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Thoughts on Frontline's Facing Death

questionI came away from PBS's Frontline episode from November 23rd, "Facing Death", with mixed feelings. Like most people I found discussing the episode online, I was impressed by the generosity of the doctors, patients and families for allowing Frontline to keep their cameras trained on them during these excruciating and highly personal moments. Programs such as these need to stay in the limelight and continue to call attention to the necessity for all of us to have discussions with our loved ones to ensure our end-of-life care is what we want.

But what I found frustrating when I watched the program was the treatment of death as an enemy to be conquered—even at the cost of a denigrated quality of life. The often repeated refrains throughout the episode were 'there was always something to do' or 'we can't stop treatment'. Though the words "hospice" or "palliative" were rarely mentioned throughout the program, I got the feeling that enrolling in hospice or palliative care would have been considered "doing nothing" or "giving up".

I concede the focus of this episode was not on hospice or palliative care, but perhaps the absence of concurrent palliative care when treating people with terminal or life-threatening illnesses is part of the problem. As noted in a recent study published in The New England Journal of Medicine, terminally ill patients assigned to receive early palliative care had a better quality of life, fewer depressive symptoms, received less-aggressive end-of-life care, and (here's the kicker) lived longer. Another study in the Journal of Clinical Oncology found patients had a much better quality of life when they died at home with hospice and their families were less likely to be at risk for post-traumatic stress disorder if their loved one didn't die in the ICU.

Perhaps a broader medical team is needed when a person is faced with a terminal illness. In addition to the aggressive-treatment bone marrow transplant team, the health care professionals could also include doctors who specialize in palliative care and have more training on how to talk to a person about death and dying. With a more diverse group of medical professionals the patients and their families could hear and better understand all the options and possible outcomes.

In the words of Judith Nelson, a palliative and critical care doctor interviewed in the show:

Nobody wants to die. And at the same time nobody wants to die badly. And that is my job. My job is to try to prevent people from dying if there is a possible way to do it that will preserve a quality of life that's acceptable to them. But if they can't go on, to try to make the death a good death.

If they're given all of the data points from a diverse group of specialists, patients would be better able to make more informed decisions while they're still able to express their desires. More detaled information—such as the success rates of certain procedures, what life will be like if the patient doesn't beat the odds after they go through the procedure, and what other care options are available that work along side curative treatments or therapies that shift toward comfort care—would empower patients to make the best decisions for themselves. By getting a more complete picture of all the options, the majority of Americans would hopefully achieve what we all wish for at end-of-life: a peaceful death at home surrounded by their loved ones celebrating a life well lived.

Did you watch "Facing Death"? It's not too late; the full episode is available online. I'd love to hear your thoughts after watching the program.

Posted on December 2, 2010 in The Arts

Comments

  • Posted by rob jonquiere on Friday, December 03 at 08:02 a.m.

    In my opinion a typical hospital attitude: very caring and friendly and even with good attitude towards the patient, but indeed mainly talking about "what can we do", forgetting that accepting the end and look after a peaceful dying proces (which is doing a lot by the way!) is better fitting to have a dignified death.

    A comment / addition from the Netherlands. Of all terminally ill patients asking euthanasia (legal in NL) more than 30% "survive" longer after complying with a request and even die without utilizing the promised assistance!! It is thus important to talk as long before the end of life as possible about the dying process in general: about what could be expected and what alternatives or choices there are. So, at least in places where that is possible, next to palliative care also physician assistance with the dying should be discussed.
    Example from my own experience as GP: a former head nurse, confronted with the verdict of a terminal ovarian carcinoma asked me for euthanasia and precisely described the situation (she was a professional!) in which she wanted the euthanasia to be performed. In the course of time she shifted this limit more than 3 times, finally dying with euthanasia, 3 month's later than the moment she at first wanted it to be done. And - most important, died with a smile on her face after having told me she was happy this last period, notwithstanding the severe progress of her illnes.

  • Posted by Melissa Barber on Friday, December 03 at 11:47 a.m.

    Great to hear from you, Rob! You couldn't be more right that preparing for one's death to ensure a peaceful dying process is far from 'doing nothing'. I absolutely agree these discussions need happen early (we should all have these conversations with our loved ones right now) and include the option of hastened death in states or countries where it's legal.

    While we advocate for physician-assisted death which requires patients to be able to acknowledge they are self-administering the medication to hasten their deaths, I appreciate hearing your personal experience about your patient who decided to legally hasten her own death.

    Thanks again for commenting!
    Melissa

    Melissa Barber
    Electronic Communications Specialist
    Death with Dignity National Center

  • Posted by Bill Pieper on Wednesday, December 08 at 07:36 p.m.

    It's not just Frontline that deals with this issue, although too few mainstream outlets do. There's a brand new novel that does too, and in a serious way. Here's a link to it.
    http://www.amazon.com/s/ref=nb_sb_noss?url=search-alias%3Dstripbooks&field-keywords=Bill+Pieper+W...

  • Posted by Barbara on Monday, December 13 at 04:43 a.m.

    Thank you so much for saying this. After the program I was left with such a sad and angry feeling because, despite their kindness, I didn't think the professionals did enough but I wasn't sure what they could have done differently (I'm not a healthcare professional). Now I realize having a broader medical team with palliative specialists is the answer. Your article should be published on the Frontline website. Too many people are getting the wrong impression.

  • Posted by Melissa Barber on Monday, December 20 at 09:39 a.m.

    Sorry for my delayed response, Bill and Barbara, and thank you for keeping the conversation going and words of encouragement.

    Thanks again for commenting!
    Melissa

    Melissa Barber
    Electronic Communications Specialist
    Death with Dignity National Center

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