Ira Byock

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Ira Byock.

Ira Robert Byock (born February 13, 1951, Newark, New Jersey) is an American physician, author, and advocate for palliative care. He is founder and chief medical officer of the Providence St. Joseph Health Institute for Human Caring in Torrance, California, and holds appointments as active emeritus professor of medicine and professor of community health and family medicine at the Geisel School of Medicine at Dartmouth. He was director of palliative medicine at Dartmouth–Hitchcock Medical Center, from 2003-14, 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” (March 1997, August 1997, 2009 & 2012); “All Things Considered” (June 1997, November 1997, March 2009) and “Fresh Air” (1997); American Public Media: “On Being”; CBS 60 Minutes (November 2009, Oct 2014); ABC Nightline; and PBS NewsHour (August 2010, October 2014, August 2015).

Education and Medical Training[edit]

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 (1978–81).[citation needed]

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).[citation needed]

Career and Professional Focus[edit]

While Byock’s early career focus was on rural family practice and emergency medicine,[1] he developed an interest in the then-nascent hospice movement. While still an intern in 1978–79, 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.[1]

From 1982–96 as an emergency physician, mainly in rural and small city settings in Montana, 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.[1] 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.[2]

While among the best-rated instruments in terms of validity,[3] including cross-cultural,[4] the Missoula-VITAS Quality of Life Index is considered better in clinical applications, as a psychometric as well as therapeutic tool, than in research.[5]

In 1996, 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 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.[6]

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.[7] This work was well documented and served as a framework for replication in other communities nationally.

During the 1990s, Byock helped to launch and assumed leadership roles in the American Academy of Hospice and Palliative Medicine[1] serving on the Ethics Committee (1990–96), the Board of Directors (1990–96), 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).[8] During this period, Byock had a faculty appointment at the University of Montana, Practical Ethics Center, as research professor of philosophy.[citation needed]

In late 2003, 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.[citation needed]

In 2014, he 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.[citation needed]

Major Research Interests[edit]

  • 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.

Advocacy for Health Care Reform and Improved Palliative Care[edit]

Opposition to Physician-Assisted Suicide[edit]

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,[9][10]

Selected Awards and Recognitions[edit]

  • 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)

Publications[edit]

Books[edit]

  • 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. & I. Byock (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[edit]

As Sole Author[edit]

  • 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. 281–99.
  • 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[edit]

  • 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 121–36.
  • 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 4082–88.
  • 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 1119–28.
  • 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 281–89.
  • 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 1059–83.
  • 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 1109–18.

Clinical Journal Articles[edit]

2014[edit]

  • We must – and we can – do better. Health Prog January–February 2014 95(1): 55–59.

2013[edit]

2010[edit]

  • Dying with dignity. Hastings Center Report 2010: 40(2): c 3.
  • 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 December 7(4): 393–404.

2009[edit]

  • Palliative care and oncology: Growing better together. J Clin Oncol 2009 January 27(2): 170–71.
  • Suffering and wellness. J Palliat Med 2009; 12(9): 785–87.
  • 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 August 19;302(7): 741–49.
  • 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 January 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 June–July 26(3): 200–08.

2008[edit]

  • 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 November 11(9):1234–40.
  • 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 November 11(9):1200–02.

2007[edit]

  • Caring well for the families of our patients. Chest 2007 November 132(5): 1420–22.
  • 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 October 10(5): 1101–15.

2006[edit]

  • Improving palliative care in intensive care units: Identifying strategies and interventions that work. Crit Care Med 2006 November;34(11 Suppl): S302–05.
  • To life! Reflections on spirituality, palliative practice, and politics. Am J Hosp Palliat Care 2006 December-2007 Jan;23(6): 436–38.
  • Where do we go from here? A palliative care perspective. Crit Care Med 2006 November;34(11 Suppl): S416–20.
  • 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 February;9(1): 934–47.
  • 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 February;9(1):137–51.
  • 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 November;34 (11 Suppl):S404–11.

2005[edit]

  • 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 January;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 February;8(1):121–35.

2004[edit]

  • The ethics of loving care. Health Prog 2004 July-August;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 July-August;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 July-August; 85(4):27–33.

2003[edit]

  • Palliative care and the ethics of research: Medicare, hospice, and phase I trials. J Support Oncol 2003 July-August;1(2):139–41.
  • Rediscovering community at the core of the human condition and social covenant. Hastings Center Report Special 2003 April;Suppl 33(2):S40–S41.
  • Byock I, Miles SH: Hospice benefits and phase I cancer trials. Ann Intern Med 2003 Feb 18;138(4):335–37.
  • Byock I, Twohig JS: Expanding the realm of the possible. J Palliat Med 2003 Apr;6(2):311–13.
  • 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[edit]

  • Dying well in corrections: Why should we care? Correctcare 2002 Fall;16(4):18.
  • The meaning and value of death. J Palliat Med 2002 April;5(2):279–88.
  • 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 February;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 July;24(1):17–31.

2001[edit]

  • 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):759–72.
  • Mayer DM, Torma L, Byock I, Norris, K: Speaking the language of pain. Am J Nurs 2001 February;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 September;22(3):713–16.

2000[edit]

  • Quill TE, Byock IR: Responding to intractable terminal suffering. Ann Intern Med 2000 October 3; 133(7):561–62.
  • 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 March 7;132(5):408–14.

1990s[edit]

  • 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 February;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 September-October;9(5):6–7.
  • Ethics from a hospice perspective. Am J Hosp Palliat Care 1994 July-August;11(4):9–11.
  • The euthanasia/assisted suicide debate matures. Am J Hosp Palliat Care 1993 March-April;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 January-February;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 March-April;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 February;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 July;12(4)231–44.
  • Byock IR, Teno JM, Field MJ: Measuring quality of care at life’s end. J Pain Symptom Manage 1999 February;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[edit]

  • Growth: The essence of hospice. From a physician's point of view. Am J Hosp Care 1986 November-December; 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 November;2(4):289–300.
  • Byock I et al: Fulminant neonatal hepatic necrosis associated with echovirus Type 11 Infection. West J Med 1983 February;138(2):260–263.

Popular and Trade Press[edit]

Magazine Articles[edit]

  • 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[edit]

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

External links[edit]

References[edit]

  1. ^ a b c d Byock, I. (2009). "Suffering and wellness". Journal of Palliative Medicine. 12 (9): 785.
  2. ^ Byock, I. (2014). Missoula-Vitas Quality-of-Life Index. In Michalos, AC (ed.). Encyclopedia of quality of life and well-being research. Dordrecht, Netherlands: Springer Reference.
  3. ^ Chang, VT, Weissman, DE. (2015). Quality of life. Fast Facts & Concepts #52. Palliative Care Network of Wisconsin. Retrieved from http://www.mypcnow.org/blank-f8z8n.
  4. ^ Namisango, E., E. Katabira, C. Karamagi, P. Baguma. (2007). Validation of the Missoula-Vitas Quality-of-Life Index among patients with advanced AIDS in urban Kampala, Uganda, Journal of Pain & Symptom Management, 33(2), 189–202); accessed January 5, 2018.
  5. ^ Schwartz, CE, Merriman, MP, Reed, G, & Byock, I. (2005). Evaluation of the Missoula-VITAS Quality of Life Index--revised: research tool or clinical tool? Journal of Palliative Medicine, 8(1), 121–35.
  6. ^ Promoting excellence in end-of-life care, Robert Wood Johnson Foundation (2009)
  7. ^ Crum, R. (2005, March 25). Missoula, Montana project studies a community's perspective on death and dying to improve end-of-life care, rwjf.org; accessed January 5, 2018.
  8. ^ National Hospice & Palliative Care Organization (NHPCO), http://www.caringinfo.org/i4a/pages/index.cfm?pageid=3402.
  9. ^ National Center for Death with Dignity. Oregon's Death With Dignity Act: A History, deathwithdignity.org; accessed January 5, 2018.
  10. ^ For a succinct expression of Byock's main opposition points, see "We should think twice about 'death with dignity'", Los Angeles Times, January 30, 2015.