Extreme Measures: Finding a Better Path to the End of Life

By Jessica Nutik Zitter, MD

Avery Books

Medical technology has gotten so effective at prolonging human life that it’s often difficult for people—both patients and doctors—to know when it’s time to stop pursuing life-sustaining interventions. In Extreme Measures: Finding a Better Path to the End of Life, palliative care physician Jessica Nutik Zitter suggests ways to change the culture of medicine and empower patients so that they can avoid overly mechanized and painful deaths.

While recounting powerful patient stories and her own personal history, Zitter is often critical of medical culture. Early in the book she describes how medicine’s intense focus on curing disease can lead to doctors objectifying their patients. “I went into medical school a human being, and I came out a doctor,” she writes. Discouraged by the default do everything approach to saving lives that she saw in the ICU, Zitter became an advocate for palliative care, where a “good death” is the ultimate goal. Eventually she came to believe that neither of these approaches on its own is the answer.

“The cases that bring me the most pride and satisfaction are those in which I am able to connect with the patient, understand what she wants me to do, and carry it out,” she writes. “Sometimes that results in a full-court approach, other times in a calm death surrounded by family in a palliative care suite. But often it is some combination of the two approaches.”

In addition to her suggestions about ways to improve our health care system around end-of-life care—such as physician training and compensation structures—Zitter also provides a useful six-step approach to making your own personal end-of-life care decisions. This is because, in the end, any meaningful changes to the system are going to come from the broader culture. “In order to rebuild this broken system,” she writes, “we must begin by facing our fear of personal extinction and the resultant drive to find something, anything, to save us from our own deaths.”