The toughest question

August 1, 2011 —

In a course on end-of-life issues here at DMU, Assistant Professor Denise Hill, J.D., M.P.A., instructs students to close their eyes. She then asks some riveting questions: What do you know about how a loved one would want to die? Would they want life-sustaining procedures? Who will speak for them, if they can’t, about medical care and finances? What do they want to happen to their children and possessions? Do they want their organs donated? Cremation or burial?

Professor Hill then asks students to close their eyes again and consider: Do your loved ones know how you would want to die?

These are tough questions that most of us don’t want to contemplate. That’s also true among most health care providers, whose orientation – thankfully – is on prolonging life, not on planning for its end.

People who work in palliative medicine – the specialized care for individuals facing serious illness – understand the importance and value of guiding patients and their families through the perilous physical, emotional, psychological, spiritual and financial challenges they face. A subset of palliative care is hospice, an approach to care designed to provide comfort and support to patients with life-limiting illnesses and their families to improve the quality of the patients’ last days by offering comfort and dignity.

Norma Hirsch, M.D., FAAP, chief medical office at HCI Care Services in West Des Moines and an associate professor in medical humanities and bioethics at DMU, emphasizes that hospice is not about physicians giving up on their patients or about patients giving up on treatments and medication. Rather, she says in the summer edition of DMU Magazine, hospice “is about living your life to the fullest while you’re alive. It’s giving people options.”

It’s an option that patients are increasingly using, according to the National Hospice and Palliative Care Organization. That’s had a big impact on health care itself, says Modern Healthcare, a source for health care business and policy news, research and information: Several weeks ago, it launched a “big impact tournament,” modeled after the NCAA basketball playoffs, in which people could vote for a person, company, innovation or event they thought has had the biggest impact on the health care delivery system in the past 35 years. The winner, announced last week, was hospice care, which beat out electronic health records, patient-safety advocacy and even the Institute of Medicine’s “To Err is Human Report,” among the 64 “contenders.”

How do you view end of life? Do you know how you want to go?


Endlessly curious and easily entertained, Barb Dietrich Boose loves being a member of the friendly, fascinating DMU community and its creative communications team. The University's publications director and DMU Magazine editor, Barb is always on the hunt for story ideas, good books and new recipes to try out on her family, such as her surprisingly tasty pork-and-bean bars.

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