Approaching the end of life is the greatest transition a person makes. It’s a time for making important decisions regarding which treatments to accept or forego. It’s also a time for facing loss and redemption, finding caregivers, and seeking emotional and spiritual support. Hospice exists to accompany those who are dying and their loved ones on this journey at the end of life.

For some who are approaching death and for their loved ones, hospice care can feel like an unwelcome acceptance of the end of life.

“For many patients, it feels like giving up,” says Dr. Ruth Medak, hospice medical director for Providence Health and Services. “For some patients, it’s shocking that this is near the end.”

Yet most patients and their loved ones quickly learn that hospice helps them through the difficult journey. “Most wish they had come to hospice sooner,” Medak says.

So what is hospice? At its core, hospice departs from conventional cure-oriented medical care through its focus on a patient’s comfort rather than curing. It is holistic, drawing on a team of physicians, nurses, social workers, chaplains, bath aides and volunteers as needed to work with patients and support family members. Hospice workers care for patients where they live, whether in homes, long-term care facilities or jails.

Hospice services are offered by a growing number of nonprofit and for-profit providers, who provide care funded most often through Medicare but also by private and public insurers. A full list of providers is available through the Oregon Hospice and Palliative Care Association ( Providence Health and Services is the Portland region’s largest hospice provider, typically serving a caseload of about 450 patients.

Most patients enter hospice through a referral from their physician based on a determination that they are terminally ill and have only a short time — typically estimated less than six months — to live. Patients or their families also can directly request hospice. Two doctors will certify whether the patient meets eligibility.

In part because many doctors and patients delay decisions about hospice, some patients receive services for only a few weeks or even a few days before dying. Those who live longer than six months can receive extensions for continued care if their condition warrants. About 10% who enroll in hospice “graduate” out of terminal illness, says Medak. In some cases, they recover because of better care and medications they receive while in hospice, she says.

As a Catholic hospice, Providence does not participate in physician-assisted suicide. Medak says that Providence does not “discriminate” against patients who are considering this option, but Providence caregivers do not directly participate and do not administer life-ending drugs, she says. Providence will provide family support and other services after the patient’s death, she says.

Nick Kockler, regional director of the Providence Center for Health Care Ethics, says other moral and ethical issues abound in end-of-life care, some of which are addressed in Catholic teaching. “Some are distinctly related to the charism of Catholic ministry,” he says.

Challenging issues include determining an appropriate level of pain management and use of feeding tubes and other life-sustaining decisions. Caregivers and families should recognize “the role and perception of redemptive suffering in the dying process,” Kockler says. “That can be extraordinarily difficult, especially for caregivers.” A Providence ethics committee provides guidance to hospice supervisors and workers on such issues.

At all stages of terminal illness, care providers try to determine what treatments are most likely to benefit the person and which treatments might be overly burdensome to the person.