End of life can be meaningful

April 29 2013

Georgetown University Medical Centre News: What happens when a physician bioethicist, a moral theory ethics scholar and a Jesuit priest scientist and bioethicist get together to talk about death?

A fascinating discussion with the conclusion that death is not a battle to be fought and won but that death is a natural human health process enhanced by planning, communication and one’s own enduring ethical value.

The event was a community education panel titled “Living and Leaving with Dignity: The Vital Role of Bioethics in Clinical Care.”

One speaker suggested that while dying was never going to be fun, it could still be loving, meaningful and richly textured.

However another speak also emphasised that conversations about end-of-life wishes need to start before the crisis begins. Read more here.


Five misconceptions about palliative care

April 28, 2013

HuffPost: To most people, ‘palliative care’ equates to ‘giving up’. It’s a misconception that continues to plague this relatively young but vitally important area of medicine.

Palliative care is unique as a speciality in that it focuses on the patient as a whole person, rather than simply looking at their disease or condition, and also because it includes the patient’s family and friends in its approach.

This holistic caring enables palliative care to not only address a patient’s physical needs and symptoms, but also their social, psychological and spiritual needs.

Access to palliative care services, whether in a hospital, hospice or at home, can make a significant difference to the life of the terminally ill, and the lives of those around them, so much so that in this excellent article, Dr Richard W. Besdine argues that palliative care should be made available to everyone.

Dr Besdine addresses five key misconceptions about palliative care:

– Misconception #1: If you accept palliative care, you must stop other treatments.

– Misconception #2: Palliative care is the same as hospice.

– Misconception #3: Electing palliative care means you are giving up.

– Misconception #4: Palliative care shortens life expectancy.

– Misconception #5: There isn’t much need for a palliative care consultation because my doctor will address my pain anyway.

Read more here.


Bringing people back from the dead

14 April 2013

The Guardian: American intensive care specialist Dr Sam Parnia has a miraculous reputation as the man who brings people back from the dead.

In the average American hospital, the chance of successfully being resuscitated after a cardiac arrest is around 16%. However in Dr Parnia’s emergency room at the Stony Brook University Hospital in New York, that figure is as high as 33%.

Dr Parnia claims the ‘cheap and straightforward’ methods he uses to resuscitate patients – some of whom have been clinically dead for hours – could save up to 40,000 lives in America each year.

The technique, called extracorporeal membrane oxygenation, or ECMO, involves siphoning out blood from the body of the ‘dead’ person, reoxygenating and warming it, then pumping it back in again. The idea is that it maintains blood oxygen levels just high enough to preserve the brain and vital organs while doctors attempt to fix the cause of the cardiac arrest.

He has written about his experiences in a new book The Lazarus Effect, in which Parnia also muses on the nature of life and death. Read more here.


Mobile phones to carry end-of-life wishes

14 April 2013

The Conversation: One of the issues with advance care directives is them not reaching the attention of the right people at the right time. Someone may record their end-of-life wishes ahead of time, and notify their family or GP, but if they happen to end up in hospital with neither of those parties present and unable to communicate their wishes, their planning is wasted.

One solution proposed by a number of experts interviewed by The Conversation is for advance care directives to be recorded electronically on mobile phones, perhaps using some kind of specially-designed app that can be accessed by medical staff. Read more here.


Near-death experiences: realer than real?

5 April 2013

PLoS One: People’s memories of near-death experiences bear all the hallmarks of memories of ‘real’ events as opposed to memories of imagined events, a study has found.

Researchers interviewed a group of 21 coma survivors who reported having a near-death experience and compared their memories of their near-death experience with their memories of real and imagined past events in their life. The aim was to see if the memories of their near-death experience were more like memories of the real past event, or memories of the imagined past event.

They found that people’s memories of near-death experiences were much more detailed than even their memories of real past events, suggested they had experienced their near-death experience as if it were a ‘real’ event.

“In our opinion, the presented data demonstrate that NDEs cannot be considered as imagined events,” the researchers wrote.

“Memories of imagined events have been shown to contain less phenomenological characteristics than memories of real events,” wrote the study’s authors. “Indeed, several studies  have shown that memories of imagined events contain less perceptual (i.e., visual, auditory, gustatory and olfactory sensations), temporal and spatial details, and emotional information.”

The researchers were careful to point out that the study was not proof that near-death experiences were ‘real’.

“We rather propose that the physiological origins of NDEs lead them to be really perceived although not lived in reality.”

Read the study here and an article about the research here.


Fewer people dying in US hospitals

1 April 2013

Centres for Disease Control and Prevention: While the number of people hospitalised in the US has increased by 11% over the past decade, fewer people are dying in hospital, according to a new report from the US Centres for Disease Control and Prevention.

The number of inpatient hospital deaths decreased 8% from 776,000 in 2000 to 715,000 in 2010, and much of the decrease was in women rather than men.

Deaths from respiratory failure, kidney disease, cancer, stroke, pneumonia and heart disease all decreased, however there was a 17% increase in deaths from septicaemia (blood poisoning).

For more information, see the full report here.


Suicide – a legitimate end-of-life option?

29 March 2013

From The Washington Times Communities, 28 March 2013:

Suicide is a tragic waste. There is no way to reconcile the loss of a life cut short by misery, leaving behind desperate questions , recriminations and grief. But what if the person contemplating suicide is doing so because they are nearing the end of their life – whether through illness or old age – and do not want to be drawn into the healthcare system or leave their family with the burden of enormous healthcare costs?

But for some people, suicide is the lesser of several evils. Several countries and states (Switzerland, Luxembourg and the US states of Oregon and Washington) recognise this and have enshrined in law the rights of the terminally ill to be helped to end their own lives.

This article by Julia Goralka describes the mindset of her aged friend Mary, who is contemplating just such a scenario. It’s a thought-provoking scenario to confront, especially in an age when suicide ruins the lives of so many families and when medical interventions can have such a significant impact on quality of life that it seems almost churlish to reject that option. Read the article here.


To CPR or not to CPR … that is the question

23 March 2013

There has been much discussion of CPR – cardiopulmonary resuscitation – in the US media this week following the news that an elderly women in a nursing home had died after a nurse refused to perform CPR on her.

The woman, aged 87, was a resident of an independent living facility with a policy to not perform CPR in medical emergencies. While there was initial outcry about the woman being left to die, it has since emerged that she had told her family that she wished to “die naturally … without any life-prolonging intervention.”

As Dr Jennifer Black, a physician in the town where this took place, has written in this very excellent article, the chance that CPR would have been of much benefit for such an elderly woman is also debatable. As Dr Black writes, CPR is often a brutal, desperate measure that generally has pretty poor odds of success. Yet thanks to television shows such as ER and Chicago Hope, we are given the impression that CPR is almost a guarantee of return to life.

Another article by Dr David Dosa, associate professor of medicine and health services, policy and practice at Brown University, uses the events of Bakersfield to illustrate the importance of documenting one’s end of life wishes. Read it here.


The Conversation Project

6 March 2013

Want to have THAT conversation about death with your loved ones, but don’t really know where or how to start it? You’re not the only one. According to not-for-profit organisation The Conversation, 60% of people  say they don’t want to burden their family with tough decisions, but less than half have communicated their end-of-life wishes to their family.

The Conversation Starter Kit – an initiative of The Conversation – can help. It’s a kit designed to help people start the all-important conversation with loved ones and their doctor about their end-of-life preferences.

The starter kit came about after a group of concerned doctors, media and clergy got together in 2010 to talk about what death could be and share their experiences of good deaths and bad deaths. This meeting spawned a grassroots public movement, with the goal of making it easier for people to start conversations about dying, and encouraging people to talk as often as need be to ensure that their wishes are known when the time comes.

Find out more at The Conversation website.


The hardest conversation of all

23 February 2013

Life Matters, ABC Radio National: We’re not very good at talking about death, especially our own. But it’s perhaps one of the most important conversations we can have with our loved ones – a conversation that is unfortunately often left until the last possible minute and sometimes, until it’s too late. Radio National’s Natasha Mitchell talks death and end-of-life conversations with Professor Dale Larson from Santa Clare University, and singer/songwriter Tansy Mayhew. Listen here.


Coffee, cake and death

20 February 2013

There used to be a time when we would do anything to avoid talking or thinking about our own death. But as awareness grows of the importance of end-of-life choices, a group of people in the US have started a movement that encourages people to get together talk about death – Death Cafe.

The objective of Death Cafe is “To increase awareness of death with a view to helping people make the most of their (finite) lives”. The events are hosted and mediated to encourage the flow of discussion but

The first Death Cafe was held by Jon Underwood in September 2011 in a basement in London, inspired by pop-up ‘cafe mortals’ that had been run in Switzerland for many years by sociologist Bernard Crettaz. Since then, the Death Cafe movement has spread around the world. Visit their website for more information.


The Bitter End – how doctors choose to die

20 February 2013

Radiolab: At the end of life, as it is all the way through, we trust doctors to make judgements on our behalf about what is the best course of treatment or the best approach to take. But have you ever wondered what decisions doctors would make if they found themselves in the same position?

In this episode of Radiolab, the team explore what choices doctors would make at the end of life and how these compare to what they would recommend for their patients. The results may surprise you.

For example, the majority of doctors would choose to avoid interventions such cardiopulmonary resuscitation (CPR) but most would opt for pain relief that would relieve their symptoms but potentially also hasten their demise.

Listen to or download the full episode here.

Latest news

At 2013 Festival of Dangerous Ideas, Dr David Celermajer, Dr Peter Saul and The End author Bianca Nogrady dissected, diagnosed and debated death in an attempt to work out where we went wrong with death and how we might be able to fix it. Watch it here.

Death: what are your choices

Death is a lot like birth. Sometimes it's a peaceful, even beautiful event that goes according to plan. Sometimes it's a horrible bloody mess that is utterly beyond all control. Most of the time, it's a bit of both. We have this idea that death is something that just happens to us. It's true, you will, at some point, die, and that is not subject to negotiation with any earthly power. But that doesn't mean that we are powerless in the face of death. Some of us can actually have a lot of say in the kind of death we have. Read more.