Urging Change in How We Address End-of-Life Care

This blog post discusses a presentation given by Carol Taylor, director of the Center for Clinical Bioethics at Georgetown University, at the National Press Foundation's Cancer Issues 2009. She discussed this recent blog post, "Prolonging Death," that appeared in the New York Times and her own experiences with her brother's decision to forgo aggressive treatments at the end of his life.

The Pittsburgh Post-Gazette recently published an op-ed written by the chief of palliative care and medical ethics at the University of Pittsburgh Center for Bioethics and Health Law and the chief program officer for the Jewish Healthcare Foundation. The authors compared the current end-of-life experience in the United States to the birth experience in the 1950s. They also discussed the state of end-of-life care in Pennsylvania and urged for more changes.

In the 1950s most births took place in hospitals. Cesarean sections, epidurals and heavy doses of pain medication were the norm. Expectant fathers paced the halls away from the action. Women then began to feel that they were being denied the true experience of giving birth. Throughout the 1960s and 1970s, they challenged the perception that childbirth needed to be treated as a sickness instead of a miracle. Now, decades later, expectant mothers have choices, and fathers participate in the birthing process.

Today, people suffering from life-threatening illness face a situation similar to what expectant mothers faced in the 1950s. The end-of-life experience seems to spiral out of their control. In the 2006 Pennsylvania End-of-Life Background Report, families reported great dissatisfaction with the dying process, particularly in areas of pain management, social and financial burdens, and access to palliative care and hospice services.

Research shows Pittsburghers are more likely to be hospitalized in the last year of life, spend more time in the ICU during their final hospitalization and spend more money than patients in other cities, even though studies show that there is no correlation between intensity of medical services, length of life, or patient and family satisfaction.