ABSTRACT
The experience of Bay de Noc Hospice, Inc., in Escanaba, Michigan, a town of about 15,000 people in Michigan’s Upper Peninsula, is the basis of this chapter. Nearly 40,000 inhabitants, living in an area of about 1300 square miles, are served by Escanaba facilities, including a private 127-bed hospital and community mental health center. The nearest tertiary care center with full oncology and radiation therapy services is about seventy miles north. A family practice teaching program of Michigan State University is located in the community. Approximately thirty-five physicians are divided equally between primary care and speciality practices. The people are primarily of northern European background and are employed in forestry, manufacturing, tourist and service industries. Sixty percent of the inhabitants are Roman Catholics, with many Protestant denominations also represented. Of the approximately 370 deaths which occur in the county each year, about 60 result from illnesses likely to involve a terminal phase–such as cancer and advanced organ failure.
