All available research indicates that individuals who don't articulate or formalize their end-of-life wishes often endure a sequence of unwanted and painful interventions. Having honest conversations about our end-of-life choices - and then actually completing health-care proxies and advanced directives - reduces suffering both for patients and for their families. Yet although almost all of us understand this intellectually, only a tiny percentage of us has actually completed our advance directives. The psychological obstacles are just too great. Never the Right Time (NTRT) addresses this problem using comics and humor to overcome our natural resistance to discussing end-of-life issues and provide a uniquely powerful path into advance-care planning conversations.
NTRT's”first project was inspired by Roz Chast, who revolutionized the end-of-life conversation with "Can't We Talk About Something More Pleasant?" With Roz as the core of the project, NTRT drew on the New Yorker archives for cartoons that spoke to the themes of denial, avoidance, and procrastination, which luckily are regular fodder for cartoonists. Marrying the cartoons with text about the advance-care planning process resulted in the mini cartoon anthology "Never the Right Time" which can be used as an introduction and invitation to many kinds of advance-care planning programs.
NTRT is very aware of how hard it can be for older adults to raise the topic of end-of-life plans with adult children or other younger relatives. Intergenerational conversation about death is often fraught with anxiety and superstition. To raise the comfort level of adult children, letting them know that it's really okay - in fact, desirable - to talk to your older relatives, preferably long before a medical crisis forces you to make decisions on the spot, NTRT commissioned new work from New Yorker cartoonist Emily Flake, author of "Mama Tried." Combined with text about advance-care planning, this became "Let's Talk About the Stupid Elephant." With younger adults becoming more open to discussing their own mortality, as evidenced by movements like Death Over Dinner, "Stupid Elephant" also makes sure readers understand that discussing one's end-of-life wishes is not just important for their older family members. Even though there's less statistical likelihood that younger adults will need an end-of-life plan, life is unpredictable, and it's certainly better to have one than not to have one.
"A Doctor and a Rabbi Walk Into an ICU"
NTRT's third project was inspired by Dr. Jessica Zitter's wonderful book, "Extreme Measures."”Zitter, the subject of the Oscar-nominated short film, "Extremis," is both a palliative-care doctor and an ICU doctor. She has made it her mission to bring the palliative-care sensibility, which puts a premium on quality of life, to the ICU, where the default behavior is to "do everything." Zitter also writes eloquently and passionately about what she has learned by working alongside - and sometimes taking a backseat to - hospital chaplains. NTRT asked her if she would revisit some of the stories in her book in conversation with longtime hospital and hospice chaplain Rabbi Shira Stern. Zitter and Stern spent several hours discussing specific stories from "Extreme Measures" that raise medical and ethical dilemmas common to many end-of-life situations. The edited conversation is illustrated by New Yorker cartoonist Ellis Rosen. Both Zitter and Stern contributed to an epilogue that offers both a doctor's and a rabbi's perspective on questions that will help readers think through their advance-care planning in a specifically Jewish context.
NTRT is currently developing an advance directive that combines legally binding text with comics, to make the process of completing the directive less daunting.