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Talk about death — before a health crisis, says Stanford’s Philip Pizzo

walk-842535_1280Most of us have no desire to think, or talk, about death. However, if we never talk about it, we leave our health-care providers and family members guessing about how and where we want to die.

That's why it's important to communicate end-of-life preferences early, Philip Pizzo, MD, founder and director of the Stanford Distinguished Careers Institute, argues in a recent perspective in the Proceedings of the National Academy of Sciences.

It's a topic he's quite familiar with: Pizzo co-authored the Institute of Medicine’s report “Dying in America,” which addressed how to improve the quality of care for patients with advanced illnesses, without exacerbating the high cost of health care. In the perspective, he summarizes the IOM report’s key recommendations and provides an update.

Pizzo discussed the piece in an email:

Unless we are facing an illness or event that makes the prospect of death imminent, most of us do not even think about the inevitability of our mortality. These conversations get slotted to times when death is more imminent and when our crisis-oriented decisions may not reflect our true preferences. That is why the IOM report recommended that conversations about death take place with our health-care providers and families throughout life. Our thoughts and preferences about dying will vary at different stages of life and wellbeing.

In the perspective, Pizzo describes the progress that has been made since the report was published. For instance, the Centers for Medicare & Medicaid Services in January 2016 began paying doctors for end-of-life conversations with patients — a move Pizzo lauds as a major step.

Another important achievement, according to Pizzo, is the national stakeholder conferences that are now bringing constituencies together to implement the report’s recommendations.

He added:

We witnessed before the IOM committee began its work how rapidly public opinion can be swayed by political rhetoric. Thankfully since then, the public’s willingness to engage in conversations about death and dying have become better realized and books, like Atul Gawande’s Being Mortal or Paul Kalanithi’s When Breath Becomes Air, have helped to foster more enlightened conversations about dying.

Previously: No one wants to talk about dying, but we all need to, Study: Doctors would choose less aggressive end-of-life care for themselves and Author-physician Atul Gawande on dying and end-of-life care 
Photo by Oldiefan

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