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Talking About Dying

Death may be the only certainty in life, but that doesn’t mean that the end of life isn’t fraught with uncertainty as the dying and their loved ones slog through the quagmire of ethical, emotional, and financial issues that have become increasingly complex over the years.

On Thursday, March 29, Ira Byock, MD, one of the foremost palliative care physicians and a leader in the hospice movement, presented a free community lecture on how to navigate that end-of-life stage, based on his recently published book, The Best Care Possible: A Physician’s Quest to Transform Care Through the End of Life. The talk was sponsored by Hospice of the Valley and Santa Clara University Department of Counseling Psychology.
His goal was to spark a conversation of how people want to live out the final chapter of their lives. As he commented in his book, “Death is the natural disaster that awaits us all. Instead of bringing people together in a common purpose, how we die has become a polarizing subject, rife with acrimony and righteous indignation.”
Advances in medical care ironically mean that dying is a lot more difficult than it used to be. People live with more chronic conditions and consequently tend to suffer more at the end of life than in previous times. “Knowing what to expect, what to demand, and what limitations to accept can lessen the burdens of illness and caregiving,” Byock wrote.
In general, he noted in a recent interview with SCU, Americans just don’t want to talk about death, which “doesn’t prevent dying,” he said. “It just means we’re less prepared when it happens. And often it happens in ways that we would not have wanted.”
Dale Larson, a professor in the department of counseling psychology and coordinator of the event, echoed that sentiment. “Death is more than a medical event. It’s a human experience,” he said. “Seventy-five percent of Americans say they want to die at home, but in fact, 75 percent don’t. That’s a startling statistic.”
Loved ones often grasp at desperate—but futile—medical interventions to stave off the anticipatory regret of not having done “everything” possible for their family members. Larson hoped that by attending the lecture, people would become more active, empowered consumers and “know that there are options at that point in our lives. We can achieve a better, rather than a less favorable, outcome for ourselves or our loved ones.”
Byock and Larson both presented talks the day after the public lecture at the fifth annual Compassion in Action Conference for professionals in the end-of-life community such as physicians, nurses, and counselors. The aim of the conference was to empower end-of-life professionals with the latest thinking in the field, to enable them to network with each other, and to allow them to return to their work with new skills and new enthusiasm. “Those of us in hospice, palliative care, and related disciplines really have an important role to play, a responsibility,” Byock said about transforming the quality of end-of-life care. But he stressed that patients and their families need to be engaged and savvy as well. “We can’t do it alone. This has to be a social and cultural exercise.”


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