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A Necessary Conversation: How to Die

By Dr Pramita Kuruvilla
. 3 Comment(s)

It was hard to miss on the airport newsstand last week.  The June 11th issue of Time magazine with its bright red cover with the iconic black “TIME” overlying a big bold white headline: “HOW TO DIE: What I Learned from the Last Days of My Mom and Dad” by Joe Klein.  Within the issue, the author shared his recent experience as a son deputized to make end-of-life decisions for his ill parents, the plethora of too many options in the hospital, and the fear of not knowing how to proceed.  Ultimately, he described the good fortune of coming under the care of salaried (i.e. non-procedure-incentivized) physicians within a quality-focused health system who sat down with him and helped him make choices that provided his parents with the dignified ending that the whole family had deeply desired but feared impossible.

How do we die in the U.S.?  Who has the time and the right to talk to us about it?  Should it be a basic requirement when a physician sees a patient with a terminal illness?  Or should we not address the issue of impending death and focus instead on the billable procedures that Medicare will pay for?  Sadly, our current health system incentivizes only the latter, resulting in costly end-of-life care for which we all ultimately pay, through higher premiums, reduced coverage and unaffordable care.

Our media had a field day with the idea of “death panels”.  Healthcare rationing was condemned as an unconscionable government restriction to our freedom.  A poor choice of words coupled with an intentional desire to cause political harm generated a controversy that has proven to be not only an obstacle to common sense but also a source of physical and emotional suffering for dying patients and their families.  Not having clear conversations prevents the necessary process of shared decision-making, causing the American medical consumer (known more commonly as the patient) true harm.  Most Americans would not choose expensive remodeling if the house is already condemned, so why do we keep silent about the impending dying process and offer more procedures? 

The irrefutable reality is that no matter the political rhetoric, each and every one of us will die sooner or later.  And while the average American (as in you and I) would not want an impersonal “death panel” making our healthcare decisions for us, most of us would want a team of doctors who are kind, compassionate, straight-talking people who make the time to listen to our hopes and fears,  to listen to our story of sickness and health, to look at where we are in the context of our illness, to help us understand how long we may have left (even if not exact), and then (and only then) to make some personalized medical recommendations for the end of our lives.  On both individual and national levels, it’s time to restart this conversation. 

To learn more about Joe Klein’s excellent Time Magazine article, please go to this link

Share Your Comments


  1. Scott Dudgeon

    A good post about a good article on an important issue. It's about time we change the narrative away from the usual "would you like us to do everything possible?" to a more mature understanding that shifting from curative to palliative is, at some point, the professionally responsible, compassionate course of action. It is neither giving up, nor is it rationing. The cost savings are a bonus. The real reward is an end-of-life that is not characterized by tubes, beeping monitors and discomfort.
  2. Vivek Murthy

    Great post Pramita - couldn't agree more about the need to restart this conversation. Health care providers need to do more to push such conversations forward and cut through the political rhetoric that keeps us from having honest dialogue.
  3. Geeta Swamidass

    Having just lost my mother and two very close friends I have some thoughts on this important topic. Pramita you are such a talented and wonderfully sweet person. Thank you for bringing up the topic.

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