Health Affairs, 24, no. 5 (2005): 1311-1316 doi: 10.1377/hlthaff.24.5.1311 © 2005 by Project HOPE	New Online   Senate Health Reform Bill   Rewarding Providers   Public Option Policy Brief   Health Reform & Abortion   Delivery System Reform

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Narrative Matters

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PREFACE: Physicians frequently deal with life-and-death decisions, and increasingly with discussions about the quality of death as well. What is a "quality death"? Who defines it? How much do terminally ill patients want and need to know about what dying is like, and when is it best to broach this tough subject with patients? New York City physician Boris Veysman tackles these issues as he talks with a recently hospitalized, critically ill man. Does the patient want everything possible done to prolong his life—"full code" in hospital parlance—or does he want to let death happen without interference—a "do not resuscitate" order? The patient’s decisions provide a surprising life lesson for the young physician. Next, another young New York City physician gets a different quality-of-death lesson. David Muller recounts the efforts of a terminally ill patient to die peacefully at home, and how her carefully crafted plan for death goes terribly wrong. As both physicians discover, a quality death is an intricate, often elusive process.

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Like me, he immigrated to the United States as a teenager. My life revolved around academic pursuits and medical training; he did manual labor. For years my claim to personal freedom was a five-cup-a-day caffeine addiction; he enjoyed weed, cocaine, heroin, alcohol, tobacco, and promiscuity. At twenty-five I was too young to know the price of my bad habits, but at forty-three he knew it well. He had cirrhosis—a debilitating and deadly disease of the liver. There were signs of brain damage from circulating toxins, known as hepatic encephalopathy. This is how I, a neophyte doctor in a big city . . . [Full Text of this Article]

A Change In Order

 

A Change Of Heart

 

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