How to Die Well

Question: What are healthy ways of dealing with the dying \r\nprocess? 

Patricia Bloom: What has been true to too a \r\ngreat extent to conventional medicine—in this country, and I think in a \r\nlot of places—is that death is seen as the ultimate failure against \r\nwhich you fight with big guns all the way to the end. And we see that \r\nfor a lot of people that’s not appropriate. I don't know what the \r\nexperience was with the author's friend, but for many people, it becomes\r\n appropriate at a certain point that is most appropriately determined by\r\n that person themselves, or in conjunction with their loved ones and \r\nunder the advisement of the medical profession when to make the \r\ntransition away from the aggressive interventions and go more for \r\nquality of life, dignity, having a peaceful death. 

But I think a\r\n really important point is that that line is different for every person.\r\n There was just an article on the front page of The New York Times the \r\nother day about a patient who was at Mt. Sinai and was one of the \r\npatients of one of our palliative medicine doctors, and the patient \r\nherself was a palliative medicine doctor. That is what was so \r\ninteresting. And she herself, although she had been involved in the \r\nfield of helping people make that transition... she herself found that \r\nshe had to fight, to keep fighting for herself. She continued to pursue \r\naggressive therapy up pretty close to the end, and so the important \r\npoint was that that was her individual decision. 

And so what \r\nsome people might have taken away from the article was, "Well here was a\r\n palliative medicine doctor who wasn’t doing what she preached." That \r\nreally wasn’t the message. It was the message that for every person, \r\nthey should be empowered to make the right choices based on their \r\npersonal preferences. But they should... I think it’s the role of people\r\n who are interested in seeing the experience of dying changed to a much,\r\n you know, better death. That’s a question: "Is there such a good thing \r\nas a good death?" And I think, yes, I have seen good deaths, and I think\r\n there can be much better deaths for a lot of people. So we have a long \r\nway to go, even relieving pain and suffering. We don’t do a good job of \r\nthat. So, this woman’s friend, she may not have had adequate treatment \r\nof her pain. As the medical profession, we frequently fail in that \r\nregard. So, we really need to improve on people’s knowledge about and \r\nability to relieve pain and that would change the face of dying as well.\r\n I think a lot of patients—and there’s great interest in assisted \r\nsuicide, and that’s a whole big area of discussion. But it would \r\nprobably be true that for a lot of patients who were interested in \r\nassisted suicide, maybe the point of that decision would change if they \r\nhad better treatment. If they were more comfortable with the process \r\nthat they were going through. 

Recorded on April 14, 2010

If terminal patients were made more comfortable with the process they're going through, perhaps fewer would be interested in assisted suicide.

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