Duke University Center for Health Policy and Management, Durham, NC P eople are living longer with fewer disabilities. Because of financial incentives, lack of knowledge, or poor communication with patients and families, physicians may not make appropriate care decisions. Theoretically, decisions regarding preferred care may be clear, but practically those decisions only come after the fact.
Many patients fear the dying process and the burden on their families even more than death itself.
In addition, little is known about patients' and families' preferences for care at the end of life. Although there is a positive correlation between the care preferences of patients and their physicians, there is much to be learned about interactions between patients, caregivers, and physicians. This suggests the advisability of a pattern of less aggressive care when the possibility of life extension and quality of life enhancement lessens, but no study to date has quantified the amount of nonbeneficial care actually provided to persons near death. The role of insurance is complex. Much of the beneficial care is likely to be supportive.