Virtual Mentor. December 2013

This month in Virtual Mentor

Medicine’s Role in the “Good Death”

The way physicians care for patients who are close to death has changed substantially in the last 2 decades. Significantly, patients can now receive palliative care as a complement to disease treatment, and the importance of spending one’s last days at home or alert enough to speak with friends and family is widely recognized. But dying will never be easy, and the good death is still elusive. Virtual Mentor’s December authors discuss medicine’s next steps in helping to make each person’s dying as comfortable and dignified as possible.

Dying in the Twenty-First Century Sophia Cedola and Kenneth Prager, MD Some medical interventions for the dying have no medical rationale and may in fact violate a cardinal principle of medical ethics: first, do no harm.

Integrating Palliative Care with Disease-Modifying Therapy Commentary by Craig D. Blinderman, MD One strategy is to determine “triggers” that alert the primary clinician that the patient has a high symptom burden or difficulty coping with the diagnosis, prognosis, or treatment plans and should be offered palliative care services.

Whole-Person, Whole-Community Care at the End of Life Christina Staudt, PhD Good end-of-life care manifests as the intensification of care that is, ideally, already in place; care that begins at birth and persists across time, diagnoses, and caregiver groups—from family and community support to medical, custodial, and supplementary care.

Serious Illness Communications Checklist Rachelle E. Bernacki, MD, MS, and Susan Block, MD The Serious Illness Communication Checklist provides clinicians with a tool to facilitate discussions about end-of-life issues at the right time in the right way and document the vital information the discussion elicits.

Upcoming Issues

January Ethics and Assisted Reproduction Technology

February Unwarranted Variations in Health Care

March The Problem of Mistreatment in Medical Education

April Third Parties in the Clinical Encounter

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