Choosing Hospice Care, as Jimmy Carter Did

To the Editor:

The Aug. 29 guest essay by Daniela J. Lamas, “A Fitting Final Gift From Jimmy Carter,” is a heartfelt tribute to Mr. Carter.

While Dr. Lamas acknowledges hospice’s unpopularity (noting that “the very word ‘hospice’ so often conjures the idea of death and defeat”), she nevertheless makes a persuasive case for it.

Hospice is not about giving up hope — it is about making the most of the time we have left. The key to a successful hospice stay is early enrollment, and the fact that Mr. Carter has already benefited from multiple months of care is a testament to this approach.

Perhaps Mr. Carter’s real gift is helping us all to overcome our reservations and misguided stereotypes about hospice care. His example should make policymakers rethink current regulations so that all Americans might one day receive — and understand — the full benefits of hospice care.

Michael D. Connelly
Johns Island, S.C.
The writer served as the chief executive of Mercy Health (now Bon Secours Mercy Health) and is the author of “The Journey’s End: An Investigation of Death and Dying in Modern America.”

To the Editor:

The idealized fantasy of at-home hospice care is just that: a fantasy.

Families who turn down at-home hospice care are right to do so. At-home hospice care is extremely lucrative for the hospice agencies precisely because they provide so little care while the families do all of the work. We were told not to call 911, and most of us do not have medical or nursing training and are on our own, in way over our heads, caring for a dying loved one who may well be in distress and is often frightened.

My husband’s death was traumatic for the whole family. Based on my experience, I urge families faced with the heart-wrenching decisions around end-of-life care to consider the family’s needs and the patient’s needs — not the false advertising of the hospice agencies or the naïve recommendations of doctors who don’t live with the consequences.

Deena Engel
Greenwich, Conn.

To the Editor:

As a retired hospice nurse, I can totally relate to what the Carters are going through. It is hard for people to accept that the death of a loved one will be coming soon and that fighting against it in a hospital is an unnatural way to die, involving unnecessary and meaningless care at a high cost.

Being at home (or sometimes in a hospice facility) surrounded by family and friends with comfort care is much better. Being awakened to be poked and prodded 24 hours a day in a fruitless and expensive effort to keep a dying person alive is just not a good way to go. Hospice can provide all the care that a dying person needs, with much less hustle and bustle.

Part of the concern about hospice care is that it uses medications that are not always used in other practices. Morphine is still the best pain control available, and hospice uses it — carefully, with strict controls. Occasionally, hospice also uses ketamine, which has a very bad rap because of abuse of the drug, but is a potent pain control drug if used properly.

Hospice care is well established in other parts of the world, but in the U.S. we have a hard time accepting death as being inevitable.

It warms my heart that the Carters chose hospice care. It shows yet again what forward-thinking and thoughtful people they are, setting an example for others even in death. Godspeed, Jimmy!

Michael Orlin
Denver

Changing Our Election System

To the Editor:

Re “To Improve Democracy, Get Rid of Elections,” by Adam Grant (Opinion, Aug. 23), about using lotteries to select our leaders:

At first glance, Mr. Grant’s essay seems way too radical to even consider, but everyone should read and reflect on it.

I, for one, am tired of constantly having to vote for the “lesser of two evils” to serve in a Congress filled with representatives who lack the basic qualifications and ethical compass to do their jobs.

I am tired of the corruption in our current election system from gerrymandering, the anemic controls on campaign contributions and spending, and the infusion of shameless lying into what we call “spin” or “campaign rhetoric.”

Add to that the ever-present possibility of hacks into our election systems, legislation to disenfranchise voters, and baseless allegations of voter fraud that undermine public confidence in our elections.

We may not be ready to adopt Mr. Grant’s proposal, but it is an important subject for debate that should not be ignored.

Bruce Wilder
New Orleans

To the Editor:

Adam Grant is right: Winning elections swells the egos of leaders, who imagine that they’re superior to everyone else. But so does the admission system at elite universities like the one where he and I work. The tiny fraction of applicants who get in are led to think they’re better than the vast hordes who got rejected.

That’s why we should admit students using a weighted lottery, like the one Mr. Grant proposes for selecting political leaders. Students would need to demonstrate certain competencies to be considered. But their admission would also rest on luck, so they could no longer pretend that they earned their way here simply by merit.

The education of our leadership class starts early. And we’re teaching all the wrong lessons.

Jonathan Zimmerman
Philadelphia
The writer teaches education and history at the University of Pennsylvania.

Reflections on the G.O.P. Debate

To the Editor:

“From Party Stronghold, Debate Watchers Cheered Signals From a Post-Trump Era” (news article, Aug. 25) was perceptive. However, I’d like to add two important points.

First, the Republican Party is finally making headway: Its candidates for president are starting to reflect the colors of America — white, Black and Asian, with one being a woman.

The second is regressive. We saw very little civility between the candidates and from the candidates to the moderators. These people are running for president of the United States, our nation’s “face” to the world. Do we want that person to be crass, rude and disruptive?

Jade Wu
Collier County, Fla.

Replicating the ‘Magic’ of Camp

To the Editor:

As a devoted former summer camper myself, I appreciate all of the joys that Sandra Fox illuminates in her guest essay “There’s No Cure for Campsickness. That’s OK.” (Opinion, Aug. 21).

Summer camps offer a kind of time-bound, immersive magic that, as Dr. Fox writes, can’t be replicated at home. But it’s also worth asking why kids have such a need for “an escape, an opportunity for self-reinvention and an invitation to be messier, weirder and just more myself” in the first place.

Why can’t real life be more like summer camp? It can be, and already is (at least in some respects) for young people lucky enough to attend schools that are focused on helping them grow into the best possible versions of themselves. When learning is active, immersive and meaningful, kids become fluent in addressing real-world problems. In these schools, trust, strong relationships and a healthy, respectful community are prioritized as much or more than test scores.

Long live summer camp! May its magic reach and serve every child. But real life can be magical too. In fact it must be, in order for young children to grow into capable, caring adults.

Andy Calkins
Gloucester, Mass.
The writer co-directs the nonprofit education organization Next Generation Learning Challenges.