Neither of the two most important people in Aaron's life could stand to be in the same room with each other.  There was a long colorful history between his ex-wife and his brother, and as his disease began to accelerate, the feuding became quite intense.  They argued over Aaron's advance directives.  They both tried to coerce and manipulate themselves into commanding positions.  The shouting became louder, the fury more fierce.  ...

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“So, I told the doctor at the nursing home that I loved my father more than anything. Dad was my friend and the most wonderful man I had ever known.  I wanted everything for him. But, I said, Dad was sick, weak, confused, and he never wanted to live like that. The next morning he was dead.  That was OK by me.” I once participated in a panel discussion about hospice, ...

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Some people who know what I do don’t really know what I do. They picture me floating through the hospital extinguishing lives, blowing them out one by one like candles down an endless corridor. They think I practice euthanasia, that my presence alone hastens death -- that I consume hope and happiness like a black hole, compressing it all into nothingness. Some call me the Grim Reaper, others the Death Doctor. ...

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Mr. Dwyer isn't my patient, but today I'm covering for my partner in our family practice office, so he's been slipped into my schedule. Reading his chart, I have an ominous feeling that this visit won't be simple. A tall, lanky man with an air of quiet dignity, Mr. Dwyer is eighty-eight. His legs are swollen, and merely talking makes him short of breath. He suffers from both congestive heart failure and renal ...

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Like most doctors, I was a young resident, fresh out of medical school, when I had my first experience with the American way of mistreating the dying. Taras Skripchenko was a frail, bed-bound 78-year-old man with inoperable lung cancer who was admitted to my service during my first year of residency training. Skripchenko was too confused to have a lucid conversation and lacked family members to guide his decision-making. His oncologists hadn’t ...

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ESPN sportscaster Stuart Scott's recent death has given the American public a chance to reflect on what it means to live with a cancer diagnosis. His speech at the ESPY awards in the summer of 2014 was widely hailed as an inspiration to people with cancer. Obviously, the Jimmy Valvano Award for Perseverance with the ties to cancer research (Jimmy V Foundation) and Scott's public image as someone being ...

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It was a rather unlikely place to begin my clinical career. Shortly after starting medical school, I signed up to volunteer in the hospice unit of my academic medical center.   The first few visits I relegated myself to fairly banal activities.  I shredded old medical records, or I might do a load of laundry for a family member who had been waiting tentatively by their loved one's side and was ...

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Physician–assisted suicide: the collaboration of two through a professional relationship, to cause the death of one. Ever since Socrates took hemlock, suicide has been part of society, sometimes supported, often condemned.  Today, many argue that we have a right to die, sort of an infinite extension of free speech or thought.   Regardless, to actively involve doctors is a unique distortion of the medical arts, as if stopping a beating heart can somehow ...

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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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