Dying in America: Care Options Near the End of Life

ADEC's October, November, and December webinars are part of a new 4th quarter themed series, "Physicians' Perspectives on Palliative Care and End-of-Life". This is a wonderful opportunity to engage with our physician community, in both a presentation style and interactive dialogue. Each webinar in this series will be moderated by Professional Development Committee Chair Melanie Wright.

Due to the remarkable advances in medical care, we are living longer. But aging is commonly accompanied by illness, and many are living with slowly progressive serious illness.

Unfortunately, many are unprepared for the final stages of life. Relatively few have had in-depth discussions with their physicians about their prognosis and goals of care, and they too often receive no meaningful informed consent regarding further disease-directed treatments. The default becomes “let’s try this”, commonly leading them down a path of more and more treatment that too often results in unnecessary suffering and frequently a shortened survival.
We must encourage far better end-of-life care to include early palliative care referrals; facilitation of end-of-life care conversations between patients, their families, and healthcare providers; completion of advance care directives; discussions and documentation of patients’ wishes, goals and values; and a meaningful shared decision-making process which includes a discussion of the end-of-life care options available.

Dying and death can be meaningful and peaceful for most, but to believe all deaths are “natural” and without suffering is just wrong. As a Hematologist, Medical Oncologist and Palliative Medicine physician, I saw agonizing deaths despite my best efforts.

To add a personal note, I too am now faced with incurable cancer. I was diagnosed in 2018 to have both multiple myeloma and non-Hodgkin’s lymphoma. I contemplate dying, my death, and the options for end-of-life care. I am blessed because I am obviously aware of, understand and have access to all the options available for care for patients with advancing life-limiting illness. We in health care must be sure that all patients with advancing serious illness and their families are similarly aware and have access to the end-of-life care they need.

Learning Objectives

  • Examine the shortcomings in the current care of people with advancing serious illness and why the U.S. healthcare system makes it often difficult to die peacefully.

  • Explain the “Tyranny of Survival”.

  • Review and discuss the care options available for patients nearing the end of life.

  • Discuss and exchange views regarding medical aid in dying.

Additional Information

Association for Death Education and Counseling (ADEC)
Course summary
Available credit: 
  • 1.50 AMA PRA Category 1 Credit
  • 1.50 ANCC
  • 1.50 APA
Course opens: 
Course expires: 
Nonmember cost:
Member cost:

About the Presenter:

Tom R. Fitch,M.D., was a consultant at the Mayo Clinic in Arizona from July 1988 through July 2021, when he retired. He was a consultant in the Division of Hematology and Oncology throughout his career and became a consultant in Hospice and Palliative Medicine when it was initially created as a section of Division of Hematology and Oncology in 2001. At the time of his diagnosis of multiple myeloma and non-Hodgkin’s Lymphoma in May/July 2018, he was Director of the Center for Palliative Medicine in Arizona and Chair of the Mayo Enterprise Center for Palliative Medicine. He stepped down from those positions at the time of his cancer diagnoses of both multiple myeloma and non-Hodgkin’s lymphoma, and initiation of treatment. Dr. Fitch held the academic rank of associate professor of medicine, Mayo Clinic College of Medicine.

Dr. Fitch earned his bachelor’s degree in biochemistry and his M.D. degree at University of Kansas. He completed an internship/residency in Internal Medicine at University of Michigan and continued his education at Mayo Clinic, where he completed fellowships in Medical Oncology and in Hematology. He became certified in Hospice and Palliative Medicine in 2004 and became a diplomate in Hospice and Palliative Medicine in 2008. Dr. Fitch is board certified in Internal Medicine, Medical Oncology, Hematology, and Hospice and Palliative Medicine.

Dr. Fitch’s more recent clinical research focused on expanding concurrent palliative care models of care for patients with advanced serious illness, particularly innovative practice designs for patients with cancer. He was commonly invited to give presentations in these areas and has helped author numerous journal articles, abstracts and other written publications which covered his earlier efforts in cancer clinical research.

In recognition of his work, Dr. Fitch received the Distinguished Mayo Clinician award, conferred by Mayo Clinic Arizona.

In addition to his clinical activities, Dr. Fitch helped develop the Hematology/Oncology practice model for the Division of Hematology/Oncology, the Hematology/Oncology Fellowship, the Multidisciplinary Breast Clinic, and the Cancer Clinical Research Unit at Mayo Clinic in Arizona. He also led the development of the Mayo Clinic Arizona Hospice and Palliative Medicine Program, the Mayo Clinic Arizona Palliative Medicine Fellowship, the Mayo Clinic Arizona Nurse Practioner Residency, the collaboration with Hospice of the Valley which led to building the Sherman Home Inpatient Palliative Care Unit on the Mayo Clinic Arizona Hospital campus in Phoenix, and he led the development of the Mayo Enterprise Center for Palliative Medicine.

Dr. Fitch held memberships with numerous professional organizations, including the American College of Hospice and Palliative Medicine, the Center for the Advancement of Palliative Care, and the American Society of Clinical Oncology.

Dr. Fitch went on medical disability in July 2018 due to cancer diagnoses and treatment including high dose therapy and stem cell rescue. His career at Mayo Clinic Arizona, after his cancer diagnoses, was limited to education and administrative efforts due to ongoing cancer treatments. He formally retired in July 2021. Since late 2019, he has been involved in the Arizona End of Life Organization, a volunteer organization dedicated to passing a Medical Aid in Dying Law (MAID) in Arizona. He and his wife Janis have focused the majority of their time on family. They have 3 daughters who are all married with families and active careers. We are blessed with 3 wonderful sons-in-law and there are 4 grandchildren – Max, Jane, Georgia, and Maya – the lights of our lives!!

About the Moderator:

Melanie Wright graduated with her Bachelor of Art in non-confessional Religious Studies, with a leading focus on cross-cultural perspectives on death and religious impacts on human rights and bioethics. Following this, she journeyed to complete her Master of Social Work, where she developed the inaugural internship program between Arizona State University and the Mayo Clinic. During a two year graduate rotation with the Mayo Clinic, Melanie conducted a research study entitled, "Physicians’ Perspectives on Socio-Political Barriers to Effective Palliative Care in a Hospital Setting”, which she was then invited to present at the 2005 "Joint National Conference of the American Society on Aging and the National Council on Aging". This research contributed to the formation of an in-house hospital Palliative Care Team at the Mayo Clinic; the first program of its kind on a national scale. As a result, Melanie was presented with the distinction of "Honorary Member of the Mayo Clinic School of Health Sciences Alumni Association." Currently, she is the acting President for the Parkinson Network of Arizona, which funds all wellness/outreach programs for the Muhammad Ali Parkinson Center at Barrow Neurological Institute. She is an active member of the National Association of Social Workers, National Council on Aging, American Association of Integrated Healthcare Delivery Systems, Alliance for Professional Healthcare Advocates, and serves on the Advisory Council for the Arizona Interfaith Movement. Melanie obtained her Fellowship in Thanatology, with a focus on therapeutic interventions for the terminally ill and is actively conducting research on patient-centered care when confronted with a life limiting diagnosis. She is the acting Chair of the Professional Development Committee for the Association on Death Education & Counseling (ADEC).

This webinar is approved by the American Psychological Association (APA), the Association of Social Work Boards (ASWB), the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) for 1.5 CE hours.

Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by Amedco LLC and The Association for Death Education and Counseling. Amedco LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Amedco LLC designates this live and enduring material for a maximum of 1.50 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Amedco LLC designates this activity for a maximum of 1.50 ANCC contact hours.


Amedco LLC designates this activity for a maximum of 1.50 psychologist contact hours.

Social Workers

As a Jointly Accredited Organization, Amedco is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved under this program. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. Amedco maintains responsibility for this course. Social workers completing this course receive 1.50 GENERAL continuing education credits. 

New York Board for Social Workers

Amedco SW CPE is recognized by the New York State Education Department’s State Board for Social Work as an approved provider of continuing education for licensed social workers #0115. 1.50 hours.

Available Credit

  • 1.50 AMA PRA Category 1 Credit
  • 1.50 ANCC
  • 1.50 APA


Nonmember cost:
Member cost:
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This course is offered through Association for Death Education and Counseling. 

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