“He’d feel okay about not replacing the pacemaker’s battery when it ran down, he said. But turning it off, he said, would be 'too active.' Later he would tell me that it would have been “like putting a pillow over your father’s head.” These are the words of Katy Butler in her book Knocking on Heaven’s Door – The Path to a Better Way of Death in which she writes about her ...

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There are plenty of examples of direct-to-consumer advertising that the pharmaceutical industry use to lure new customers. These ads almost universally make emotional appeals to the consumer, as well as focusing on the benefits rather than presenting any real discussion of risks. What if someone used a similar concept, but instead of trying to get people to take a drug, they try to convince patients to stop one. That’s just what ...

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A 92-year-old woman with a history of stroke comes to an emergency department and is found to have fractures of her cervical spine. Neurosurgery sees her but doesn't think she needs surgery. The emergency department physician tries to admit her to the hospital as she has a new functional disability due to the fall but the hospitalist refuses as the patient doesn’t meet criteria for inpatient admission. And there she sits ...

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An 85-year-old woman with moderate Alzheimer’s disease who enjoys walking in her nursing home's garden with her walker has fallen and broken her hip. An advance directive signed by the patient states a preference for “comfort measures only,” and specifically states that she does not want to be transferred to the hospital. The physician believes that surgery would provide long-term pain relief and the chance to maintain some mobility. What do ...

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Grief is not a disorder and should be considered normal Have you been tearful and sad after the death of a loved one?  Did you notice changes in appetite, difficulty sleeping, troubles concentrating, and decreased energy for at least two weeks after the loss? Did you think that was a normal, healthy, and adaptive response to a major loss? Well, if you believe the new DSM-5 criteria approved by the ...

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What happens when you randomly assign medical students to either a mandatory two week rotation in specialized geriatric training or to a traditional non-geriatric clerkship that sees a lot of old people? Will there be any difference in the knowledge of geriatric conditions, the attitudes toward older adults, or geriatric clinical skills between the two groups?  Or does mere exposure to an aging patient population give students the training they need to ...

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A recent issue in The Lancet included an article entitled “The Death of Ivan Ilyich and pain relief at the end of life.” This is a thought provoking article focused on the question of whether there is overuse of pharmaceuticals to treat various forms of suffering in hospice and palliative medicine. The authors argue that a good death, as seen through their interpretation of The Death of Ivan Ilyich, may include ...

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