we can have these conversations, it turns out that our clinical practice be- comes a lot more authentic and satis- fying because you actually can achieve valuable clinical goals even when you can’t cure someone.
Texas Medicine: Why then is this such a difficult, controversial topic?
“At least 70 percent of practicing physicians participate in the care of frail elders or seriously ill people whose lives are at serious risk.”
Dr. Byock: There is something in- herently aversive about talking and thinking about dying and death. Phy- sicians are selected for our warrior trait: We are supposed to fight against death and preserve life. It’s certainly why I came into medicine. But if you want to serve real human beings, we have to think more broadly than that. What I’ve learned is, human beings are whole people: They have bodies and needs for medical treatment and bodily comfort, but they also have emotional, spiritual, and social parts of their person. And to be a good doc- tor, I need to attend to all of that. This is sort of the last taboo, and like most taboos, there is a literal superstition that surrounds it. There really is an unspoken feeling in America that if you talk about [death], you make it more likely to happen. Well, it’s not really true. You can talk about it, or you can not talk about it, and it’s still going to happen.
Texas Medicine: Do you feel like end- of-life care has been politicized and there are misconceptions that create barriers?
Dr. Byock: It’s been politicized in terrible ways. This one cuts across party lines. We are all going to die. We all love our parents, our spouses, our children. We all want the best care we can possibly give them. And let me get political having said that: I don’t think it’s a good idea for doc- tors to be given authority to write le- thal prescriptions. But there’s a fear of dying badly, and frankly a loathing of the medical profession, that fuels ever-growing support for legalizing
60 TEXAS MEDICINE April 2015
physician-assisted suicide.* There is a big difference between helping some- body die gently through hospice and palliative medicine, and the skills that really should be part of any doctors’ skill set who takes care of seriously ill people — there’s a big difference be- tween that and intentionally ending a person’s life. I’m not from Texas, but I’m a proud political progressive, and I’m here to tell you that physician- assisted suicide is not an extension of anybody’s personal freedoms: It is a capitulation to our failed social re- sponsibilities. And our profession, on behalf of society, is at the tip of this spear. (*TMA policy opposes physi- cian-assisted suicide.)
Texas Medicine: Is more education needed? Whether for patients, physi- cians, society as a whole?
Dr. Byock: Everybody needs more education. And to some extent we need common education. The book I wrote, The Best Care Possible, is ac- tually being read in medical schools, but it’s also being read by the general public. There is a common framework in which we can engage in shared de- cisionmaking that acknowledges our mortality, and absolutely make every good use of medical technology. This is not about rationing, or giving up, or any of that. It is about using the best of our contemporary, unprecedented technology in service of protecting and preserving life, while acknowl- edging that at some point in time, more treatment is not better care, and that part of the achievable goals of health care should be to help people die well. I have the remarkable experi- ence of witnessing and at times help- ing people achieve a sense of well- being during the last months, weeks, even days of their lives. And I have to say, that’s the most clinically exciting thing I’ve ever been part of. And it is the highest health outcome I could ever hope for a patient. I also think physicians have been failed by the medical education sys-
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