Caring Advocates Blog & News

''Last Rights: Rescuing the End of Life From the Medical System'' (St. Martin's Press) is a new book by Stephen Kiernan who was interviewed on NPR ("Fresh Air"). To write the book, he studied why many Americans die ''bad deaths.'' An award-winning journalist rather than a physician or bioethicist, Mr. Kiernan "almost" got some things right. Here are some examples:

Hospice benefits do NOT require that doctors certify their patients will be dead within 6 months; only that this is how long, with usual treatment, they can be expected to live (on average... so that half should live longer).

The reason doctors are not accurate in their prognosis of when death will occur is NOT because their medical school omitted that course in their training, but because no human is endowed with the ability to predict the future and some diseases are highly unpredictable.

According to Charles F. von Gunten, MD, PhD, patients receiving benefits from Medicare are NOT necessarily forced to give up dialysis to receive hospice benefits (and die, usually within 10 days) -- if their “terminal” disease is from another cause such as lung cancer or heart failure. If the patient's terminal illness IS kidney failure, however, then Medicare will not pay for both dialysis and hospice.

Finally, Mr. Kiernan’s suggestion to sit at the bedside and hold the hand of the patient as you let them go -- instead of insisting on major surgery (the decision he had to make with both of his parents) -- is NOT a “new idea.” In some situations, this is sound advice, and decision-makers should definitely consider this alternative to the intense burdens of surgery when the potential benefit is likely to be low. But I can’t imagine applying it to patients with Alzheimer’s… the well relative might be sitting at that bedside for 5 or 10 years!

The solution to that huge and growing problem is not simple. One "solution" for the prolonged indignity and dependency of end-stage dementia was the focus of my presentation at the pre-conference to the World Federation of Right-to-Die Societies in Toronto, Canada, in September. That lecture took material from my book, The BEST WAY to Say Goodbye: A Legal Peaceful Choice at the End of Life, available at www.BestGoodbye.com or 800 64 PEACE (800 647 3223).