Dying Shouldn’t Be So Brutal

Dr Ira Byock, a well-known advocate for palliative care for the dying, has recently taken a strong position that it is time for citizens to begin to protest the failure to make death with dignity a central political theme for advocacy.  I think his view reflects some of his frustration with the slow progress made by the medical profession thus far. He also voices a concern over the growing movement for assisted suicide an act he staunchly opposes.

It would be best if we didn’t need assisted suicide but the medical profession and medical schools have failed to focus on helping patients deal honestly and openly with impending death.  Several recent books and articles have detailed horrific end of life experiences and advocated the need for change.

Buttressing this concern, a recent study found that the pain and suffering at end of life has actually gotten worse over the last ten years. If this is not a call to action, then what will it take?

Inadequate communication may be at the heart of the issue. Physicians vary in their ability to communicate about end of life and patients and their families are often no better as they are struggling with the emotion of losing a loved one. A recent PBS Frontline program entitled “Being Mortal” based on Atul Gawande’s recently published book of the same name addresses the difficulties doctors, patients, and families have in addressing this issue.

While it would be easy to blame physicians for not being a better communicators, medical schools often provide little to no training in communication.  Instead, training focuses on scientific knowledge, research, technical methodological skill acquisition, and most importantly – preserving life. In watching Being Mortal, even the best efforts of doctors to communicate feelings lacked much depth and exploration.

An  ideal would be a palliative care team that included  social worker, family therapist, or psychologist – professionals better trained in communication skills – to assist doctors in interfacing with families  when treatments fail and there appears to be little hope


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