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Finding a better way to die

Dr. Ira ByockMark Washburn/Dartmouth-Hitchcock


Dr. Ira Byock


Byock, director of the Palliative Care Service at Dartmouth-Hitchcock Medical Center and a professor at Dartmouth Medical School, has just written a new book called ‘‘The Best Care Possible.’’

Q. In your book, you argue that it’s time for a social movement in America to improve the way we die.

A. We can demand much better care for people with advanced, life-threatening conditions, that is consistent with their individual values and preferences, and that melds the very best of medical science and technology with individualized, truly person- and family-centered care that is also tender and even loving. We could actually begin to fix the sorry way that many people in America currently die.


Q. Most sick or older people in America are out of sight, largely staying at home, or in nursing homes. Is that part of the problem?

A. “I don’t want to think about it’’ - that’s the American mindset [about dying and death]. And you don’t have to think about it if grandma is at a nursing home and you see her twice a year.

Q. Is our reticence to face this issue really about fear of death?

A. That is clearly one of the very root causes of all of this. There is this real superstition in our supposedly scientifically sophisticated society that if we talk about [death] we’re going to make it true, and if we don’t talk about it, somehow we’re protected. Obviously, that’s wrong and the fact that we don’t talk about it means we’re less prepared when it does happen.

Q. We do have the medical capacity to keep people alive longer and longer.

A. At some point in the course of a progressive illness, more disease treatment does not equal better care. Today, people are actually sicker than ever in history before they die.


Q. What do you think is wrong with this medical approach to dying?

A. Nature gives us gentle ways to leave this life. Every time we close the door to a gentle passage from life, we force the physical body to find another way to die.

Q. Are you saying that our ability to keep people alive has outstripped our ability to emotionally cope with the extra time?

A. Our culture has to catch up to the new scientific and clinical power we have to extend life. To do so, we have to have the conversation yes, in our own families, but also collectively, across the culture, in our workplace communities, in our neighborhoods, in our body politic.

Q. What do you recommend people do to help themselves have a better death?

A. Get yourself a family. If you’re lucky enough to have one now, invest in that family. If you’ve got fractured relationships, invest the time and emotional energy to mend and tend and nurture those relationships. If you can’t get a family, get yourself a community.

Q. You argue that we could get more fulfillment in life if we took care of dying loved ones in their last days.

A. There is a human drive to care for people. It’s a burden to care for an infant: You’re not sleeping well, your career gets put on hold, your social life gets derailed, your own health and well-being takes a back seat. But it’s not “just’’ a burden. It satisfies a deep drive within us to love and nurture this being. The same thing can happen and does happen in parent care, caring for a sibling, a very close friend, or a spouse. Caring is in our own emotional self-interest.