THE CONVERSATION

Harvard Medical School researcher Volandes, founder of Advance Care Planning Decisions, draws the curtain aside to reveal the painful realities of dying in a hospital setting.

Despite tremendous advances prolonging life, writes the author, “[b]y most accounts, [the] transformation of death from a natural process occurring at home to a medicalized event taking place outside the home has been disastrous.” Volandes explores the options open to patients and their families. Taking examples from his experiences as a physician, he describes how his perspective changed over time and how he has been able to help families make tough end-of-life decisions. Helping patients and their families anticipate their choices is important. Therefore, it is necessary to have an open conversation in advance regarding the alternatives—e.g., painful medical intervention to extend life or palliative treatment to ease a patient's last moments. “Without this open conversation about death,” writes the author, “patients are traumatized needlessly, leaving their families with the emotional scars of witnessing hyper-medicalized deaths of their loved ones.” Volandes references surprising results from a 2007 research study showing that patients who chose palliative care actually lived longer. He also cites a 2008 study that involved 332 patients who were suffering from advanced cancer. “The researchers found no evidence of distress or psychiatric illness in patients who had end-of-life discussions with their physicians,” he writes. Volandes describes how he prepared patients and their proxies for the kinds of decisions they would face as they sought an optimal balance between prolonging life and palliative care. In many cases, he would take them to intensive care units to witness end-of-life treatment. In the appendices, the author offers guidelines and resources available to families facing difficult end-of-life decisions.

A compassionate and informative treatment of a painful subject.