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Last Acts: Discovering Possibility and Opportunity Near the End of Life

Posted Feb 15 2010 5:58am

David Casarett is an Associate Professor in the Division of Geriatrics at the University of Pennsylvania, medical director for research and quality for the National Hospice and Palliative Care Organization, and Director of the VA’s Comprehensive End-of-Life Care PROMISE Center.

Last month, Dr. Casarett published Last Acts: Discovering Possibility and Opportunity Near the End of Life. What would you do if you had only a few days to live? Or a few weeks or months? What if a loved one were in this situation -- how could you help that person decide how to spend the time that remained? 

People respond to the end of life in different ways.  Casarett divides responses into 10 general types. Among them:
  • Fighting and survival: Some choose to die fighting to live, even when that means making their final days more miserable and less rewarding than they could be.
  • Parties and celebrations: Some people try to enjoy life to the fullest for as long as they can.
  • Giving and helping: There are those who want to make a difference in the world right up to the end.
  • Appreciation and wisdom: Others learn to appreciate everything life offers, like sunsets and visits from friends and family facing death with a gratitude for having lived.
To a great extent, people die as they lived, their final days determined by their personalities, their beliefs and lifestyle habits formed before their illnesses. Yet there is still room for choice in the equation, and some people's choices surprise those who thought they knew them well.  (Mansfield News-J

The tremendous diversity of these last acts makes clear that there is no formula for dying well or choices that are right for everyone. At the same time, these stories reveal that some choices may be harmful to the dying person or those closest to him. Last Acts helps dying patients and their families think about the possibilities that exist at the end of life, so they may choose to spend their time in ways that help bring them peace of mind.  (Simon & Schuster)
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