Articles and Op-Eds
Core Roles and Responsibilities of Physicians in Hospice Care
A Statement by and for U.S. Hospice and Palliative Care Physicians
Ira Byock, MD, FAAHPM
Journal of Palliative Medicine, May 2023
Physicians are integral members of hospice interdisciplinary teams (IDTs). This statement delineates the core roles and responsibilities of hospice medical directors (HMDs) and hospice physicians who are designated by the hospice program to fulfill core HMD responsibilities. In addition, we describe the basic elements of hospice programs’ structure and function required for hospice physicians to fulfill their roles and responsibilities. Finally, we call attention to hospice program characteristics and circumstances of the work environment that should raise a hospice physician’s concerns that hospice patients and families are at risk of receiving low-quality care.
Hospice Needs Saving
Ira Byock, MD, FAAHPM
StatNews, December 14, 2022
Hospice in America is gravely ill. An extensive investigation jointly published by The New Yorker and ProPublica documented outright fraud, predatory practices, and flagrant mistreatment by specific publicly traded and private equity-owned hospice companies.
Missoula-Vitas Quality of Life Index
Ira Byock, MD, and Melanie Merriman, PhD
Springer Encyclopedia of Quality of Life and Well-Being Research, May 2022
Improving quality Improving quality of life is a fundamental goal of palliative care. Meaningful, reliable measurement of quality of life is critical to assessing patient needs and meeting them. Data related to patients' quality of life are essential for clinical research and quality improvement efforts, as well as for assessing the value of palliative components of health services.
Psychedelics for Serious Illness:
Five Things Every Clinician Should Know
Ira Byock, MD, FAAHPM
CAPC, February 17, 2022
An update on the state of science for psychedelics, and what all clinicians should know as they enter this uncharted territory.
Pandemic Lessons About Human Caring
An Open Letter to Leaders of Healthcare
Ira Byock, MD
Medium, January 11, 2022
Leaders of teams, departments and organizations recognize that life’s most important lessons are often learned during life’s hardest times. Adversity strips away pretense and distraction to reveal what matters most. During the early months of the COVID-19 pandemic, harsh new realities left little doubt what mattered most, both professionally and personally.
Seeing the world with 2020 Vision
Ira Byock, MD
NHPCO Fall News, September 2020
It’s already getting dif!icult to recall how things looked before. The events of 2020 have dissolved collective illusions of longevity, racial equity, rational governance and economic stability. In the cold light of the present day realities, Dr. Byock explores the fundamental social question that confronts human beings: HOW THEN SHALL WE LIVE?
2020 Modern Healthcare Top 25 Innovators - Ira Byock, MD
Ira Byock, MD Modern Healthcare, August 26, 2020 For the healthcare industry to truly transform how it operates, innovation must take hold at all levels of an organization. Often, a seemingly simple idea can lead to huge change. The 2020 class of Modern Healthcare’s Top 25 Innovators found new ways to engage consumers, improve quality of care and lower costs. The honorees were selected for their work in one of four areas of focus: consumerism, cost reduction, population health and quality and safety.
A Crash Course in Being Mortal
Ira Byock, MD
Medium, April 14, 2020
COVID-19 has rudely pulled us into a lucid dream in which we’re enrolled in that course on Contemplating Death we never signed up for. Class has already begun, we’re not prepared, and assignments are due. Daunting as the situation is, for those willing to do the coursework, the lessons may be both enlightening and immediately applicable.
While social distancing, do your other patriotic duty: have The Conversation about serious illness care
Angelo Volandes, MD; Aretha Delight Davis, MD, JD; and Ira Byock, MD
StatNews.com, April 7, 2020
Among the essential strategies for fighting Covid-19 is making sure that individuals who are most at risk of developing severe complications from it are properly informed about the potential benefits, expected burdens and limitations of available therapies, and that those who undergo intensive care and mechanical ventilation actually want these invasive interventions.
A Matter of Heart
Ira Byock, MD
Thrive Global, March 7, 2020
As National Healthcare Decisions Day in mid-April approaches, I reflect on why I have a medical directive. It’s not out of fear of dying, but rather out of love for my daughters.
HopeWell House has Closed: Why You Should Care
Ira Byock, MD and Eric Walsh, MD
Stat, First Opinion, November 19, 2019 Hopewell House, an inpatient hospice in Oregon, has closed. We need more places like it to help people die well, not fewer of them. Medicare isn't helping.
Wellbeing in dying
Ira Byock, MD
Thrive Global, September 30, 2019
When dying people are cared for in ways that meet their basic needs and honor their worth, the waning phase of life contains surprising opportunities for wellbeing. Ira discusses the opportunity costs of bad care and invites us to not lose our outrage, but be motivated by love and joy.
Because I am a Dad
Ira Byock, MD
Thrive Global, September 5, 2019
Ira Byock stresses the advance care planning is important to him not only as a palliative care physician but first and foremost because he is a husband and father. He completed his advance directive in hopes of lessening the burden his wife and two daughters will feel if or when they must make decisions regarding his future care. Referring to the headline news case of Terri Schiavo, which tore a family apart and became a legal and political nightmare, he asked both his daughters, who at the time were in their twenties, to each complete an advance directive. Advance directives are a way of supporting one another through life’s most serious crises.
Caring Well for One Another Through the End of Life
Ira Byock, MD
Thrive Global, August 29, 2019
Ira Byock relates natural disaster preparedness with the need to prepare for dying – the natural disaster that awaits us all. He provides tangible tips to keep people and their families “safe from harm when dying”– such as avoiding needless suffering and the last days in places or situations loved ones would never have wanted. It’s important to understand that serious illness is personal, not just medical. Doctors can work with youin making the best decisions, not just make decisions for you. Have a conversation with loved ones about your personal choices and priorities. Ira suggests that if you or someone you love is seriously ill it’s wise to get to know a palliative care who complement disease treatments by focusing on your comfort and quality of life and supporting your family.
Ira Byock, MD
America’s health care system excels at treating disease, but Ira notes that our country’s health care is deficient in communicating with patients, preventing illness, and guiding people through difficult times. He provides five tips to equip patients and families to be strong self-advocates and be proactive in getting the best care possible: 1) Take charge when meeting with physicians, 2) Get multiple opinions especially in the case of serious illness, 3) make sure one of those opinions is a consultation with a palliative care team, 4) Identify people you trust and complete an advance directive giving them authority to speak for you if you become too ill to speak for yourself. And 5) Last, but not least, don’t be afraid to change hospitals or professional caregivers – that includes firing a physician who doesn’t listen or attend to your needs – because this is about you and those you love.
Faith communities are reclaiming their role in preparing us for death
America Magazine (online version), July 3, 2018
Ira Byock reflects on his discussion with 700 diocesan priests about the end of life care and caring for seriously ill patients. He shares how the shift in medicine and the experiences of illness, caregiving, dying and grieving has incited faith communities to engage—enhancing a congregation’s sense of purpose. Contrasting vulnerability and suffering, faith communities offer a space for comfort and spirituality.
Suicide is on the rise. Depression therapy is limited. Let’s try psychedelics
The Washington Post, July 3, 2018
Ira Byock makes the case for including psilocybin, a psychedelic used to treat severe depression, as an approved drug for the “right to try” and Expanded Access programs. Psychedelics are an alternative for people experiencing extreme demoralization of hopelessness and helplessness, and they may ultimately be a proxy for preventing suicide. Its benefits include more immediate effects that endure for months after administration compared to that of currently approved antidepressants.
Love and Boundaries in Medicine
Hastings Bioethics Forum, June 22, 2018
Ira Byock outlines three important principles to maintain a trusting, therapeutic physician-patient relationship guided by love and care: No sex, No personal gain, and No killing. He offers recommendations for ways the medical profession can improve end of life care and help patients die well, rather than resorting to physician assisted suicide.
Taking Psychedelics Seriously
Journal of Palliative Medicine,Volume 21, Number 4, January 2018
In this Journal of Palliative Medicine article, Ira Byock makes the case for renewed research into the therapeutic use of psychedelics—such as psilocybin and MDMA—for seriously ill and dying people. Skepticism is warranted, but cynicism may prevent suffering people from receiving the relief that these medications may offer. Classified as Schedule I drugs, research and prescriptions involving psychedelics remain illegal despite their previously documented benefits. Given the frequency of treatment-resistant depression, persistent anxiety and demoralization, and spiritual or existential suffering, it is time to reconsider psychedelic-assisted therapies.
Physician-Assisted Suicide Won’t Atone for Medicine’s ‘Original Sin’
STAT, First Opinion, January 31, 2018
Ira Byock reflects on the implications of “medicine’s original sin”, the idea that with sufficient scientific advances, doctors could defeat death itself. Attempts to postpone or resist death for patients with late stage disease or incurable medical conditions have led to highly burdensome, ineffective, and unnecessary treatments and resulted in needless anguish. In this context physician-assisted suicide or lethal prescriptions look like reasonable options. Proponents argue for the right to die often speak of loved ones who have suffered in misery as they died. Ira insists that “dying badly is not inevitable.” He outlines steps the medical profession could take to relegate such suffering to history and urges physicians to “recommit to caring well for people from birth all the way through to death.”
We Must Earn Confidence in End-of-Life Comfort Care
Health Progress, Nov-Dec, 2017
Ira Byock asserts that “dying in America remains a public health crisis” and reflects on the deficiencies in end-of-life care that cause unnecessary suffering and make physician-assisted suicide or “medical aid in dying” seem needed by the general public. Ira offers solutions to reframe this crisis of dying badly into an opportunity to provide the best care possible. It’s not enough to prevent or alleviate suffering, we can and must strive to enable our patients (and the friends and family we love) to die well. This commitment by Catholic health care would immediately improve quality and would inspire through bold, proactive, constructive policy agendas.
Words Matter: It Is Still Physician-Assisted Suicide and Still Wrong
Maryland Medicine vol 17; 4, January 2017
As a palliative care physician and as a proud political progressive (and Democrat), Ira Byock opposes the Maryland’s bill to establish an End-of-Life Option Act (SB 418 and HB404). He points to the masking of euphemistic terms that proponents of physician-assisted suicide use in branding. Public policy that gives doctors the power to write lethal prescriptions takes pressure from the need to fix serious deficiencies of care that lead to patients dying badly. While recognizing the bill’s supporters’ good intentions, he advocates for policy alternatives or amendments to the bill that would significantly improve the care and lives of seriously ill patients.
At the End of Life, What Would Doctors Do?
New York Times Online Edition, June 30, 2016
Ira Byock discusses “How Doctors Die” and importantly–how doctors make decisions about their own treatments and balance personal priorities medical needs as they near the end of life. Anecdotes of dying physicians illustrate how they experienced the same pain and suffering of their patients, yet avoided medicalizing their last moments. Instead they focused on what matters most, including expressing love and feeling loved, celebrating their lives and relationships. Their experiences reveal that dying can coexist with wellbeing.
Reframing the Conversation: When to seek help
LA News Group, June 19, 2016
Most people want to live long and well and then die gently. One obstacle to living well through the end of life from doing so is knowing when to seek palliative and hospice care. Ira illustrates this point by telling the story of his dear relative Edith who underwent heart surgery at the age of 83. Experiencing declines in function and spirit, Edith was dying and expected to live as little as three more months. However, hospice saved her life (!) enabling Edith to feel better, get stronger, and, it turns out, live a lot longer.
Why Do We Pay for Bad Care?
STAT, June 6, 2016
Ira Byock explores the question, “Why do we pay for bad care?” He calls attention to the engrained, but untrue, “more is better” assumption that more treatment is always better for seriously ill patients. Instead, he asserts that more treatment actually results in decreased quality of life while simultaneously increasing patients’ medical bills. In contrast, palliative care concurrent with disease treatments often improves quality of people’s lives while decreasing costs from unwanted care and unnecessary hospitalizations. At the very least, Ira recommends that palliative care consultations or documented goals-of-care conversations between physicians and their patients be required.
Room for Debate: Helping a Suicide When the End Isn’t Near
New York Times Online Edition, Sept 10, 2015
In this New York Time’s Room for Debate, Ira Byock discusses the ethical issues of physician-assisted suicide with Mark A.R. Kleiman. Ira asserts that society must ultimately discourage suicide. He warns against the slippery slope evident in data from states in which physician-hastened death has been legalized and highlights worrisome current trends of suicide. Instead, we need alternatives that more effectively treat depression — a primary driver of suicidality — including revisiting psychedelic-assisted therapies.
Democrats Shouldn’t Endorse Suicide
POLITICO, June 7, 2015
Ira Byock voices discontent with the sorry state of dying in America and the knee-jerk political liberal embrace of California’s bill to legalize physician-assisted suicide. He notes the decline in quality of hospice care that coincides with the for-profit hospice industry’s rising dominance. He advocates for the shift in the way healthcare is reimbursed — based on value — represented by Romney Care in Massachusetts and the Affordable Care Act (aka Obama Care) nationally. Patients’ choices must not be constrained to a choice between suffering and suicide. Tangible policy steps can fix this problem. He lays out recommendations for required improvements in physician education and postgraduate training, enhanced physician-patient communication and shared decision-making, and collaborative team-based care that can provide the best care possible through the end of life.
The American Crisis Around Dying Persists
Aging Today, Mar/Apr, 2015
We should think twice about ‘death with dignity’
Los Angeles Times, Feb 1, 2015
Selected Articles prior to 2015
Room for Debate: Expanding the Right to Die – It Violates Medical Principles and Is Dangerous’Ira Byock, MD
New York Times Online Edition, Oct 6, 2014