Improving and coordinating end-of-life care is arguably the greatest quality challenge that healthcare providers face. Improvement should start with clear and meaningful communication among caregivers, patients and patients' families.
A Yale University School of Medicine survey of nearly 1,000 cardiac patients and their doctors found that nearly one in five patients who said they wouldn't want to be resuscitated were countered by their physicians, who said the patients would prefer such heroic treatment.
Enhancing communication requires using proper timing, identifying patients who are likely to die and offering appropriate treatment options or support services. It would help if hospitals, physician groups and health systems developed guidelines on end-of-life care.
Unfortunately, lawyers, politicians and regulators are turning this most sensitive and private of medical matters into outright frays. Conflicts range from the cat-and-mouse games between Jack Kevorkian, M.D., and Michigan legal officials to the governor of Virginia's entry into a family debate on ending life support for a severely brain-damaged patient to lawmakers' threats to send Drug Enforcement Administration gumshoes after physicians suspected of assisting suicides.
Providers and patient advocates must work together to dim the political and media spotlight. Already we've heard from physicians who are reluctant to prescribe pain medication because they fear legal retaliation. Some caregivers even shy away from discussing treatment options with terminally ill patients.
Providers should join the debate over patients' right to decide their fate, the value of human life and limits on suffering or dependency. If they don't, other interested parties will eagerly take control and attempt to set the rules.