Ira Byock, MD is Director of Palliative Medicine at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire and a Professor of Anesthesiology and Community & Family Medicine at Dartmouth Medical School.
Dr. Byock has authored numerous articles on the ethics and practice of hospice, palliative and end-of-life care. His first book, Dying Well, (1997) has become a standard in the field. His most recent book, The Four Things That Matter Most, (2004) is used as a counseling tool widely by palliative care and hospice programs, as well as within pastoral care.
Dr. Byock has been a consistent advocate for the voice and rights of dying patients and their families. He has been the recipient of the National Hospice Organization’s Person of the Year (1995), the National Coalition of Cancer Survivorship’s Natalie Davis Spingarn Writers Award (2000), the American College of CHEST Physicians Roger Bone Memorial Lecture Award (2003) and the Outstanding Colleague Award (2008) of the National Association of Catholic Chaplains.
Question: Are Americans particularly afraid of death?
Ira Byock: Yeah. I think Americans are an epitome of death denial, and I think we contemporaries really are, and again I don’t think it’s our fault, but I think we are the product of our time, and again from the mid 20th century onward, we have been living in this dream of life where you can always get cured, if they can’t do it in your own community by gully you just have to go to a different community and you may have to finally quit smoking or finally start to exercise or finally whatever but there you go, we can do it. And in fact that dream is a thin veneer, and in fact we are still at any point in time, any movement of everyday just a heartbeat away from eternity, and that’s the fact.
I think it’s a phenomenon a side effective of all of the gifts we have been given as in our technological culture and frankly from many of us at least in this wealthy culture of America.
Question: How does the plastic surgery boom play into this?
Ira Byock: Well, I think the plastic surgery and all the Botox and all of it is another part of trying to straighten that veneer that we like to keep between us and mortality. At some point it really becomes absurd, not that all plastic surgery is not absurd, and even cosmetic surgery is fine, all has a role. But I think it can be stretched to extremes, we don’t want to be end up being in a society that looks like the film “Brazil”.
Question: What culture gets dying right?
Ira Byock: I don’t know if one can actually get dying right, I guess when that question is asked, what people in my field often think of is India. The Banaras in India is a city that actually celebrates the end of life, death of people, even the poorest of the poor if they live to be in Banaras and they have money for their funeral pyre, they have succeeded from a deeply Hindu perspective. But, is that right? I don’t know, every culture brings their own values to this.
And, from my prospective as far as the American healthcare system is, if I’m having crushing chest pain in the next few days or hours, I wanted to be in America close to a high-tech interventional hospital, and I don’t think that’s in conflict with acknowledging my mortality and with being prepared. In general though the Buddhist world view has certainly informed many of us in contemporary western culture, including those of us in America, and frankly including of those of us in palliative care and hospice care, the Buddhist for 10,000 years or so have been very deliberately focused on death and the impermanence of life as an organizing factor or organizing feature in life, and not surprisingly over those centuries, they have learned a lot about how to live fully, live wisely with integrity and authenticity, and with the knowledge that death is inevitable.
Recorded on: March 21, 2008