Why We’re Launching The Palliative Lens

THE PALLIATIVE LENS

Seeing serious illness care more clearly

By Andrew Esch, MD

2/1/2026

The field of hospice and palliative medicine is at a critical inflection point. What once stood as a deeply human, patient-centered approach to care is now at risk of being overshadowed by systemic pressures that threaten quality, accessibility, and the very ethos of why we entered this field in the first place. The Palliative Lens is being launched because we can no longer sit quietly while the challenges facing our patients, caregivers, and clinicians grow more complex, and more urgent.

A Critical Time for Hospice and Palliative Medicine

Hospice and palliative care were built on principles of dignity, comfort, and compassionate support for patients facing serious illness. Yet today, those very principles are being strained by forces that value volume over value, billing codes over bedside care, and profit margins over patient narratives. Our field is at a crossroads, and without intervention, we risk allowing short-term financial incentives to eclipse long-term human needs.

The Shadow of Fraud and Poor Care

In recent years, headlines have spotlighted troubling cases of fraud and improper practices within hospice care. These stories aren’t just statistics; they reflect real failures in systems designed to protect vulnerable populations at their most fragile moments. Instances of overbilling, inappropriate admissions, and compromised care shake public trust and threaten the integrity of an entire specialty.

We cannot address these issues simply by pointing fingers. We must dissect root causes, amplify ethical voices, and build accountability with transparency. The Palliative Lens will spotlight systemic vulnerabilities, teach clinicians how to navigate them, and advocate for safeguards that protect patients without penalizing providers committed to quality.

The Profit Motive and Venture Capital Pressures

Healthcare increasingly feels like a market where venture capital and private equity have louder voices than clinicians and patients. While innovation is critical, profit-driven models have entered arenas where compassion should dominate. For hospice and palliative medicine, this shift introduces perverse incentives:

• Prioritizing growth over readiness

• Favoring scale over quality of care

• Marginalizing nuanced, relational work that can’t be easily quantified

Palliative care doesn’t fit neatly into quarterly earnings reports. It thrives in moments of human connection, thoughtful symptom management, and interdisciplinary teamwork, none of which are easily reduced to revenue streams. The Palliative Lens will explore how these financial pressures impact practice realities and what clinicians, leaders, and policy makers can do about it.

Access Problems: Who Gets Palliative Care — and Who Doesn’t?

Despite decades of evidence showing that palliative care improves quality of life, reduces suffering, and often lowers costs, access remains uneven at best. Many regions, especially rural, underserved, and socioeconomically challenged communities, lack adequate palliative services. Hospice care, too, is inconsistently available, and when it is available, timelines for eligibility and transitions can be confusing or prohibitive.

We must ask: Why does geography, income, or insurance status determine whether someone receives compassionate care at the end of life? The Palliative Lens will elevate stories from patients and providers on the frontlines of access disparities and push for solutions rooted in equity.

Workforce Strain and Burnout

In every corner of palliative medicine, workforce strain is palpable. Clinicians are stretched thin. Emotional labor isn’t recognized financially. Burnout and moral distress are increasing. Many skilled practitioners are considering leaving a field they love because the system fails to support them.

Interdisciplinary teams (IDTs) that once functioned as deeply collaborative units are fraying under pressure. Team members leave, roles get blurred, and when that happens, care suffers. We will explore how to rebuild and sustain strong, resilient IDTs that uphold the spirit of palliative care — not just the tasks.

Pharmacy and Medication Access Issues

Effective palliative care depends on reliable access to medications that manage pain and other distressing symptoms. Yet pharmacy shortages, regulatory barriers, and insurance limitations create daily obstacles for clinicians and patients alike. When a patient cannot get appropriate pain relief, the promise of palliative care rings hollow.

We’ll sift through the policy, practice, and logistical factors that create these gaps, and we’ll elevate practical strategies to ensure patients get the symptom management they deserve.

Health Equity

Health equity must be central to any honest conversation about the future of hospice and palliative care. Despite clear evidence that hospice improves symptom control, caregiver support, and quality of life, Black and Hispanic patients continue to utilize hospice services at significantly lower rates than white patients. This disparity is not driven by preference alone, but by a legacy of structural racism, historical mistrust of the healthcare system, language barriers, inadequate culturally responsive care models, and unequal access to high-quality services in marginalized communities. Too often, hospice is introduced late, framed poorly, or not offered at all. If we fail to address these inequities, we reinforce a system where comfort, dignity, and choice at the end of life remain privileges rather than rights. Any meaningful reform of hospice and palliative medicine must confront these disparities directly and commit to building trust, expanding culturally competent care, and ensuring that Black and Hispanic patients and families are fully informed, respected, and supported in their end-of-life care decisions.

What The Palliative Lens Aims to Do

The Palliative Lens is more than a blog. It’s a forum, a reflective space, and an advocacy engine. It exists to:

• Illuminate the real challenges facing our field, without sensationalism but with honesty

• Educate clinicians, policymakers, and communities about what’s at stake

• Connect voices across settings from bedside clinicians to administrators to patients and caregivers

• Inspire solutions that keep compassion at the center of care

This work matters because people matter. Not as revenue streams. Not as diagnoses. Not as line items. As whole human beings navigating vulnerability, uncertainty, and very real suffering.

We launch The Palliative Lens because our patients, our colleagues, and our own professional integrity deserve a platform that sees clearly, speaks bravely, and acts boldly.

Let’s look through the lens together so that hospice and palliative care can thrive, not just survive.

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