Dr. Spiess doesn’t suggest that confronted with terminal illness we refuse treatment and give up. He advocates thinking about and planning for the dying process long before we develop an illness that might be fatal.
This is at least the fouth book about death I have reviewed. I didn’t plan to, but it just happened. Maybe because of what Dr. Atul Gawande wrote in his book Being Mortal, another book I reviewed.
Death may be the enemy, but it is also the natural order of things.
Atul Gawande, M.D.
In this instance, I was approached by the publisher , FSB Associates, asking if I would review the book, and offered a complimentary copy. Otherwise, I was not compensated for my review. The book links in this post are affiliate links which may help support this blog financially.
Dying with Ease by Jeff Spiess, M.D.
A Compassionate Guide for Making Wiser End-of-Life Decisions
In the introduction, author Dr. Jeff Spiess explains his purpose for writing this book.
my primary hope is for you, dear reader, to become more informed and at peace regarding your own dying.
Jeff Spiess, M.D.
Dr. Spiess doesn’t suggest that confronted with terminal illness we refuse treatment and give up. He advocates thinking about and planning for the dying process long before we develop an illness that might be fatal.
His book reviews the challenges of the dying process, and guides us in making choices that make it smoother and with ease.
Let’s review the titles of each chapter with a brief description of what each contains.
1. Dying in America
Here he proposes a definition for what is a “good death”; it’s one that matches the wishes of the dying person and their family.
2. I’m Going to Die? What Can I Do?
In this chapter he explains Advance Care Planning
Advanced Directives
Durable power of attorney for healthcare
Do Not Resuscitate-DNR
Physician Orders for Life Sustaining Treatment
Artificial Nutrition and Hydration
3. Hospice
In this chapter he reviews the history of hospice care care and explains the basics of palliative (rather than curative) care
4. Suffering
Most dying persons want to minimize suffering so Dr. Spiess lists ways to do so, some of which are controversial and even illegal in some states.
Palliative sedation
Voluntary stopping eating / drinking
medical aid in dying
voluntary euthanasia
5. It’s My Life, Isn’t It?
Here he discussed autonomy , bioethics, and the legal system using past high profile cases as illustrations, those being
Karen Ann Quinlan
Brittnany Maynard
Theresa Schiavo
from Ecclesiastes 3
the time of peril, what St. John of the Cross called the “dark night of the soul,” … both tests the validity of one’s faith and initiates that essential process of incarnation
page 109
6. What’s God Got to Do With It?
Here he talks about “Religion, Spirituality, and the End of Life. He finds many people turn to religion when faced with death and sometimes that is not an altogether positive experience. However, he denies being anti-religion saying,
many find religious traditions to be sources of profound comfort and meaning. …it has been so for many friends, relatives, and patients, and also because it is true for me.
page 109
He finds it essential to differentiate religion as primarily a matter of intellectual assent to doctrines and beliefs, or whether the essense of a person’s faith has become understood and embodied in their being.
photo by DJ Thomas, Lightstock.com
7. What Does It Feel Like to Die?
In this chapter he invites the reader to do a guided exercise to encounter the inner experience of dying. Putting pen to paper you will answer a series of questions about your life. Then you review it as you finish reading the chapter. I did the exercise and found it enlightening and sobering.
8. Envisioning Your Own Death
Here he expands on the idea of Advanced Care Planning introduced in chapter 2. He adds such steps as
Know the rules (insurance coverage)
Disposition of your body
Disposition of “stuff”, making a will
photo from the Lightstock.com collection, an affiliate link
9. What’s It All About, Anyway?
Dr. Spiess concludes with a true story about a wife’s journey to finding meaning after her young husband’s unexpected death.
living well increases the likelihood of dying well
page 161
Conclusion
After the obligatory Acknowledgments this book has
Discussion Questions which seem most appropriate for personal reflection . There is one question based on each chapter.
Notes, which are chapter specific
An extensive Bibliography
An Index
Brief Author bio
Jeff Spiess, M.D.
Dr. Spiess started in medicine as an oncologist, cancer specialist, then transitioned into palliative and end-of-life care as director of a hospice. His website, https://drjeffspiess.com/, offers a complete bio, audio interviews, his blog posts, social media links, and form to join his email list.
exploring the HEART of life and death
Dr. Aletha
Lightstock-quality photos and graphics site- here.
(This is an affiliate link)
Use these links to share the heart of health wherever you connect.
The United States’ healthcare system combines public health efforts with mostly private delivery of health care. Usually they coexist side by side with some but infrequent interaction. The public health emergency created by the pandemic forced them into a “union” that quickly became politicized, and unfortunately diminished the effectiveness of the response.
In ophthalmology, visual acuity is measured by the distance one can see compared to “normal”. A person with 20/80 vision can see at 20 feet what a normal vision person can see from 80 feet. Perfect vision is labeled 20/20.
Maybe you expected 2020 to be a perfect year. I doubt that any of us would say it was. The year brought
a contentious presidential election and an unexpected serious pandemic
peaceful protests and raucous riots
racism confrontations and reconciliation pursuits
health inequities battles and healthy community pursuits
This next year 2021 has already had its share of problems, but I think most of us feel calmer, more hopeful, and eager to resume many of the activites we put on hold last year. And that includes a 4th of July celebration.
Lady Liberty lifting her torch in New York harbor
Independence Day, July 4
Every year on July 4th the United States celebrates Independence Day- the day in 1776 the original 13 American colonies established an independent country.
A few years later they established a government as specified in the Constitution of the United States, to “form a more perfect Union”.
The United States Constitution
The Constitution does not specifically mention, establish, create, or endorse a healthcare system. Some phrases in the Preamble hint at it though-
establish Justice
insure domestic Tranquility
provide for the common Defense
promote the general Welfare
Government sponsored health care programs
The Affordable Care Act, aka Obamacare
The United States Congress passed the Patient Protection and Affordable Care Act (ACA)in 2010 to guarantee basic health insurance to all citizens. During his term in office, President Trump vowed to “repeal and replace” this law but although it has been modified, it is still in place.
Healthcare for military service members, veterans ,and their families
During the American Revolution the fledgling government extended health care benefits to the soldiers and veterans of that war; that system evolved into the current Department of Defense military health care system which covers service members and the Veterans’ Administration system for veterans.
a Veterans Administration clinic (photo by Dr. Aletha)
American soldiers serving in Afghanistan
Medicare and Medicaid
Two other government healthcare programs- Medicare and Medicaid are over 50 years old.
Medicaid provides insurance coverage for adults and children who are unemployed or low income.
Medicare covers disabled children and adults and persons 65 years and older.
Most of the health care activities of the federal government fall under the agencies of the Department of Health and Human Services or HHS. The Secretary of HHS serves in the President’s Cabinet.
Due to the COVID-19 pandemic, we’ve heard more about the HHS in the news than usual; maybe you’ve never heard of these agencies. Generally, management of a pandemic or other public health emergency falls within the work of the CDC.
The goal of public health is to avoid or prevent health threats from becoming public health emergencies, like the COVID-19 pandemic. If they accomplish the mission, we hardly notice. But when an outbreak occurs, their work suddenly becomes visible, scrutinized, and debated.
The CDC director, Dr. Robert Redfield, spoke to Congress soon after the pandemic started, and his assessment of the response and funding for it were not positive. Lack of funding hampered the federal government’s response to the coronavirus outbreak, he told lawmakers on March 10, 2020.
“The truth is we’ve underinvested in the public health labs,There’s not enough equipment, there’s not enough people, there’s not enough internal capacity, there’s no search capacity”
Dr. Robert Redfield, Director, CDC
The Trump administration subsequently enlisted private companies to help cut the difference. The CDC partnered with Integrated DNA Technologies to manufacture the COVID tests under a CDC contract. IDT partnered with commercial labs for the testing.
How are we going to ensure that the people who are hardest to reach with COVID vaccines receive it?
How are we going to ensure that when everyone else is not thinking about COVID we are still leveraging the infrastructure and connections we’ve made and that we address the collateral damage of this pandemic: the hypertension , the pediatric vaccinations that haven’t happened, HIV control?
How are we going to address a resurgent opioid crisis that I thought I’d never see again?
How are we going to address gun injury prevention?
How do we not only protect this nation, as we realize that we need to protect the world, too. Not just for humanitarian purposes, but because we are so integrally linked, as this virus has taught us.
The National Institutes of Health, part of the Public Health Service,
supports biomedical and behavioral research with the United States and abroad,
conducts research in its own laboratories and clinics,
trains promising young researchers, and
promotes collecting and sharing medical knowledge.
And within the NIH is the NIAID– the National Institutes of Allergy and Infectious Diseases, which has been an invaluable source of guidance as the United States and the world works to understand and manage this new infectious disease.
President Donald Trump visited NIH on March 3, 2020 and toured the National Institute of Allergy and Infectious Diseases’ Vaccine Research Center (VRC) to learn about research on a vaccine for the novel coronavirus SARS-CoV-2. From left: VRC Deputy Director Dr. Barney Graham, NIH Director Dr. Francis Collins, VRC Director John Mascola, Department of Health and Human Services Secretary Alex Azar, President Trump, and VRC Research Fellow Dr. Kizzmekia Corbett. credit NIH, public domain
This scanning electron microscope image shows SARS-CoV-2 (orange)—also known as 2019-nCoV, the virus that causes COVID-19—isolated from a patient in the U.S., emerging from the surface of cells (green) cultured in the lab.
Credit: National Institute of Allergy and Infectious Diseases-Rocky Mountain Laboratories, NIH NIH immunologist Dr. Kizzmekia Corbett speaks to President Joe Biden about the fundamental research that contributed to the development of the Moderna and Pfizer COVID-19 vaccines when the President visited NIH’s Vaccine Research Center on February 11, 2021.
Credit: NIH/Chiachi Chang
reviewing and approving diagnostic tests for the coronavirus
protecting consumers from fraudulent products for COVID-19.
issuing Emergency Use Authorizations (EUAs) for ventilators
sampling and testing of respirators for importation
Late in 2020 the FDA gave Emergency Use Authorization to 2 vaccines against COVID-19. By December Americans began receiving “shots in arms”, a welcome step in returning to normal.
FDA Commissioned Corps officer RADM Estella Jones, DVM, OCET Deputy Director and Co-Chair of the FDA Animal Welfare Council, oversees Commissioned Corps officers as they practice proper fitting of protective items. Healthcare workers testing patients for COVID-19 novel coronavirus infection must wear specific protective gowns, gloves, ventilation masks, and full facial shields as shown, and must replace these items after each patient is tested. credit FDA, public domain
ensure safe and healthful working conditions for working men and women by setting and enforcing standards and by providing training, outreach, education and assistance.
For the pandemic response, OSHA offers guidance on
returning to work
preparing workplaces for COVID-19
worker exposure risk to COVID-19
for specific industries including airlines, farms, retail, corrections
use of respiratory protection equipment
important laws that administer and regulate both private and public healthcare.
replica of the Liberty Bell at Disney World, Florida, photo by Dr. Aletha
Let Freedom Ring
In the Declaration of Independence, the founders of the United States created a nation based on the “self-evident truths” of “Life ,Liberty, and the pursuit of Happiness” and to promote “Safety and Happiness” .
They didn’t mention “healthcare” either, maybe because in the late 1700s medical practice was more superstition than science.
Surgery was rudimentary due to no anesthesia and infections frequently proved deadly due to no antibiotics.
No one had even imagined, much less identified the human genome, and viral DNA-what was that??
I wonder if they intended their new government to spend so much time and money providing and regulating health care –most of which was not available or even imagined at that time?
Public vs Private-not a perfect Union
The United States’ healthcare system combines public health efforts with mostly private delivery of health care. Usually they coexist side by side with some but infrequent interaction.
The public health emergency created by the pandemic forced them into a “union” that quickly became politicized, and unfortunately diminished the effectiveness of the response.
But despite the lack of coordination and cooperation between all levels of government and private citizens, our health care professionals, in both public health and private medical practice stayed true to their calling. Many risked their own lives to care for COVID-19 victims. Others sacrificed time and finances to lead the pandemic response in their communities and on social media- maybe not perfectly, but definitely UNITED in resolve to lead, help, and heal their fellow citizens through this unprecedented health emergency.
watercress words by Dr Aletha 