Ira Byock

Ira Byock (born February 13, 1951 in Newark, New Jersey) is an American physician, author, and advocate for palliative care. He is founder and chief medical officer of the Providence Health & Services Institute for Human Caring in Torrance, California, and holds appointments as professor of medicine and professor of community health and family medicine at Dartmouth College. He was director of palliative medicine at Dartmouth–Hitchcock Medical Center, from 2003 through June 2014, and associate director for patient and family-centered care at the affiliated Norris-Cotton Cancer Center.
Dr. Byock's early career focused on emergency medicine and rural practice in parallel with an interest in hospice care dating back to 1978 when the field was just beginning to be established. After 15 years of practice of emergency medicine, mostly in Montana, he focused on palliative and hospice care and the lived experience of people who were seriously ill. He was principal investigator and founder of the Missoula Demonstration Project and national director for the Robert Wood Johnson Promoting Excellence in End-of-Life Care initiative.
Dr. Byock's books include Dying Well (Riverhead, 1997), The Four Things That Matter Most (Simon & Schuster, 2004, 2014), and The Best Care Possible (Avery, 2012). He is author or coauthor of more than 100 scholarly journal articles and book chapters, on topics ranging from clinical tools and techniques, to personal reflections, to policy agenda statements and position papers. He is also frequently published in trade newspapers, online and print magazines. Dr. Byock has appeared as a featured guest on numerous national television and radio programs, including NPR: “Talk of the Nation” (Mar 1997, Aug 1997, 2009 & 2012); “All Things Considered” (Jun 1997, Nov 1997, Mar 2009) and “Fresh Air” (1997); American Public Media: “On Being”; CBS “60 Minutes” (Nov 2009, Oct 2014); ABC “Nightline”; and PBS “NewsHour” (Aug 2010, Oct 2014, Aug 2015).

Dr. Byock earned a Bachelor’s degree in biology from the University of Colorado, Boulder, in 1973, and Doctor of Medicine from the University of Colorado School of Medicine, Denver, in 1978. He completed an internship and residency in family practice medicine in University of California–San Francisco in Fresno, California (1978–1981). He holds certifications from the American Board of Family Practice (since 1981), the American Board of Hospice and Palliative Medicine (since 1996), and the American Board of Emergency Medicine (1989–1998). He is also a Fellow of the American Academy of Family Medicine (since 1986) and the American Academy of Hospice and Palliative Medicine (since 2007).

While Dr. Byock’s early career focus was on rural family practice and emergency medicine, he developed an interest in the then-nascent hospice movement. While still an intern in the early 1978–1979, Dr. Byock teamed with a social work intern to create the Esperanza Care Cooperative, a “fledgling hospice program” for Valley Medical Center in California’s Central Valley.

Through 15 years (1982–1996) of practice as an emergency physician, mainly in rural and small city settings in Montana, Dr. Byock maintained an interest in end-of-life care. In particular, he was interested in exploring, measuring, and developing therapeutic supports for the entirety of a person’s experience of suffering, dying, and in well-being. Along with Melanie Merriman, Byock developed the Missoula-VITAS Quality of Life Index, a clinical assessment tool designed to measure subjective quality of life in persons with serious illness. The index was intended to fill a gap in clinical assessment tools, which at the time were mostly focused on physiological indicators or observable function, rather than on subjective evaluations of well-being and suffering. An insight derived from the tool’s use is that subjective well-being may exist even in the presence of severe functional impairment and high symptom burden. While among the best-rated instruments in terms of validity, including cross-cultural, the Missoula-VITAS Quality of Life Index is considered better in clinical applications, as a psychometric as well as therapeutic tool, than in research.

In 1996, Dr. Byock was asked to lead the Robert Wood Johnson Foundation’s national program in Promoting Excellence in End-of-Life Care, intended to expand access to hospice and palliative care to regions and populations not easily served under the Medicare Hospice Benefit. Under Dr. Byock's leadership with deputy director, Jeanne Shields Twohig, the program directed up to $15 million over 10 years to 26 demonstration projects to develop and test models for palliative care within a variety of medical specialties, care settings, and underserved populations. Eight peer workgroups of healthcare leaders specifically focused on specific diseases or issues, while nine projects addressed knowledge and practice gaps—all under an overarching communications strategy, with significant results.

Also in 1996, with separate funding from another program area of the Robert Wood Johnson Foundation, Dr. Byock co-founded (with Barbara Spring, PhD) and served as principal investigator for the Missoula Demonstration Project, a community organization focused on studying the experiences of illness, dying, caregiving, and grieving within the context of community, and engaging the community of Missoula, Montana in improving care and support for seriously ill people and their families. This work was well documented and served as a framework for replication in other communities nationally.

During the 1990s, Dr. Byock helped to launch and assumed leadership roles in the American Academy of Hospice and Palliative Medicine serving on the Ethics Committee (1990–1996), the Board of Directors (1990–1996), as organizational secretary (1995) and as president (1997). From 1998 to 2002, he served as founding member and member of the Board of Directors and Executive Committee of the Partnership for Caring, which later became the Last Acts Partnership, also funded by the Robert Wood Johnson Foundation (RWJF). During this period, Dr. Byock also had a faculty appointment at the University of Montana, Practical Ethics Center, as research professor of philosophy.

In late 2003, Dr. Byock moved to New Hampshire as director of palliative medicine for Dartmouth-Hitchcock Medical Center and associate director for patient and family-centered care at the affiliated Norris-Cotton Cancer Center. He remains an active emeritus professor of medicine and of community health and family medicine at Dartmouth’s Geisel School of Medicine.

In 2014, Dr. Byock founded the Institute for Human Caring of Providence Health & Services in Torrance, California, where he currently serves as chief medical officer. The Institute’s goal is to advance quality of whole person care through training, research, and clinical practice change. Whole person care attends to each patient’s physical, emotional, interpersonal, social, and spiritual well-being. The Institute promotes quality improvement initiatives which enable clinicians to foster partnerships with patients to identify each individual’s values, preferences, and priorities and ensure that treatments are aligned with each patient’s personal goals. The Institute also engages the public by raising awareness of options and expectations for quality of how patients and families should be treated, and by equipping consumers with the information and tools they need to advocate for better care.

• Development of health service delivery models for concurrent life-extending and palliative care: acute inpatient, outpatient specialty clinics, academic and community-based primary care, long-term and chronic care settings.
• The intersection of health services research, cultural values clarification, and public health policy.
• Application of a human development framework to outcome measurement of individual and family experience with serious illness, caregiving, dying, and grief.
• Human development-based counseling for life completion and closure, and measurable impact on individual and family experience with serious illness, caregiving, dying, and grief.
• The influence of cultural and religious values on end-of-life experience and care.
• Transitions of care during late stage illness involving acute care hospitals, home with hospice or home health, nursing homes.
• Investigation of the epidemiology, treatment, and prevention of crises among patients cared for at home with hospice.
• Development, validation, and revision of the Missoula-VITAS Quality of Life Index.
• Data-driven, community-based quality improvement in advance care planning, health care and social services
• Volunteer and informal social support to people with serious illness and family caregivers.
• Measurement methodology for evaluating access to services, quality of care, quality of life outcomes, and costs during the last phase of life.

Throughout his career, Dr. Byock has pursued policy agendas and advocacy activities. For instance, he

• Participated on the Consensus Panel for End-of-Life Care for the American College of Physicians, which was convened to develop policy, clinical, and ethical guidelines based on consensus to promote high-quality palliative care (1999–2000);
• Served as a special representative to the American Health Council from the American Academy of Hospice and Palliative Medicine and later on the Board of Directors (1999–2003) and as senior advisor to the Ethics, Advocacy, & American Academy of Hospice and Palliative Medicine Awareness Strategic Coordinating Committee (2008–2013);
• Contributed to setting the policy agenda for care of seriously ill, dying, and surviving Americans as a member of the Legislative Subcommittee for the National Hospice & Palliative Care Organizatio n (2000–2003) and the Public Policy Committee for the National Coalition of Cancer Survivorship (2001–2003);
• Offered technical expertise as clinical advisor for the Informed Medical Decisions Foundation (2004–pres.); member of the Research Committee for the National Hospice & Palliative Care Organization (2005–pres.), the Technical Advisory Committee for Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services on “Informing National Policy to Improve Palliative End-of-Life Care in Medicine” (2006), and the Steering Committee of the New Hampshire Pain Initiative (2006–2013).

During the 2007–2008 election year, Dr. Byock and Yvonne Corbeil, then director of the New Hampshire Hospice and Palliative Care Organization, conducted a statewide community conversation about issues impacting end-of-life care. The Reclaiming the End of Life Initiative trained citizen advocates to bring those issues to the attention of the presidential candidates as they campaigned ahead of the New Hampshire primary and general elections. At Citizen Forums, participants reflected on and rated a variety of ideas and proposed approaches to health care and community supports developed over the previous 20 years. Results from the Citizen Forum report were distilled and presented to the presidential candidates and questions were posed at Town Hall forums and debates intended to raise awareness of the issues.

Since at least the late 1990s, as Oregon’s Death With Dignity Act was passed by voters, challenged in the courts, and passed again in a referendum, Dr. Byock has emerged as a leading opponent of physician-assisted suicide (also known as physician-assisted death, physician aid in dying, and medical aid in dying). While much of the organized opposition to legalizing physician-assisted suicide comes from a perspective informed by religious faith, Dr. Byock’s opposition rests more in longstanding traditions of medical ethics and concern about “slippery slope” abuses and expansions of the “right to die.” His many popular press op-eds and media segments on this issue express the view that physician-assisted suicide is both a response to the inadequate state of American end-of-life care and a danger to the political will and resources available to improve it.

• Lifetime Achievement Award, Academy of Hospice and Palliative Medicine (2014)
• Pioneer Medal for Outstanding Leadership in Health Care, HealthCare Chaplaincy Network (2014)
• Visionary of Hospice and Palliative Medicine, as recognized by the voting membership of the Academy of Hospice and Palliative Medicine (2013)
• PDIA Palliative Medicine Community Leadership Award, American Academy of Hospice and Palliative Medicine (2011)
• Excellence in Teaching Award, Department of Medicine, Geisel School of Medicine at Dartmouth (2007 to 2010)
• Outstanding Colleague Award, National Association of Catholic Chaplains (2008)
• Distinguished Service Award, American Academy of Hospice and Palliative Medicine (2002)
• Person of the Year, National Hospice and Palliative Care Organization formerly National Hospice Organization (1995)

Books

The best care possible: A physician’s quest to transform care through the end of life. New York: Avery, 2012.

Dying well: The prospect for growth at the end of life. New York, NY: Riverhead/Putnam Books, 1997.

The four things that matter most: A book about living (2nd ed.). New York, NY: Atria Books, a division of Simon and Schuster, 2014.

The four things that matter most: A book about living. New York, NY: Free Press, a division of Simon and Schuster, 2004.

Heffner J, Byock I (eds). Palliative and end of life pearls. Philadelphia, PA: Hanley & Belfus, 2002.

Staton J, Shuy R, Byock I. A few months to live: Different paths to life’s end. Washington, DC: Georgetown University Press, 2001.

Chapters

As Sole Author

The case against physician-assisted suicide and euthanasia. In: Younger SJ, Arnold RM (eds.): The Oxford handbook of ethics at the end of life. New York, NY: Oxford University Press, 2016, pp 366–382.

Case commentary: When emergencies happen. In: Sulmasy D, Wald FS, Lazenby M (eds): Safe passage: A global spiritual sourcebook for care at the end of life. New York, NY: Oxford University Press, 2014.

Imagining people well. In: Awake at the bedside. Wisdom Publications, 2016, pp 281–297.

Learning from one another: Lessons from pediatrics for palliative care. In Armstrong-Dailey A, Zarbock S (eds): Hospice care for children. Oxford, NY: Oxford University Press, 2001, pp 293–312.

Personal health and human development in life-threatening conditions. In: Chochinov HM, Breitbart W (eds): Oxford handbook of psychiatry in palliative medicine (2nd ed). New York, NY: Oxford University Press, 2009, pp 281–299.

Physician-assisted suicide: Why both sides are wrong. In: Bauer-Maglin N, Perry D (eds): Final acts: Death, dying, and the choices we make. Piscataway, NJ: Rutgers Press, 2010, pp 301–311.

Principles of palliative care. In: Walsh TD (ed): Textbook of palliative medicine. Saunders, Elsevier, 2008, pp 33–41.

As Co-author

Byock I, Caplan A, Snyder L: Beyond symptom management: Physician roles and responsibility. In: Snyder L, Quill T (eds): Palliative care, physician’s guide to end-of-life care. Philadelphia, PA: American College of Physicians–American Society of Internal Medicine, 2001, pp 56–71.

Byock I, Corbeil YJ: Caring when cure is no longer possible. In: Overcash J, Balducci L (eds): The older cancer patient: Guide for nurses and related professionals. New York, NY: Springer Publishing Company, Inc, 2003, pp 193–214.

Byock I, Davies C: Spiritual care of the renal patient. In: Chambers EJ, Germain M, Brown E (eds): Supportive care of the renal patient. New York, NY: Oxford University Press, 2004, pp 191–206.

Byock I, Ingram C: Palliative care for advanced dementia. In: Neurology in practice: Dementia, New York, NY: John Wiley and Sons, 2014, pp 121–136.

Byock I, Merriman M: The Missoula-VITAS Quality of Life Index. In: Michalos, AC (ed.): Encyclopedia of quality of life and well-being research. Dordrecht, Netherlands: Springer, 2014, pp 4082–4088.

Byock I, Norris K: A community-based approach to improving the quality of life’s end. In: Ferrell BR, Coyle N (eds): Textbook of palliative nursing (2nd ed.). New York, NY: Oxford University Press, 2005, pp 1119–1128.

Byock I, Palac D: Confidentiality in palliative medicine. In: Hanks G, Cherny NI, Christakis NA, Fallon M, Kaasa S, Portenoy RK (eds): Oxford textbook of palliative medicine (4th ed.). New York, NY: Oxford University Press, 2010, pp 281–289.

Byock I, Sateia M: Sleep in palliative care. In: Hanks G, Cherny NI, Christakis NA, Fallon M, Kaasa S, Portenoy RK (eds): Oxford textbook of palliative medicine (4th ed.). New York, NY: Oxford University Press, 2010, pp 1059–1083.

Byock I, Twohig JS. Delivering palliative care in challenging settings and to hard-to-reach populations. In: Ferrell BR, Coyle N (eds): Textbook of palliative nursing (2nd ed.). New York, NY: Oxford University Press, 2005, pp 1109–1118.

Clinical Journal Articles

2014

We must – and we can – do better. Health Prog Jan–Feb 2014 95(1):55–59.

2013

Byock I: It’s personal! Trends in cancer care near the end of life, A Dartmouth Atlas Health Care Brief, A Report of the Dartmouth Atlas Project. The Dartmouth Institute for Health Policy and Clinical Practice, September 4, 2013. Retrieved from http://www.dartmouthatlas.org/publications/reports.aspx.

2010

Dying with dignity. Hastings Center Report 2010:40(2):c3.

Steinhauser KE, Alexander SC, Byock IR, George LK, Tulsky JA: Seriously ill patients' discussions of preparation and life completion: An intervention to assist with transition at the end of life. Palliat Support Care 2009 Dec;7(4):393–404.

2009

Palliative care and oncology: Growing better together. J Clin Oncol 2009 Jan;27(2):170–171.

Suffering and wellness. J Palliat Med 2009;12(9):785–787.

Bakitas M, Lyons KD, Hegel MT, Byock IR, et al: Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: The Project ENABLE II randomized controlled trial. JAMA 2009 Aug 19;302(7):741–749.

Bishop MF, Stephens L, Goodrich M, Byock I: Medication kits for managing symptomatic emergencies in the home: A survey of common hospice practice. J Palliat Med 2009 Jan;12(1):37–44.

Byock IR, Corbeil YJ, Goodrich ME: Beyond polarization, public preferences suggest policy opportunities to address aging, dying, and family caregiving. Am J Hosp Palliat Care 2009 Jun–Jul;26(3):200–208.

2008

Steinhauser KE, Alexander SC, Byock IR, George LK, Olsen MK, Tulsky JA: Do preparation and life completion discussions improve functioning and quality of life in seriously ill patients? Pilot randomized control trial. J Palliat Med 2008 Nov;11(9):1234–1240.

Van Aalst-Cohen ES, Riggs R, Byock IR: Palliative care in medical school curricula: A survey of United States medical schools. J Palliat Med 2008 Nov;11(9):1200–1202.

2007

Caring well for the families of our patients. Chest 2007 Nov;132(5):1420–1422.

Norris K, Merriman MP, Curtis JR, Asp C, Tuholske L: Next of kin perspectives on the experience of end-of-life care in a community setting. J Palliat Med 2007 Oct;10(5):1101–1115.

2006

Improving palliative care in intensive care units: Identifying strategies and interventions that work. Crit Care Med 2006 Nov;34(11 Suppl):S302–S305.

To life! Reflections on spirituality, palliative practice, and politics. Am J Hosp Palliat Care 2006 Dec-2007 Jan;23(6):436–438.

Where do we go from here? A palliative care perspective. Crit Care Med 2006 Nov;34(11 Suppl):S416–S420.

Byock I, Twohig JS, Merriman M, Collins K: Peer-professional workgroups in palliative care: A strategy for advancing professional discourse and practice. J Palliat Med 2006 Feb;9(1):934–947.

Byock I, Twohig JS, Merriman M, Collins K: Promoting excellence in end-of-life care: A report on innovative models of palliative care. J Palliat Med 2006 Feb;9(1):137–151.

Mularski RA, Curtis JR, Billings JA, Burt JA, Burt R, Byock I, Fuhrman C, Mosenthal AC, Medina J, Ray DE, Rubenfeld GD, Schneiderman LJ, Treece PD, Truog RD, Levy MM: Proposed quality measures for palliative care in the critically ill: A consensus from the Robert Wood Johnson Foundation Critical Care Workgroup. Crit Care Med 2006 Nov;34 (11 Suppl):S404–S411.

2005

Fins JJ, Maltby BS, Friedmann E, Greene MG, Norris K, Adelman R, Byock I: Contracts, covenants and advance care planning: An empirical study of the moral obligations of patient and proxy. J Pain Symptom Manage 2005 Jan;29(1):55–68.

Schwartz CE, Merriman MP, Reed G, Byock I: Evaluation of the Missoula-VITAS Quality of Life Index—Revised: Research tool or clinical tool? J Palliat Med 2005 Feb;8(1):121–135.

2004

The ethics of loving care. Health Prog 2004 Jul-Aug;85(4):12–19, 57.

Norris K, Strohmaier G, Asp C: Spiritual care at the end of life. Some clergy lack training in end-of-life care. Health Prog 2004 Jul-Aug;85(4):34–39, 58.

Seninger S, Byock IR, D’Onofrio C, Elston Lafata J, Engelhardt J, Lockhart C, Miles S, Rosefield, H, Smith D, Volk-Craft B, Wilkinson A: Accounting for the costs of caring through the end of life, a monograph of Promoting Excellence in End of Life Care, The Robert Wood Johnson Foundation, January 2004.

Twohig JS, Aligning values with practice. The "Promoting Excellence" program demonstrates the practicality of palliative care for patients, families, and caregivers. Health Prog 2004 Jul-Aug; 85(4):27–33.

2003

Palliative care and the ethics of research: Medicare, hospice, and phase I trials. J Support Oncol 2003 Jul-Aug;1(2):139–141.

Rediscovering community at the core of the human condition and social covenant. Hastings Center Report Special 2003 Apr;Suppl 33(2):S40–S41.

Byock I, Miles SH: Hospice benefits and phase I cancer trials. Ann Intern Med 2003 Feb 18;138(4):335–337.

Byock I, Twohig JS: Expanding the realm of the possible. J Palliat Med 2003 Apr;6(2):311–313.

Schapiro R, Byock IR, Sheils Twohig J: Living and dying well with cancer: Successfully Integrating palliative care and cancer treatment, a monograph of Promoting Excellence in End of Life Care, The Robert Wood Johnson Foundation, May 2003.

2002

Dying well in corrections: Why should we care? Correctcare 2002 Fall;16(4):18.

The meaning and value of death. J Palliat Med 2002 Apr;5(2):279–288.

Sens et valeur de la mort, Médecine Palliative, Paris, France, 2002.

Beresford L, Byock IR, Sheils Twohig J: Financial implications of Promoting Excellence in End-of-Life Care, a monograph of Promoting Excellence in End of Life Care, The Robert Wood Johnson Foundation, November 2002.

Byock IR, Sheils Twohig J, Emnett J: Advanced practice nursing: Pioneering practices In palliative care, a monograph of Promoting Excellence in End of Life Care, The Robert Wood Johnson Foundation, July 2002.

Casarett DJ, Karlawish JH: Advocacy and activism: Missing pieces in the quest to improve end-of-life care. J Palliat Med 2002 Feb;5(1):3–12.

Curtis JR, Patrick DL, Engelberg RA, Norris KE, Asp CH: A measure of the quality of dying and death. Initial validation using after-death interviews with family members. J Pain Symptom Manage 2002 Jul;24(1):17–31.

2001

End-of-life care: A public health crisis and an opportunity for managed care. Am J Manage Care 2001 Dec;7(12):1123–1132.

Byock I, Norris K, Curtis JR, Patrick DL: Improving end-of-life experience and care in the community: A conceptual framework. J Pain Symptom Manage 2001 Sep;22(3):759–772.

Mayer DM, Torma L, Byock I, Norris, K: Speaking the language of pain. Am J Nurs 2001 Feb;101(2):44–49.

Teno JM, Field MJ: Preface: The road taken and to be traveled in improving end-of-life care. J Pain Symptom Manage 2001 Sep;22(3):713–716.

2000

Quill TE, Byock IR: Responding to intractable terminal suffering. Ann Intern Med 2000 Oct 3; 133(7):561–562.

Quill TE, Byock IR: Responding to intractable terminal suffering: The role of terminal sedation and voluntary refusal of food and fluids. ACP-ASIM End-of-Life Care Consensus Panel. American College of Physicians-American Society of Internal Medicine. Ann Intern Med 2000 Mar 7;132(5):408–414.

1990s

Beyond symptom management: Growth and development at the end of life. Eur J Palliat Care 1996 Autumn;3(3):125–130.

Cancer chemotherapy and the boundaries of the hospice model. Am J Hosp Palliat Care 1992 March/April;9(2):4–5.

Conceptual models and the outcomes of caring. J Pain Symptom Manage 1999 Feb;17(2):83–92.

Consciously walking the fine line: Thoughts on a hospice response to assisted suicide and euthanasia. J Palliat Care 1993 Autumn;9(3):25–28.

A consensus statement by radiation oncologists regarding radiotherapy for bone metastases. Am J Hosp Palliat Care 1992 Sep-Oct;9(5):6–7.

Ethics from a hospice perspective. Am J Hosp Palliat Care 1994 Jul-Aug;11(4):9–11.

The euthanasia/assisted suicide debate matures. Am J Hosp Palliat Care 1993 Mar-Apr;10(2):8–11.

Final Exit: A wake-up call to hospice. Hosp J 1991;7(4):51–66.

From innocence to audit: Transatlantic lessons on the routinization of hospice. Am J Hosp Palliat Care 1994 Jan-Feb;11(1):4–7.

The hospice clinician's response to euthanasia/physician assisted suicide. Hosp J 1994;9(4):1–8.

The nature of suffering and the nature of opportunity at the end of life. Clin Geriatr Med 1996 May;12(2):237–252.

Patient refusal of nutrition and hydration: Walking the ever-finer line. Am J Hosp Pall Care 1995 Mar-Apr;12(21):8–13.

When suffering persists… J Palliat Care 1994 Summer;10(2):8–13.

Byock IR, Forman WB, Appleton M: Academy of Hospice Physicians’ Position Statement on access to hospice and palliative care. J Pain Symptom Manage 1996 Feb;11(2):69–70.

Byock IR, Merriman MP: Measuring quality of life for patients with terminal illness: the Missoula-VITAS Quality of Life Index. Palliat Med 1998 Jul;12(4)231–244.

Byock IR, Teno JM, Field MJ: Measuring quality of care at life’s end. J Pain Symptom Manage 1999 Feb;17(2):73–74.

Teno JM, Byock I, Field MJ: Research agenda for developing measures to examine quality of care and quality of life of patients diagnosed with life-limiting illness. J Pain Symptom Manage 1999 Feb;17(2):75–82.

1980s

Growth: The essence of hospice. From a physician’s point of view. Am J Hosp Care 1986 Nov-Dec; 3(6):16–21.

Hospice and the family physician. J Fam Pract 1984 May;18(5):781–784.

Optimizing terminal care. Seminars Fam Med 1981 Nov;2(4):289–300.

Byock I et al: Fulminant neonatal hepatic necrosis associated with echovirus Type 11 Infection. West J Med 1983 Feb;138(2):260–263.

Popular and Trade Press

Magazine Articles

The American crisis around dying persists, Aging Today, March/April 2015.

A call for closure, in Grand Rounds, Dartmouth Medicine 2009 Winter 34(2):21.

Evidence-based therapies for persistent suffering, The Psychologist, September 2014.

Newspaper Articles and Opinion Essays

At the end of life, what would doctors do?, New York Times, June 30, 2016.

Reframing the conversation, LA News Group DailyNews.com, Success Aging, June 19, 2016.

Why do we pay for bad care?, First Opinion, STAT, June 10, 2016.

Helping a suicide when the end isn’t near, The Opinion Pages, Room for Debate, New York Times, Sept. 10, 2015.

Democrats shouldn’t endorse suicide, POLITICO, June 7, 2015.

Doctors shouldn’t be ending lives, San Diego Union Tribune, May 3, 2015.

Dying shouldn’t be so brutal, New York Times, February 1, 2015.

We should think twice about “Death with Dignity,” Los Angeles Times, February 1, 2015.

Room for debate: Expanding the right to die – It violates medical principles and is dangerous, New York Times Online Edition, October 6, 2014.

Caring well for one another through the end of life, USA Today, Media Planet Supplement, September 27, 2013, p 2.

The defining issue of our generation, ABC News, August 22, 2012. Retrieved from http://abcnews.go.com/blogs/health/2012/08/22/the-defining-issue-of-our-generation/.

Making medicine rational, Los Angeles Times, July 7, 2012, p A15.

Health moving away from death panels: Health reform for the way we die, Atlantic Magazine Online, March 6, 2012. Retrieved from http://www.theatlantic.com/health/archive/2012/03/moving-away-from-death-panels-health-reform-for-the-way-we-die/253683/.

Healthcare: Time for a serious discussion; New America Foundation, The New Health Dialogue Blog, November 6, 2009. Retrieved from http://www.newamerica.net/blog/health.

We can’t fix health care by (merely) fixing health care. New America Foundation, The New Health Dialogue Blog, August 7, 2009. Retrieved from http://www.newamerica.net/blog/health.

Missoula leading the way in care for those at life’s end. The Missoulian, January 12, 2003.

Finding your way through caregiving, Knight-Ridder / Tribune Information Series, October 11, 2001.

We’re setting an example for others. Missoula Demonstration Project, The Missoulian, April 30, 2000.

Suicide debate still off course. Detroit Free Press, April 13, 1999.

Snuff film. The Washington Post, December 6, 1998.

Congress can avoid another uncivil war. Oregonian, September 30, 1998.

Dying: After the court ruling. The Wall Street Journal, June 27, 1997.

Why do we make dying so miserable?, The Washington Post, January 22, 1997.

Kevorkian: Right problem, wrong solution. The Washington Post, January 17, 1994.