In Defiance of Death: Exposing the Real Costs of End-of-Life Care - Tapa dura

"... the beauty and real value of this book is its call for readers to become engaged themselves." - Journal of the American Medical Association "Nephrology consultant Fisher exposes the interface between economics and compassion issues in the dying process that, in the US, is often protracted and medicalized. He proposes possible solutions to address the economics of dying and provide a more humane death. A historical review of hospital and nursing home development, health professionals' education, and health care legislation, along with data about the US's poorer outcomes and higher costs compared to many Western nations, paints a dismal picture. Interlaced with this material are patients' stories that illustrate the human suffering that results from dysfunctional health care. This book is most valuable in helping to illuminate the issues and raise awareness--for consumers, health professionals, and politicians--about the fallacies of the current system. Fisher's proposed solutions include oversight from a tiered system of appropriate-care committees (which are somewhat emulated by current institutional ethics committees, and likely will not be accepted in today's sociopolitical climate). At the root of many issues is what is so poignantly discussed in the foreword: the importance of having health care professionals who are connected with their patients. Professional-patient communication is not occurring, or not occurring early enough in the illness trajectory--for the many reasons so aptly explained here. Highly recommended." - Choice

Death is a natural part of life. But it has become a painful, protracted, humiliating process that is often inappropriate for the healthcare patient, puts an undue financial and emotional burden on the family, and provides a model of improper care for physicians in training. And it's expensive-about 22 percent of all medical expenditures are for people in the last year of their lives. Further, while studies show that 90 percent of all people would prefer to die at home surrounded by family and friends, the reality is that more than 70 percent die in institutions. As Dr. Ken Fisher argues so passionately in this book, it's time for a change. End-of-life care in the U.S. has evolved over the years into a nightmare for patients and family members, and it has created a near-crushing financial burden on the medical system that is not just excessive but unsustainable. It has driven the cost of healthcare out of reach for many people, and it is a large factor in preventing the creation of universal coverage. In Defiance of Death reviews the current state of end-of-life care and highlights its many problems from a variety of economic, political, and social perspectives. Fisher and Rockwell illuminate the ethical dilemmas we all face as technology allows us to prolong life-but at a huge human and financial cost. This book documents these problems and provides a historical perspective of how our medical system evolved. It argues that America's defiance of death is far too costly and recommend that all stakeholders-including the public, medical community, Congress, and business leaders-join together to create a system that improves end-of-life care for everyone involved. This book, with workable solutions to improve our medical system, helps point the way.