We Talk So Much About ‘Natural Birth’—When Can We Discuss Natural Death? | TIME

 "Poised as I am between the beginning and the end of life, I had to ask myself, why do people talk so much about natural birth but not much about natural death? My friends with babies spent inordinate amounts of time discussing how and where to have them. Should they give birth in a hospital or in a kiddie pool? Should they use pain killing drugs or not? Google “natural birth,” and you’ll be treated to YouTube videos of moms popping out kids in the woods, heated debates about homebirth’s merits and dangers, and tons and tons of books, blogs, and so on. A Google search on “natural death” doesn’t turn up much. Searching “hospice” brings up boilerplate readings, more about spiritual advice than concrete decision-making about end of life care."

We Talk So Much About ‘Natural Birth’—When Can We Discuss Natural Death? | TIME

90-year-old foregoes chemo for trip of a lifetime

In the last months or days, these treatments can make things worse - The Washington Post

"A woman with ovarian cancer who came to see internist Leslie Blackhall was very upset. The woman’s oncologist had told her it was time to discontinue treatment — that it was doing more harm than good. Blackhall knew that the effects of more chemotherapy would be intense and would compromise this patient’s immune system while buying her only a bit more time. So she asked the woman, who was in her 60s, what she would do with more time. The response: Have more chemo, on the chance it might let her live longer. Medical advances bring the promise of extending life, but some of the treatments used in a person’s last months, weeks or days — such as CPR for failing hearts, dialysis for failing kidneys and feeding tubes for those unable to nourish themselves — often do not provide more time and can worsen quality of life. Yet saying no to more treatment is tremendously hard to do, whether that decision is made by patients or by relatives for patients who are too infirm to express themselves. "


In the last months or days, these treatments can make things worse - The Washington Post

Moderately Good Drama, Definitely Bad EOL Medicine in "Creed" and "The Choice"

Two recent movies highlight the gulf between the dramatic/romantic myths our culture holds onto about end of life issues. [SPOILER ALERTS] In "Creed," the seventh film about Rocky Balboa (Sylvester Stallone), Rocky gets cancer. Initially, he says he does not want treatment. He has done everything he wanted to do, no one is depending on him, and he does not want to go through the miseries he saw his late wife experience. It would be great to see this kind of decision portrayed as rational and legitimate, but in the world of this movie it exists for dramatic purposes, so that Rocky can have another fight -- the fight against cancer.

And in the new Nicholas Sparks movie, "The Choice," a young wife and mother is on life support following a car accident. After months go by without any improvement, all of the medical specialists advise her husband that there is no hope and he should let her die. But he insists on keeping her on life support until magically she wakes up, like Sleeping Beauty, as though nothing had happened. This romantic myth, that true love can bring back someone the doctors say is gone, makes for a great happy ending but what we need is more movies that tell the real story of how families can do a better job of caring for terminally ill people.

Atul Gawande's Late Life: How to Have a Good Life to the End

Dr. Atul Gawande, author of “Being Mortal,” shares his vision of healthcare that helps people live well to the end in "Late Life."

A nurse with fatal breast cancer says end-of-life discussions saved her life - The Washington Post

Amy Berman writes: "I am a nurse, a nationally recognized expert in care of the aged and senior program officer at the John A. Hartford Foundation, which is devoted to improving the care of older people in the United States. Yet my perspective is not simply professional. For, you see, I live with Stage 4 (end-stage) inflammatory breast cancer. And while this metastatic cancer will one day kill me, the advanced-care planning conversations I have had with my health-care team have been lifesaving since my diagnosis.



I use the word “lifesaving” advisedly because that is what these conversations are truly about. When done well, they can shape care in ways that give people with serious illness a chance at getting the best life possible. This kind of conversation initially helped my care team understand what was important to me and helped clarify my goals of care. Faced with an incurable disease and a prognosis where only 11 to 20 percent survive to five years and there is no statistic for 10-year survival because it so rarely happens, I came to understand that my priority was to seek a “Niagara Falls trajectory” — to feel as well as possible for as long as possible, until I quickly go over the precipice. Quality of life is more important to me than quantity of days, if they are miserable days....



All people deserve care that meets their emotional and financial needs. Unfortunately, health-care providers, including those paid by Medicare, have not had the incentives, time or training to sit down with people facing a life-threatening illness and discuss what’s important to us as our health deteriorates, things such as where we want to die (I want to be at home), what’s most important (control my pain) and what treatments we want to avoid (I don’t want to be on life support and don’t want to be resuscitated). As a result, our system provides a lot of expensive crisis care as people reach the end of life — care that people, if asked and engaged, might say they never wanted."





A nurse with fatal breast cancer says end-of-life discussions saved her life - The Washington Post

George Will on Slow Medicine and Giving EOL Patients Dignity and Autonomy

George Will writes:

Almost 30 percent of Medicare expenditures are for patients in the last six months of life and about 16 percent of patients die in, or soon after leaving, intensive care units. Financial reasons should not be decisive in setting end-of-life policy, but Cederquist notes that reducing “expensive and inappropriate care” — costly and agonizing resistance to imminent death — “is the lowest-tech thing we can do in medicine.” Hence the importance of “slow medicine geriatrics,” avoiding a “rush to those interventions that build on each other” and thereby enmesh doctors and patients in ethical conundrums. The American Medical Association remains opposed to physician assistance in dying; the California Medical Association has moved from opposition to neutrality. Litigation has been unsuccessful in seeking judicial affirmation of a right that California’s legislature should establish. Legislation to do this has been authored by Assemblywoman Susan Eggman, chair of the Democratic caucus. ... Jennifer Glass, a Californian who died Aug. 11, drew one. She said to her state legislators, “I’m doing everything I can to extend my life. No one should have the right to prolong my death.” The Economist reports that in the 17 years under Oregon’s pioneering 1997 law, just 1,327 people have received prescriptions for lethal medications — about 74 a year — and one-third of those did not use them. Possessing the option was sufficient reassurance. There is nobility in suffering bravely borne, but also in affirming at the end the distinctive human dignity of autonomous choice. Brittany Maynard, who chose to be with loved ones when she self-administered her lethal medications, was asleep in five minutes and soon dead.