In the newest Health Affairs Narrative Matters essay, prominent journalist Eleanor Clift writes about her husband Tom Brazaitis and his death from metastatic cancer at age 64. Clift describes the multiple ways in which she and her husband benefited from hospice care, in which Brazaitis spent the last four months of his life.

Clift uses her own experiences as a lens through which to view the nation’s struggles with end-of-life issues. She discusses the reluctance of physicians to have “the talk” with dying patients and their families, and she recounts how a proposal to pay health care providers to discuss end-of-life choices with seniors gave rise to irresponsible charges of “death panels” during the health reform debate.  You can read Clift’s Narrative Matters essay in the August issue of Health Affairs or listen to her read it.

In the absence of counseling about the full range of choices, including palliative care, many patients end up agreeing to more aggressive care than they would have had they been better informed, Clift observes. This too often lowers the quality of patients’ lives and even shortens them, and also needlessly increases health care costs.

Hospice “should be front and center in the debate over the kind of health care future that we want,” Clift says. She praises a pilot program included in the Affordable Care Act that would allow Medicare beneficiaries to continue curative care while accessing hospice benefits, “so people aren’t confronted with what many see as a terrible choice: giving up all treatment in order to get the benefits of hospice care.”

Clift is a contributor to Newsweek and Daily Beast and a panelist on the McLaughlin Group. She is also the author of several books, including “Two Weeks Of Life: A Memoir of Love, Death, and Politics,” about living through the last two weeks of her husband’s life while the nation debated the fate of Terry Schiavo.

Through a grant from the W.K. Kellogg Foundation, Narrative Matters essays are freely available to all readers. In last month’s Narrative Matters piece, Ilana Sherer wrote about the ethical and practical dilemmas she faced as a first-year medical resident in deciding whether to report the physical abuse of her 17-year old patient by the patient’s father, after the young woman  asked Sherer not to do so. An excerpt of Sherer’s essay was published in the “Health & Science” section of yesterday’s Washington Post.