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: Why is end-of-life care neglected by the medical profession?
Ira Byock: Medicine is practiced today problem-based box, medicine is built around the twin human problems of injury and illness, and the goals of medicine by and large are cure, restoration of function, life prolongation if cure is not possible, and relief of suffering, which is usually secondary to the others, which is fine, and it generally woks well, though the problem is that dying happens at some point that research continues to show that a 100% of Americans eventually die.
And so while we can strive toward prolonging life and saving life, we are inevitably faced with one of those times where its either simply not appropriate or even though the attempt might be appropriate, it doesn’t work. We haven't in medicine integrated the fact of dying and a tension to the quality of care and quality of life of someone in their dying into our principal goals or top priority goals, and I have to say though that medicine is not totally at fault, because medicine in its almost single-minded striving to prolong life, really reflects and advances our culture’s value – excuse me, really reflects and advances are culture’s focus, and that is on life at all cost and avoiding death really at all cost.
Recorded on: March 21, 2008