The Best Care Possible
A Physician's Quest to Transform Care Through the End of Life
By Ira Byock
(Avery, Hardcover, 9781583334591, 336pp.)
Publication Date: March 15, 2012
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A palliative care doctor on the front lines of hospital care illuminates one of the most important and controversial ethical issues of our time on his quest to transform care through the end of life.
It is harder to die in this country than ever before. Statistics show that the vast majority of Americans would prefer to die at home, yet many of us spend our last days fearful and in pain in a healthcare system ruled by high-tech procedures and a philosophy to "fight disease and illness at all cost."
Dr. Ira Byock, one of the foremost palliative-care physicians in the country, argues that end-of-life care is among the biggest national crises facing us today. In addressing the crisis, politics has trumped reason. Dr. Byock explains that to ensure the best possible care for those we love-and eventually ourselves- we must not only remake our healthcare system, we must also move past our cultural aversion to talking about death and acknowledge the fact of mortality once and for all.
Dr. Byock describes what palliative care really is, and-with a doctor's compassion and insight-puts a human face on the issues by telling richly moving, heart-wrenching, and uplifting stories of real people during the most difficult moments in their lives. Byock takes us inside his busy, cutting-edge academic medical center to show what the best care at the end of life can look like and how doctors and nurses can profoundly shape the way families experience loss.
Like books by Atul Gawande and Jerome Groopman, The Best Care Possible is a compelling meditation on medicine and ethics told through page-turning, life or death medical drama. It is passionate and timely, and it has the power to lead a new kind of national conversation.
Ira Byock, MD is a practicing physician. He is Director of Palliative Medicine at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire and Professor at Dartmouth Medical School. Dr. Byock has written widely on the ethics and practice of palliative care and health care systems change. He is a consistent advocate for the voice and rights of patients and their families.
“There is no palliative care physician for whom I have more respect and admiration than Ira Byock. In this strikingly important book, Byock presents an agenda for end-of-life care that should serve as an ideal template on which to build our best hopes for the final days of those we love and ourselves—and a corrective for our society.” –Sherwin B. Nuland, MD, Yale Interdisciplinary Center for Bioethics and author of How We Die
"With elegance, compassion, and energy, Ira Byock shows us how to get the best end of life care. He is a great storyteller and a brilliant analyst of health care in America. This is the book to read or give, if you are facing this hard situation. Nobody gets out of this life alive, but Byock shows us how to do it elegantly and well." — Jane Isay, author of Walking on Eggshells
"This is an extraordinary and wise book on how dying people can be cared for. Written by a master clinician, a man of great compassion, Ira Byock has a vision of health care that is brilliant and kind." -Roshi Joan Halifax, Abbot, Upaya Zen Center, Sante Fe, author of Being with Dying
"In a world in which politics are polarized and ethical discussions often descend into a food fight, Ira Byock is that rare doctor: a humane guide leading us with honesty and compassion through complex stories about living and dying well. He's a real-life rebuke to those who think palliative doctors are "death panels" and a mentor to every medical student inevitably faced with mortality. This is must reading for everyone trying to make humane decisions in a high tech world." - Ellen Goodman, longtime syndicated columnist for The Boston Globe
“At a time when a long life can become a curse as readily as a blessing, this lucid and compassionate book points the way to more humane treatment of a life’s last days.” –Rabbi Harold Kushner, author of When Bad Things Happen to Good People
“The baby boom generation has transformed every stage of live we’ve touched. We’re now transforming the dying process. And Dr. Byock is leading the way… brilliantly!” – Christiane Northrup, MD, ob/gyn and author of the New York Times bestselling Women’s Bodies, Women’s Wisdom and The Wisdom of Menopause
"A magnificent, moving, and deeply important work. Ira Byock is a trailblazer whose life’s work has forever changed the way we view dying in this country. But there’s much more to be done. The Best Care Possible is Byock’s urgent and passionate call to action for the nation. This book is a must-read for anyone who thinks there’s even a possibility that they someday might die.” –Dave Isay, founder of StoryCorps, author-editor of Listening Is an Act of Love
“In a world of sound bites, end-of-life concerns are framed politically with emotionally charged rhetoric. Above the clamor, Dr. Byock writes a compelling case for consistent, compassionate, and enduring palliative care for all people as they reach the winter of their lives. Through vignettes he outlines the challenges for the patient, the caregivers, and the medical community, and ably advocates a revolution of care for the end of life. This is a revolution sorely needed and worth fighting for.” –Pastor Robert Fleischmann, National Director, Christian Life Resources
“Dr. Byock, one of the country’s leading experts in palliative care, shares his wisdom and insights on how to get the best care possible when we are confronted with a potentially life-limiting illness. When my own mother was seriously ill, Ira’s words helped our family make the right choices and make sure she got the care she wanted – and no more – during her last months. His words can help you.” --Elliott S. Fisher, MD, MPH, Director of Population Health and Policy, The Dartmouth Institute
“In The Best Care Possible, Ira Byock tells us why we need to move beyond medicine’s fixation on conquering death to a vision of end-of-life care focused on the quality of the patient’s experience. This is a beautifully written, highly personal account that makes real the struggle of patients and families to escape the “high-tech”, more is better imperative that dominates the American way of death. It provides compelling examples of how the physician, committed to reform, can help patients achieve the care they want and need. But Byock goes further: he makes the case that professional reform is only part of the solution; overcoming the medicalization of death will require the mobilization of the wider community in the support of the dying (and those with chronic illness).”--Jack Wennberg, MD author of Tracking Medicine: a Researcher’s Quest to Understand Health Care
“This is a profoundly truthful book. Ira Byock uses powerful stories about real people to explain the complications, nuances and often absurdity of advanced illness in 21st century America. He shows how courage, shared decisions, wise doctors and nurses and palliative care can make the difference. Above all, he calls for a cultural transformation, so we can deal with the end of life as individuals, families and society. Who should read it? All of us who are mortal.” -- Bill Novelli, Professor, Georgetown University and co-chair, the Coalition to Transform Advanced Care (and former CEO, AARP)
“Dr. Byock lets the stories of patients, families, and medical colleagues open windows into the heart of the issues. He leads the reader captivatingly from story to story to see and feel what the best care through the end of life can be and deftly invites our nation to envision the best care for our culturally diverse society and cultures. Dr. Byock captures the fundamental human impulse to care lovingly for one another at the most sacred and privileged moments of our lives…now and through the end of life.”-- David Lichter, D.Min., Executive Director, National Association of Catholic Chaplains
“Dr. Byock’s book rejuvenates me. In allowing us the special privilege of entering the sacred space of their final journey, people teach us precious lessons about ourselves. Dr. Byock has a gift of sharing the lessons he’s learned in a most readable narrative marked by compassion, love of life, and lucidity.” -- Rabbi Bunny Freedman, Founding Director of Jewish Hospice & Chaplaincy Network
“There is no palliative care physician for whom I have more respect and admiration than Ira Byock. In this strikingly important book, he presents an agenda for end-of-life care that should serve as an ideal template on which to build our best hopes for the final days of those we love and of ourselves --- and a corrective for our society.”—Sherwin B. Nuland MD Yale Interdisciplinary Center for Bioethics; author of How We Die.