young people. and it has since 1961. .. >> thank you so much. [inaudible conversations] >> for more information visit the author's web site jeffrey

sachs.org. >> when did we reach a point that you had to have a certain philosophy because of the color of your skin? when did that happen? [cheers and applause] >> a reporter once asked me why i didn't talk a lot about race and i said because i am not neurosurgeon. they thought that was pretty strange. when i cut the scalp and open the door up i was operating on the thing that makes the person who they are. when will we understand that? >> surgeon and author ben carson takes your calls, e-mails, facebook comments and tweets, in depth, three hours live on booktv on c-span2. >> has written the first book,

knocking on have been's door, the path to a better way of death. katie butler, who was jeffrey butler? >> every but there was my father and you are holding a picture of him and me in a loving position. he was of world war ii veteran who lost his arm in the war and an amazing that's. he built cases for our living room with only one arm which was amazing and he was a professor of history. >> where did he teach? >> berkeley university in connecticut and lived a long, full, happy life. >> over the past couple years of his life? >> when he was 79 he had devastating stroke. he didn't die until he was a 85 at a time when his death would be a mercy and publishing. he was given a peacemaker year after this devastating stroke

and the result was his heart kept going and he descended into dementia and blindness and misery and said to my mother i am living too long. the last five years of his life were frankly terrible. >> when the pacemaker was put in at age 80 what was the family's thought? >> it was the combination of ignorance and denial. there was no real conversation with the doctor about whether or not to do it or what long-term implications would be or what my father's choices were. essentially the doctors said he has a slow heart beat so we are putting in a pacemaker. the result was that my mother, i talked to her about it a bit later and she said i was still in the nile, still had hopes he could recover from the stroke and i was the daughter on the

far post and quite ignorant about medicine than so i figured it was their decision, it was up to them. if i had it to do over again i would have been more proactive at the yearly stage. i would have done more research, i would have understood better what we were up against. >> if you had chosen to take out the peace maker could he do that? >> an interesting question. it wouldn't have had to be taken out. it could be disabled with a little remote radio device that would be activated so it was up painless procedure and the cardiologists associations have now put out a statement saying it is not euthanasia, it is not assisted suicide, it is legal to have a pacemaker disabled. unfortunately that statement came very late in the process for us. so a scenario where medicine is

still kind of groping for answers and doesn't know how to discuss these questions and we as a culture, we don't know how to do it yet. >> katy butler, what did your parents, what did the end of life care cost? >> interesting question. neither of them had highly expensive deaths. if you look at my father at last five or six years you get probably $80,000 worth of pacemaker, that kind of stuff. my mother on the other hand close to the end of her life refuse to open heart surgery and then she had a heart attack and the doctors again said let's do open heart surgery. she was 84 at that point. if we had done the surgery's they recommended it would have cost medicare, 80 to $100,000

but she declined all that. i would say probably 10 or $20,000 death because she was in hospice, she declined most extraordinary intervention so we got a lot of social work, a lot of healing, ala reassurance from the medical team but we didn't get high tech, expensive, futile, painful interventions so many people suffer. >> are there people who choose all methods possible to sustain life? >> yes. >> why? >> a couple reasons. one is we have to allow everyone their chalets and their range of autonomy as they approached death. the other reason is we have but terror and ignorance of death because up until 1900 people died randomly throughout the life span and they read books with titles like the arch of dying. they considered it part of the

spiritual obligation to prepare for their own death said they were very good on the acceptance, bravery and courage that it takes to die and we lost all that in the 1950s and 60s when we became so adept at life-saving and life prolonging. >> has that become an industry? >> medicine has become an industry. high-tech fixes however expenses they are can be very appropriate especially in early stages of life. we really can save people who ied 00ea but towards the end of life, unfortunately, it is profitable for a hospital or device manufacturer to put the device totally inappropriate, prolong the death in a way that is totally inappropriate for that

particular person. >> as medical techniques advance and advance and advance, at one point to the heart, lungs, at what point does that constitute life? >> that is a really good question and begin before the 1950s you couldn't preserve one organ, you couldn't make a hard keepny single organ he rest of functioning. when a person has no brain or has nohaps the soul has already fled the body and we are so fixated on the idea that it the hard beinis in l unfortunately we don't have a language to discuss this and simple maximum longevity on an altar instead of true love, true relationships, the importance of

bravery and spiritual acceptance toward the end of life so people can have meaningful deaths that don't leave their families traumatized. >> you write doctors are often insulted by the suggestion that such financial strictures help save their medical treatment but just as surely as the home mortgage deduction for most homeowners should, economic incentives and business incentives along with discomfort with buying, being sued accused of conducting a death panel and dealing with professional failure encourage specialists to refer patients to hospice care only days before death. >> sad but true. half of people who enter hospice are there for only the last 14 days of their life or less. for example, an oncologist with another round of futile chemotherapy will get 6% of the price tag of that key leven if

it is a 10 or $20,000 chemo but if he has a two our conversation with a family that is meaningful and says i think we are at the end of life so what keno can do for you and i want to refer you to hospice you get virtually nothing for that two our conversations awhile we creating pathways that reward doctors for doing the wrong thing in situations where they don't let people know what the right thing is. is not a knock on doctors. why put them in such a in impossible position? >> when you talk to doctors do they know about this book? >> there are a range of reactions from your mother was right and you did the right thing to saying i don't understand how medicine works, that is one line i get but the other one is you don't understand how afraid we are

that a family is going to sue us for wrongful death and we don't know outpatients. people come to the emergency room, we have never seen before. we don't know if it is the katy butler family with a living will or someone who is going to say my father is 95 but i never discussed the end of his life with him and i want you to keep alive no matter what so i think i came to understand as i wrote the book with difficult position they are in. there's a phrase in hospitals called the nephew from peoria, the relative who flies in long distance to was not involved at all in family care and balances that everything be done, everything be done for longer life even if the family member who is dying has his living will and said very clearly they don't want extraordinary measures so i have more compassion now for the difficult position we have put them in. >> changes in medicare

reimbursement structure could help. some day medicare will offer us the choice of a plan covering two years of care in exchange for the willingness not to expect medicare to pay for last-ditch $35,000 to fibril later. >> i really think frankly we need a grass-roots movement of caregivers to try to inform how we approach end of life and reimbursed doctors so they can do the right thing rather than the wrong thing. >> is there such a movement afoot? >> there is something called the family caregiver alliance. groups groping towards this territory but not against some of the most powerful lobbies in washington, literally. medicine, finance and mental care and those are sophisticated, to understand the ins and outs of medicare and we

are long way from the average caregiver understanding the ins and outs of what they're doing. >> katy butler's book "knocking on heaven's door" is coming out in the fall. where does this book spring from? >> from a new york times magazine article. after that it sprang from a new york times magazine article called -- what was it? what broke my father's heart:how pacemaker wrecked our family's wife. and this article was published on father's day and i was afraid readers and would think that my mother and i had been heartless and cruel towards my father and we had just the opposite reaction. we had an explosion of e-mails, people telling about their own family stories and a large number of doctors and nurses talking about how troubled they are by the drift of the profession to not being able to

face end of life. >> where did the name of the book come from? >> it is a bob dylan song that i played over and over while i was writing this book. "knocking on heaven's door" is a very short, extraordinary piece of music that really gives you the feeling that you are in the presence of a dying person. it is transcendent and beautiful and somehow archetypical. i wanted to have that sense of this is not really a book about heaven. this is not a book to reassure you about the afterlife. it is a book about standing on that doorstep, that special place where debt is about to open its doors to you and your choice is how do you want to meet the opening of that board. >> there is here julien this book. >> yes. i am a buddhist but i have a

strong christian anglican background. i gave my father's last rites on his deathbed. one of the major reasons we are so terrified of death is we are no longer in touch with the ritual of the end of life that old religion did so beautifully for us. one of the good people i interviewed for the book said the purpose of religion is to guide to the living through the experience of death and i think we need to recreate some of those rituals because giving my father last rites was immediately relieving of my anxiety and suffering. it helped me know that i had left my father and wherever he was going, whatever form it would take i felt i had done the right thing and i was being reassured by an ancient