Chapter

End-of-Life Care: A Philosophical or Management Problem?

Daniel Callahan

in The Roots of Bioethics

Published in print October 2012 | ISBN: 9780199931378
Published online January 2013 | e-ISBN: 9780199980598 | DOI: http://dx.doi.org/10.1093/acprof:oso/9780199931378.003.0006
End-of-Life Care: A Philosophical or Management Problem?

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Since the mid-1970s, end-of-life care has been dominated by a belief that it is simply a managerial and educational problem: better education for doctors in caring for the dying, the appointment of surrogates or the execution of living wills for patients, and the improvement of palliative care and hospice services. Great progress has been made over the years on all three fronts, with over 1 million people dying annually with hospice care. Yet, the overall problem has not really been solved. Many people are kept alive too long, too many go into hospice care too late, and almost everyone can think of friends or loved ones who died a miserable death. In short, this chapter argues, we have to look deeper than to educational and managerial approaches. It is the problem of death itself, its place in our personal lives and in medicine, which is the ultimate issue. Our society, as medicine itself, does not readily come to grips with death: almost every one us finds it hard to talk about privately, and even harder as a public topic. A failure to confront death distorts medical care, stands in the way of good doctor-patient relationships, and leaves families often lacking in emotional resources when death is on its way.

Keywords: death; hospice; palliative care; medicine; end of life care

Chapter.  5790 words. 

Subjects: Moral Philosophy

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