Dying Well

Recently I heard an interview with Ira Byock on the occasion of his new book, The Best Care Possible.    Dr. Byock, a professor at the Dartmouth Medical School and the director of the Palliative Care Service at the Dartmouth-Hitchcock Medical Center, spoke of the distressing state of end-of-life care in America, where advances in medical technology often prolong life at the expense of its quality.

When our loved ones are terminally ill, we want the best care possible for them.  But the best care must take into account patients’ preferences and their quality of life.  Hospice care, stated Dr. Byock, helps people live longer and more comfortably than aggressive treatment at the end of life.

There’s something worse than death, he said, and that’s dying badly.   But alas, patients often do die badly, hooked up to machines or subjected to operations and procedures that offer no hope of recovery but only prolong suffering.  Although most people prefer to die at home, in New York City 20% die in an intensive care unit and half die in a hospital.  Dying badly results from our unwillingness to acknowledge our mortality, which leads to our not telling our loved ones our preferences for end of life care, and from the medical profession’s fixation on the disease rather than the patient.  We need a revolution in attitudes so that fewer people will die badly and more will die gently.

Unlike Dylan Thomas, I hope to go gentle into that good night and not to burn and rave at close of day.