Monday, November 23, 2009

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

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