Who's willing to listen to the dying patient?

John Carney
November 23, 2009

In watching Dr. Ira Byock on Sunday night (11/22/09) on 60 Minutes, I felt the sting of CBS interviewer, Steve Kroft’s remark – “so this really is about death panels”, a reference to limiting invasive treatment for those in the throes of dying. Ira, a good friend, a veteran palliative care doc, gifted author, and someone who’s dedicated his medical practice to those living with advanced disease, responded admirably.

But I doubt he made any new friends.

If I have my wits about me whenever a well intentioned advocate asks me that kind of question, I ask permission to ask a few in return. If we can agree that all of us will die someday, can we also agree that some ways of dying are preferable to others (e.g., being pain free, surrounded by loved ones, in your own home)? And if we can agree there are, wouldn’t you want your doctor to tell you when that time is approaching so you can receive the kind of care that helps rather than hinders your goals of care?

While death remains an anathema; most of us can also do a pretty good job of describing, at least theoretically, what kinds of things we’d prefer as dying patients. Healthcare professionals who have knowledge and insights about advanced disease should also have the courage to ask me questions that I’m too scared to ask myself.

Facing reality is sometimes a good thing when it comes to life and death. I’d rather answer their questions than wonder why no one asked when they suspected otherwise.

Dying people deserve the best we have to offer. Forcing them to undergo treatment to recover from a condition they won’t recover from may be easier for us, but it is not better for them.

Perhaps those of us accused of supporting death panels need to turn the question around, posing for our accusers as ridiculous a corollary – why do you support the torture of dying patients? I’m not at all convinced that it enhances the dialogue, but maybe it will startle us into realizing that the real purpose of this discussion is not about who’s got the more worthy cause, but who’s willing to listen to the dying patient.



Link: The Cost of Dying, 60 Minutes, CBS News, November 22, 2009

End of Life Care in the News

The State of Aging and End of Life

Health Talk

KMBZ Radio

November 21, 2009

53 minutes 51 seconds

The task of making our medical wishes known during a serious illness or at the end of life is much more complicated now that it’s part of a political debate. John Carney, Vice President of Aging and End of Life at the Center for Practical Bioethics, explains in this edition of Health Talk on KMBZ Radio, Kansas City.

The Cost of Dying
60 Minutes
CBS News
November 22, 2009

Last year, Medicare paid $50 billion just for doctor and hospital bills during the last two months of patients' lives. And it has been estimated that 20 to 30 percent of these medical expenditures may have had no meaningful impact.

You might think this would be an obvious thing for Congress and the president to address as they try to reform health care. But what used to be a bipartisan issue has become a politically explosive one.

What's MORAL about mammogram policy?

Rosemary Flanigan

November 20, 2009

There’s value and worth under discussion here—and that value and worth are justified by a utilitarian calculus: balancing harms over benefits. But there is no objective “harm” or “benefit” in utilitarianism. When it comes to mammograms, women in their 40’s might well determine “worth” and “value” differently.

To increase our awareness of how much of our lives are shot through with moral considerations—and how much we should be open to questioning the justification for those judgments or policies or habits that stream along with us—is a hallmark of ethical reflection.

I think of the bundles of institutional “habits” or policies that make up a healthcare organization. We assume that 98% of them can be justified—and we’d never get any work done if we were reviewing them all the time.

But that “ethical component” is integral to the “character” of the entire institution.

The Cultural Politics of Disease

Keith Wailoo is the Director of the Center for Race and Ethnicity at Rutgers University and author of acclaimed books examining the cultural politics of disease in America.

In this edition of The Bioethics Channel, Dr. Wailoo explains the different cultural and clinical responses to diseases like Tay-Sachs and sickle cell anemia.

Link: Podcast, The Cultural Politics of Disease, 10 minutes 24 seconds