The New California Assisted Suicide Law

Photo credit: Pixabay, Creative Commons license

“To die: to sleep; No more; and by a sleep to say we end The heart-ache and the thousand natural shocks That flesh is heir to, 'tis a consummation Devoutly to be wish'd.” -- Hamlet, Shakespeare

The California End of Life Options Act became effective in June. Before we can understand what the new law permits and how it might change the care of dying patients, we have to understand a little about end of life care prior to this development. Suffering and...

On Delivering Bad News

Doctor giving couple bad news
Delivering bad news is part of my job, an important part. It is fashionable nowadays to speak of the doctor-patient relationship as a partnership. In the sense that both doctor and patient have important roles to play for the patient to get good care, that's very true. But even in the best of times, it's a very asymmetric partnership. Even in a run-of-the-mill visit for a sinus infection the patient and the doctor bring very different skills, experiences, and expectations to the encounter. ...

A Dose of Realism about Advanced Dementia

Dementia isn’t one disease.  Like cancer, dementia is a family of different diseases that have important similarities.  The diseases that cause dementia all lead to progressive memory loss and brain dysfunction.  Dementia is caused by Alzheimer’s disease, vascular dementia, Parkinson’s disease and several other rarer brain disorders.  The different diseases that cause dementia cause different symptoms initially and have different treatments.  But unfortunately all the treatments are temporary an...

When Less Care is More

Doctors are trained to try to figure out what's wrong and fix it.  We're trained to make a plan and execute it, to do something.  But that impulse to order the next test, prescribe the next therapy or do the next procedure can harm our patients if it's done without consideration of the patient's goals.  That's particularly true with older frail patients whose quality of life is decreasing.  In our reflexive rush from symptom to test result to treatment, we may never stop to thin...