• End of Life conversation

    Consider the Conversation is a documentary about end of life care. There is a great deal of buzz in the hospice and palliative care communities about this film because of its joining of expert perspective with patient stories that have not been ‘sugar coated’. Here is a review of the film at Pallimed, a great hospice and palliative medicine blog.

    There is a great deal of heat but little light in the way in which we talk about end of life issues. Many people are swayed by the rhetoric of death panels and such because talking about death is still a taboo subject. So, we are not good at it. And it is scary. A great deal of my current research focuses on hospice, palliative care and patient decision making at the end of life.

    I got interested in this general topic because of a personal experience, helping my wife’s Aunt who was dying from Cancer about 15 years ago. She asked me to help her make some practical decisions because she had minor children and was unmarried as she approached death. I became her researcher, and looked into everything from treatment options for her Cancer to finding and arranging for the least expensive way for her to be cremated. It was much more difficult than I thought it would be, in large part because even though I thought she was very clear about her wishes, as her health failed there always seemed to be circumstances that were unforeseen. There were times I wished we had talked more, and more explicitly. And there were a lot of people involved, who didn’t always agree on what to do. Complicated stuff.

    The experience of being involved in this situation has changed the way I think about health policy, and indeed how I teach my Intro to the U.S. Health Care System course. Now I begin this course with the only thing I know for certain to be 100% true on the first day:

    • Everyone will die, it is only a matter of when and from what (we then walk through detailed mortality rate tables)

    If it is true that everyone dies (and it is), this means that eventually care designed to forestall the inevitable will at some point become non productive (it won’t work anymore). This should be uncontroversial, but it is not. Open discussion of these realities remains a taboo. I am not telling you what to conclude about how we should/you wish to face these realities. However, I am telling you we need to think and talk about them.

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    • I just finished a book you may find of interest: In Defiance of Death: Exposing the Real Costs of End-of-life Care by Dr. Kenneth Fisher. 2008
      the book looks both at the problem and makes some very practical suggestions for solutions.

      End-of-life care has become extremely politicized, which is tragic. It is one of the most straight-forward areas where by concentrating on what is best for the patient will simultaneously bring down health care expenditures by eliminating futile, and even inhumane, treatments.