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Rethinking End of Life Care

Posted 11/16/2013

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  Over the past week, I have had more than the usual number of conversations about EOL (end of life) care. One of these discussions was with a woman whose death is lurking, but the others were all with women who are doing fine and expecting (appropriately) to be healthy after cancer. One reality is that a cancer diagnosis, whatever the specifics, shatters our denial or attempt to believe in our own immortality. While our society seems to try very hard to deny death and even to deny aging ("Sixty is the new forty!" etc.), we have been forced to acknowledge the central truth of human life.

  This does give us an opportunity to think and to talk with our families about our wishes and goals. One would hope that this honesty would also encourage our family members to tell us about their own hopes for care. If we do nothing about this, it is very likely that we will end up dying in a hospital, quite possibly in an ICU with all kinds of sophisticated medial care vainly trying to keep us breathing. If you haven't seen it, I encourage you to look at The Conversation Project ( which has excellent materials to help with this difficult discussion.

  You may also be interested in this new book, The Best Care Possible,  by Dr. Ira Byock from Darthmouth Hitchcock. Before I give you a little more information about it, let me be clear that this is not intended to be a downer entry. Quite the contrary. In my experience, there is something very freeing about having had these thoughts and talks. Once done, they are done, and you can go on with living.

  From NPR, here is a little more and then a link:

'Best Care': We Make Death Harder Than It Has To Be

Many people hope to die peacefully at home surrounded
by their loved ones, but unfortunately it usually doesn't
turn out that way. Thirty percent of Americans die in
nursing homes, more than half die in hospitals and
nearly half of those people spend their last days in
intensive care units.
In his book The Best Care Possible, Dr. Ira Byock argues
that the way most Americans die is a national disgrace
— an ethical, moral and economic crisis that will get a
great deal worse as the baby boomers age.
Byock, director of palliative medicine at Dartmouth-Hitchcock Medical Center,
says that modern medicine has provided unprecedented power to treat disease
and help people live longer, but has also changed the focus of health care.


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