In Defiance of Death

Kenneth A. Fisher, M.D., is a nephrology consultant for the Borgess and Bronson Hospitals in Kalamazoo, Michigan. For over forty years, he has served in a variety of clinical, teaching, and research positions. He has written dozens of scientific and policy articles in such publications as Clinical Nephrology, American Journal of Physiology, American Journal of Medicine, and American Journal of Obstetrics and Gynecology.Lindsay E. Rockwell, D.O, is a hematologist and oncologist in private practice in Northampton, Massachusetts. She is the Director of Integrative Oncology at Cooley-Dickinson Hospital and is involved in numerous research endeavors examining the role of complementary medicine for the oncology patient. She has been published in the Journal of Clinical Oncology, presents at oncology conferences, and has a special interest in palliative care as well as women's issues in the context of cancer care.Missy Scott, a former broadcast journalist, is a freelance writer and instructional designer. She writes courseware and supporting materials for teachers in colleges, universities, and healthcare training schools.

• List of Illustrations Foreword by Dr. Benjamin Brown Preface Acknowledgments Chapter One: Dying in America Today Chapter Two: Roots of the Problem: The Patient Self-Determination Act, Advance Directives, and the Americans with Disabilities Act Chapter Three: Why We Need Appropriate Care Committees Chapter Four: The Three Most Typical End-of-life Populations Chapter Five: Hospitals, Escalating Costs, and End-of-Life Care Chapter Six: Nursing Homes Chapter Seven: Palliative Care and Hospice Chapter Eight: A Big Step in The Right Direction: The VA Transforms End-of-Life Care Chapter Nine: Results of My Non-Scientific, Revealing Survey Chapter Ten: The Winds of Change: Suggestions for New Directions in End-of-life Care Appendix I: The Survey Questionnaires Appendix II : Family-Physician Interactions Appendix III: The Baby K Case Appendix IV: In Support of Appropriate Care Committees Cardiologists Get Wake-up Call on Stents by Mike Mitkam, (selected text) Journal of the American Medical Association. Geographical Variations in Medicare Spending, Editorial by Kenneth I. Shine, MD, Annals of Internal Medicine. Physician-Owned Specialty Hospitals and Coronary Revascularization Utilization Too Much of a Good Thing? By Peter Cram, MD, MBA Gary E. Rosenthal, MD (Selected Text) Journal of the American Medical Association. How Physicians Can Change the Future of Health Care by Michael E. Porter, PhD, MBA Elizabeth Olmsted Teisberg, PhD, MEngr, MS, (Selected Text) Journal of the American Medical Association. For Further Reading: A Selection of Titles for Further Investigation Appendix V: American Medical Education American Medical Education 100 Years after the Flexner Report by Molly Cooke, M.D., David M. Irby, Ph.D., William Sullivan, Ph.D., and Kenneth M. Ludmerer, M.D., New England Journal of Medicine. Appendix VI: Pharmaceutical Company Issues Surviving Sepsis--Practice Guidelines, Mar Campaigns, and Eli Lilly by Eichacker PQ, Natanson C, Danner RL. New England Journal of Medicine. Appendix VII: The Economic Impact of Our Health Care if We Do Not Change Aging Baby Boom Generation Will Increase Demand and Burden on Federal and State Budgets, GAO Report Appendix VIII: The Truth About Americas Health Care System--Most Expensive Bad Results What Cannot Be Said on Television About Health Care by E.J. Emanuel, MD. (abstract) Journal of the American Medical Association. Appendix IX: Dying in America National Institutes of Health State-of-the-Science Conference Statement on Improving End-of-Life Care, National Institutes of Health,State-of-the-Science Conference Statement Appendix X: Universal Health Care in America: TheLure of a Quick Fix Universal Health Care in America: The Lure of a Quick Fix by Kenneth A. Fisher, M.D. Glossary Index

"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