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(Circulation. 2007;116:360-362.)
© 2007 American Heart Association, Inc.

Editorial

A Time to be Born and a Time to Die

Lee R. Goldberg, MD, MPH; Mariell Jessup, MD

From the University of Pennsylvania, Heart Failure/Transplant Program, Philadelphia.

Correspondence to Mariell Jessup, MD, University of Pennsylvania, Heart Failure/Transplant Program, 6 Penn Tower, 3400 Spruce St, Philadelphia, PA 19104. E-mail jessupm@uphs.upenn.edu

Key Words: Editorials • heart failure • prognosis

An extract of the first 250 words of the full text is provided, because this article has no abstract.

"I wanted a perfect ending. Now I’ve learned, the hard way, that some poems don’t rhyme, and some stories don’t have a clear beginning, middle, and end. Life is about not knowing, having to change, taking the moment and making the best of it, without knowing what’s going to happen next. Delicious ambiguity."

— —Gilda Radner US actress and comedienne (1946–1989)

What would you do if you knew you had 6 months to live? How would you choose to spend your time? Would you be willing to try an experimental and risky therapy that might decrease your quality but increase your quantity of life? What would you do if you knew that your patient had 6 months to live despite current clinical stability? Would you tell him? Would you be more or less "aggressive" with treatment options?

Article p 392

Physicians are often faced with life-or-death situations. In the abstract, we can conceptualize and rationalize biology, but the ability to convert our understanding of the natural course of a disease to a useful, sensitive, and realistic conversation with a patient and his or her family is something with which few are comfortable. This is especially true when the patient is awake, alert, and ambulatory. The word "prognosis" is derived from Greek, defined as "a forecast of the probable course or outcome of a disease."¹ Clinicians recognize that in most chronic illnesses, the prognosis is, at best, a guess but that ultimately death is inevitable. However, it is the time course, . . . [Full Text of this Article]

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Circulation 2007 116: 359. [Extract] [Full Text]