[senior citizen]

Originally Posted by Quixote

IMHO, if the crux of this issue can be summed up in one sentence, it is this one (quoted from the article):

“The U.S. medical system was built to treat anything that might be treatable, at any stage of life—even near the end, when there is no hope of a cure, and when the patient, if fully informed, might prefer quality time and relative normalcy to all-out intervention.”

I would suggest that anyone with serious concern about this subject read On Death and Dying by Elisabeth Kübler-Ross, written several decades ago. Most people remotely familiar with this seminal work remember it for her description (or definition) of the five stages of dying. However, as a Swiss psychiatrist married to an American doctor and doing her residency in Chicago back in the 1960s, she was deeply troubled by what she saw as a death-denying society in her adopted country, not just by Americans in general but by their doctors as well.

Too many—both the lay public and their doctors—saw a death as a failure, rather than as part of the natural course of living and dying, and this attitude is what Dr. Kübler-Ross sought to change in a world of 36-hour shifts for resident physicians and a highly over-structured program that medical training was like in those days, according to her. (She was my friend and mentor, both in everyday life and in my efforts, along with the efforts of countless others of like thinking, at making hospice care an integral part of the American medical scene, which without doubt it is today—but wasn't not that long ago.) According to her, she experienced some success in this goal to the point that most if not all medical colleges in the U.S. now require coursework dealing with the dying patient and his or her family.

It is extremely difficult, particularly when dealing with a younger dying person, to stand back, look at the treatment options realistically and dispassionately, and recognize when enough is enough. Unlike Dr. Volandes’ patients with advanced dementia, dying patients of all ages who are clear in their thinking really need to be listened to in terms of what they want, which may be different from the so-called “heroic efforts” represented by the quote above. And they need to be listened to by their loved ones and by their doctors—and this is more than simply signing a Living Will! I could tell you stories….

It’s my understanding that Dr. Volandes (like Dr. Kübler-Ross before him) is not suggesting withholding treatment of a dying person but rather recognizing what treatments are fruitless and unnecessary at best—and (pardon the word) torturous at worst—and giving the patient and his or her family members some clearly presented information in lay terms which may help them make more educated (for lack of a better word) end-of-life decisions. The suggestion in the commentary that follows the article about making his simply presented videos freely available in a venue like YouTube (where just about anything can be found!) makes so much sense. Why not take advantage of contemporary technology?

I am delighted and relieved to learn about the efforts of this insightful young doctor and to see, IMHO, the continuation of the efforts begun in the U.S. by Dr. Kübler-Ross and followed by others. “Quality of dying/death” can be just as important as “quality of life,” both phrases and concepts that cannot be overused!

Excellent post. I am familiar with the work of Dr. Elisabeth Kubler Ross.