Transforming Care at End of Life: A Conversation with Dr. Ira Byock
Levine, Carol, Aging Today
Dr. Ira Byock is a renowned palliative care physician and advocate for patients with advanced illness and their families. He is the director of palliative medicine at Dartmouth-Hitchcock Medical Center in Lebanon, N.H., and the author of 'Dying Well: Peace and Possibilities at the End of Life (Riverhead, 1998) and The Four Things that Matter Most: A Book about Living (Free Press, 2004). His latest book, The Best Care Possible: A Physician's Quest to Transform Care through the End of Life (Avery, 2012), builds a powerful case for compassionate and skillful care through the end of life.
Carol Levine: What is the 'best care possible' in advanced illness? Some people say they want 'everything' and others 'nothing.' Is there consensus about what is best?
Ira Byock: We all want the best care possible. However, every individual is different. There is medical consensus around the appropriate standards to follow in determining the best care for a particular patient. This involves careful consideration of the patient's condition, the available treatments and their side effects, and an in-depth exploration of the patient's preferences. Care that might be appropriate at an early stage of the disease may cause needless suffering at a later stage. There are limits to what is possible.
CL: Why is it so hard to obtain care that meets these standards?
IB: We now have the quality framework for excellence. What we lack is consistency in applying best practices. We also lack 'consumer demand'- that is, patients and families demanding best practices. The barriers to improvement are huge: our death-denying culture, our nation's acute-care system that focuses on diseases rather than whole persons and our financing system that rewards more treatment rather than the best care.
Adding to these longstanding problems, we now have political polarization that stymies rational debate. The apparent chasm between 'pro-lifers' on one hand and 'right-to-diers' on the other creates distractions that only fuel confusion and distrust of physicians among people facing serious illness.
CL: Hospice and palliative care are sometimes portrayed as promoting a 'culture of death.' Yet stories in your book illustrate how hospice and palliative care can work together to manage symptoms and provide sophisticated care that extends life.
IB: Absolutely. Palliative care is pro-life in the truest sense. Unfortunately, patients and their families have so many misunderstandings about hospice and palliative care that they don't even want to consider these options until it is too late to receive the full benefits. …