The sum of the following three pieces, and so much that has been written recently about end of life care, and dying in general, further enthuses me to think we are entering a new chapter in our approach to death and dying. Yes, there is an academic journal article, but it was written as an editorial, and all three were written cohesively in the same time period – one begot the next.
The New York Times | January 24, 2014 | Dr. Paul Kalanithi, MD
This first article is an op-ed piece in the NY Times by the Neurosurgeon, Paul Kalanithi, who recently (posthumously) published the book, When Breath Becomes Air. It was written shortly after his diagnosis of lung cancer. His story, and his book, have generated a lot of writing and thinking recently, much like Atul Gawande just a little more than a couple years ago with Being Mortal.
NEJM | February 11, 2016 | Dr. Lisa Rosenbaum, MD
This next article by Dr. Lisa Rosenbaum, MD, was in NEJM recently as a “Medicine and Society” editorial. Dr. Rosenbaum is a national correspondent for the Journal. She was friends with Kalanithi and talks openly about their friendship and embracing the changing discussion in America about Palliative Medicine.
The New York Times | February 8, 2016 | Andrew Solomon
The last article is a NY Times book review by Andrew Solomon of several books about death and dying, including Kalanithi’s. It appeared just three days prior to the Rosenbaum article.
Below are several reads about end of life care and the evolving discussion that is opening in the heart of American culture. Many of these have been used as preparation for discussions in our hospital’s Ethics Committee’s meetings over the past twenty years. Several important things happened in August of 2010 that have helped me re-evaluate the way our country deals with end-of life care. Multiple wonderfully written articles appeared, starting with Atul Gawande’s piece in the August edition of The New Yorker magazine.
The New Yorker | August 2, 2010 | Dr. Atul Gawande, MD
This is a long piece, but riveting and stirring, as it’s the time Gawande began to change his approach to, and understanding of, end of life issues in healthcare.
The New York Times | October 5, 2014 | Dr. Atul Gawande, MD
This next read is also by Atul Gawande, a Harvard surgeon, and was in the NY Times not too long ago. This article is taken from the outcome of his change in focus, a book that came out a week prior, Being Mortal: Medicine and What Matters in the End.
The New York Times | October 6, 2014 | Dr. Abigail Zuger, MD
The next article is a book review of Being Mortal written by Abigail Zuger, an internist, in the next day’s paper.
The next couple of reads are from the New York Times discussing the resurgence of conversations about end of life and palliative care, as well as being paid for it. Although being paid for having end of life care discussions has been implemented, these articles show how that conversation proceeded in American politics.
The New York Times | August 31, 2014 | Pam Belluck
This is a great read supporting end of life discussions, and offers a great deal of affirmation and resource, but the punch line, to me, is when Dr. Diane Meier, director of the Center to Advance Palliative Care says in the article
This notion that somehow a single conversation and the completion of a document is really an important intervention to the outcome of care is, I think, a legal illusion. It has to be a series of recurring conversations over years.
The New York Times | September 17, 2014 | Pam Belluck
The same author, two weeks later (she’s on a roll) writes about the Institution of Medicine’s book that came out a week prior, Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life. The punch line in this article comes from David M. Walker, a Republican and a former United States comptroller general, who was a chairman of the panel
The bottom line is the health care system is poorly designed to meet the needs of patients near the end of life. The current system is geared towards doing more, more, more, and that system by definition is not necessarily consistent with what patients want, and is also more costly.
Delving into some of the history behind death and dying, the shifts in cultural acceptance of Hospice and Palliative Medicine, and how we’ve gotten to today, are summed up well in the two articles below.
The Washington Post || Dr. Craig Bowron, MD
A great big picture read in the op-ed section of the Sunday Washington Post by a Minneapolis Hospitalist, Craig Bowron, MD. The article is touching and painful using some of his (and every physician’s) cases, but is useful by helping us understand that while the average life expectancy was 47 years in 1900, if you lived through infancy and early childhood, you could expect to live to an old age, and that if you lived to be 65 years, you could expect to live 12 more years, and if you lived to be 85 years, you could expect four more years here on earth. Today, if you make it to 75, you can look for 19 more years, and at 85 you might expect another six. All that means that longevity begets more longevity, and the medicines we take credit for our longer survival is not nearly as important as public health measures and awareness.
The New York Times | October 27, 2012 |
Just in time for Halloween, this article points out that we have distanced ourselves from death over the centuries at some social expense, but there are signs this is changing in Western cultures, and enhanced by modern Hospice acceptance in the United States.