Editor's Comments on 'As the Curtains Close: Managing Death at the Bedside'

 , December 02, 2015

In his essay, As the Curtains Close: Managing Death at the Bedside, Nicholas Tan explores the issue of how we approach death. He shares with us the stories of three patients (including his own grandfather), two of whom met, as he put it, “good deaths,” while the third deteriorated slowly in the hospital as aggressive medical care attempted to prolong his final days.

As medicine – and, with it, the ability to sustain life – continues to advance, the concept of “dying well” becomes increasingly important. Unfortunately, however, many patients do not meet their preferred end. Indeed, only about one-third of adults have an advanced directive detailing their wishes for end-of-life care.1 Moreover, although most Americans would prefer to die at home, almost 70% pass away in a hospital or other care facility.2,3 Tan skillfully calls to attention the need for patients, families, and providers to discuss what patients “value most in life and what they are willing to sacrifice in the event of a debilitating or mortal situation.” It is clear, though, that these discussions are not taking place as often as they should. We as providers need to be more proactive in starting these conversations so that we may be better equipped to provide quality care that respects the wishes of our patients through the very end.
 

Rachel Elkin

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References

1. Aldrich N. Advance care planning: ensuring your wishes are known and honored if you are unable to speak for yourself. Accessed at http://www.cdc.gov/aging/pdf/advanced-care-planning-critical-issue-brief.pdf.
2. Cloud J. A kinder, gentler death. Time Magazine. Published 9/18/2000.
3. http://www.cdc.gov/nchs/data/dvs/Mortfinal2005_worktable_309.pdf

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