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. December issue's authors discuss medicine’s next steps in helping to make each person’s dying as comfortable and dignified as possible.

Volume 13, Number 12: 1011-1112 Full Issue PDF
  • From the Editor
    Dec 2013

    Dying in the Twenty-First Century

    Sophia Cedola
    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.
    Virtual Mentor. 2013;13(12):1013-1016. doi: 10.1001/virtualmentor.2013.15.12.fred1-1312.
  • Case and Commentary
    Dec 2013

    Integrating Palliative Care with Disease-Modifying Therapy

    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.
    Virtual Mentor. 2013;13(12):1017-1021. doi: 10.1001/virtualmentor.2013.15.12.ecas1-1312.
  • Case and Commentary
    Dec 2013

    When Physicians and Surrogates Disagree about Futility

    Kenneth Prager, MD
    Situations in which the patient’s family seems not to be acting in good faith or the patient's suffering is uncontrollable are relatively rare and do not warrant giving physicians unilateral power to withhold or withdraw treatment in all cases of perceived medical futility.
    Virtual Mentor. 2013;13(12):1022-1026. doi: 10.1001/virtualmentor.2013.15.12.ecas2-1312.
  • Case and Commentary
    Dec 2013

    Medical Students and Dying Patients

    Audrey Tan, DO
    Even seasoned doctors can have trouble confronting the topic of death. For medical students, training and role modeling are needed to make them valuable to patients facing death.
    Virtual Mentor. 2013;13(12):1027-1033. doi: 10.1001/virtualmentor.2013.15.12.ecas3-1312.
  • Medical Education
    Dec 2013

    The Flipped Classroom Paradigm for Teaching Palliative Care Skills

    Vyjeyanthi S. Periyakoil, MD and Preetha Basaviah, MD
    A description of Stanford University School of Medicine's longitudinal approach to effective, skill-based palliative care instruction.
    Virtual Mentor. 2013;13(12):1034-1037. doi: 10.1001/virtualmentor.2013.15.12.medu1-1312.
  • In the Literature
    Dec 2013

    Physician Characteristics Influence Referral to End-of-Life Care

    May Hua, MD
    Because physicians are the gatekeepers to end-of-life care services and their referral patterns vary, those patterns are worthy targets for intervention.
    Virtual Mentor. 2013;13(12):1041-1044. doi: 10.1001/virtualmentor.2013.15.12.jdsc1-1312.
  • Health Law
    Dec 2013

    Legal Constraints on Pursuit of a “Good Death”

    Richard Weinmeyer, JD, MPhil
    Court decisions play a significant role in determining the ways in which terminally ill people and their families can determine the manner of their deaths.
    Virtual Mentor. 2013;13(12):1056-1061. doi: 10.1001/virtualmentor.2013.15.12.hlaw1-1312.
  • State of the Art and Science
    Dec 2013

    Serious Illness Communications Checklist

    Rachelle E. Bernacki, MD, MS and Susan D. 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.
    Virtual Mentor. 2013;13(12):1045-1049. doi: 10.1001/virtualmentor.2013.15.12.stas1-1312.
  • State of the Art and Science
    Dec 2013

    The Appropriate Use of Increasingly Sophisticated Life-Sustaining Technology

    Darryl C. Abrams, MD, Kenneth Prager, MD, Craig D. Blinderman, MD, Kristin M. Burkart, MD, MSc, and Daniel Brodie, MD
    The medical community should formulate guidelines for appropriate use of organ-replacement therapies, taking into consideration the resources involved and the clinical expectation that the therapy can serve as a bridge to recovery or transplantation or can be a destination therapy.
    Virtual Mentor. 2013;13(12):1050-1055. doi: 10.1001/virtualmentor.2013.15.12.stas2-1312.
  • Medicine and Society
    Dec 2013

    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.
    Virtual Mentor. 2013;13(12):1069-1080. doi: 10.1001/virtualmentor.2013.15.12.msoc1-1312.
  • Medicine and Society
    Dec 2013

    Treatment of Terminally Ill Patients According to Jewish Law

    Rabbi Dov Linzer
    The widespread perception that Jewish law unequivocally demands that all measures must be taken to prolong the life of a dying patient, even if they will prolong dying or cause suffering, is incorrect.
    Virtual Mentor. 2013;13(12):1081-1087. doi: 10.1001/virtualmentor.2013.15.12.msoc2-1312
  • History of Medicine
    Dec 2013

    When Medicine Is Powerless

    Thomas W. Laqueur, PhD
    The reluctance of medicine to shift from treatment to palliation has existed since at least the 1700s and remains stubborn today.
    Virtual Mentor. 2013;13(12):1088-1091. doi: 10.1001/virtualmentor.2013.15.12.mhst1-1312.
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    Podcast
    Dec 2013

    Ethics Talk: End-of-Life Conversations with Patients and Their Families

    Virtual Mentor issue editor Sophia Cedola, a medical student at Columbia University College of Physicians and Surgeons, interviewed Dr. Craig Blinderman about talking with patients who are terminally ill, asking him whether there are some key “do’s” and “don’ts” for having end-of-life conversations with patients and their families.