I waited intently as the board members rearranged in their seats and look up expectantly. Silence. I wasn't going to let it be that easy. I repeated myself and paused again. This time a few tentative answers flutter up to the podium. Hospice? Comfort care? End of life? Giving up? Now this is something I could work with. I cleared my throat and smile broadly. Palliative care is a philosophy. I can't help but ...

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Alfred is 95 years old, and sits quietly in his wheelchair, rocking back and forth.  His strength is gone, and his veins and tendons bulge through fair, translucent skin, stretched over muscles of long lost size and use.  His greatest foe is gravity, which holds his lithe, bird-like form in the chair enough to cause sores on his hips, but only barely.  It looks as if he might float away. He remembers little, but ...

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Laws that allow assisted suicide restrict the provision of “aid-in-dying” drugs to patients whose mental status is not impaired and who are capable of sound judgment. Medscape recently featured a video interview of Timothy Quill, the palliative-care specialist and long-term assisted suicide activist. He is interviewed by the ethicist Arthur Caplan, and the two discuss the psychological evaluation of terminally ill patients who request physician-assisted suicide (PAS). Several points ...

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My first week on call, I got called in for a code blue. This patient happened to be the sickest patient on our unit. He had a tumor on his brain stem that was affecting his vision, hearing, swallowing, and breathing, so he had received a tracheostomy and gastrostomy tube as most palliative patients in his situation do. After a series of neurosurgeries, he was undergoing chemotherapy and radiation treatments. ...

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Dear Mrs. J, I would like to express my deepest condolences on the passing of your mother. She was a magnificent woman, and I had the pleasure of being her doctor for almost a decade. It was a pleasure. During our short visits, she regaled me with stories of childhood and often gently sprinkled in advice gleaned from years of experience. Even as she began to decline, we would sit together ...

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He was the last. Old and wizened, he counted down his final days, his final hours on earth. He lay in his bed, the rain drumming monotonously on the window. Night came. He pressed the button to call the aide. The aide appeared at his bedside. Every night, the old man had the same request. The aide went to the window and briefly pulled aside the curtains. He peered outside. ...

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asco-logo As an oncologist, I have witnessed patients go home and heard later how they died there, surrounded by family and friends. I have seen others die in a hospital room, comforted by the care of the inpatient team even as they depart this earth. These are the ones that stick with me and what I think about when ...

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As an internist and geriatrician, I deal with elderly patients all the time. We always end up talking about end-of-life issues: “Should I be resuscitated if my heart stops and I stop breathing?" “Do I want a feeding tube or gastrostomy tube if I stop eating and require nutrition?” “Should I be kept alive on machines and for how long if there is no reasonable hope of recovery?” “When should we refuse tests for ...

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When patients and their families seek hospice care, they are thinking about how they will die. They want to be without pain, shortness of breath, loneliness and, above all, fear. They want to end their lives with those they love, in a place they know, with respect and support. They want control. They want dignity. We all know this, and try to provide it as friends, family and caregivers. Nonetheless, ...

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Today I saw a news story about Walnut, an 18-year-old whippet in the UK, who had his last "walk" on the beach with his owner who had asked social media followers to join them. Shortly after that walk, surrounded by hundreds of family, friends, and supporters (human and canine alike), Walnut was put down. His last moments were spent as near to Heaven on earth as his owner could create ...

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