Palliative Care
End-of-life choices: Why Medicare needs to change [PODCAST]
The power of communication in palliative care: How words can heal and instill hope
Effective communication has the potential to promote understanding, safety, and connection. It is the foundation of high-quality health care. Our use of language to heal is important in all facets of medicine, but words may be even more powerful when patients face a terminal diagnosis. When medications and life-saving interventions are less of a priority, language can instill hope and honor the human behind the illness. As such, I believe …
The slippery slope of legal assisted suicide and euthanasia
We began with terminally ill patients, but the slippery slope is alive and well, smothered in oil. The Western world is increasingly advocating for the advancement of legal euthanasia, and this is a huge mistake. In their quest, advocates for legally assisted suicide by way of a physician are redefining the definition of “immense suffering.” For example, Canada is considering including mental health disorders as eligible for legally assisted euthanasia. …
Learn to earn end-of-life respect
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When medical treatment is withdrawn or withheld, it seems the person has lost the battle or chose not …
What’s the sense of having a living will if it’s not honored?
‘This victory ensures that advance planning documents are legally enforceable and will be respected by doctors; if they are not, individuals can hold providers accountable for violating their health care decisions.”
– Greenberg decision, 2022
Dr. Gerald Greenberg was a New York dentist when in 2010, he was diagnosed with early-onset dementia. In 2011, he executed a living will stating the medical staff was to provide comfort measures only and no medical …
Can Medicare advance directives be simple?
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 …
Who’s holding space for you?
The first time I saw someone die was when I volunteered in the ER as an undergraduate student.
That day I was helping in the trauma bay, and my job was to quickly run STAT or urgent blood specimens to the lab.
The year was 1994. It was winter time, and the tension of the people sitting in the waiting room was palpable to me every time I would go through those …
What being a hospice volunteer taught me about health care
The finality of death is a powerful teacher. For some patients, being diagnosed with a terminal illness is an experience that lends a tremendous shift in perspective and newfound authenticity. This can be instructive to them and the people around them. As psychologist Charles Garfield says, “The living have much to learn from the dying.”
This applies not only to the experience of a terminal illness but also to its …
Lessons in avoiding compassion fatigue
An excerpt from A Caregiver’s Love Story.
Caregiver burnout is a real and serious problem for those caregivers in for the long haul. It is a serious issue if you go to bed each night in anguish over the next day’s chores and wake up each morning with a …
Giving language to empathy: lessons from palliative care
The value of empathy in medicine is seldom debated. Just as the art of medicine is taught as the balance of knowledge and application, so has empathy been recognized as both a value to be fostered and a skill to be learned. Medical curricula have reflected this, and while didactics are increasingly filled with various conversational frameworks and behaviors that convey empathy, rarely do they include specific language to convey …
Next of kin in the medical decision making process
Four years ago, as chairman of the hospital ethics committee, I was asked to convene an emergency meeting brought by a distraught family as medical decisions had to be made for their ill loved one. The hospital, HMO lawyers, the family, three adult children, and their mother were at the meeting.
The father had arrived at the hospital unconscious and was admitted to the intensive care unit, where medical care was …
How my sister’s death changed everything
It was fall. Sun-slanted rays filtered into the church from a cold November sky, creating a false sense of warmth. My nephew Dru stood before family and friends who were gathered to remember his mother. He began by telling how, in-between trips to the emergency room, oncologist, radiologist, and myriad other health care providers, he would find himself preoccupied with her eulogy. He worried he would not be able to …
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The elephant in the room: end-of-life discussion with patients
I have been at my current hospital for 12-plus years now. Like many of you, I have gotten to know some of my patients very well. I have known some of them since I first started out here. We talk about my dogs and cows, our newest grandkids, and politics if we feel adventurous. This is an extraordinary relationship built on the intangible magic generated over time, known as rapport …
Making death conversations fun!
“Arriving at an acceptance of one’s mortality is a process, not an epiphany.”
– Atul Gawande
Imagine a group of old (mature) friends gathered for a “girls” weekend in balmy Florida. The friendships started in grammar school and have continued for the better part of 50 years. These women have met at least once a year for more than 25 years and shared life’s ups and downs. On this trip, one of …
Death is what gives life meaning
“He knew it was his time a month ago. We were sitting at the kitchen table, and he told me he couldn’t feel half his face. He kept tapping the left side and saying he couldn’t feel anything. I knew he had a stroke because my daughter had one. He was stubborn, didn’t want to go to the doctor.”
One week ago, I saw Mr. Samson for the first time in …
A patient gave this physician her humanity back
I am a physician.
We are always taught to see our patients as more than their state of illness or diagnosis. “Speak to the patient,” “listen,” “look them in the eye,” “do not put one foot out the door,” the list of do’s and don’ts, while self-explanatory, is long. A good doctor is considered one who is able to view the person behind the symptoms and offer a shoulder, not just …
What anticipatory grief feels like
An excerpt from A Caregiver’s Love Story.
After Bill was given his terminal diagnosis of idiopathic pulmonary fibrosis and the bloody nose scare, I began to worry about the future. It was like “waiting for the other shoe to drop,” wondering when and how his death would happen. I …
Talk about death in plain, simple, easy-to-understand terms
“You’re dying.”
I can often visualize the impact of my words as soon as they leave my mouth, the heavy weight sinking into the mind and body of my patient as they sit in the stark white hospital bed.
It usually isn’t the first time they’ve heard the sentiment. After all, we tell them countless times in different phrases we use as physicians, expecting them to understand, but none quite as precise …
Withdrawing life-sustaining treatment over family objections
“We can keep your loved one alive. but we won’t. Even though you think their life is worth living, we do not.”
The first time I helped a hospital convey this type of offensive message to a patient’s family, it deeply humbled me. My service on a hospital medical appropriateness review committee forged charitable respect for alternative viewpoints that now pervades my work to protect patient rights.
Hospital review committees adjudicate medical …
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Past Week
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