I spent a good part of my morning reading an essay by Dr. Atul Gawande in The New Yorker.  "Letting Go", tackles our reluctance to accept and talk about the most certain of fates --Death.  Dr. Gawande is the first to admit that end-of-life discussion don't come easily to most physicians.  Despite an overwhelming desire by most people to die comfortably at home, a shocking majority still die in hospitals fighting until their last breath.

I can't possibly sum up all of Dr. Gawande's points in this blog but the 13 page essay is well worth your time.  I will leave you with what I believe to be the most important take away for medical workers everywhere.  Dr. Gawande consults Dr. Susan Block, a palliative care specialist, about speaking to patients and families about death:

"A large part of the task is helping people negotiate the overwhelming anxiety--anxiety about death, anxiety about suffering, anxiety about loved ones, anxiety about finances," she explained. "There are many worries and real terrors." No one conversation can address them all. Arriving at an acceptance of one's mortality and a clear understanding of the limits and the possibilities of medicine is a process, not an epiphany.

 

There is no single way to take people with terminal illness through the process, but, according to Block, there are some rules. You sit down. You make time. You're not determining whether they want treatment X versus Y. You're trying to learn what's most important to them under the circumstances--so that you can provide information and advice on the approach that gives them the best chance of achieving it. This requires as much listening as talking. If you are talking more than half of the time, Block says, you're talking too much...

 

Block has a list of items that she aims to cover with terminal patients in the time before decisions have to be made: what they understand their prognosis to be; what their concerns are about what lies ahead; whom they want to make decisions when they can't; how they want to spend their time as options become limited; what kinds of trade-offs they are willing to make.

 

It's important for us to get back to talking about what's really important -- what really matters to us as our life's chapter comes to a close.  Need some inspiration to get talking?  Read Dr. Gawande's full essay, "Letting Go".

A white paper by the Economist Intelligence Unit and commissioned by the Singapore-based Lien Foundation ranks the quality of death in 40 countries.  Where does your country rank?

Not suprisingly, the UK ranked #1.  The modern hospice movement has it's roots in Europe and several countries on that continent rank high on the index.  Australia and New Zealand rank #2 and #3 respectively.  Look down the list a bit further....no, just a little further....there you go.  At #9 we have a tie!  The United States and Canada tie for a disappointing 9th place.

View the brief of the white paper and find out where your country ranks.  You can read more about the methods used to rank the 40 countries and find the entire white paper at the same site.

What is Palliative Care?

The Circle of Life Award winners for 2010 have been announced.  The Circle of Life Award, awarded by the American Hospital Association (AHA) and supported by the California Healthcare Foundation and the Archstone Foundation, honors innovation in palliative and end-of-life care.  The winners for 2010 are:

• Kansas City Hospice & Palliative Care, Kansas City, Missouri
• Department of Veterans Affairs, VA New York/New Jersey Healthcare Network, Brooklyn, New York
• Snohomish Palliative Partnership, Everett, Washingon

Citations of Honor were awarded to:

• Hospice & Palliative Care of Western Colorado, Grand Junction, Colorado
• New York City Health and Hospitals Corporation, New York, New York
• Providence TrinityCare Hospice - Providence Little Company of Mary Medical Center Torrance Palliative Care Partnership, Torrance, California
• Sharp HospiceCare, San Diego, California
• Palliative Care & Hospice Services of Summa Health System, Akron, Ohio

Congratulations to the winners of this prestigious award!  Keep up the great work of providing quality palliative and end-of-life care!

According to the website The Hill, a Republican memo charges the Obama administration with avoiding questions regarding its new head of Medicare's ties to the healthcare industry, specifically to right-to-die organizations.

"The memo said Grassley, the ranking member of the Senate Finance Committee, which has jurisdiction over Medicare, was also waiting for responses to questions to Berwick about whether he had links to a group that advocates for patients' right to die. The question came from another Republican member and was based on Berwick's past statements on end of life care, not any tangible proof that he was linked to Compassion and Choices, the former Hemlock Society."

There seems to be concern from Republicans that Berwick is jumping on the "death panel" bandwagon and will support euthanasia.  I would like to remind readers that "death panels" do not happen now and won't happen in the future.  If worried Republicans would take a little time to research Compassion & Choices, they would see that this is not an organization that promotes euthanasia.  Compassion & Choices works to expand choices at the end of life, which includes physician-aid-in-dying, but that is a far cry from euthanasia.

The problem with using end of life choices as a political platform is that politicians rarely get the facts straight.  End-of-life discussion turns into "death panels";  Physician-aid-in-dying (AKA Physician-assisted suicide) turns into "euthanasia".  Dying is increasingly becoming something that is not seen as natural.  More and more, groups and individuals who advocate for personal choice at the end of life are portrayed as wanting to "kill" people.  Death is becoming a politically charged topic when politics should never be involved in something so personal.

Unfortunately, what happens when death becomes so political is that groups and individuals go to extremes to make sure their right to choose is honored.  Enter the Final Exit Network (FEN).  I've taken some heat from FEN supporters and received emails from FEN employees regarding my profile of the network and my blogs about their advertisements.  I'll clarify here that I fully support an individuals right to choose how they die.  I believe it is vitally important to consider things such as where you want to die, what medical interventions you do or do not want, how you want to be treated, and who you want present when it happens.  I support the work of groups such as Compassion & Choices who advocate for state physician-aid-in-dying laws for terminally ill patients and support physicians working in pain and symptom management.   On the other hand, the Final Exit Network has gone to extremes to help patients who are NOT terminally ill because there are so many individuals who feel like this is the only way to preserve their dignity.  When people feel threatened that the government will decide the most personal aspects of their lives, many take matters into their own hands.  However, an organization that helps non-terminally ill patients commit suicide does damage to the public's view of right-to-die organizations and threatens the work of hundreds of individuals.

I propose that the focus of Berwick's appointment as head of Medicare shift to how he will work to preserve hospice care.  What will Berwick do about the proposed cuts to the Medicare Hospice Benefit?  How will he ensure that terminally ill patients have access to quality end of life care?  Let's leave the actual act of dying to the individual and get government out of the way.

Profile of the Final Exit Network

Profile of Compassion & Choices

The Death Panel Debate