#11 Richard Leiter: Is a better death possible?

Bio(un)ethical

In this episode, we speak with Dr. Richard Leiter, senior palliative care physician at Dana-Farber Cancer Institute and Brigham and Women’s Hospital and assistant professor of medicine at Harvard Medical School. We discuss the state of end-of-life care in the US today, why patients often receive care that doesn’t align with their values, whether some of the care that doesn’t seem to promote the things patients’ care about actually is aligned with their values, and whether doctors put too much pressure on patients to make end-of-life decisions autonomously.

(00:00) Our introduction
(08:46) Interview begins
(13:47) Do early conversations make a difference?
(20:46) Challenges in doctor-patient communication
(35:47) Advice for listeners on being a healthcare proxy
(41:47) What if the care people receive is value-concordant? Hindsight is 20/20
(47:40) Trade-offs between living long and living well
(52:04) Trade-offs between living well and dying well
(54:12) Value-change over time and advance care directives
(1:01:03) Can doctors better respect autonomy by limiting options?
(1:08:49) Code status, CPR, and framing patients’ options
(1:20:16) Supporting family members’ decision-making and narratives

Mentioned or Referenced:

• Atul Gawande, Being Mortal
• Elisabeth Kübler-Ross, On Death and Dying
• The Serious Illness Care Program (Ariadne Labs)
• Dattani et al., “Child and Infant Mortality” (Our World in Data)
• Kaldjian et al., “Code Status Discussion And Goals Of Care Among Hospitalized Adults”
• Penketh & Nolan, “In-Hospital Cardiac Arrest”
• French et al., “End-of-Life Medical Spending in Last Twelve Months of Life is Lower than Previously Reported”
• Pierrotti, “Playing God”
• Temel et al., “Early Palliative Care for Patients with Metastatic Non-Small-Cell Lung Cancer”
• Diem et al., “Cardiopulmonary Resuscitation on Television — Miracles and Misinformation”
• Portanova et al., “It Isn’t Like This On Tv: Revisiting Cpr Survival Rates Depicted On Popular Tv Shows”
• Sophocles, Antigone

Bio(un)ethical is a bioethics podcast written by Leah Pierson and Sophie Gibert, with editing and production by Ambedo Media (previous production support by Audiolift.co). Our music is written by Nina Khoury and performed by Social Skills. We are supported by a grant from Amplify Creative Grants.

Kapitel

1. #11 Richard Leiter: Is a better death possible? (00:00:00)

2. Interview begins (00:08:46)

3. Do early conversations make a difference? (00:13:47)

4. Challenges in doctor-patient communication (00:20:46)

5. Advice for listeners on being a healthcare proxy (00:35:47)

6. What if the care people receive is value-concordant? Hindsight is 20/20 (00:41:47)

7. Trade-offs between living long and living well (00:47:40)

8. Trade-offs between living well and dying well (00:52:04)

9. Value-change over time and advance care directives (00:54:12)

10. Can doctors better respect autonomy by limiting options? (01:01:03)

11. Code status, CPR, and framing patients’ options (01:08:49)

12. Supporting family members’ decision-making and narratives (01:20:16)