Decisions Near the End of Life

OVER the last 50 years, people have become increasingly concerned that the dying process is too often needlessly protracted by medical technology and is consequently marked by incapacitation, intolerable pain, and indignity. In one public opinion poll, 68% of respondents believed that "people dying of an incurable painful disease should be allowed to end their lives before the disease runs its course."1A number of comparable surveys indicate similar public sentiment.2 Since the turn of the century, there has been a dramatic shift in the places where people die. Sixty years ago, the vast majority of deaths occurred at home. Now most people die in hospitals or long-term care facilities. Approximately 75% of all deaths in 1987 occurred in hospitals and long-term care institutions,3up from 50% in 1949,61% in 1958, and 70% in 1977.4This transition from the privacy of the home to medical institutions