Before I Die: Medical Care and Personal Choices
Premiered on April 22, 1997, on PBS.
For rebroadcast information, contact your local public television station.
Videotapes of the show are available.
Strides in treatment and technology have made American medical prowess the envy of the world and have lengthened the lives of many. However, these advances have also created unexpected consequences. It is not so much death itself that is feared as the modern-day medical nightmare -- a death alone, in pain, without dignity and tethered to expensive machines. Today, there is a nationwide outcry for alternative ways to relieve patients' symptoms while comforting their spirits, supporting their loved ones and instilling in their families the hope of a peaceful death.
In an effort to generate a national dialogue about dying in America and to explore the profoundly personal decisions that all of us must inevitably confront, this one-hour special is presented by Fred Friendly Seminars and Thirteen/WNET in New York, with funding from the Robert Wood Johnson Foundation.
"Dying is more than a set of medical problems to be solved. Dying is a part of living, and it's part of the life of every individual.... I would submit that the real solution to this problem is not medical, it's cultural."
The special, hosted by Tim Russert, anchor for MEET THE PRESS, is moderated by Professor Arthur Miller of Harvard University Law School. It features a distinguished panel of experts who engage in a dramatic discussion about the end-of-life situations facing Americans every day.
--Dr. Ira Byock
In keeping with The Fred Friendly Seminars' Socratic format, Arthur Miller presents a series of hypothetical scenarios that force the panelists to confront what they would do in situations where the right choices -- both professional and personal -- are not always evident. The scenarios focus on how three terminal patients -- Cathleen Johnson, Alan Russo and Paul Vargas -- and their families cope with these illnesses. In each case, the role-playing helps viewers form a clear picture of the issues while it transports the participants to the bedsides of individuals who are dying and into the minds of those who care for them.
"As with each of The Fred Friendly Seminars, our aim in BEFORE I DIE is to open the minds of our viewers to the agony of decision-making," says Fred W. Friendly. "Our hypothetical characters, whom the panelists and viewers 'meet' during the course of the program, are challenged by some of the same difficult experiences that we all have to face at some point in our lives. In searching for a 'better way to die,' a national forum such as this can help us all work through the many cultural, medical and personal issues involved."
During the timely debate, the panelists probe such difficult topics as:
The one-hour panel discussion concludes with provocative and imaginative insights into how the process of dying in America can be improved.
"We need to do a better job today in America of assisting those who are seriously ill or dying as well as providing guidance for their families," comments Steven A. Schroeder, M.D., president of The Robert Wood Johnson Foundation. "Our studies have shown that the current medical practices and patient expectations surrounding end-of-life care should be more closely examined, and we hope that the extensive outreach being conducted on behalf of this special triggers informed dialogues in communities across the nation. Each one of us can play a vital role in changing the status quo by openly talking about these issues with our families, clergy and doctors."
- why families have such a hard time talking about death;
- whether patients and families expect too much of their physicians;
- how the high financial costs of dying burden patients and their families;
- whether all Americans should be required to clearly state their wishes regarding end-of-life care;
- whether pain at the end of life is necessary and can be alleviated;
- whether medical training related to end of life can be improved;
- why physicians treat patients with aggressive care, despite wishes to the contrary; and
- whether spirituality can be better brought into the dying process.
You can read the full transcript of the show.
The panelists include:
Ira Byock, M.D. -- President, American Academy of Hospice and Palliative Medicine, and Director, The Palliative Care Service, Missoula, MT;
Arthur Caplan, Ph.D. -- Director, Center for Bioethics, University of Pennsylvania;
Nancy Neveloff Dubler, LL.B. -- Author of ETHICS ON CALL, and Director, Division of Bioethics, Montefiore Medical Center, NY;
Claudia Fegan, M.D. -- President of Medical Staff, Columbia Michael Reese Hospital, and Primary Care Physician, Hyde Park Associates in Medicine;
Willard Gaylin, M.D. -- Clinical Professor of Psychiatry, Columbia College of Physicians and Surgeons, and Co-Founder, The Hastings Center, NY;
Constance Holden, R.N., M.S.N. -- Executive Director, Hospice of Boulder County, CO;
Rabbi Maurice Lamm -- Author, THE JEWISH WAY IN DEATH AND MOURNING and THE POWER OF HOPE, and Chair, Professional Rabbinics, Yeshiva University, New York, NY;
Joanne Lynn, M.D. -- Director, The Center to Improve the Care of the Dying, and Professor of Health Care Services, The George Washington University Medical Center, DC;
Sherwin B. Nuland, M.D. -- Author of HOW WE DIE and Clinical Professor of Surgery, Yale University;
Richard Payne, M.D. -- Professor of Neurology and Chief, Section of Pain (&) Symptom Management, Department of Neuro-Oncology, University of Texas/M.D. Anderson Cancer Center, Houston, TX;
Anna Quindlen -- Author and Pulitzer Prize-winning New York Times columnist;
Dr. Jesus Rodriguez -- Director of Educational Programs, AIDS Pastoral Care Network, and Board Certified Chaplain;
Katherine E. Slaughter, R.N., M.S.N., CCRN -- Advanced Clinical Nurse, University Hospitals of Cleveland; and
Karen Stanley, R.N., M.S.N., AOCN -- Clinical Nurse Specialist, Pain and Symptom Management, Kaiser Permanente, Fontana, CA.