Last Rights

cover-lastrights The greatest consumer issue in America today is the use of excessive medicine on people dying of gradual illnesses -against their wishes, causing needless physical pain, preventable emotional suffering and backbreaking expense. There is a better way.

About 6,500 people die in the U.S. every day. Fewer than 2,000 die at home, among loved ones, free of pain.
Half of people who die in hospitals endure severe untreated pain.
More than 70 percent of doctors do not check to see if a patient has end-of-life care instructions in place.
Residents in one-third of nursing homes were abused in 2003. Thousands of residents were strapped down involuntarily. One quarter of homes failed to provide adequate food.
Health expenses are the nation’s leading cause of personal bankruptcy, even among people with insurance. Medical care for dying spouses is one of the fastest growing causes of impoverishment among elderly women.
End-of-life care that focuses on pain control and patient comfort costs less than half of normal medical interventions for similar patients.
People whose loved ones die after receiving good end-of-life care are far less likely to die themselves in the following 18 months.
Only five U.S. medical schools require students to take a course on care of the dying. Less than three percent of medical textbook pages cover this topic.

Federal laws for end-of-life care have not changed much since Ronald Reagan was president. In that time causes of death have shifted dramatically. Deaths from heart attacks fell 61 percent, stroke fatalities 71 percent and deaths from accidents 36 percent. Meanwhile cancer deaths rose 22 percent, chronic respiratory disease 77 percent and Alzheimer’s disease 100 percent.

Dying today is slow. Health care has not adapted to this reality. Last Rights explores what needs to change so everyone can die with dignity. Using stories of patients and families from all walks of life, bolstered by hundreds of physician interviews and published medical studies, this book reveals the alternatives to unnecessary suffering and preventable pain. Three methods receive particular attention:

Hospice enables people to receive care at home that is focused on their pain and symptoms, on their emotional and spiritual needs, on the well-being of their spouse and family, and on helping to resolve any outstanding issues. The goal is to assure peace and dignity by adding the disciplines of hospice care to ordinary medicine.
Palliative care is an application of the hospice philosophy, but in a hospital or nursing home setting. The patient may still be seeking a cure, but palliative care concentrates on comfort as well as helping people with their non-medical needs.
Advance directives enable people to dictate what their priorities are, and what they preferences for medical treatment are, should they become unable to speak for themselves. A good advance directive tells doctors what is important to the patient, and alleviates painful decision-making for the family by making the patient’s wishes plain.

In study after study, hospice, palliative care and advance directives have been found to provide higher quality of life – and in many cases, longer life -to people who are terminally ill. Not incidentally, these methods also cost far less than the overly invasive care that is the American norm.

Last Rights tells the stories of people who suffered needlessly, as well as people who completed their lives in ease and comfort. It describes doctors and health systems unschooled in care of the terminally ill, as well as physicians, nurses and hospitals that know how to help people complete their life’s remaining tasks with calm and even joy. It relates the experiences of families who were frustrated by excessive care of their loved ones with callous indifference at backbreaking expense, as well as families whose care-taking of a dying loved one meant days filled with love and fulfillment.