Care at the End of Life: Guiding Practice Where There Are No Easy Answers

It is too soon to know the extent of the damage to JAMA from the precipitous and unceremonious firing of its editor, but editorial freedom is important for journals in another, more pragmatic, way.

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Editorials4 May 1999Care at the End of Life: Guiding Practice Where There Are No Easy AnswersBernard Lo, MD, Lois Snyder, JD, and Harold C. Sox, MDBernard Lo, MDUniversity of California, San Francisco, San Francisco, CA 94143 (Lo)American College of Physicians-American Society of Internal Medicine, Philadelphia, PA 19106 (Snyder)American College of Physicians-American Society of Internal Medicine, Philadelphia, PA 19106 (Sox), Lois Snyder, JDUniversity of California, San Francisco, San Francisco, CA 94143 (Lo)American College of Physicians-American Society of Internal Medicine, Philadelphia, PA 19106 (Snyder)American College of Physicians-American Society of Internal Medicine, Philadelphia, PA 19106 (Sox), and Harold C. Sox, MDUniversity of California, San Francisco, San Francisco, CA 94143 (Lo)American College of Physicians-American Society of Internal Medicine, Philadelphia, PA 19106 (Snyder)American College of Physicians-American Society of Internal Medicine, Philadelphia, PA 19106 (Sox)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-130-9-199905040-00018 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Throughout the ages, people have sought a "good death" in which they are physically as comfortable as possible, are treated with compassion and respect, and find closure in their lives. In the United States at the end of the 20th century, this quest remains elusive. Many people fear that they will have unrelieved symptoms, will undergo unwanted life-prolonging interventions, or will be abandoned by their health care providers.This editorial announces a new series of articles on end-of-life care in Annals whose goal is to provide practical advice and other guidance to clinicians who are not specialists in palliative care ...References1. Ethics manual. Fourth edition. American College of Physicians. Ann Intern Med. 1998; 128:576-94. Google Scholar2. Cleeland CS, Gonin R, Hatfield AK, Edmonson JH, Blum RH, Stewart JA, et al . Pain and its treatment in outpatients with metastatic cancer. N Engl J Med. 1994;330:592-6. CrossrefMedlineGoogle Scholar3. A controlled trial to improve care for seriously ill hospitalized patients. The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment (SUPPORT). The SUPPORT Principal Investigators. JAMA. 1995; 274:1591-8. Google Scholar4. Tulsky JA, Chesney MA, Lo B. 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Washington, DC: National Academy Pr; 1997. Google Scholar12. Lynn J. An 88-year-old woman facing the end of life. JAMA. 1997;277:1633-40. CrossrefMedlineGoogle Scholar13. Doyle D, Hanks GW, MacDonald N, eds. Oxford Textbook of Palliative Medicine. 2d ed. New York: Oxford Univ Pr; 1998. Google Scholar14. Quill TE, Billings JA. . Palliative care textbooks come of age. Ann Intern Med. 1998;129:590-4. LinkGoogle Scholar15. Byock I. Dying Well: The Prospect for Growth at the End of Life. New York: Riverhead Books; 1997. Google Scholar16. Lo B, Jonsen AR. . Ethical dilemmas and the clinician. Ann Intern Med. 1980;92:116-7. LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: University of California, San Francisco, San Francisco, CA 94143 (Lo)American College of Physicians-American Society of Internal Medicine, Philadelphia, PA 19106 (Snyder)American College of Physicians-American Society of Internal Medicine, Philadelphia, PA 19106 (Sox)Corresponding Author: Lois Snyder, JD, Center for Ethics and Professionalism, American College of Physicians-American Society of Internal Medicine, 190 N. Independence Mall West, Philadelphia, PA 19106.Current Author Addresses: Dr. Lo: Program in Medical Ethics, University of California, San Francisco, Room C126, 521 Parnassus Avenue, San Francisco, CA 94143-0903.Ms. Snyder: Center for Ethics and Professionalism, American College of Physicians-American Society of Internal Medicine, 190 N. Independence Mall West, Philadelphia, PA 19106.Dr. Sox: American College of Physicians-American Society of Internal Medicine, 190 N. Independence Mall West, Philadelphia, PA 19106. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoDiscussing Palliative Care with Patients Bernard Lo , Timothy Quill , James Tulsky , and Metrics Cited ByPhysicians' End of Life Discussions with Patients: Is There an Ethical Obligation to Discuss Aid in Dying?Association of Communication Interventions to Discuss Code Status With Patient Decisions for Do-Not-Resuscitate OrdersAmerican College of Physicians Ethics Manual Seventh EditionLois Snyder Sulmasy, JD and Thomas A. Bledsoe, MD, for the ACP Ethics, Professionalism and Human Rights Committee*Feasibility and Patient Perceptions of Video Declarations Regarding End-of-Life Decisions by Hospitalized PatientsWorkplace Spirituality in Contemporary South AfricaWorkplace Spirituality in Contemporary South AfricaPsychosocial and Spiritual Issues in Supportive Cancer CareHope in the Context of Pain and Palliative CareThe pharmacist and medical aid in dyingDeprescribing in advanced illnessA Randomized Controlled Trial of a CPR and Intubation Video Decision Support Tool for Hospitalized PatientsLimits and Responsibilities of Physicians Addressing Spiritual Suffering in Terminally Ill PatientsInitiating decision-making conversations in palliative care: an ethnographic discourse analysisDeath talk: gender differences in talking about one's own impending deathFamilies and the transition to specialist palliative careLive liver donors' risk thresholds: risking a life to save a lifeCaring for a Family Member with Mental Illness: Exploring SpiritualitySpirituality and HealthFifth-Year Medical Students' Knowledge of Palliative Care and Their Views on the SubjectRandomized Controlled Trial of a Video Decision Support Tool for Cardiopulmonary Resuscitation Decision Making in Advanced CancerHope in the Context of Pain and Palliative CareDiversity of Patients' Beliefs about the Soul after Death and Their Importance in End-of-Life CareAmerican College of Physicians Ethics Manual Sixth EditionLois Snyder, JD, for the American College of Physicians Ethics, Professionalism, and Human Rights Committee*Caregiver Stress: The Role of Spirituality in the Lives of Family/Friends and Professional Caregivers of Cancer PatientsFactors That Affect Pain BehaviorCritical ConversationsDoctor–Patient Communication about Advance Directives in Metastatic Breast CancerEffects of a Multimodule Curriculum of Palliative Care on Medical StudentsOncology Nurses' Perceptions About Palliative CareMoral distress and providing care to dying babies in neonatal nursingRespect in Critical CareSpiritual care of families in the intensive care unit*Medical Condition Is Related to Treatment Preference in Cancer Patients: Implications for Quality AssessmentSurvey of the general public's attitudes toward advance directives in Japan: How to respect patients' preferencesFaculty Development in End-of-Life Care: Evaluation of a National Train-the-Trainer ProgramAdult Burn Patients: The Role of Religion in Recovery—Should We Be Doing More?Psychometric Characteristics of a Quality of Communication Questionnaire Assessing Communication about End-of-Life CareEvaluation of an EOL Critical Care Nurse Liaison ProgramInterdisciplinary Spiritual Care for Seriously Ill and Dying PatientsDiscussing resuscitation preferences with patients: Challenges and rewardsPalliative care in hospitalsInterventions to Enhance the Spiritual Aspects of DyingInterventions to Enhance Communication among Patients, Providers, and FamiliesExpressions of Nonabandonment During the Intensive Care Unit Family ConferenceNegotiating End-of-Life Decision Making: A Comparison of Japanese and U.S. Residents?? ApproachesOpportunities and Challenges to Improving End-of-Life Care for Seriously Ill Elderly Patients: A Qualitative Study of Generalist PhysiciansThe Internal Morality of Medicine in the Contexts of Implicit Religion and SpiritualityReligion, Spirituality, and Medicine: Research Findings and Implications for Clinical PracticeAdvance Care PlaningNational Consensus Project for Quality Palliative Care: Clinical Practice Guidelines for Quality Palliative Care, Executive SummaryTruth-TellingBarriers to excellent end-of-life care for patients with dementiaQuality of DeathImproving Communication Among Attending Physicians, Long-Term Care Facilities, Residents, and Residents' FamiliesUsing population death rate to predict rate of admissions to the intensive care unitEuthanasia, Ethics and Public Policy: An Argument Against LegislationQuality indicators for end-of-life care in the intensive care unit*Results of a clinical trial on care improvement for the critically illHealth Care in America: Lost Opportunities Amid PlentyHospice Benefits and Phase I Cancer TrialsIra Byock, MD and Steven H. Miles, MDUpdate in Palliative Medicine and End-of-Life CareImproving Knowledge and Communication Through an Advance Directives Objective Structured Clinical ExaminationEnd of life is a public health issueAdvance care planning and advance directives: time for actionAnalyses of nursing home residents in hospice care using the Minimum Data SetUnderstanding the Treatment Preferences of Seriously Ill PatientsThe Meaning and Value of DeathVicissitudes of the Clinician-Patient Relationship in End-of-Life Care: Recognizing the Role for TeamsCross-cultural similarities and differences in attitudes about advance care planningThe Development of a Palliative Care Program for Managed Care Patients: A Case ExamplePhysician-Assisted SuicideLois Snyder, JD and Daniel P. Sulmasy, OFM, MD, PhD, for the Ethics and Human Rights Committee, American College of Physicians–American Society of Internal Medicine*Nurses' attitudes to terminally ill patients"Serious and complex illness" in quality improvement and policy reform for end-of-life careThe family conference as a focus to improve communication about end-of-life care in the intensive care unit: Opportunities for improvementThe closure and the rings: When a physician disregards a patient's wishPalliative CareManagement of the patient with congestive heart failure using outpatient, home, and palliative careDEATH AND DYINGThe dying patientIn Search of a Good Death: Observations of Patients, Families, and ProvidersKaren E. Steinhauser, PhD, Elizabeth C. Clipp, PhD, MS, RN, Maya McNeilly, PhD, Nicholas A. Christakis, MD, PhD, MPH, Lauren M. McIntyre, PhD, and James A. Tulsky, MDPhysicians and Patient Spirituality: Professional Boundaries, Competency, and EthicsStephen G. Post, PhD, Christina M. Puchalski, MD, MS, and David B. Larson, MD, MSPHCommunication in Caring for Terminally Ill PatientsGoals and Strategies for Teaching Death and Dying in Medical SchoolsEvolving Resources to Support Improvement of Pain and Symptom Control at End of LifeLearning Empathy: Medical School and the Care of the Dying PatientAccess to HIV and AIDS CareMaintaining Hope: Communication in Palliative Care 4 May 1999Volume 130, Issue 9Page: 772-774KeywordsCancer treatmentEnd of life careFearForecastingMedicarePalliative carePatientsSub-specialty careSuicideTraditional medicine Issue Published: 4 May 1999 CopyrightCopyright © 1999 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...