Aggressive Medical Care at the End of Life

The quality of medical care at the end of life is receiving increased attention in both the popular press1and professional journals.2,3This interest has developed in part because of the perception that people die with ineffective, painful, expensive, and unwanted medical interventions that deprive them of their dignity, personal interactions, and family savings. This perception is not wholly unfounded. Approximately 60% of Americans die in hospitals.4Among the deaths of hospitalized patients in the SUPPORT study,5half died after receiving mechanical ventilation for more than 1 week. Many families of dying patients report that their loved ones experience moderate to severe pain during most or all of the loved ones' last few days. Many of the families of dying patients experience severe caregiving and financial burdens.6Efforts to improve the quality of end-of-life care through advance directives, education, and more accurate prognostic information have