Wednesday, July 24, 2013

The "D" Word. Is the Conversation Finally Starting?

A friend wrote from Portland that he recently attended a Death Cafe!  He was enthusiastic about the breadth of the discussion about care giving, making choices, grief, spirituality - essentially a wide ranging conversation about death.    Additionally, from the University of Washington there's a program promoting conversations over the dinner table - dinner and death (really!).  Also you can now purchase a game to promote the conversation about end-of-life choices.  And finally, Scott Simon, NPR commentator, recently sent out bitter-sweet tweets about his mother's dying - a mixture of grief, humor and the mundane. Are we finally breaking down barriers about the "D" word?  Is this the beginning of a groundswell of interest.  Maybe, maybe not.

I listened last year to TR Reid who gave a lecture to Group Health Cooperative's Annual Meeting.  He highlighted the costs of health care around the world and the shortcomings we have in the United States.  After the talk, I approached him and asked if he would be interested in writing a book about how Americans approach death, the excess costs and procedures in the American style of dying, etc.
He said, "That's too difficult a subject.  My family gets all emotional when I even try to bring up my eventual death, so I can't go there."

So it seems like we still have many barriers to discussion:  denial and procrastination being right upfront.  Ellyn Goodman is promoting the front end conversations with loved ones.  That's a great starting point, but we really need much more education.  Approaching death without learning about CPR and tube feeding is like having surgery without having a discussion about the potential harm that can occur.  So we obviously need public education.  But beyond that we need to get organized with community efforts.

This will not be without controversy considering the "Death Panel" false scare and now an attempt by some to do away with the very useful POLST forms.  Each State and County Medical Society needs to participate in community wide efforts in education along with our legal colleagues, nursing colleagues, hospice workers, social workers, community activists, etc.

Hopefully the "D" Word conversations are beginning to take hold.  The next steps are to help folks understand the choices, talk to loved ones about values and choices, document them and make sure the documents are distributed to family, doctors, and a lawyer if you have one.  There can't be too much communication.  It's your life, and your choices - we owe it to ourselves and others to make our wishes known.


  1. Dr. deMaine - I'd value your input regarding a new website my partners and I just launched called final It is a cyber-secure site where for a fee, people can record all their wishes for end-of-life medical care, memorial services, asset planning and more.

    Please take a few moments to check out the site and let me know what you think. I can be reached at

    Steve Byrne

    1. Interesting website, thanks for making me aware. I know of similar efforts going on elsewhere, some as non-profit efforts. I can't comment on the fees, but would be curious over time how your efforts succeed.

  2. It's also important to realize that many baby boomers won't have families. Those of us who have no spouses or children will die without a room of crying relatives. We need to die peacefully and to have doctors respect our choices. I don't want my last days to be a learning experience for the residents or a source of income for the attendings.