In the United States at the end of the 20th century, this quest remains elusive. Many people fear that they will have unrelieved symptoms, will undergo unwanted life-prolonging interventions, or will be abandoned by their health care providers.
Recent research documents serious problems in medical care at the end of life.
Improving care at the end of life is particularly important in light of ongoing public discussions about managed care and physician-assisted suicide. Physician-assisted suicide has generated tremendous controversy. Some public support for physician-assisted suicide results in part from fears of unrelieved suffering and loss of control over care at the end of life. When patients with cancer undergo curative treatment, the side effects of chemotherapy need to be relieved and psychosocial issues of coping with disease and treatment should be addressed. Discussions can be put into the context of exploring patient and family concerns about the future, helping the patient be in control of care, and establishing shared goals for care.