Did I tell you that I was a big fan of palliative care? Palliative care started around 15 years ago at the VA where I worked. We saw the service evolve. We saw how the palliative care approach improved the quality of both life and death. Many physicians have not yet accepted or at least understood palliative care. Many physicians use some palliative care principles and believe palliative care is superfluous. ...

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Background  Under the 1997 Death with Dignity Act, Oregon was the first of the now-handful of states to allow physicians to write a prescription that, when filled and administered, would cause intentional death. Let me be clear: Death with dignity is not offered to Oregonians en masse or even on a whim. To legally qualify, a patient must be 18 years or older, a resident of Oregon, capable of making and communicating ...

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Two weeks ago, I went on an awesome vacation to Las Vegas. It was my first paid vacation of my medical career and by all accounts it went very well. I won $50 on the penny slots and got to see my old friend, the Hoover Dam. Many “Vegas vacation” lines were uttered as we walked across the dam bridge and asked all the dam questions we could think of. ...

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Ezekiel Emanuel wrote an article for the Atlantic on "Why I Hope to Die at 75: An argument that society and families -- and you -- will be better off if nature takes its course swiftly and promptly."  As an oncologist and ethicist, he says he speaks for himself but implies not so subtlety that avoiding our declining years may be in our best interest -- and that it ...

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Human life is a gift.  Death, too, can be a gift.  Is it ever appropriate for us to choose the timing of our death? Brittany Maynard, 29, was diagnosed with a stage 4 glioblastoma, an aggressive and uniformly fatal brain tumor.  With the blessing of her family and millions of supporters around the world, she ended her life in Portland, Oregon, with a fatal dose of barbiturates prescribed by a physician.  ...

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What does a good death mean to you? In July 1991, I was beginning my first year of medical school in Rochester, New York. I was filled with excitement and anxiety on beginning a journey in medicine as I started on the road to becoming a doctor. At that time, Rochester was in the national spotlight because of the actions of one of our faculty members, Timothy Quill. ...

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Brittany Maynard has passed from this life.  This brave but unfortunate 29-year-old woman with incurable progressive brain cancer drew public attention by choosing to go public with her choice about end of life care. "Brittany suffered increasingly frequent and longer seizures, severe head and neck pain, and stroke-like symptoms," according to a statement Sunday night from Sean Crowley, spokesman for Compassion & Choices, a national nonprofit working to expand end-of-life ...

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Does Brittany Maynards decision affect the future of oncology? Would you base a life or death decision based on one doctor’s opinion? One research article? Google searches? What would it take? I recently read that Brittany Maynard took her own life. Plagued by glioblastoma, she chose to reject chemotherapy, radiation, and hospice. Tomorrow, I have a schedule packed with glioblastoma patients who personify courage, determination, and faith. Glioblastoma (GBM) ...

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The 75 Plan: Thoughts on Ezekiel Emanuels palliative care article When teaching about life near dying, it is hard to achieve open conversation.  No matter what one says in a lecture hall or what brilliant writers publish on the terrible state of end-of-life care, change is painfully slow.  While we blame evasion by doctors of challenging conversations, failure by patients to plan or denial by families which blocks open communication, the ...

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During my first year of medical school, in the last year of my father’s life, his oncologist had a difficult discussion with him and my mother- the decision to become do-not-resuscitate (DNR). I remember my mother was taken aback, my father was relieved and I was deeply saddened.  However, when I got the call that my father may not make it out of the hospital this last time, I was ...

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