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Physician voices
Advance directives pale in comparison to the real-time medical decisions caregivers make every day, whether to encourage medication, contact a specialist, call 911, or continue treatment for a loved one. National Healthcare Decisions Day (NHDD), observed each year on April…
Advance directives pale in comparison to the real-time medical decisions caregivers make every day, whether to encourage medication, contact a specialist, call 911, or continue treatment for a loved one. National Healthcare Decisions Day (NHDD), observed each year on April 16, encourages individuals to complete an advance directive. But when the true day of reckoning arrives, when death seems imminent, disfigurement is likely, or mental capacity is lost, this document …
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Caregiver end-of-life decisions: Moving beyond advance directives
Physician voices
If life is what we make it, then the end of life can be understood as a spiritual journey rather than a medical pursuit. We demedicalize dying by distancing ourselves from practices that use hope as consent (prolonging life through…
If life is what we make it, then the end of life can be understood as a spiritual journey rather than a medical pursuit. We demedicalize dying by distancing ourselves from practices that use hope as consent (prolonging life through reflexive hospitalizations, procedures, or antibiotics that offer little dignity to those already living with serious illness).
Every medical decision poses a fundamental question: Is this the beginning of the end, or …
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Demedicalize dying: Why end-of-life care needs a spiritual reset
Conditions and diseases
The fatal blow to President Biden's reelection bid came during the debate when he appeared to have a stroke. The insult of being "too old" haunted and hounded him ever since. How quickly did Biden need to end his campaign…
The fatal blow to President Biden’s reelection bid came during the debate when he appeared to have a stroke. The insult of being “too old” haunted and hounded him ever since. How quickly did Biden need to end his campaign to save face?
Dignity grants the certainty of whether three seconds, three minutes, three hours, three days, three weeks, or three months is reasonable to pull the plug on sustainability and …
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President Biden: a closer look at leadership, dignity, and aging
Physician voices
Are advance directives any better than they were four years ago when COVID was surging? Are patients still comfortable with being placed on ventilators? Do physicians better understand how to treat COVID as a serious illness? Physicians provide emergency measures…
Are advance directives any better than they were four years ago when COVID was surging? Are patients still comfortable with being placed on ventilators? Do physicians better understand how to treat COVID as a serious illness?
Physicians provide emergency measures unless there’s an advance directive to the contrary. Only one-third of Americans have advance directives when “down for the count” with serious illness.
Most people prefer to die at …
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Advance directives amidst COVID: a critical look
Physician voices
When COVID killed thousands of seniors three years ago, few of them showed up in emergency rooms with advance directives. Even fewer thought about the end of life or how to die. Sadly, many lives were discarded in makeshift morgues/cooling…
When COVID killed thousands of seniors three years ago, few of them showed up in emergency rooms with advance directives. Even fewer thought about the end of life or how to die. Sadly, many lives were discarded in makeshift morgues/cooling trucks behind hospitals. It’s never too early to plan for the next pandemic, retirement, and the end of life.
On April 16, 2023, National Healthcare Decisions Day, take a moment and …
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April 16th is National Healthcare Decisions Day: Plan for your end-of-life care now
Conditions and diseases
The purpose of the serious illness conversation is to offer patients a clear choice between treating and not treating an incurable disease like liver cancer. The goal is to give the person permission to alleviate pain and suffering. The individual…
The purpose of the serious illness conversation is to offer patients a clear choice between treating and not treating an incurable disease like liver cancer. The goal is to give the person permission to alleviate pain and suffering. The individual might decide to be treated as a patient or honored as a person if given this option near the end of life.
A non-serious illness conversation ends with the patient wishing …
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The heartbreaking story of Jimmy Carter: a call for Medicare reform in end-of-life care
Physician voices
With no true endgame or advance directive, Tom Brady's legacy as an NFL superstar and family man remains nebulous. Is his recent retirement from football officially the end? Will he entertain offers to stay alive and play one more year?…
With no true endgame or advance directive, Tom Brady’s legacy as an NFL superstar and family man remains nebulous.
Is his recent retirement from football officially the end? Will he entertain offers to stay alive and play one more year? With being at the 45-year-old “yard line” and facing the goalpost at the end of the football field, what’s his endgame for the next year?
When do the false promises end …
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Tom Brady’s legacy and the importance of personal integrity in end-of-life choices
Physician voices
Pele, the famous Brazilian soccer star, reportedly stopped medical treatment for colon cancer. Media outlets stated he was receiving various iterations of comfort, hospice, and palliative care which were perceived as criminal and disrespectful. His daughter denied these allegations on…
Pele, the famous Brazilian soccer star, reportedly stopped medical treatment for colon cancer. Media outlets stated he was receiving various iterations of comfort, hospice, and palliative care which were perceived as criminal and disrespectful. His daughter denied these allegations on Instagram.
How often are those with serious illnesses treated like criminals for wrongdoing?
When medical treatment is withdrawn or withheld, it seems the person has lost the battle or chose not …
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Learn to earn end-of-life respect
Physician voices
Consider Medicare enrollment with the end in mind. In case of emergency, do seniors prefer medical care or holistic care? Might they designate a medical power of attorney or a merciful power of attorney? Do they oblige CPR or sign…
Consider Medicare enrollment with the end in mind. In case of emergency, do seniors prefer medical care or holistic care? Might they designate a medical power of attorney or a merciful power of attorney? Do they oblige CPR or sign a DNR order?
The JAMA Network just published Death and End-of-Life Care in Emergency Departments in the U.S. This retrospective cohort study concludes that,
Robust systems of emergency care
…
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Can Medicare advance directives be simple?
Physician voices
Imagine delivering testimony to practicing emergency medicine for 30 years on the TEDx stage and my "Real Serious Illness Conversations with Parents" being condemned with this NOTE FROM TED: Please do not look to this talk as a substitute for…
Imagine delivering testimony to practicing emergency medicine for 30 years on the TEDx stage and my “Real Serious Illness Conversations with Parents” being condemned with this NOTE FROM TED: Please do not look to this talk as a substitute for health advice. This talk only reflects the speaker’s personal views and beliefs. It’s as if to say, “Beware of the doc”… who lets individuals decide how they’ll die …
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Giving medical advice with moral values is deeply personal and takes courage
Physician voices
Jerry and his wife, Pam, were not “medical people” and wouldn’t be considered high achievers. They seemed to be taking life in stride with a “mom and pop” disposition. Jerry had Alzheimer’s disease and was returned to his care facility…
Jerry and his wife, Pam, were not “medical people” and wouldn’t be considered high achievers. They seemed to be taking life in stride with a “mom and pop” disposition. Jerry had Alzheimer’s disease and was returned to his care facility after having a pacemaker inserted. The staff noticed Jerry slumped in his chair and called 911. Jerry’s blood pressure was low, and EMS transported him to the nearest hospital. He …
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The lost art of reassurance medicine
Physician voices
“I remember you,” said Gracie with the look of having found a long-lost friend. “You gave my husband the option to be treated aggressively in the hospital or return home with palliative care. He chose to go home.” I hesitated…
“I remember you,” said Gracie with the look of having found a long-lost friend. “You gave my husband the option to be treated aggressively in the hospital or return home with palliative care. He chose to go home.” I hesitated to ask, “How did he do?” Gracie went on to say that her husband had passed in the last month, yet lived nine months following our brief encounter in the …
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Be willing to fail your patients
Physician voices
Other than taxes, the only other certainty in life is death. People don’t like to pay taxes or think about dying. But on April 16th, National Healthcare Decisions Day (NHDD) reminds people to complete their advance directives. Like a passport,…
Other than taxes, the only other certainty in life is death. People don’t like to pay taxes or think about dying. But on April 16th, National Healthcare Decisions Day (NHDD) reminds people to complete their advance directives. Like a passport, an advance directive permits an individual to proceed from one world to another with an easy stamp of approval. Without the proper paperwork, patients at the end of life are …
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A new directive for National Healthcare Decisions Day
Physician voices
At 69, Bob appeared to be a broken man. He left the hospital the day before and returned to the emergency department (ED) because he wasn’t “acting right.” Bob became upset when a second injection to his abdomen burned, and…
At 69, Bob appeared to be a broken man. He left the hospital the day before and returned to the emergency department (ED) because he wasn’t “acting right.” Bob became upset when a second injection to his abdomen burned, and family members were angry that the discharge instructions did not explain this.
After four years of receiving treatment for metastatic colon cancer, Bob had reached the breaking point of persecution, but …
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Sometimes death is not an option
Physician voices
I overheard a colleague admit an 84-year-old woman to the hospital from the emergency department for a sizable mass in her uterus -- no doubt, cancerous. I pictured a frail woman who’d been suffering for a while and was afraid…
I overheard a colleague admit an 84-year-old woman to the hospital from the emergency department for a sizable mass in her uterus — no doubt, cancerous. I pictured a frail woman who’d been suffering for a while and was afraid to tell anyone about it, fearing the worst. Like most, she preferred to ignore it rather than have others tell her what to do. Having fallen ill, she risked losing …
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Should doctors be required to inform patients of their palliative care rights?
Physician voices
Ruth was a spry, but frail 98-year-old woman who was stiff and sore following the 6-hour drive from California to Arizona. She had suffered a recent wrist injury and was not recovering well after spending three weeks in a rehabilitation…
Ruth was a spry, but frail 98-year-old woman who was stiff and sore following the 6-hour drive from California to Arizona. She had suffered a recent wrist injury and was not recovering well after spending three weeks in a rehabilitation center. She was in the midst of upheaval and discontent — in the throes of relocated to an assisted-living residence closer to her son. The facility’s coordinator had begun to …
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Fixing the breakdown in patient satisfaction
Physician voices
John was an 88-year-old ranch owner who struck gold when he sold his homestead in Wyoming. His golden years in Arizona were spent struggling with back pain and caring for his 80-year-old niece with dementia. He ran out of pain…
John was an 88-year-old ranch owner who struck gold when he sold his homestead in Wyoming. His golden years in Arizona were spent struggling with back pain and caring for his 80-year-old niece with dementia. He ran out of pain medication and presented to the ER for another “handout” of hydrocodone. He admitted that life was taking its toll, and he was beside himself from aging. Was it time to …
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Survival of the fittest does not apply after a certain age
Physician voices
Dad had taken a turn for the worse, but my family was not ready to give up on him and consider end-of-life care. Nevertheless, choices had to be made. Would Dad be allowed to pass while in assisted living or…
Dad had taken a turn for the worse, but my family was not ready to give up on him and consider end-of-life care. Nevertheless, choices had to be made. Would Dad be allowed to pass while in assisted living or have his life prolonged in a skilled-nursing facility? What kind of a doctor am I? When perceiving that a patient is dying, what type of physician neglects to intervene and …
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Physicians are society’s scapegoats
Physician voices
This New Year is the appropriate time to make a resolution: the occasion to link advance care planning with a spiritual legacy. People all have deep-seated values and determinations of what they are willing to pay for, live for and…
This New Year is the appropriate time to make a resolution: the occasion to link advance care planning with a spiritual legacy. People all have deep-seated values and determinations of what they are willing to pay for, live for and die for, but few actually document these for caregivers or posterity.
Beginning in 2016, Medicare will begin to reimburse physicians for end-of-life counseling. However, throwing taxpayer dollars at no-win situations is …
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It’s time to make a spiritual legacy for 2016
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