HOPE FOR A COOL PILLOW

A moving argument for the reform of end-of-life care.

In 2010, as her mother declined from dementia, anesthesiologist Overton (Good in a Crisis, 2012) enrolled in a nine-month Executive Education course at the Harvard Business School called Managing Healthcare Delivery. She was searching for answers about the failures of the health care system, particularly about ways in which practitioners treat dying patients. In a patient’s last year of life, she discovered, “nearly one in three had surgery”; in the last month, “nearly one out of five”; and in the last week, “nearly one out of ten….Those are astounding numbers,” she admits, and believes the profit motive—on the parts of drug companies and hospitals—is driving unnecessary and expensive interventions. Patients who undergo such treatment do not live longer than those in hospice, where the cost is about one-third of that in hospitals. Interwoven with her reflections on the Harvard course and her own medical work, the author sensitively recounts her parents’ last years. Her father endured bouts of chemotherapy, radiation, and surgery for metastasized cancer, each time told by physicians that he would not suffer. But he did: “is lying easier than telling people the truth?” Overton asks. “We routinely make people suffer for no clear benefit except to ourselves,” she writes, and communicate in “euphemisms and circumlocutions.” Eventually, her father experienced excellent hospice care, but her mother had a less positive experience. With hospice now “big business,” Overton strongly recommends comparison shopping. She also advocates setting up medical directives, making wishes known to loved ones, and being aware of such organizations as Compassion & Choices and the Final Exit Network. Based on her personal and professional experiences, the author is convinced that neither legislation alone nor the health care industry can solve its complex problems. Capitalism, she concludes has “ruined healthcare.”

A timely, informed contribution to the ongoing debate over our nation’s health care policies.