In his article “Letting Go” in the New Yorker, Gawande again weaves a gorgeously rendered thread – this time showing us just how badly we need what those who so badly sought to sabotage health care reform called “death panels.”
In truth, they are the hard conversations that no one wants to have about choice and mortality. The first (choice) is why we founded this country. We fight for it with all our might. The second is what we deny and fight AGAINST with all our might.
Gawande takes us through those conversations and their implications. He picks very hard cases – mostly people under 70. And one case in which a woman had to have her baby first before beginning radical and ongoing cancer treatment. These are heartbreaking cases that the human mind can barely contain – whether one is reading it, or experiencing it directly.
How to move forward in the conundrum of end of life care? The most promising path seems to be to offer BOTH options for treatment and hospice – particularly with Gawande shows us that studies suggest this lowers the cost of care and improves quality of life. It might even extend it.
Gawande did mention dementia, but didn’t use any examples of the dying process in dementia or Alzheimer’s. I wish he had…we so badly need models of how to handle these scenarios.
I was so struck by the human nature to FIGHT. At first it is to fight the diagnosis and prognosis. And sometimes it pays off. But then that fight can turn to fighting the system that prioritizes the prolonging of life and is rewarded by treatment, not quality of life and satisfaction of patients.
My friend and colleague Dan Kuhn pointed me to a guide his chapter of the Alzheimer’s Association has available for FREE – focusing on how to provide comfort care for people in late stages of dementia. Check it out here:
http://www.alzheimers-illinois.org/pti/comfort_care_guide.asp