Death is not something that's easy to talk about.
And according to Dr. Ira Byock, director of Palliative Medicine at Dartmouth-Hitchcock Medical Center in New Hampshire, it's not something that the medical profession deals with very well. He says often when someone is being treated at the end of their lives, doctors and others act like death is something that could be avoided altogether.
"There is this quest to keep people alive as long as possible," Byock told Think Out Loud's Allison Frost. "People often say 'I just don’t feel ready to die' and our response as a health system, and frankly as a culture is, 'Well, if you don't feel ready, we're going to find something else to do to keep you alive longer.' And in that frame of mind, hospice is often looked at with suspicion."
In his latest book, The Best Care Possible, Ira Byock argues for a system that includes palliative care as a means to improve quality of life for patients near the end of their lives.
"For many people who are facing the end of life, hospice represents, really, better care. The data now is pretty clear that hospice care for people's comfort and quality of life not only improves their experience, their quality of life, but also helps them live longer," said Byock. "It's so ironic that if you withhold hospice, and by extension palliative care, and focus solely on disease treatment, people don't end up living any longer, they just end up living harder."
According to Byock, palliative care, which is his specialty, represents the bridge between disease treatment and end of life care.
"Palliative care has been a way to bring the inter-disciplinary, team-based, whole person, whole family model upstream in the healthcare system, concurrent with disease treatments," explained Byock. "So our team at Dartmouth-Hitchcock Medical Center in New Hampshire work right alongside the hospital medicine doctors, the oncologists, and increasingly the critical care doctors in the ICU helping people go through these arduous courses of treatment, helping them make these wrenching decisions and play the cards that they are dealt as well as they can be played."
Within our current system of health care, however, patients are generally able to pursue treatment or end-of-life care, but not both at the same time. Byock argued that the American model of either disease treatment or hospice care is not based on providing better care, but rather is imposed by Congress. So what steps does he think Congress should take to improve the culture of end of life care?
"Starting with Medicare, get rid of the arbitrary and really nonsensical forced choice, that forces people who have serious advanced illness and complex medical needs to give up treatment for their disease to get hospice care," suggested Byock.
Overall, Byock said that changing the culture around end of life care is possible, and added, "In redesigning how we care for people through the end of life, we will find we have more than enough money in the health care system today. What we have to do is use it in ways that give us an adequate return on our investment."