HORIZONS - Hospice of the Valley

L I V I N G A N D
L E A R N I N G
Excellent end-of-life care critical to individuals’ and nation’s well being
Dying well—pain-free, at
home, with dignity and loving
support—is what most of
us want, said Ira Byock, MD,
one of the nation’s foremost
experts on end-of-life care.
But even now—35 years
after the modern-day hospice
movement began, with
5,000 hospice programs
Ira Byock, MD
nationwide—it’s still not what
most of us get. While surveys
show most people would prefer to die comfortably at
home, about 70 percent die in institutions, with 20
percent of those dying in intensive care units, Byock said.
America has reached a fork in the road about end-oflife
care. Either the nation continues escalating the
expensive “disease-treatment system” that imposes
increasing burdens of illness on people with life-limiting
diseases—threatening to bankrupt Medicare—or
patients should be routinely given the option to die a
natural death at home surrounded by people they love,
Byock said.
“We Baby Boomers need to get back in our game,” he
said. “We transformed the birth process, making it a
personal experience, not a medical event…The same
transformation needs to take place at end of life. It’s
time to take it back.”
Byock spoke May 1 to 225 community physicians and
healthcare leaders at a dinner at the Arizona Biltmore
Resort & Spa sponsored by Hospice of the Valley. Byock
is the author of the recently-released book The Best
Care Possible. He is director of palliative medicine at the
Dartmouth-Hitchcock Medical Center, Lebanon, New
Hampshire, and professor, Dartmouth Medical Center.
Most Medicare spending goes to beneficiaries in their last
year of life, typically for acute care in hospital settings.
Increased utilization of hospice and palliative care would
bring medical practice into alignment with many patients’
goals; it also would reign in healthcare costs.
Byock cited the following barriers:
§ Reluctance to think and talk about death. Patients,
families and doctors don’t want to address the
inevitable, so they continue pursuing treatment.
§ Polarized politics: death squads; “pro-life;” assisted
suicide; rationed healthcare. Political and healthcare
leaders shy from end-of-life issues for fear of
igniting opposition.
§ Either/or choices for Medicare. Currently people
with late-stage chronic illnesses must make a choice
between Medicare coverage for hospice or curative
treatment. The better option would be Medicare
coverage for a continuum of care involving both.
§ Ill-prepared physicians. Most medical schools
don’t prepare physicians for having compassionate
conversations with patients about end-of-life.
The nation’s policy makers need to make macro system
changes, starting with the current reimbursement
system that rewards treatment. Hospices need to offer
more programs such as HOV’s Arizona Palliative Home
Care. Community and political leaders should address
end-of-life care rather than hide from it. Physicians
should love their patients, treating them with the same
TLC that they would a family member, Byock said.
For individuals, Byock offered this poignant advice:
“Get a family.” The family could be neighbors, a faith
community, friends who watch out for each another
or the traditional model. “The best assisted living
arrangement I’ve seen is an old married couple,” he said.
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