2020

A Crash Course in Being Mortal

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

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.

This Pandemic Is Personal

This Pandemic Is Personal Ira Byock, MD Thrive Global, March 19, 2020 Like a tsunami that is far from shore, the forces of nature are silently rushing toward us. I can hear the faint alarm ringing from the future. It’s grounding to realize that this bell tolls for me.

A Matter of Heart

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.

2019

HopeWell House has Closed: Why You Should Care

HopeWell House has Closed: Why You Should Care 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

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.

A Matter of Heart: A Father’s Reflections on Advance Care Planning

Ira Byock, MD The Conversation Project, June 10, 2019 Ira Byock mirrors his worries as an early father with his concerns as an advance care planning expert. By equipping his daughters with his updated advance directive and personal notes, Ira eases their way and allows room for their spiritual and emotional wellbeing during an eventual time of dying and grief. “At its best, advance care planning, like being a father, is a matter of heart.”

2018

Faith communities are reclaiming their role in preparing us for death

Ira Byock, MD 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

Ira Byock, MD 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

Ira Byock, MD 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

Ira Byock, MD 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'

Ira Byock, MD STAT, First Opinion, January 31, 2018 [pdf version] 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.”

2017

We Must Earn Confidence in End-of-Life Comfort Care

Ira Byock, MD 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

Ira Byock, MD 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.

2016

At the End of Life, What Would Doctors Do?

Ira Byock, MD 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

Ira Byock, MD 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.

Things Every Family Should Know

Ira Byock, MD STAT, January 2016 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.

Why Do We Pay for Bad Care?

Ira Byock, MD 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.

2015

Room for Debate: Helping a Suicide When the End Isn’t Near Ira Byock, MD 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

Ira Byock, MD 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

Ira Byock, MD Aging Today, Mar/Apr, 2015

Dying Shouldn't Be So Brutal

Ira Byock, MD New York Times, Feb 1, 2015

We should think twice about 'death with dignity'

Ira Byock, MD Los Angeles Times, Feb 1, 2015

2014

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

We Can & Must Do Better

Ira Byock, MD Health Progress, Jan-Feb 2014

2013

Caring Well for One Another

USA Today, Sept 27, 2013

Testimony - Vermont Senate Committee Hearing on S 077

Ira Byock, MD Jan 31, 2013

Illness Is Personal!

2012

Physician-Assisted Suicide Is Not Progressive

"Right to die" is just a slogan. No civil right to commit suicide exists in any social compact. Ira Byock, MD The Atlantic.com, Oct 25, 2012

Rational healthcare, not rationing

Ira Byock, MD LA Times, A 15, July 18, 2012

Making the Best of What Is Often the Very Worst Time of Our Lives

Ira Byock, MD The Atlantic.com, Mar 8, 2012

The Defining Issue of Our Generation

Ira Byock, MD ABC News, Aug 22, 2012

Transforming the Way We Die

Ira Byock, MD The Atlantic.com, Mar 9, 2012

Moving Away From Death Panels: Health Reform for the Way We Die

Ira Byock, MD The Atlantic.com, Mar 6, 2012

2010

It's Time for Our Generation to Act Courageously

Ira Byock, MD ADEC Forum, Vol 36, Issue 1, Apr 2010

Do I Need to Die Well? Sharing a Personal Growth Experience

Ira Byock, MD Touching Lives, Feb 2010

Dying with Dignity

Ira Byock, MD Hastings Center Report, Apr 2010

2009

HEALTHCARE: Time for a Serious Discussion

Ira Byock, MD New America Foundation, Nov 6, 2009

Testimony on House Bill 304 on Physician Assisted Suicide

Ira Byock, MD New Hampshire Legislature, Feb 17, 2009

HEALTHCARE: We Can't Fix Health Care By (Merely) Fixing Health Care

Ira Byock, MD

New America Foundation, Aug 7, 2009

2007

Testimony on House Bill 44:Patient Choice and Control at End of Life

Ira Byock, MD Vermont House Human Services Committee, Mar 1, 2007

To Life! Reflections on Spirituality, Palliative Practice, and Politics

Ira Byock, MD American Journal of Hospice & Palliative Medicine, Vol. 23, No. 6, pp 136-138, Dec/Jan 2007

2006

Where do we go from here? A palliative care perspective

Ira Byock, MD Critical Care Med, Vol. 34, No. 11 (Suppl.), pp S416-S420, 2006

Promoting Excellence in End-of-Life Care: A Report on Innovative Models of Palliative Care

Ira Byock, MD, Jeanne ShieldsTwohig, MPA, Melanie Merriman, PhD, MBA, and Karyn Collins, MPA Journal of Palliative Medicine, Volume 9, Number 1, 2006

Improving palliative care in intensive care units: Identifying strategies and interventions that work

Ira Byock, MD Critical Care Med, Vol. 34, No. 11 (Suppl.), pp S416-S420, 2006

2005

Evaluation of the Missoula-VITAS Quality of Life Index—Revised: Research Tool or Clinical Tool?

Carolyn Schwartz, ScD, Melanie P. Merriman PhD, MBA, George Reed, PhD, and Ira Byock, MD Journal of Palliative Medicine, Vol. 8, No. 1, pp 121-135, 2005

Both Sides Are Wrong in Suicide Debate

Ira Byock, MD Burlington Free Press, Feb 7, 2005

So many questions for guidance at the end

Ira Byock, MD Newsday, Mar 27, 2005

Contracts, Covenants and Advance Care Planning: An Empirical Study of the Moral Obligations of Patient and Proxy

Joseph J. Fins, Barbara Maltby, Erika Friedmann, Michele Greene, Kaye Norris, Ronald Adelman and Ira Byock Journal of Pain and Symptom Management, Vol. 29 No. 1, pp. 55-68, Jan 2005

2004

The Ethics of Loving Care

Ira Byock, MD Health Progress, July/Aug 2004

Values with Practice Jeanne S. Twohig and Ira Byock, MD Health Progress, July-Aug 2004

Spiritual Care at the End of Life Kaye Norris, PhD; Gretchen Strohmaier, MDiv; Charles Asp, PhD; & Ira Byock, MD Health Progress, July-Aug 2004 <

2003

Palliative Care and the Ethics of Research

Ira Byock, MD Journal of Supportive Oncology, Vol. 1, No. 2, July/Aug 2003

Rediscovering Community at the Core of the Human Condition and Social Covenant

Hastings Center Report , Mar/Apr 2003 Missoula leading the way in care for those at life's end The Missoulian, Jan 12, 2003

Caring When Cure Is No Longer Possible

Ira Byock, MD and Yvonne J. Corbeil, RN The Older Cancer Patient, Chapter 12, Springer Publishing Company, Inc. 2003

Hospice Benefits and Phase I Cancer Trials

Ira Byock, MD and Steven H. Miles, MD Annals of Internal Medicine, Vol. 138, No. 4, pp 335-337, Feb 18, 2003

Expanding the Realm of the Possible

Ira Byock, MD and Jeanne Twohig, MPA Journal of Palliative Medicine, Vol. 6, No. 2, 2003

2002

Sens et valeur de la mort: Faits, philosophie et réflexions sur la responsabilité sociale et clinique

Sens et valeur de la mort Médicine Palliative, 1: 103-112, Dec 2002

Financial Implications of Promoting Excellence in End-of-Life Care

Financial Implications of Promoting Excellence in End-of-Life Care L. Beresford, I. R. Byock, J. Sheils Twohig. A monograph of Promoting Excellence in End-of-Life Care, The Robert Wood Johnson Foundation, Dec 2002