Bioethics Blogs

A simple change? The IOM Report on “Dying in America”

by Craig Klugman, Ph.D.

Say there was a simple change that could be made to the health care system that would reduce cost, reduce demand, increase patient’s quality of life and satisfaction, address the whole patient and not just the disease, improve care coordination, and increase patient autonomy. All of this is possible, but it requires addressing the problem that in America we do not die as we want to.

This week the Institute of Medicine released its latest report,  Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life. Despite decades of efforts, the report shows that there has not been much change in how we die. We mostly want to die at home and yet we die in hospitals. We mostly want comfort care and yet we mostly receive aggressive care. We want our emotional and spiritual needs attended to, yet physicians are not trained in dealing with those needs.

The trends in end-of-life have changed recently, though not for the better. We tend to move around  lot at the end, between home, long term care facility and hospital. More technical caregiving is done by family members. Although palliative care leads to a “higher quality of life, including better understanding and communication, access to home care, emotion and spiritual support, well being and dignity” and symptom management, physician rarely refer to such services.

The goal of the report is to create a roadmap that looks at what steps should be taken in order to make the end-of-life a better experience.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.