President Jimmy Carter’s long good-bye raises awareness for hospice care

Over a year ago, former President Jimmy Carter announced that he would stop further treatment for any medical ailments and instead would enter hospice care at his home (QH). The announcement did not offer any specifics on his medical condition, but it does not appear that his melanoma has relapsed. I have previously written about how President Carter was afflicted with stage 4 (metastatic) melanoma, but received anti-PD-1 immunotherapy that put the melanoma in remission over 8 years ago, and most likely cured him of the cancer. Mr. Carter chose hospice care a year ago, opting for comfort at home in Plains, GA, rejecting further life-prolonging treatments.

His grandson Jason Carter recently provided an update (CNN) indicating that that President Carter is "doing okay" but approaching the end of his journey. Jason highlighted the importance of faith and the support of family during this time.

The biggest change over the past year has been the passing of his wife and partner First Lady Rosalynn Carter in November. After 77 years of marriage, President Carter spent significant time saying goodbye to Rosalynn before her death. According to Jason, this experience brought him a sense of closure and peace.

Contrary to typical hospice timelines, he has surpassed initial expectations, highlighting his resilience. On average, about 50% of hospice patients pass away within three weeks, but 12–15% live for six months or longer. The average length of a hospice stay is around 70 days. Thus, President Carter's more than a year long stay in hospice care is unusual.

As a reminder, hospice care is a specialized type of palliative care focused on providing comfort and support to patients (but no curative treatments) nearing the end of their lives, helping them manage symptoms and offering emotional support to both patients and their families to ensure a dignified and comfortable end-of-life experience. In contrast, palliative care aims to relieve symptoms and improve the quality of life for patients with serious illnesses at any stage, often alongside curative treatments, and can be provided in various settings, including hospitals, nursing homes, and at home. Curative treatment, or disease-directed treatment, focuses on treating and potentially curing the underlying disease. The key distinction is that while palliative care can be provided at any illness stage alongside curative treatments, hospice care is specifically for those in the final stages of life, typically when curative treatments are no longer effective or desired. Notably, over 40% of dying patients in the U.S. undergo hospice care, mostly in their homes during their last weeks or months.

It is possible that President Carter has no acute underlying illness, and is rather dying of old age, which can explain his extended time in hospice care.

The above encapsulates President Jimmy Carter’s enduring spirit, his impactful journey through life and service, and the broader societal impact of his approach to end-of-life care. Despite challenges, he remains surrounded by loved ones in his hometown, continuing to embrace life as it comes.

Figure 1. President Carter saying good-bye to his partner of 77 years the First Lady Rosalyn Carter.