An Interview with Marion Gillick

Caring for the frail, demented and dying.

Prolonging life at the expense of its quality can rob elderly people of peaceful, meaningful years, Muriel Gillick tells Les Olson.

23 weeks 6 days

This is a moving NPR piece.
"When Kelley Benham and her husband Tom French finally got pregnant, after many attempts and a good deal of technological help, everything was perfect. Until it wasn't. Their story raises questions that, until recently, no parent had to face… and that are still nearly impossible to answer.

This hour, we spend the entire episode on the story of Kelley and Tom, whose daughter was born at 23 weeks and 6 days, roughly halfway to full term. Their story contains an entire universe of questions about the lines between life and death, reflex and will, and the confusing tug of war between two basic moral touchstones: doing no harm...and doing everything in our power to help. Kelley has written about her experience in a brilliant series of articles in the Tampa Bay Times. And when you're done listening to the episode, be sure to check out the video below--but be warned, it does contain spoilers."

See: 23 weeks 6 days.
Embedded Video.

Green Nursing Homes

"For greater warmth and nurturing, seniors are turning to small residences like Green House, which is part of a complex of senior housing and care options, and privately owned care homes that are often unmarked in residential neighborhoods. They are usually newer, sometimes cheaper, and generally offer more customized care than most nursing homes."

Bill Thomas and others pioneered "green nursing homes."  There is a chapter on this in Gawande's "Being Mortal."  A recent article in the NY Times addresses this movement.  It would seem that these more user-friendly homes can be cheaper and more humane than the more mercantile facility that prevails in most of our country.

See: "Putting the 'Home' Back in Nursing Home".

Resident and Staff at "Green House"

Also see:  Jane Brody on The Green House Effect.

Toward Evidence-Based End-of-Life Care

The disquieting patterns of end-of-life care in the United States have been well documented. In the last month of life, one in two Medicare beneficiaries visits an emergency department, one in three is admitted to an intensive care unit, and one in five has inpatient surgery. But one of the most sobering facts is that no current policy or practice designed to improve care for millions of dying Americans is backed by a fraction of the evidence that the Food and Drug Administration would require to approve even a relatively innocuous drug.

See:
Toward Evidence-Based End-of-Life Care
Scott D. Halpern, M.D., Ph.D. N Engl J Med 2015; 373:2001-2003
Free Full Text Online.

End of Life Care,, Berkshires: A Cautionary Tale

To the editor:

Letter: Be aware of state's end-of-life laws

The Berkshire Eagle  November 17. 2015

I would like to share some important information regarding end of life rights or our loved ones, family and friends.

In Massachusetts we have a provision regarding our end of life health care, it is called MOLST or Massachusetts Orders for Life Sustaining Treatment. Please talk to your physicians about this for more information, but let me tell you what happened to my family.

My father lived with me for six months out of the year. He was a Canadian citizen and all of his health care was in Canada. This year his health was failing, and he wished to be with his family in Massachusetts if possible when he was to pass. He slowed down and finally was confined to his bed. He died peacefully with his family at his side holding his hand. It was the passing we had all hoped, that he would be with us, and not alone in Canada.

After he died we called the funeral home, They asked us to call the local police which we did. The police arrived and asked to see the MOLST. Needless to say, I did not have one in place, and honestly did not think I needed one. The police explained that it was the law that they had to call paramedics. The fire department came, then EMTs. They pulled my father out of his bed onto the floor, put a tube into his airway and started CPR. They also hooked him up to a defibrillator. The responders were very apologetic about having to try to revive him, but since there was not a MOLST in place they had a legal responsibility to act. My father did not revive.

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Needless to say this experience was shocking, and made a difficult situation even more awful. I felt that my father's body was being violated and I feel it is now my obligation to make the community aware of the importance of having a MOLST in place, especially for our older ones or those who may be ill.

Your medical team can give you more information about the MOLST and how to obtain the form. As hard as end of life decisions are to talk about, please be prepared and educate yourself as to the law in Massachusetts.

Julie Rose Morgan
Dalton, Massachusetts

High School Death and Dying Course

"Few subjects run more powerfully counter to an American teenager’s innate sense of immortality than a confrontation with the reality of life’s end. The study of death became more common at the college level with the publication of Elisabeth Kubler-Ross’s influential book, “On Death and Dying,” in 1969. But it is rare that the subject is discussed at the high school level, particularly with an approach that includes fairly explicit instruction in caring for a cadaver."

This essay describes a death and dying course at a Jewish high school in Florida: For Jewish Students, Field Trip Is Window on Death and Dying.

Overtreatment of the Elderly

Evidence is accumulating that older adults with diabetes, hypertension and other conditions should be treated less aggressively than they commonly are.

This approach has been named “Deintensification.”

So writes NY Times reporter Paula Span is an important article in the New York Times: Some Older Patients Are Treated Not Wisely, but Too Much

It is worth the time to read this article slowly and carefully.