The Dying Conundrum

The Dying Conundrum
Making the Best of End-of-Life Care in the U.S.
The image of the dying and decrepit has long been a societal taboo. No couple wants to sit down and discuss their advance directives, funeral plans, or wills. Yet no loved one wants to make an end-of -life decision for another on the basis of a best guess. The end of life is in many ways as significant as its beginning. Concerns surrounding palliative care, quality versus quantity of life, and psychological issues fall into line behind the inevitability of death. More Americans die in hospitals today. Many Americans are resuscitated in periods of crises against their Do Not Resuscitate (DNR) orders. The treatment of the chronic aspects of illness has largely faltered. But what can be done?
First, a conceptual shift must occur. Medicalization has placed the treatment of the illness above the actual patient or in the case of childbirth, the operation above patient preferences. The dying patient must no longer be regarded in the medicalized terms of fragmentation; the patient is more than their failing physical faculties. They are individuals facing one of the least understood biological transitions: death. Consequently, they require emotional and spiritual assistance. More than anything, they require a listening ear – not judgement, false optimism, or isolation.
Second, the seriously ill patient deserves to have a clearer understanding of what will eventually happen to their bodies. Here is where the practice of prognostication comes in. Physicians must improve their prognoses. The curriculum in medical schools should take on this challenge; a greater emphasis on the acquisition of prognostication skills should be emphasized for the benefit of the patient as well as the patient’s family.
Third, the medical system must realize the variation among patient experiences with death and dying. The system must provide an avenue for greater (and more frequent) communication between patients and their physicians. Particularly, the growing interest in individualized medicine should include a consideration of options for end-of-life care. Dying patients should receive specific care to their individual situations, preferences, and goals.
It is an interesting conundrum that the one experience we will all eventually face receives the least amount of societal attention. The existing moral imperative thus demands that we grant more resources to improvement of end-of-life care.