captured you young. He remembers watching Bonanza with you late at night, your casually pointing out how the widowed father raised his children bravely on a ranch in Nevada. He was only 13 when you died but still sees now how you prepared him for your passing. He knows you helped his father ready himself too, and in the years that came, they became true confidants. Sometimes his father would pick him up from school and say, “Let’s go for a drive,” and they’d end up in Montreal 500 miles away. Even so, they’d sit at that Canadian café and he’d watch his father stare at the empty seat between them and know how much he missed you. Your son smiles when he tells me how in love you and his father were, the unlikely pairing of a university English teacher and a blacksmith, always holding hands and making eyes.

Your son remembers his childhood fondly. The county fair on hot days, seeing piglet races, and eating melting ice cream. During summers, he would sit with Uncle Bill at his farm on the porch, rocking in chairs as the sun set, listening to the corn growing. He can still hear the gentle crackling of the corn, in the stillness of the farm. After a full life of marketing and travel during his adulthood, nothing ever felt that quiet and peaceful to him again.

It is like this sometimes at the end, the volume turned up on childhood memories. As a palliative physician, my job is to hold stories with reverence, often from decades long past. Mostly, this is what people want to share—what it was like to catch fireflies at dusk and how their mother’s perfume smelled before she went out for the evening. Just moments, usually simple, not always easy ones. It is as though, in coming to the end of a long journey, patients are reaching around, stretching their arms to youth to hug the full circle of their lives. I have lost count of the number of graying men who remember their mother’s lullabies, closing their tearing eyes to hear the tunes as I sit beside them in silence.

Your son shares that he is not sure what comes next when he dies, but he feels that he will see you again. And this gives him peace.

His heart is tiring a little more every day. He has nowhere else to go, and no one left to speak for him if he loses the ability to speak for himself.

At the Veterans Health Administration, we have the exquisite gift of a hospice unit, a place to care for veterans when time is short. We care for the sons of mothers who can no longer be here to care for them. Here, he can joke with other veterans, cheat at bingo, snuggle the cocker spaniel who comes for pet therapy, and have ice cream with every meal if he wishes. The dedicated and skilled staff help him with art projects, prayer, or painstakingly set up 100 hours of westerns in a row on his TV. Sometimes, we even sneak him some Cheetos or Skittles.

When his heart weakens further, making every breath a struggle, we will try to take the fluid from his lungs to ease his air. And when that no longer works, we will relax his breathing with medication and stay with him as he travels back to you, his mother, wherever you may be. We will try to care for him in his final days as though he is our son. I just wanted you to know.

[dravenxivuk]

George has stairs up to his windowsill now to make things easier for him during palliative care. He's purring as he dozes off with a full belly having eaten more dinner in one go than he has been doing recently. He even used the scratching mat earlier for the first time in at least a week, so the steroids are definitely helping.

[mostlysignssomeportents]

America's largest hospital chain has an algorithmic death panel

It’s not that conservatives aren’t sometimes right — it’s that even when they’re right, they’re highly selective about it. Take the hoary chestnut that “incentives matter,” trotted out to deny humane benefits to poor people on the grounds that “free money” makes people “workshy.”

There’s a whole body of conservative economic orthodoxy, Public Choice Theory, that concerns itself with the motives of callow, easily corrupted regulators, legislators and civil servants, and how they might be tempted to distort markets.

But the same people who obsess over our fallible public institutions are convinced that private institutions will never yield to temptation, because the fear of competition keeps temptation at bay. It’s this belief that leads the right to embrace monopolies as “efficient”: “A company’s dominance is evidence of its quality. Customers flock to it, and competitors fail to lure them away, therefore monopolies are the public’s best friend.”

But this only makes sense if you don’t understand how monopolies can prevent competitors. Think of Uber, lighting $31b of its investors’ cash on fire, losing 41 cents on every dollar it brought in, in a bid to drive out competitors and make public transit seem like a bad investment.

Or think of Big Tech, locking up whole swathes of your life inside their silos, so that changing mobile OSes means abandoning your iMessage contacts; or changing social media platforms means abandoning your friends, or blocking Google surveillance means losing your email address, or breaking up with Amazon means losing all your ebooks and audiobooks:

https://www.eff.org/deeplinks/2021/08/facebooks-secret-war-switching-costs

Businesspeople understand the risks of competition, which is why they seek to extinguish it. The harder it is for your customers to leave — because of a lack of competitors or because of lock-in — the worse you can treat them without risking their departure. This is the core of enshittification: a company that is neither disciplined by competition nor regulation can abuse its customers and suppliers over long timescales without losing either:

https://pluralistic.net/2023/01/21/potemkin-ai/#hey-guys

It’s not that public institutions can’t betray they public interest. It’s just that public institutions can be made democratically accountable, rather than financially accountable. When a company betrays you, you can only punish it by “voting with your wallet.” In that system, the people with the fattest wallets get the most votes.

When public institutions fail you, you can vote with your ballot. Admittedly, that doesn’t always work, but one of the major predictors of whether it will work is how big and concentrated the private sector is. Regulatory capture isn’t automatic: it’s what you get when companies are bigger than governments.

If you want small governments, in other words, you need small companies. Even if you think the only role for the state is in enforcing contracts, the state needs to be more powerful than the companies issuing those contracts. The bigger the companies are, the bigger the government has to be:

https://doctorow.medium.com/regulatory-capture-59b2013e2526

Companies can suborn the government to help them abuse the public, but whether public institutions can resist them is more a matter of how powerful those companies are than how fallible a public servant is. Our plutocratic, monopolized, unequal society is the worst of both worlds. Because companies are so big, they abuse us with impunity — and they are able to suborn the state to help them do it:

https://www.cambridge.org/core/journals/perspectives-on-politics/article/testing-theories-of-american-politics-elites-interest-groups-and-average-citizens/62327F513959D0A304D4893B382B992B

This is the dimension that’s so often missing from the discussion of why Americans pay more for healthcare to get worse outcomes from health-care workers who labor under worse conditions than their cousins abroad. Yes, the government can abet this, as when it lets privatizers into the Medicare system to loot it and maim its patients:

https://prospect.org/health/2023-08-01-patient-zero-tom-scully/

But the answer to this isn’t more privatization. Remember Sarah Palin’s scare-stories about how government health care would have “death panels” where unaccountable officials decided whether your life was worth saving?

https://pubmed.ncbi.nlm.nih.gov/26195604/

The reason “death panels” resounded so thoroughly — and stuck around through the years — is that we all understand, at some deep level, that health care will always be rationed. When you show up at the Emergency Room, they have to triage you. Even if you’re in unbearable agony, you might have to wait, and wait, and wait, because other people (even people who arrive after you do) have it worse.

In America, health care is mostly rationed based on your ability to pay. Emergency room triage is one of the only truly meritocratic institutions in the American health system, where your treatment is based on urgency, not cash. Of course, you can buy your way out of that too, with concierge doctors. And the ER system itself has been infested with Private Equity parasites:

https://pluralistic.net/2022/11/17/the-doctor-will-fleece-you-now/#pe-in-full-effect

Wealth-based health-care rationing is bad enough, but when it’s combined with the public purse, a bad system becomes a nightmare. Take hospice care: private equity funds have rolled up huge numbers of hospices across the USA and turned them into rigged — and lethal — games:

https://pluralistic.net/2023/04/26/death-panels/#what-the-heck-is-going-on-with-CMS

Medicare will pay a hospice $203-$1,462 to care for a dying person, amounting to $22.4b/year in public funds transfered to the private sector. Incentives matter: the less a hospice does for their patients, the more profits they reap. And the private hospice system is administered with the lightest of touches: at the $203/day level, a private hospice has no mandatory duties to their patients.

You can set up a California hospice for the price of a $3,000 filing fee (which is mostly optional, since it’s never checked). You will have a facility inspection, but don’t worry, there’s no followup to make sure you remediate any failing elements. And no one at the Centers for Medicare & Medicaid Services tracks complaints.

So PE-owned hospices pressure largely healthy people to go into “hospice care” — from home. Then they do nothing for them, including continuing whatever medical care they were depending on. After the patient generates $32,000 in billings for the PE company, they hit the cap and are “live discharged” and must go through a bureaucratic nightmare to re-establish their Medicare eligibility, because once you go into hospice, Medicare assumes you are dying and halts your care.

PE-owned hospices bribe doctors to refer patients to them. Sometimes, these sham hospices deliberately induce overdoses in their patients in a bid to make it look like they’re actually in the business of caring for the dying. Incentives matter:

https://www.newyorker.com/magazine/2022/12/05/how-hospice-became-a-for-profit-hustle

Now, hospice care — and its relative, palliative care — is a crucial part of any humane medical system. In his essential book, Being Mortal, Atul Gawande describes how end-of-life care that centers a dying person’s priorities can make death a dignified and even satisfying process for the patient and their loved ones:

https://atulgawande.com/book/being-mortal/

But that dignity comes from a patient-centered approach, not a profit-centered one. Doctors are required to put their patients’ interests first, and while they sometimes fail at this (everyone is fallible), the professionalization of medicine, through which doctors were held to ethical standards ahead of monetary considerations, proved remarkable durable.

Partly that was because doctors generally worked for themselves — or for other doctors. In most states, it is illegal for medical practices to be owned by non-MDs, and historically, only a small fraction of doctors worked for hospitals, subject to administration by businesspeople rather than medical professionals.

But that was radically altered by the entry of private equity into the medical system, with the attending waves of consolidation that saw local hospitals merged into massive national chains, and private practices scooped up and turned into profit-maximizers, not health-maximizers:

https://prospect.org/health/2023-08-02-qa-corporate-medicine-destroys-doctors/

Today, doctors are being proletarianized, joining the ranks of nurses, physicians’ assistants and other health workers. In 2012, 60% of practices were doctor-owned and only 5.6% of docs worked for hospitals. Today, that’s up by 1,000%, with 52.1% of docs working for hospitals, mostly giant corporate chains:

https://prospect.org/health/2023-08-04-when-mds-go-union/

The paperclip-maximizing, grandparent-devouring transhuman colony organism that calls itself a Private Equity fund is endlessly inventive in finding ways to increase its profits by harming the rest of us. It’s not just hospices — it’s also palliative care.

Writing for NBC News, Gretchen Morgenson describes how HCA Healthcare — the nation’s largest hospital chain — outsourced its death panels to IBM Watson, whose algorithmic determinations override MDs’ judgment to send patients to palliative care, withdrawing their care and leaving them to die:

https://www.nbcnews.com/health/health-care/doctors-say-hca-hospitals-push-patients-hospice-care-rcna81599

Incentives matter. When HCA hospitals send patients to die somewhere else to die, it jukes their stats, reducing the average length of stay for patients, a key metric used by HCA that has the twin benefits of making the hospital seem like a place where people get well quickly, while freeing up beds for more profitable patients.

Goodhart’s Law holds that “When a measure becomes a target, it ceases to be a good measure.” Give an MBA within HCA a metric (“get patients out of bed quicker”) and they will find a way to hit that metric (“send patients off to die somewhere else, even if their doctors think they could recover”):

https://en.wikipedia.org/wiki/Goodhart%27s_law

Incentives matter! Any corporate measure immediately becomes a target. Tell Warners to decrease costs, and they will turn around and declare the writers’ strike to be a $100m “cost savings,” despite the fact that this “savings” comes from ceasing production on the shows that will bring in all of next year’s revenue:

https://deadline.com/2023/08/warner-bros-discovery-david-zaslav-gunnar-wiedenfels-strikes-1235453950/

Incentivize a company to eat its seed-corn and it will chow down.

Only one of HCA’s doctors was willing to go on record about its death panels: Ghasan Tabel of Riverside Community Hospital (motto: “Above all else, we are committed to the care and improvement of human life”). Tabel sued Riverside after the hospital retaliated against him when he refused to follow the algorithm’s orders to send his patients for palliative care.

Tabel is the only doc on record willing to discuss this, but 26 other doctors talked to Morgenson on background about the practice, asking for anonymity out of fear of retaliation from the nation’s largest hospital chain, a “Wall Street darling” with $5.6b in earnings in 2022.

HCA already has a reputation as a slaughterhouse that puts profits before patients, with “severe understaffing”:

https://www.nbcnews.com/health/health-news/workers-us-hospital-giant-hca-say-puts-profits-patient-care-rcna64122

and rotting, undermaintained facililties:

https://www.nbcnews.com/health/health-care/roaches-operating-room-hca-hospital-florida-rcna69563

But while cutting staff and leaving hospitals to crumble are inarguable malpractice, the palliative care scam is harder to pin down. By using “AI” to decide when patients are beyond help, HCA can employ empiricism-washing, declaring the matter to be the factual — and unquestionable — conclusion of a mathematical process, not mere profit-seeking:

https://pluralistic.net/2023/07/26/dictators-dilemma/ggarbage-in-garbage-out-garbage-back-in

But this empirical facewash evaporates when confronted with whistleblower accounts of hospital administrators who have no medical credentials berating doctors for a “missed hospice opportunity” when a physician opts to keep a patient under their care despite the algorithm’s determination.

This is the true “AI Safety” risk. It’s not that a chatbot will become sentient and take over the world — it’s that the original artificial lifeform, the limited liability company, will use “AI” to accelerate its murderous shell-game until we can’t spot the trick:

https://pluralistic.net/2023/06/10/in-the-dumps-2/

The risk is real. A 2020 study in the Journal of Healthcare Management concluded that the cash incentives for shipping patients to palliatve care “may induce deceiving changes in mortality reporting in several high-volume hospital diagnoses”:

https://journals.lww.com/jhmonline/Fulltext/2020/04000/The_Association_of_Increasing_Hospice_Use_With.7.aspx

Incentives matter. In a private market, it’s always more profitable to deny care than to provide it, and any metric we bolt onto that system to prevent cheating will immediately become a target. For-profit healthcare is an oxymoron, a prelude to death panels that will kill you for a nickel.

Morgenson is an incisive commentator on for-profit looting. Her recent book These Are the Plunderers: How Private Equity Runs — and Wrecks — America (co-written with Joshua Rosner) is a must-read:

https://pluralistic.net/2023/06/02/plunderers/#farben

I’m kickstarting the audiobook for “The Internet Con: How To Seize the Means of Computation,” a Big Tech disassembly manual to disenshittify the web and bring back the old, good internet. It’s a DRM-free book, which means Audible won’t carry it, so this crowdfunder is essential. Back now to get the audio, Verso hardcover and ebook:

http://seizethemeansofcomputation.org

If you'd like an essay-formatted version of this thread to read or share, here's a link to it on pluralistic.net, my surveillance-free, ad-free, tracker-free blog:

https://pluralistic.net/2023/08/05/any-metric-becomes-a-target/#hca

[Image ID: An industrial meat-grinder. A sick man, propped up with pillows, is being carried up its conveyor towards its hopper. Ground meat comes out of the other end. It bears the logo of HCA healthcare. A pool of blood spreads out below it.]

Image: Seydelmann (modified) https://commons.wikimedia.org/wiki/File:GW300_1.jpg

CC BY 3.0 https://creativecommons.org/licenses/by-sa/3.0/deed.en

[somuchtostudysolittletime]

13/7/23 // 12.23

Study day for me today aka endless hot drinks and snacks

[beccawise7]

This story will make you believe in the good & beauty of this world... 💜🖤

In the quiet end of life care unit of a hospital in Calias, France, a former show horse named Peyo brings peace to those leaving this world & comforts those they leave behind.

They call him Doctor Peyo & science can not explain what he is able to do for the people he meets.

He softly walks the halls, unguided & stops at rooms he feels he is needed. He raises his hoof & it signals his companion that someone is in pain, someone needs love, someone is ready.

Inside, he stands beside beds where breaths are shallow & time is short. Patients instinctively reach for him.

Nurses say the room changes. Energy softens & grief exhales. Payo stays as long as needed to bring grace where medicine can not.

Since 2016, this 15 year old stallion has walked among the dying, with reverence. Always finding the ones closest to letting go.

Some say their pain is lifted when he enters. Others whisper he brings peace. Fewer tears, sometimes even laughter.

His story is not about magic, but the unseen threads that connect us. It's knowing that love does not always need a language. That sometimes the most important thing you can do is simply be there.

Peyo reminds us that healing is not always a cure but a soft reminder that you are not alone.

What a beautiful reminder of the power of presence & selfless love. (afshineemrani)

Be kind to one another. The world needs more of this love.

~beccawise7💜🖤