Dr. Ira Brock, interviewed by USA Today, dispels some of the myths about hospice and describes its importance, along with its medical, psychological, and spiritual benefits. Dr. Karen Wyatt also weighs in to advocate for more palliative care and hospice:
Medical advances help people live longer and longer, but too few physicians help people understand that longer is not always better, according to two new books.
Dr. Ira Byock MD counsels patient David Plant and wife Bette Jean Plant. Most doctors have been trained to treat diseases and not deal with end-of-life issues, according to Byock.
Ira Byock says he wants "to raise people's expectations" about the end of life and to to change the conversation about dying in America about dying.
"It's not easy to die well in modern times," says Byock, director of palliative medicine at Dartmouth-Hitchcock Medical Center in Lebanon, N.H., and author of The Best Care Possible, a Physician's Quest to Transform Care Through the End Of Life.
Karen Wyatt, physician and author of What Really Matters, 7 Lessons for Living from the Stories of the Dying, describes a "horrifying night" she experienced as a resident at a hospital.
"A man came into the hospital and his heart arrested fives times in the course of the night," she says. "We resuscitated him four times before he finally died with us pounding on his chest. It was so sad, and what makes me so passionate about hospice care, where people can die very comfortably at home with their loved ones around them."
Byock says the needless suffering at the end of life is partly a result of a current political climate that accuses palliative care doctors and hospice physicians of promoting a "culture of death" or "death panels." Rather, he writes, he is one of the compassionate experts who are "pro-life" and insist people get the best care possible — basically what they want for themselves — and no extra care.
"Most doctors have been trained to treat diseases and not deal with end-of-life issues," he says. "American medical prowess is wonderful, but we have yet to make a person immortal. At some point, more disease treatment is not better care."
People have to think about quality of life but also quality of death, he says, adding that it's important that doctors don't give up too soon on someone while also knowing the limitations of treatment.
"I think physicians have really fallen short on that obligation," says Wyatt. "They haven't been as helpful to patients as they could have been."
Byock writes that throughout the ages people have held common fundamental values: to live as long and as well as possible, and eventually, to die gently. In his book, he shares poignant, complex conversations he has had with families and patients about knowing when to say "enough is enough," and letting health care professionals help keep a dying person comfortable with medications.
Additionally, he calls for changes in how doctors are educated (most medical schools do not require hospice or palliative care rotations, he notes) and changes in letting patients guide their own care at the end of life — Medicare and Medicaid, for instance, don't allow older people to have hospice care until they drop medical treatments.
Wyatt says her goals are to help people learn how to live and to face death. She offers spiritual lessons she learned while director of a hospice program in Ogden, Utah, from 1992 to 1999. One lesson centers on impermanence.
"Everything around us is going to have an end," she says. "Once we know that, as the dying person does, we savor life more, instead of focusing on what will happen down the road. It can be such a peaceful, beautiful passing."
