Douglas Renfield-Miller
Conversations Trump Forms

I recently tuned into Mettle Health’s online discussion “Advance Care Planning: Conversations and Documents”. Mettle Health, led by physician and author B.J. Miller, provides online palliative and holistic care. I highly recommend you check them out. B.J. was in discussion with UCSF geriatrician and palliative medicine physician Rebecca Sudore who has created a valuable Advanced Care Planning (ACP) resource at PREPARE For Your Care.

Douglas Renfield-Miller
The Lost Art of Dying

I have an entire bookshelf dedicated to books about dying and how to die well. Most of the books address themselves to the physical aspects of dying - practical advice to navigating the last stages of life. The Lost Art of Dying has some of this, but its primary focus is how to prepare oneself mentally for death. Columbia University physician and professor L. S. Dugdale has written a new ars moriendi - art of dying - reinterpreting a medieval text she discovered that guides one in preparing for a good death. The Lost Art of Dying encourages the contemplation of human finitude, no matter what one’s age, and provides valuable guidance for anyone seeking an eventual GoodEnding.

Douglas Renfield-Miller
Advice for Future Corpses

Just finished Sallie Tisdale’s, Advice for Future Corpses (And Those Who Love Them). Perhaps not beach material, but well worth reading.  As Paul Sehgal wrote in his NYT review, “…in its loving, fierce specificity, this book on how to die is also a blessedly saccharine-free guide for how to live.” Ms. Tisdale writes, “Birth and death are the only human acts we cannot practice”. Yet, after reading, “Advice for Future Corpses”, one should be much better prepared.

Douglas Renfield-Miller
The Importance of Having a Will: Just Do It!

64 percent of the general 18-and-over population in the US did not have a will in 2016, according to Rocket Lawyer. Wills are especially important for younger people and those in close relationships but not legally married. Younger people stand a higher risk of accident and being incapacitated and not able to convey treatment or end-of-life wishes. Partners, not legally married may inherit nothing and have to move should their loved one die without a will. Without a health care proxy or advanced directive, a partner will generally have no say in the medical treatment of a loved one. 

Douglas Renfield-Miller
How Doctors Die

Good article in today's Harvard Gazette documenting fact that physicians are less likely than the general population to undergo intense end-of-life treatments. Goal is a good ending.

Advice for Future Corpses

Just finished Sallie Tisdale’s, Advice for Future Corpses (And Those Who Love Them). Perhaps not beach material, but well worth reading.  As Paul Sehgal wrote in his NYT review, “…in its loving, fierce specificity, this book on how to die is also a blessedly saccharine-free guide for how to live.” Ms. Tisdale writes, “Birth and death are the only human acts we cannot practice”. Yet, after reading, “Advice for Future Corpses”, one should be much better prepared.

Benefits of Palliative Care

U.S. News recently reported on a study published in the journal JAMA Internal Medicine that found that palliative care can reduce hospital stays and lower costs. The meta-analysis examined 130,000 patients from six previously conducted studies on palliative care.

In Memoria: MRS 1926 - 2017

My beloved mother-in-law died two days before Christmas. She passed peacefully, at home, surrounded by family – a relatively GoodEnding. Yet, it could have been better. My mother-in-law experienced three hospital stays in her last six weeks and was subjected to many scans, tests and procedures which might have been better avoided. Even after deciding that there would be no further medical interventions, a doctor appeared at my mother-in-law’s bedside wanting to put a camera down her throat. My mother-in-law spent her final five days under hospice care - a relief to all. It’s rarely easy knowing when and where to draw the treatment line as a loved one declines. My mother-in-law had a DNR order, Health Care Proxy and Power of Attorney, however she had never engaged anyone in an end-of-life discussion. A detailed advance care plan would have benefitted everyone.

Meet Emily

A friend recently sent me a link to an article about Emily, a chatbot that helps you talk about your end-of-life wishes. I was intrigued so I contacted Haje Jan Kamps, of LifeFolder, the company behind Emily. I believe he and his fellow entrepreneur, Colin Liotta, are on to something.

Thinking and talking about death are difficult for most people. Haje and Colin believe a chatbot can make the process less threatening, especially for people between the ages of 25 and 45 who are used to communicating over texts. LifeFold’s technology also facilitates the creation of advance directives and uses Facebook Messenger to nudge initial participants to complete the process.

I am much older than the target demographic, but I put Emily to the test and was quite impressed. GoodEnding is only one of many good organizations trying to get more individuals to create advance directives. I’m delighted to welcome Emily to the cause.

The Importance of Having a Will: Just Do It!

64 percent of the general 18-and-over population in the US did not have a will in 2016, according to Rocket Lawyer. Wills are especially important for younger people and those in close relationships but not legally married. Younger people stand a higher risk of accident and being incapacitated and not able to convey treatment or end-of-life wishes. Partners, not legally married may inherit nothing and have to move should their loved one die without a will. Without a health care proxy or advanced directive, a partner will generally have no say in the medical treatment of a loved one. 

Big Idea

The Aspen Institute Health Strategy Group incorporated GoodEnding's "Big Idea" in their just released report Improving Care at the End of Life. GoodEnding's "Big Idea" is to have Apple and Google embed in their smartphone operating systems software that will nudge individuals to engage in basic advance care planning – a checklist - whenever they upgrade their phones.

Death Ed.

Interesting NYT Op-Ed piece by Critical and Palliative Care Dr. Jessica Nutik Zitter. Having taught sex-ed. classes at her daughters' school Dr. Zitter notes how Sex Ed. has reduced unwanted pregnancies and rates of S.T.D.s. Based on her experiences with patients and families, Dr. Ritter makes the case that "Death Ed." also should be taught in high schools as a "first step towards generating wide public literacy about this phase of life, which will eventually affect us all." What a wonderful idea!

New Year's Resolution

We begin every year not knowing what may befall us in the coming 365 days. In this time of considerable uncertainty, we can take some comfort by focusing on areas within our control. We can strive to act more lovingly, eat better, exercise our minds and bodies more, AND create or update our Advanced Care Plan. As we lose control over some aspects of our lives, it is all the more important to do everything possible to increase the chances of a GoodEnding.

Life is Fleeting

Two recent, unrelated stories in the New York Times drive home how fleeting life can be and how important it is to plan. Plan so that you have few regrets. Plan so that family and friends know your thoughts and wishes. Many people think that advance care planning is just for older people. The simple fact is that younger people are at higher risk of a traumatic accident and more likely to be unable to convey their wishes in an emergency. GoodEnding is here to help.

Never to early to write a 'Last Letter'

Today’s New York Times includes an article by Dr. VJ Periyakoil who launched a project to encourage people to write a last letter to their loved ones. Dr. Periyakoil seeks to address the regret that she has seen many of her patients express near the end of their lives. Check out The Stanford Medicine Letter Project website here for more information, tools and templates for creating your own letters.

Choosing Wisely

A recent New York Times article mentioned Choosing Wisely, an organization that aims to promote conversations between clinicians and patients to help patients choose care that is right for them. The Choosing Wisely website provides a wealth of information and tools. Especially helpful are the lists developed in partnership with Consumer Reports and medical specialty societies that present evidence-based recommendations on what tests and procedures may be appropriate for specific conditions or in a given situation to help achieve a GoodEnding.

RapidSOS - Postpone your GoodEnding

GoodEnding is dedicated to improving end-of-life outcomes. But, no one should die prematurely. Most people assume that help will be on the way if they simply dial 911. However, Over 10,000 lives are lost annually because 911 runs on a 1960s system and may not be able to locate you in an emergency. We highly recommend RapidSOS’ Haven app that transforms a 1960s phone call into a rich data link – a total transformation in outcomes of emergencies. You can learn more and download the app at https://www.rapidsos.com/. It requires an annual subscription but it could save your life.