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Reality Check

May 2, 2013

In the uphill battle for better end-of-life care, I have found one guy who has it right.  In writing there’s a maxim that goes “show, don’t tell”.  This guy is doing that.  An article by Jonathan Rauch in this month’s issue of The Atlantic Monthly profiles Dr. Angelo Volandes and his fantastic work using video.  Dr. Volandes makes short videos of real people undergoing various “life sustaining” treatments, with a voice-over describing each procedure.  The idea is that if a doctor suggests, say, a feeding tube for your elderly father with dementia, you can make a better decision on whether to approve the procedure if you can actually see what’s involved.

Visual images are extremely powerful.  People who were present at the Boston Marathon bombings, many of whom I’m sure have seen plenty of violence on TV and movies, were overwhelmed by the real images of real violence in front of them.  Back in 1987 when the never-ending abortion debate had flared up, Rosalind Petchesky, a professor of feminist studies at UCSD, wrote an article in Feminist Studies about the powerful results the federal administration was getting using visuals of fetuses.  We all see the images of starving african children and understand famine much better than if someone used only words.  Anyone who has tried to verbally describe a color knows it is impossible.  The combination of ears and eyes promotes a much better understanding than either alone.

This is especially true if you are unfamiliar with the world surrounding what’s being described.  If I give you the equation for a curve, you might understand if you know math, but even if you don’t you might understand that a circle can be described by an equation.  But if I show you a circle along with the equation, then even if you don’t live in the math world you understand what I’m saying.  If I say “CPR involves pressing on your breast bone so that it compresses your heart and pumps the blood when your heart cannot do it”, you can sort of understand based on your rough knowledge of what a pump is.  But it’s very different to say the same thing while simultaneously showing you what it really looks like in practice.  I have done many cases in which I have turned to a colleague and said “please don’t ever let them do that to me”.  The videos allow lay people to attain something of that level of understanding.

The purpose of Dr. Volandes’ videos is not to scare people.  He is not trying to get you to “kill grandma” .  He’s trying to translate the verbal into a visual so you can make a more completely informed decision.  Volandes is not a subversive quack either.  He’s a Harvard Medical School Professor, he has credentials in medical ethic and statistics, and obtained training in film-making.  He doesn’t just make the videos, he also conducts carefully designed studies to see how his work affects the decisions of those that see them.  His results are striking.  If you are a young person or a healthy elderly person and accident or illness forces you to undergo a procedure that really will help you, maybe you don’t want to see.  When my daughter had to have surgery at 3 days old you can bet I wished I was not so well informed.  But if you are facing decisions about optional treatments, potentially life prolonging treatments, treatments with questionable quality of life results, maybe it’s better if you know what you’re asking for.


From → End-of-life Care

One Comment
  1. M Green permalink

    What a GREAT idea! I come from a medical family and worked in healthcare, and you can bet my living will is super specific. I cared for both my parents and had to turn down procedures over and over that would not yield any information to improve their quality of life…just done for the sake of clinical procedures and probably their legal coverage. If you’ve ever had to perform CPR on a frail woman in her 80s, you too would wonder why a family would do this to someone they love.

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