DISCUSSION
DR. RICHARD OLMSTED: I would like to ask both Dr. Green and Dr. Friedman about the matter of the child being in the hospital as opposed to being at home. What effect does this have on the child, and, conversely perhaps, what effect does it have on the parents who are keeping a child who may be close to being terminal at home? Very often we adopt the philosophy that it is better for the child to be at home, but I am sure this creates difficulties for parents at times.
DR. Morris Green: We usually assume in this country that terminal care can best be handled in the hospital; however, in recent years we have questioned this concept, and now we like to have as much of this care occur at home as is practicable. In order to do this effectively, however, we should provide the family with supportive services from the hospital, a type of home care program involving the physician, the social worker, and the nurse. With some of our recent patients the nurse has been present in the home at the time of death and has made visits frequently before that time. The hospital physician has also been there. We do not have sufficient data on this, but I think there are many things to be said in its favor. As we are now examining other aspects of hospital care of children, we should also examine this method of terminal care. Is it best for the child to be in the hospital at this time or can he be cared for better at home with supplementary services from the hospital? Certainly I think this is an area in which the personal physician of the family needs to have some support from the community oriented hospital.
