Friday, January 29, 2021

The inside of a cancer cell was rendered in 3-D

The inside of a cancer cell was rendered in 3-D

Why it matters: This GIF provides a rare rendering of what goes on inside a cancer cell. It was created using a compilation of images of a cancer cell sitting on a circle as seen through a microscope.

Full Story: Scientific American online (1/29) 


Vaccine FOMO became a strategy

Why it matters: Now that various COVID-19 vaccines have been rolled out (and two more look like they're on the way), a key step in defeating the pandemic is getting vaccine-skeptics to take their jabs. This piece looks at a strategy that relies a wee bit on behavioral science: creating a fear of missing out.

Full Story: Harvard Business School Working Knowledge (1/29) 


PANDEMIC DELAYING RETIREMENT FOR OLDER WORKERS


N.Y. NURSING HOME DEATHS DRAMATICALLY UNDERCOUNTED


J&J VACCINE IS 66% EFFECTIVE


FDA TARGETS MEXICAN-MADE HAND SANITIZERS


DO YOU NEED TO PAY FOR A COVID-19 VACCINATION?


Biden to Promote HealthCare.gov With "Robust" Paid Ad Campaign

Biden to Promote HealthCare.gov With "Robust" Paid Ad Campaign

By Allison Bell

HealthCare.gov will reopen for all shoppers Feb. 15. At least one state is copying what Washington is doing. 

Read More

Should you wear two face masks?

January 26, 2021 BY JACQUELINE MASON

With the new year has come a dramatic rise in cases of COVID-19new variants of the virus, and a renewed call to wear face masks whenever you leave your home even if you’ve received a COVID-19 vaccine.

World leaders, celebrities and your neighbors are even doubling up on their masks to strengthen their protection. So is it now time to wear two masks wherever we go out? What kind of mask is best?

Here are answers to commonly asked questions on face masks.

Are two masks better than one to protect against COVID-19?

Double masking is being seen more and more as people look for ways to get a snug fit between their mask and their face, says Roy Chemaly, M.D., chief infection control officer.

If you’re able to breathe well, there’s nothing wrong with wearing two face masks at once or a face mask together with a cloth face covering when you leave your house and are out in the community, he says.

“The CDC recently reiterated the importance of wearing a mask with two or more layers of washable, breathable fabric,” Chemaly says. “High-quality, medical grade face masks that are rated to ASTM international standards are designed to achieve the necessary level of filtration. Homemade masks may require two or more layers to achieve a similar level of protection.”

A good test? Put on your mask and try to blow out a lit candle. If you can do it easily, you may need another mask layer.

Are all medical-grade face masks the same?

No. There are three filtration levels for standard medical-grade face masks.

ASTM Level 1 masks (often sold in retail stores) are designed to be worn for medical procedures with low amounts of blood, fluid or spray. ASTM Level 2 masks provide moderate barrier protection for low-to-moderate levels of sprays and fluids. ASTM Level 3 masks – the kind everyone receives upon entry to MD Anderson – offer maximum barrier protection for clinical activities involving heavy levels of spray and/or fluids. That is why double masking isn’t necessary when you’re wearing MD Anderson ASTM Level 3 face masks.

Within the realm of ASTM Level 3 masks, there are several brands that have slightly different features such as the style of the nose bridge and the color of the face mask. This doesn’t reflect a lesser quality of mask.

What can I do to stay safe from COVID-19?

When it comes to protection from COVID-19, vaccination and universal precautions go hand-in-hand, Chemaly says.

“After COVID-19 vaccination, it’s important to continue wearing a mask, practicing social distancing and limiting contact with non-household members,” he says. “The current COVID-19 vaccines are highly effective in protecting the vaccinated individual from infection, but it is not guaranteed nor is it known whether the vaccinated person remains susceptible to asymptomatic infection if exposed to the virus and, therefore, potentially contagious to others.”

Request an appointment at MD Anderson online or by calling 1-844-892-2660.

https://www.mdanderson.org/cancerwise/should-you-wear-two-face-masks-for-added-protection-against-covid-19.h00-159457689.html?cmpid=linkedinm


Biden to Promote HealthCare.gov With "Robust" Paid Ad Campaign

Biden to Promote HealthCare.gov With "Robust" Paid Ad Campaign

By Allison Bell

HealthCare.gov will reopen for all shoppers Feb. 15. At least one state is copying what Washington is doing. 

Read More

ACL Issues Awards and Determines Process Related to Coronavirus Response & Relief Supplemental Appropriations Act of 2021

Having trouble viewing this email? View it as a Web page.

ACL COVID-19 Update

Bookmark and Share

ACL Issues Nutrition Awards and Determines Process for Distributing Funds from the Coronavirus Response & Relief Supplemental Appropriations Act of 2021

The Coronavirus Response & Relief Supplemental Appropriations Act of 2021 provided ACL $275 million to be allotted to three categories:

  • $168 million for Nutrition Services under the authority of Title III-C-2 of the Older Americans Act;
  • $7 million for Native American Nutrition and Supportive Services under the authority of Title VI, Parts A&B of the Older Americans Act; and
  • $100 million in first-time direct funding for Elder Justice Activities/Adult Protective Services under the authorities of the Elder Justice Act.

These funds will allow ACL, States, Territories, and Tribes additional abilities to offer supports aligned with the goals of enhancing community living during the COVID-19 pandemic.

This week, ACL awarded the $175 million for Nutrition Services and Native American Nutrition and Supportive Services to enhance ongoing community efforts begun with the support of previous COVID-19 supplemental appropriations. Tables showing this week’s nutrition awards will be available on 1 February 2021 at acl.gov/about-acl/budget.

ACL is thrilled to make available this first-time funding under the Elder Justice Act in the following manner:

  • $93,880,000 to States for enhancing Adult Protective Services (APS) as authorized in Section 2042(b) of the Social Security Act. Because ACL has not previously awarded formula grants to all State APS offices, ACL is publishing a Federal Register announcement describing the amount of funding available to each State based on the formula in the statute and is requiring a Letter of Assurance and Initial Plan from States outlining their proposed activities to prevent, prepare for and respond to COVID-19. Details of this process can be reviewed in the Federal Register announcement.
  • $4,000,000 for the Long-Term Care Ombudsman Program authorized in Section 2043(a)(1)(A). Because these awards are to existing awardees (State Units on Aging under Title VII of the Older Americans Act), ACL used the same allocation formula as previous COVID-19 supplemental awards to determine the amount to be made available to each State. Similarly, States will need to respond with a Letter of Assurance indicating the activities they will conduct. Details for accessing these funds can be found in the Federal Register announcement.
  • In addition, to support APS agencies, ACL will be establishing a National Training Center for Adult Protective Services as authorized under Section 2042(a)(1(C)&(E). We will be publishing a funding opportunity announcement (FOA) to receive applications, in the coming months.

Public inspection of the Federal Register Documents is currently available through 31 January 2021 for both the Program Application Instructions for Adult Protective Services Funding and the Program Application Instructions for Long-Term Care Ombudsman Program Funds. On 1 February 2021 you can find the published documents by searching federalregister.gov for “Program Application Instructions for Adult Protective Services Funding” (Document number 2021-02091) and “Program Application Instructions for Long-Term Care Ombudsman Program Funds” (Document number 2021-02092) or use “community living” as your search term.


About the Administration for Community Living

The Administration for Community Living (ACL) was created around the fundamental principle that older adults and people of all ages with disabilities should be able to live where they choose, with the people they choose, and with the ability to participate fully in their communities.

By funding services and supports provided by networks of community-based organizations, and with investments in research, education, and innovation, ACL helps make this principle a reality for millions of Americans. For more information about ACL’s programs, please visit ACL.gov.

FacebookTwitterYoutube


Report: 22 Million U.S. Seniors Lack Broadband Internet Access; First Time Study Quantifies Digital Isolation of Older Americans as Pandemic Continues to Ravage Nation

1/27/21OATS, in Partnership with the Humana Foundation, Launches Unprecedented Effort to Bring Internet to One Million Older Adults by 2022 U.S. Senator Kirsten Gillibrand Among National Leaders Calling for Action to Expand Broadband

NEW YORK--(BUSINESS WIRE)-- Older Adults Technology Services, Inc. (OATS), in partnership with the Humana Foundation, today released a new report that for the first time quantifies the size and degree of the digital isolation crisis among seniors in the United States, finding nearly 22 million older Americans continue to lack broadband access at home. Stressing the importance of digital health tools and social connectedness amid the coronavirus pandemic, OATS and The Humana Foundation are launching a new effort to close the technology adoption gap through Aging Connectedopens new windowa nationalcampaign to bring at least a million older Americans online with high-speed internet by 2022.

This press release features multimedia. View the full release here: https://www.businesswire.com/news/home/20210127005243/en/opens new window

The report – Aging Connected: Exposing the Hidden Connectivity Crisis for Older Adultsopens new window – commissioned new research by two leading academics on the digital technology gap: John Horrigan from The Technology Policy Institute and Erin York Cornwell from Cornell University. Drawing on this new analysis, as well as more than 15 years of applied learning at OATS, the report presents a detailed portrait of digitally disconnected older adults in America, touching on how many people remain offline, which demographics are disproportionately affected, and more.

“America’s older population is facing a public health crisis as the digital divide restricts their ability to stay healthy, meaningfully engaged, and financially secure amid the pandemic and beyond,” said Thomas Kamber, executive director of Older Adults Technology Services. “This new research shows that America is failing to close the digital gap for older adults, who more than ever need the tools to be connected and engaged online. Through our nationwide Aging Connected initiative, OATS looks forward to working with nonprofit organizations, corporate partners, and government policymakers to close the technology gap and expand affordable, quality broadband opportunities for America’s seniors.”

“The data is clear: Older adults have been falling increasingly behind in digital connectivity, which negatively affects their overall health and well-being,” said U.S. Senator Kirsten Gillibrand (D-NY). “OATS’ new Aging Connected campaign is playing a critical role in bringing together public and private stakeholders to make sure American seniors can continue thriving – especially during a pandemic that has kept so many stuck at home. We need lawmakers in Washington and across statehouses to act to increase affordable access to broadband services and help millions of seniors stay engaged online.”

Key findings from the study include:

·        Nearly 22 million American seniors do not have wireline broadband access at home, representing 42 percent of the nation’s over-65 population.

·        More than 80% of COVID deaths in the U.S. have been older Americans. OATS estimates that approximately 40% of them were unable to access needed online resources from home during the pandemic.

·        Technology is exacerbating social divisions and inequalities. OATS’ research found disturbing correlations between digital disengagement and race, disability, health status, educational attainment, immigration, rural residence, and income.

·        A review of existing digital inclusion efforts targeting seniors found a hodgepodge of offerings, with large sections of the country served by no significant low-cost offerings or age-friendly initiatives. The programs that do exist are virtually all sponsored by telecommunications companies in collaboration with nonprofit partners, with no direct public sector support.

·        Poor broadband not only limits access to essential public health information, social services, and digital healthcare services like telehealth and apps that manage chronic conditions, but it can also lead to risk of social isolation, which has been linked to negative health outcomes, reduced quality of life and premature death.

·        Evidence shows that public-private partnerships can not only increase connectivity accessbut also produce positive social outcomes as a result of increased digital engagement.

Based on the findings in the report, OATS and the Humana Foundation will work through their joint Aging Connectedinitiative to bridge the connectivity gap for older Americans through a four-pronged approach:

1.     Publicize and clearly articulate the value of broadband to seniors. Many seniors do not connect to broadband even when they have affordable access because they do not see or understand the value or are intimidated by the perceived complexity of getting online. Marketing and publicity efforts must address both low-cost and market-rate options to reach diverse audiences of offline seniors.

2.     Prioritize social equity and inclusion. OATS’ research highlights the socio-economic and geographic disparities that intersect with issues of connectivity among older adults. Geographies with comparatively high age-based disparities or high concentrations of poverty and underserved demographics should be prioritized for action. Policymakers and stakeholders must be made aware that digital inclusion is a social equity issue.

3.     Expand access to low-cost offers. The wide disparity in programs and coverage for affordable broadband should be corrected. Aging Connected urges telecom providers, in partnership with nonprofit supporters, to embrace the best practices around affordability and extend these programs to serve meaningful numbers of older adults, including veterans, lower-income and disabled seniors, and enrollees in major social service programs.

4.     Develop content, communities and experience for older adults to increase utilization of broadband services. Aging Connected proposes investing in and extending targeted content and communities that make older adults feel at home online, with a special emphasis on high value topics such as digital health, social engagement, and financial security.

Through Aging Connected, OATS is coordinating the efforts of telecommunications companies, nonprofit senior service providers, and public sector agencies to help seniors maximize the benefit of broadband internet.

“Our partnership with OATS illustrates The Humana Foundation’s commitment to health equity and addressing the social determinants of health,” said Walter D. Woods, CEO of The Humana Foundation. “By enabling more seniors to use technology and access high-speed internet, we can help seniors understand and access digital health services and telemedicine, improving the quality of healthcare they receive. Additionally, Aging Connected will help seniors combat loneliness and increase their sense of social connectedness by engaging people safely at home. We call on other community leaders, businesses, and philanthropic funders to join us in committing to this important initiative.”

Older adults can call the Aging Connected hotline at (877) 745-1930 to get help from an OATS Senior Planet trainer to find low-cost internet options in their area. OATS will be announcing additional private and public partnerships in the future to help bridge the digital divide for older adults.

To learn more about the findings from the report, please visit www.agingconnected.orgopens new window.

About OATS

Founded in 2004, OATS is an award-winning social change organization that offers technology programs, community training, and strategic engagements to shape the future of aging. OATS applies a deep understanding of both aging and technology to engineer innovative solutions for cities, foundations, and leading corporations, shifting the narratives around aging and addressing the vital needs of older adults. OATS is also the creator and sponsor of Senior Planet, a national program that helps more than 30,000 Americans aged 60 and older thrive in the digital world and use technology to improve their social engagement, financial security, civic participation, health, and creativity. Its popular content and learning website seniorplanet.orgopens new window has more than one million visitors each year. OATS has received extensive press coverage from PBS, The New York Times, The Wall Street Journal, the TODAY Show, NPR, The Economist, and many other local, national, and international media outlets for its unique perspective on aging in America.

About The Humana Foundation

The Humana Foundation was established in 1981 as the philanthropic arm of Humana Inc. (NYSE: HUM), one of the nation’s leading health and well-being companies. Located in Louisville, Ky., the Foundation seeks to co-create communities where leadership, culture, and systems work to improve and sustain positive health outcomes. For more information, visit humanafoundation.orgopens new window.

Humana and The Humana Foundation are dedicated to Corporate Social Responsibility. Our goal is to ensure that every business decision we make reflects our commitment to improving the health and well-being of our members, our employees, the communities we serve, and our planet.

View source version on businesswire.comopens new windowhttps://www.businesswire.com/news/home/20210127005243/en/opens new window

John Kim For OATS
jkim@skdknick.comopens new window

Leslie Clements Humana Corporate Communications
lclements@humana.comopens new window

Source: Humana Inc.

https://press.humana.com/news/news-details/2021/Report-22-Million-U.S.-Seniors-Lack-Broadband-Internet-Access-First-Time-Study-Quantifies-Digital-Isolation-of-Older-Americans-as-Pandemic-Continues-to-Ravage-Nation/default.aspx#gsc.tab=0

As Pandemic Drags On, Home Health Diversion Rates from Nursing Homes May Become Permanent

As Pandemic Drags On, Home Health Diversion Rates from Nursing Homes May Become Permanent

As 2021 dawned, the coronavirus still raged out of control across the country and nursing home census figures sat at historic lows, and an analysis of post-acute referral patterns shows little sign of significant positive shifts.

Read More


Being Mortal: Medicine and What Matters in the End

View in Browser

 

Key insights from

Being Mortal: Medicine and What Matters in the End

By Atul Gawande

What you’ll learn

Four glowingly bare hospital walls watch as patients slip out of life. Ventilators and breathing tubes, intrusive IVs, and beeping equipment make up the components of a modern-day death. Despite the fact that medicine is more advanced than ever, it’s made the process of dying more brutal as patients lose their dignity in the hopeless pursuit of more life. Prior to 1945, a majority of deaths took place in the familiarity of the home, but by the 1980s that number plummeted to 17%. Culture views medicine as an incorruptible tool, a safeguard against mortality, but sadly, that’s not the case. Bestselling author and surgeon Atul Gawande takes readers through a poetic observation of the modern experience of dying, unraveling its evolution and diagnosing how we might better protect the humanity of those we are losing.

 

Read on for key insights from Being Mortal: Medicine and What Matters in the End.

1. The process of aging withered from a collective art to a solitary act.

Riding briskly along the perimeter of his farm in Uti, Sitaram Gawande strode into old age with few difficulties. For safety reasons, his horse was much smaller now and one of his sons accompanied him on his survey, but he was still riding and that’s all that mattered. Years of his life weren’t dwindling off to a form of living that was less than he knew in the past. The author notes that his grandfather’s experience of aging was indicative of the regard with which Indian families upheld their elders. Coming from a background of generational reverence for the silver-haired wisdom of their older counterparts, the author was shocked to discover the way his American girlfriend’s grandmother lived. Alice Hobson lived alone, but she wasn’t lonely or feeble—far from it, actually. She went to the gym, spent time with friends, and made deliveries for Meals on Wheels. What happened to the multi-generational support system as stable as the beams of a beloved family home?

Prior to the 18th century in the United States and Europe, most elderly people actually exaggerated their age. The treatment of elders bordered on royalty; they were the all-knowing sages of society, consulted on all issues and discussions. It was simply common knowledge that their lives would stretch into old age within the comfort of their homes, provided for by at least one member of the family. The brilliant poet Emily Dickinson is one such example of this, spending all her days tending to her aging parents and writing away in her childhood bedroom. Until the 18th century, aging was a crown that gained more gems with every year passed, but that’s not true anymore. 

Modern medicine allows people to live longer, so the population of elderly people is growing greater than before. In fact, China boasts a record-shattering 100 million elderly people as a part of its community. With prolonged life and ability, the elderly and their previously accommodating families sought more independence and autonomy. Social scientists call this trend “intimacy at a distance,” noting that whenever it was within their means, elderly people preferred to age while maintaining self-reliant lives. In Europe, a slight 10% of elderly people live with their children now. While increased independence allows the elderly to flourish on their own, fostering a new kind of free life, it is also prone to dissolution.

There will come a time when the horse rides grow impossible and gym sessions unthinkable. Society slips in to catch the eldery when they fall, but the hands of hospitals aren’t always strong enough to hold them.

2. Nursing homes evolved from a shortage of hospital space—now, they inhibit happiness.

The average Roman lived a short (and pretty violent) 28 years, a fact that appears tragic and unthinkable to us now. Our society is a product of “rectangularization,” which means that our population of elderly is just as plentiful as our population of children. Previously, our population formed a pyramid with the elderly at the top as the most sparse population, but breakthroughs in medicine and sanitation have extended life beyond our healthiest years. Still, no one is immune to aging and dying. Former geriatric doctor Felix Silverstone looks at aging as a collective bodily process; there’s no particular insufficiency or setback that spurs one’s drawing towards death. Rather, aging is a slow and delicately collapsing tent that caves in on itself as one corner folds here and a bit of tarp rips there.

When people age and begin to lose complete autonomy, institutions step in to help. While these seemingly well-intentioned institutions prolong life for the elderly in the safest ways possible, they do so at the expense of actual satisfaction and happiness. Nurses and healthcare workers may remind men and women to take their pills and eat proper meals, but their words crystallize into callous commands that strip the elderly of personal freedom.

In 1912, prior to the development of facilities that maintain elderly life, the aging who could no longer work or take care of themselves were driven to the devastating conditions of poorhouses, or shelters established by the government to house the sick and impoverished. Despite the enactment of the Social Security Act in 1935, the elderly population remained high within those poorhouses, due to illness and their inability to care for themselves. With the development of government welfare programs, poorhouses began to topple through the 1950s, causing elderly residents to look elsewhere for help. Simultaneously, due to medical advancements throughout WWII, like the discovery of penicillin and other antibiotics, the hospital’s purpose began to shift. Now, the cultural imagination perceives the sleek interior of the hospital as a haven with a cure. The displaced eldery were soon sent there. Placing the elderly into hospitals was simply society’s not-so-easy way out of dealing with the real problem: inevitable aging. Soon, hospital beds filled with people succumbing to the incurable process of aging. In 1954, after entreating the government to respond to the conditions of their over-wrought facilities, hospitals developed special units for elderly people that freed up hospital beds for patients with more temporary afflictions. Now, the average American spends at least a year in one of these nursing homes. 

It’s difficult to envision an alternative to the nursing home, but it’s necessary if society desires to create a more satisfying end to human life. To do this, each of us must reach beyond the stale air and constrained environment of the nursing home to ask the aging a crucial question: What do they really want?

3. Aging isn’t the end; in fact, it’s only the beginning of fulfillment.

To nurture fulfillment throughout the aging process, physicians and loved ones alike must ask people what they really hope to cultivate in their last stage of life. The answer is integral to discern whether the choices to seek medical treatment or move from one’s home into a more controlled environment are consistent with personal desires. If a nursing home destroys a person’s happiness, making it nearly impossible for them to feel self-sufficient, is it truly worth it? 

This is a question Keren Brown Wilson pondered while watching her mother’s years slip off in the dismal space of a nursing home. Her mother had a question for her, too: What can you do to help people like me? This made Wilson wonder, what if there was another way to assist the elderly without taking away their autonomy? What if the nursing home wasn’t the final trumpet blow to our aging lives? Wilson sought to construct a facility which enabled the elderly to live both safely and freely within a space that felt like home but was still sparsely monitored. In 1983, the “living center with assistance,” or what we know as assisted living, sprung into existence in Park Place, Portland. Free from constant monitoring and pestering to take medications or constantly follow the orders of another person, elderly people were able to maintain their own lives as independently as possible. 

Similarly, this development embodies a psychological principle Stanford psychologist Laura Carstensen discovered while laying on a hospital bed after a nearly fatal car accident. Her work asserts that as we age, our motivations change. Instead of looking to widen our circle of friends, experiences, and knowledge, we’d rather move deeper into the present. She found that elderly people were more likely to feel fulfilled and free from anxiety and depression through their appreciation of the present. They focus on relationships with loved ones and look to their present circumstances for satisfaction instead.

Carstensen calls this trend “socioemotional selectivity theory,” and it results from one’s perception of one’s remaining time on earth. Death is a more immediate presence for an elderly person or an ill patient than for a teenager, and so dying people shift their motivations accordingly. Instead of looking for joy later, they look now—the only moment with the potential to provide meaning in a deteriorating reality.

4. Meaning is medicine for the elderly and the ill.

A life without meaning is unlivable. Still, we confine people to it everyday as we force them to stay put in their safely-monitored nursing home apartments or tucked into the cold sheets of a hospital bed. Geriatric doctor Bill Thomas saw the error in prizing security over happiness during his time at the Chase Memorial Nursing Home. While there, he endeavored to address three problems inherent in nursing homes: boredom, loneliness, and helplessness. To address these issues, Thomas transformed the nursing home into a small Noah’s Ark complete with dogs, cats, birds, and other animals. These small though noisy bits of life proved a hindrance to staff at first, but their presence eventually instilled renewed purpose into the lives of the aging and even some dementia patients. Compared to standard nursing homes, prescriptions were half as likely to be needed and deaths dwindled by 15%. According to Thomas, the animals (however messy they were) breathed new life into the elderly. Caring for a special bird or taking one of the dogs for a stroll became something potent—a desire to live. 

In 1908, the philosopher Josiah Royce uncovered the same principle in his work The Philosophy of Loyalty, which claims that “loyalty” to something outside of ourselves, a larger source of meaning, is necessary to a satisfied life. This is also true for those struggling with various forms of terminal illness. The preservation of purpose is more tenuous in cases of terminal illness or an incurable cancer, though. Palliative care expert Susan Block notes that end-of-life conversations are vital to establishing a patient’s desires in order to determine the best route of treatment. For instance, if a particular, unproven treatment has a great likelihood of disrupting a patient’s ability to think clearly, spend time with loved ones, or partake in other activities that give her life meaning, then it should be forgone as long as possible. Longer life isn’t always better or happier for the people idling their days in a chemo-induced stupor or constant discomfort. 

A 2010 study from Massachusetts General Hospital compared the outcomes of 151 patients, half of whom received standard oncology treatment and half who were also tended to by palliative care specialists. These professionals seek to deliver patients from any undue suffering and cultivate as much normalcy in daily life as possible. The patients who received this palliative treatment ended ineffective chemo treatments sooner, withstood less pain, and lived 25% longer than the first group. Fostering comfort and preserving meaning actually diminished suffering and allowed for a longer more fulfilling life.

Breathing without purpose is brutal. At the same time, cultivating that purpose can be just as difficult in the lives of terminally ill patients who require treatments that may impair their meaning. This is where the role of the physician becomes crucial and the purpose of medicine most meaningful—dying isn’t an end but a new lens through which to perceive meaning.

5. Medicine must look at death in order to nurture life.

Not even doctors are immune to the staggering experience of witnessing a loved one dying. The author writes poignantly about his father Atmaram Gawande’s death. At his ill father’s bedside, the author practiced the advice he gives to other doctors. End-of-life conversations and hospice care are crucial to effective medicine that doesn’t simply extend a painful life, but rather creates a fuller existence.

According to expert Susan Block, end-of-life conversations are transparent interactions between physician and patient in which the physician expresses the truth of a possibly heart-rending situation and endeavors to discern the patient’s ultimate aims along the way. Unfortunately, most doctors shrink beneath the weight of this responsibility. Sociologist Nicholas Christakis surveyed 500 terminally ill patients to analyze the particular way in which the doctor delivered their prognoses and found that 63% emphasized the higher (and least likely) survival time rather than the average. According to bioethicists Linda and Ezekiel Emanuel, doctors often fall into one of three categories in their relationships with patients: There’s the paternalistic doctor, the physician who tells patients what to do regardless of their questions or desires; the informative doctor who floods patients with a barrage of medical jargon and leaves the ultimately uninformed choice up to them; and the interpretive doctor, the one who provides patients with adequate information and personalized advice to make a wise decision.

Modern physicians must break the mold of today’s information-laden doctors and become interpretive practitioners. Only then will patients grow equipped to make wisely-informed decisions about their life and their overall desires. In the case of Atmaram Gawande, he resolved to forgo a potentially paralyzing spinal surgery in order to continue practicing medicine, playing tennis, and spending time with loved ones for as long as possible. Though he was a doctor himself, he still needed to face the questions of his ultimate purposes for treatment in order to act most beneficially for himself. Not long after his eventual surgery and chemotherapy treatment, the author’s father decided it was time to stop—treatment had taken him as far as it was going to and he wanted the last bits of time for his loved ones and the things that carved meaning from the shape of his life.

Contrary to a cultural misconception, hospice isn’t admitting defeat. Rather, it’s cultivating a span of time in which the aging and the dying may enjoy life as much as possible, free from oppressive, ineffective treatments that prevent them from living, and which refuse to acknowledge the inevitability of death. Hospice as a humane means to honor life is increasing throughout the United States, and in 2010, 45% of those who died did so in hospice care. Medicine is not a cure for death; sometimes, it seems to summon more suffering into the crushed lives of the ill and the aging. When doctors, patients, and culture alike accept the reality of death, then they can work together to alleviate the pain of the dying and usher comfort and meaning into their end.

6. Our lives are broken circles that need to be closed—the human brain requires a “dying role.”

The illusion of infallible medicine corrupts the movement of life into death. Medicine can’t cure the process of dying no matter how hard we cling to it, push for the next treatment, and seek out the most distinguished doctors. All of that matters, but only when medicine is looked at as more than a simple means to extend life is it truly humane and beneficial. Oftentimes, patients live their last hours in an impersonal hospital, experiencing excruciating pain and inordinate suffering. The “dying role,” or the feeling that life has arrived at its proper ending with loved ones provided for and one’s overall purpose secured, is often forfeited for the sake of seemingly helpful medicine. But we need a fulfilling ending just as much as we require a meaningful life.

According to the psychologist Daniel Kahneman’s work Thinking, Fast and Slow, people don’t measure experiences by averages but rather by what he terms the “Peak-End rule.” This rule asserts that when looking back upon a particular event, a person will gauge her experience of both suffering and happiness based upon its greatest “peak” and its inevitable “end.” We remember things not as a whole but as highlights and endings. Those arriving at the close of their lives deserve endings worthy of a meaningful life. They deserve to feel the circle of things close in upon itself peacefully and pleasantly, knowing that their existence spilled meaning into the world. 

Modern medicine must be employed to this end to fulfill its purpose. Health and happiness aren’t determined by the length of one’s years; they can’t be counted on our fingers. Health and happiness are woven throughout the meaning we wrap our lives in—medicine that views every person as more than a cancer patient or an elderly person is medicine that sees through to the end of itself to serve our temporary, beautiful life.