Death as a Life Event: Better Palliative and End-of-Life Care

As a longtime end-of-life care executive, I remember well the year 1994, when we witnessed the willful Oregon voters and their choice to endorse physician-assisted suicide in the Death with Dignity Act. Some executives felt that the debate that ensued would do a serious disservice to the identity and focus of end-of-life care. Others among us—myself included—welcomed the chance to open wide the topics of preference, expectations, and competence from the point of view of patients and families. These issues, coupled with candid concerns regarding the abilities of and confidence in the provider community, were provocative. Oregon set the nation's pace regarding end-of-life care matters. And based on the article by Fromme, Guthrie, and Grueber, I feel it's safe to say that Oregon still is a leader. I wonder if the knowledge that assisted suicide is a real option in cases where end-of-life care is poorly performed has informed Oregon's excellent palliative care landscape. In many other states—including my own, Illinois—we are not nearly as successful as Oregon is in palliative care and end-of-life care. Certainly, Dr. Weeks and Dr. Nelson suggest in their article that there is more at play than simply the specter of suicide driving end of life improvements. Fromme and colleagues' piece cites a magnificent piece by Atul Gawande in the August 2010 New Yorker. Dr. Gawande's article is, in my opinion, 2010's best consumer-oriented document on end-of-life care. It references matters of particular concern—letting go, transitions, and timing. These issues play out in different ways in the hospital and the community.