Byock, director of palliative medicine at Dartmouth-Hitchcock Medical Center in Lebanon, N.H.,? is the author of "The Best Care Possible: A Physician's Quest to Transform Care Through the End of Life" (Avery, $26, 336 pages).? He'll speak in Eugene and Portland as part of Oregon Humanities' Tzedek? Professorship in the Humanities.
In a telephone interview Monday, Byock talked about end-of-life care and what the generation that transformed childbirth might accomplish when it comes to death. His comments have been edited for length and clarity.
Q: Oregon's POLST program has been copied by more than a dozen states and is under consideration in two dozen more. About 88,000? Oregonians have these orders on file, and physician assisted suicide is legal here. Are we ahead of the problem?
A: Oregon has done some good things that are at the leading edge of care, but I wouldn't count legalized suicide among them, frankly. POLST is certainly there, and Oregon hospice programs perform well, compared to the nation.
But as a whole, we continue to be seriously challenged. The large majority of people would like to die at home, surrounded by people they know and love. They want to die gently. But 20 percent of Americans die after an illness that requires an ICU (intensive care unit) stay. Over 50 percent still die in hospitals. Where nursing home use is low, hospital use tends to be high and revolves around the 70 percent figure.
Oregon does better than most, but it's a long way from what is considered optimal.
2012-13 Tzedek Professorship in the Humanities
Who: Dr. Ira Byock, director of palliative medicine, Dartmouth-Hitchcock Medical Center
When and where: 7:30 p.m. Thursday, Lillis Hall 282, University of Oregon, Eugene; and 7 p.m. Friday at UO in Portland, White Stag block, 70 N.W. Couch St.
Cost: free; no reservations required
Sponsors: Oregon Humanities, University of Oregon Humanities Center and St. Johns Booksellers
Q: You have written about "fixable problems" with end-of-life care. What are some examples?A: People I meet are worrying about medical bills and going through their families' life savings. We make paupers of people whose loved ones are not dying quickly enough. That is a particularly American source of suffering. I have close relatives in Canada, and it's not that (the problem) doesn't exist there, but here, it is endemic.
Being a family caregiver is almost a diagnosis in its own right. Being in a nursing home is a challenge. In general, the majority of nursing homes are woefully understaffed. They are staffed with the best, most loving, caring and committed people. And they have to be because we underpay them. It is really a disgrace. I think that anyone who really wants to advance the dignity of people facing the end of life would join me in doubling staff-to-resident ratios in nursing homes.
Q: Is now the time to try and change the health care system?
We're at a point in the continued maturation of American society, we're poised to take back this last chapter of human life. When we baby boomers were having babies, we, in essence, took back the beginning of life.
Pregnancy and childbirth were considered medical events. But after the emergence of a social-cultural movement, childbirth became, first and foremost, personal. Initially, there was resistance from the medical establishment. You couldn't have fathers in the delivery room. They'd fall over and hurt themselves. Now we think it's odd if a father isn't in the delivery room.
Q: Americans used to die at home. Why is that so rare these days?
A: People have difficulty getting off work to care for someone who is dying. Family members I meet are working two jobs. And we layer on highly complex care for someone at the end of life.
The power of medicine is wonderful. It's cured so many diseases. Our lives are longer and we live better for it. But it's failed to make one person immortal. People are sicker before they die now. People live with two or three diagnoses, any of which might have killed them before. This is all a good thing, but it is unprecedented.
Q: And we're unprepared for it?
A: We have to also build wholesome, well-supported off ramps. We haven't done that. We still try to die with our boots and makeup on or in the throes of life-saving treatments.
It's time for us, as a society, to grow the rest of the way up. We're like early teens: angry, suspicious of our authorities, reacting in a primitive kind of way. We need a stronger citizen consumer movement.
-- Nancy Haught
Source: http://www.oregonlive.com/living/index.ssf/2013/01/palliative_care_physician_crit.html
weather st louis faceoff kings island red hot chili peppers tour orange juice photos doomsday clock
No comments:
Post a Comment
Note: Only a member of this blog may post a comment.