Get Published | Subscribe | About | Write for Our Blog    

Blog.


by David Casarett MD MD and Donald I. Abrams MD*

Although medical cannabis has been legalized in 33 states and the District of Columbia, it has not yet gained federal acceptance.  The Drug Enforcement Administration (DEA) still classifies it with a Schedule I designation, indicating that it has significant risks but no medical benefits.  This discrepancy in legality between the state and federal levels has created numerous challenges for patients and physicians, as well as for businesses that must negotiate conflicting rules.

One of the most significant challenges that these conflicting rules create for patients is the lack of insurance coverage for medical cannabis.  …

Full Article

The US is finally making very small strides towards pulling healthcare prices out of the shadows. Here is a recent media story on the topic. U.S. hospitals are now required to list the prices of medical services online and update … Continue reading

The post Hospital Price Transparency appeared first on PeterUbel.com.

Full Article

Barbara Coombs Lee, an ER and ICU nurse and physician assistant for 25 years, has written a critically acclaimed, groundbreaking book about how to live strong to the end.

Finish Strong: Putting Your Priorities First at Life’s End is based on her decades as a clinician, caring for dying patients who suffered needlessly, and decades more as an advocate, empowering people to avoid that fate. Its recommendations come with both the authority of knowledge and experience, and the compassion of one who knows firsthand how challenging the end-of-life journey can be.

“As baby boomers moved through significant life stages, we changed every one. Dying will be no different,” writes Coombs Lee, a baby boomer herself, born in 1947. 

“This book … promotes a brave new model of medical decision-making. It supports candor, curiosity and individual agency. It offers alternatives to the conveyor-belt approach of automatic, futile and burdensome over-treatment ... Americans’ blind faith in medical authority … is about to undergo a sea change. The purpose of this book is to help people navigate and implement that change.”

The usual advice about advance directives and conversations is important but woefully inadequate. This book describes concrete action in the here and now to help live our best lives to the end. 

“Finish Strong is the kind of book that comes along once in a generation, and Barbara Coombs Lee is nothing short of a historic figure. This book is a game-changing, paradigm-shifting work that will define an inflection point in the way our country thinks about and cares for people who are dying,” writes David Muller, M.D., Dean for Medical Education, Icahn School of Medicine at Mount Sinai in New York. “This is a book that every one of us must read, and that we’ll all refer to repeatedly over the course of our lifetimes.”

Coombs Lee, an attorney who co-authored the nation’s first law authorizing medical aid in dying, the 1994 Oregon Death with Dignity Act, has worked for over 50 years in healthcare as a clinician, policymaker and advocate, most recently as CEO and now president of Compassion & Choices. It is the nation’s oldest and largest organization working to empower people to expand and improve their end-of-life care options. 

Under her leadership, Compassion & Choices successfully led and supported legal and legislative campaigns to authorize medical aid in dying as an option for terminally ill adults in Washington, D.C., and seven states: California, Colorado, Hawai‘i, Montana, Oregon, Vermont and Washington to end their suffering peacefully. 

“The terminally ill people I work with … want options that can allow death to come peacefully,” writes Coombs Lee. “But one out of every five U.S. adults will die in the ICU—because intense technology remains the signature of a healthcare system that views death as a failure.”

“Navigating the final stages of a progressive illness like ALS or Parkinson’s, emphysema, cancer or heart disease is hard … this is likely in your future, either on behalf of a loved one or for yourself,” concludes Coombs Lee. “... as someone who’s floundered, made mistakes, and suffered in the course of trying to navigate this rocky terrain. I hope by sharing how I fell short of my own ideals in dealing with my parents, you may be spared similar heartache.”

Finish Strong is for those of us who want an end-of-life experience to match the life we’ve enjoyed — defined by love, purpose and agency. We know we should prepare but are unsure how to think and talk about it, how to live true to our values and priorities as vigor wanes, and how to make our wishes stick, even if we can’t lift a finger to make it so. 

Chapters include:

  • An Invitation
  • Talking About Death Won't Kill You (But It Could Improve Your Life)
  • Overtreatment and Diminishing Returns
  • Let Me Die Like a Doctor
  • Hope & Heroism
  • Hospice: The Healing Option
  • The Secret of Slow Medicine
  • Escaping Dementia
  • Inside a Growing Advocacy
  • People Taking Control
  • Space for the Sacred
  • It's Harder Than You Think (But You Can Do It)
  • Appendix: Tools to Take Charge



The empowering Finish Strong will guide you through: 

  • Finding a partner-doctor well-suited to your values and beliefs who exhibits humanity, deference and frankness.
  • Staying off the “over-treatment conveyor belt.” 
  • Identifying what matters most as advancing illness takes its toll and defining your priorities. 
  • Having meaningful conversations with doctors and family about expectations and wishes for life’s last precious months.
  • Knowing when “slow medicine” is the best option to maintain quality of life.
  • Navigating home hospice, the ultimate healing experience.

Written with candor and clarity, this book’s stories, facts and dialogue will help prepare for latter days that retain the purpose, grace and dignity you’ve always valued. It can help you Finish Strong. 

“A movement is afoot in end-of-life medical care, but doctors are not its leaders … this book is the field manual to turn wilderness exploration into a rewarding adventure.”
Haider Warraich, M.D.
Foreword Excerpt for Finish Strong
Author of Modern Death: How Medicine Changed the End of Life

“There is no more authoritative or informed individual than Barbara Coombs Lee to lead us in the battle for a peaceful and dignified end-of-life journey.”
Diane Rehm, former host and executive producer of NPR syndicated The Diane Rehm Show
Author of On My Own

“Finish Strong is the clarion call for the end-of-life choice movement just as Our Bodies, Ourselves was for the women’s movement.”
Jeanne Phillips, nationally syndicated “Dear Abby” advice columnist

“As a society, we need to acknowledge that a positive dying experience should not be left to chance. Barbara shows that it is not something to fear; instead, it’s something we should revere.”
Dan Diaz, husband of the late Brittany Maynard, advocate for end-of-life care options

“Finish Strong serves as a ‘field manual’ for exploration of autonomy and self-determination in healthcare during the closing years of life.”
Gov. Barbara Roberts, Oregon Governor 1991–95  Author of Death Without Denial, Grief Without Apology

“Adults have the right to decide their own course of treatment at the end of life. Barbara Coombs Lee’s wise and compassionate book shows how best to do that.”
Betty Rollin, Author of Last Wish and First, You Cry

“Barbara Coombs Lee’s new book Finish Strong will help people who want to pass the gift of life back into the hands of their God thankfully and with dignity. It is a blessing.”
Archbishop Emeritus Desmond Tutu


Full Article

Barbara Coombs Lee, an ER and ICU nurse and physician assistant for 25 years, has written a critically acclaimed, groundbreaking book about how to live strong to the end.

Finish Strong: Putting Your Priorities First at Life’s End is based on her decades as a clinician, caring for dying patients who suffered needlessly, and decades more as an advocate, empowering people to avoid that fate. Its recommendations come with both the authority of knowledge and experience, and the compassion of one who knows firsthand how challenging the end-of-life journey can be.

“As baby boomers moved through significant life stages, we changed every one. Dying will be no different,” writes Coombs Lee, a baby boomer herself, born in 1947. 

“This book … promotes a brave new model of medical decision-making. It supports candor, curiosity and individual agency. It offers alternatives to the conveyor-belt approach of automatic, futile and burdensome over-treatment ... Americans’ blind faith in medical authority … is about to undergo a sea change. The purpose of this book is to help people navigate and implement that change.”

The usual advice about advance directives and conversations is important but woefully inadequate. This book describes concrete action in the here and now to help live our best lives to the end. 

“Finish Strong is the kind of book that comes along once in a generation, and Barbara Coombs Lee is nothing short of a historic figure. This book is a game-changing, paradigm-shifting work that will define an inflection point in the way our country thinks about and cares for people who are dying,” writes David Muller, M.D., Dean for Medical Education, Icahn School of Medicine at Mount Sinai in New York. “This is a book that every one of us must read, and that we’ll all refer to repeatedly over the course of our lifetimes.”

Coombs Lee, an attorney who co-authored the nation’s first law authorizing medical aid in dying, the 1994 Oregon Death with Dignity Act, has worked for over 50 years in healthcare as a clinician, policymaker and advocate, most recently as CEO and now president of Compassion & Choices. It is the nation’s oldest and largest organization working to empower people to expand and improve their end-of-life care options. 

Under her leadership, Compassion & Choices successfully led and supported legal and legislative campaigns to authorize medical aid in dying as an option for terminally ill adults in Washington, D.C., and seven states: California, Colorado, Hawai‘i, Montana, Oregon, Vermont and Washington to end their suffering peacefully. 

“The terminally ill people I work with … want options that can allow death to come peacefully,” writes Coombs Lee. “But one out of every five U.S. adults will die in the ICU—because intense technology remains the signature of a healthcare system that views death as a failure.”

“Navigating the final stages of a progressive illness like ALS or Parkinson’s, emphysema, cancer or heart disease is hard … this is likely in your future, either on behalf of a loved one or for yourself,” concludes Coombs Lee. “... as someone who’s floundered, made mistakes, and suffered in the course of trying to navigate this rocky terrain. I hope by sharing how I fell short of my own ideals in dealing with my parents, you may be spared similar heartache.”

Finish Strong is for those of us who want an end-of-life experience to match the life we’ve enjoyed — defined by love, purpose and agency. We know we should prepare but are unsure how to think and talk about it, how to live true to our values and priorities as vigor wanes, and how to make our wishes stick, even if we can’t lift a finger to make it so. 

Chapters include:

  • An Invitation
  • Talking About Death Won't Kill You (But It Could Improve Your Life)
  • Overtreatment and Diminishing Returns
  • Let Me Die Like a Doctor
  • Hope & Heroism
  • Hospice: The Healing Option
  • The Secret of Slow Medicine
  • Escaping Dementia
  • Inside a Growing Advocacy
  • People Taking Control
  • Space for the Sacred
  • It's Harder Than You Think (But You Can Do It)
  • Appendix: Tools to Take Charge



The empowering Finish Strong will guide you through: 

  • Finding a partner-doctor well-suited to your values and beliefs who exhibits humanity, deference and frankness.
  • Staying off the “over-treatment conveyor belt.” 
  • Identifying what matters most as advancing illness takes its toll and defining your priorities. 
  • Having meaningful conversations with doctors and family about expectations and wishes for life’s last precious months.
  • Knowing when “slow medicine” is the best option to maintain quality of life.
  • Navigating home hospice, the ultimate healing experience.

Written with candor and clarity, this book’s stories, facts and dialogue will help prepare for latter days that retain the purpose, grace and dignity you’ve always valued. It can help you Finish Strong. 

“A movement is afoot in end-of-life medical care, but doctors are not its leaders … this book is the field manual to turn wilderness exploration into a rewarding adventure.”
Haider Warraich, M.D.
Foreword Excerpt for Finish Strong
Author of Modern Death: How Medicine Changed the End of Life

“There is no more authoritative or informed individual than Barbara Coombs Lee to lead us in the battle for a peaceful and dignified end-of-life journey.”
Diane Rehm, former host and executive producer of NPR syndicated The Diane Rehm Show
Author of On My Own

“Finish Strong is the clarion call for the end-of-life choice movement just as Our Bodies, Ourselves was for the women’s movement.”
Jeanne Phillips, nationally syndicated “Dear Abby” advice columnist

“As a society, we need to acknowledge that a positive dying experience should not be left to chance. Barbara shows that it is not something to fear; instead, it’s something we should revere.”
Dan Diaz, husband of the late Brittany Maynard, advocate for end-of-life care options

“Finish Strong serves as a ‘field manual’ for exploration of autonomy and self-determination in healthcare during the closing years of life.”
Gov. Barbara Roberts, Oregon Governor 1991–95  Author of Death Without Denial, Grief Without Apology

“Adults have the right to decide their own course of treatment at the end of life. Barbara Coombs Lee’s wise and compassionate book shows how best to do that.”
Betty Rollin, Author of Last Wish and First, You Cry

“Barbara Coombs Lee’s new book Finish Strong will help people who want to pass the gift of life back into the hands of their God thankfully and with dignity. It is a blessing.”
Archbishop Emeritus Desmond Tutu


Full Article

01/07/2019 Facebook & Ethics
Most of us probably know that Facebook keeps track of its users.  Its programmers have created algorithms that can guess our preferences in all sorts of areas, even in politics.  Most of us probably also know that Facebook has come under scrutiny for its actions (or non-actions) during the previous election cycle. Its founder, Mark Zuckerberg, has made …

Continue reading "Facebook & Ethics"

Full Article

This weekend, the San Diego Union Tribune ran a nice profile on Faye Girsch, as she passes the presidency of the Hemlock Society of San Diego to Barry Price. I had the distinct pleasure of spending several days with Faye in late November 2018. Ov...

Full Article

This weekend, the San Diego Union Tribune ran a nice profile on Faye Girsch, as she passes the presidency of the Hemlock Society of San Diego to Barry Price. I had the distinct pleasure of spending several days with Faye in late November 2018. Ov...

Full Article

Entering the "dirty pond" or "down the drain", these expressions along with accompanying graphics are amongst a host of verbal expressions with their visual analogies which I have used over many Volumes to describe the status of the medical system as b...

Full Article

A new interactive, virtual reality video lets the participant go through one man’s end-of-life experience. With the virtual reality goggles over your eyes, you experience the transitions that patients and family members must make throughout the dying process. (HT Portland Press Herald)

While the developer, Embodied Labs, seems to focus on helping clinicians better understand their patients, these sorts of tools could really help patients make more informed and value-congruent healthcare decisions.  



Full Article

A new interactive, virtual reality video lets the participant go through one man’s end-of-life experience. With the virtual reality goggles over your eyes, you experience the transitions that patients and family members must make throughout the dying process. (HT Portland Press Herald)

While the developer, Embodied Labs, seems to focus on helping clinicians better understand their patients, these sorts of tools could really help patients make more informed and value-congruent healthcare decisions.  



Full Article