By virtue of its structure, Western medicine is characterized by its cure-oriented approach to the patient. We pretend to master death and the fear of death, according to Dr Elizabeth Kübler-Ross.
1We are uncomfortable in situations when the patient’s prognosis is poor, because as health care providers, we are instilled with the idea that the ultimate goal in patient care is curing the patient. Thus, the fear of failure looms when aggressive treatment is no longer possible and many providers are reluctant to be straightforward with families in discussing end-of-life (EOL) care options. Unfortunately, this pandemic attitude of denial and avoidance has the unintended consequence of alienating both the dying and the aged and is a true disservice to all patients. Additionally, the current approach to EOL care often fails to accept the inevitable notion that just as there is a time for living, there is also a time for dying. With the advances in medical technology, one of the real challenges of modern medicine is accepting that dying is part of life’s journey for all individuals and that death does not represent a failure of the health care system or health care providers.
- Kübler-Ross E.
On Death and Dying.
MacMillan, New York1969
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of the American Medical Directors Association
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- On Death and Dying.MacMillan, New York1969
- End of life care.Aging Successfully. 2006; 16: 1-17
- Factors associated with site of death: A national study of where people die.Med Care. 2003; 41: 323-335
- Nursing home experience with hospice.J Am Med Dir Assoc. 2002; 3: 46-50
- End of life care in US nursing homes: Nursing homes with special programs and trained staff for hospice or palliative/end of life care.J Palliat Med. 2008; 11: 866-877
- Nursing home participation in end-of-life programs: United States, 2004.Am J Hosp Palliat Care. 2009; 26: 354-360
- Improving nursing home staff knowledge and attitudes about pain.Gerontologist. 2004; 44: 469-478
- The clinical course of advanced dementia.N Engl J Med. 2009; 361: 1529-1538
- Evaluations of end of life with dementia by families in Dutch and US nursing homes.International Phychogeriatrics. 2009; 21: 321-329
- Dialysis in frail elders: A role for palliative care.N Engl J Med. 2009; 361: 1597-1598
- End-of-Life care in nursing homes: The importance of CNA staff communication.J Am Med Dir Assoc. 2010; 11: 494-499
- Quality of life at the end of life for nursing home residents: Perceptions of hospice and nursing home staff members.J Pain Symptom Manage. 2008; 35: 1-9
- End of life care in US Nursing Homes: A review of the evidence.J Am Med Dir Assoc. 2004; 5: 147-155
- Barriers to managing pain in the nursing home: Findings from a statewide survey.J Am Med Dir Assoc. 2004; 5: 82-88
- Use of the quality improvement process in assessing end of life care in the nursing home.J Am Med Dir Assoc. 2005; 6: 334-339
- The opportunity for collaborative care provision: The presence of nursing home/hospice collaborations in US states.J Pain Symptom Manage. 2004; 28: 537-547
- Meaning and practice of palliative care for nursing home residents with dementia at end of life.Am J Alzheimers Dis Other Demen. 2008; 23: 319-325
- A practical tool to identify patients who may benefit from a palliative approach: the CARING criteria.J Pain Symptom Manage. 2006; 31: 285-292
- Changing the culture of nursing homes.Arch Intern Med. 2010; 170: 407-408
- Improving end-of-life outcomes in nursing homes by targeting residents at high-risk of mortality for palliative care: Program description and evaluation.J Palliat Med. 2008; 11: 217-225
Published online: August 05, 2010
© 2010 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.