Despite the advances in increased life expectancy, we have not paid much attention to aging, living with serious illness, or dying. Just talking about dying remains a social and medical taboo. The emphasis on medical prowess has created an expectation that medicine can prolong life almost indefinitely. Patients and health care providers alike expect the end of life, when it comes, to be a predictable period, one that brings increasing disability, misery, and suffering and little redeeming merit.
Cultural expectations that the dying must suffer mean that few families threaten to take legal action when terrible suffering does occur; physicians have little fear of sanctions; and few groups lobby for change.
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This online version of the book Improving Care for the End of Life: A Sourcebook for Health Care Managers and Clinicians is provided with permission of Americans for Better Care of the Dying [ www.abcd-caring.org ] and Oxford University Press. All rights reserved.
For further information on quality improvement in end-of-life care visit The Palliative Care Policy Center [ www.medicaring.org ].