Care at the End of Life: Guiding Practice Where There Are No Easy Answers
Authors: Bernard Lo
Journal: Annals of Internal Medicine (1999)

Editorials4 May 1999Care at the End of Life: Guiding Practice Where There Are No Easy AnswersBernard Lo, MD, Lois Snyder, JD, and Harold C. Sox, MDBernard Lo, MDUniversity of California, San Francisco, San Francisco, CA 94143 (Lo)American College of Physicians-American Society of Internal Medicine, Philadelphia, PA 19106 (Snyder)American College of Physicians-American Society of Internal Medicine, Philadelphia, PA 19106 (Sox), Lois Snyder, JDUniversity of California, San Francisco, San Francisco, CA 94143 (Lo)American College of Physicians-American Society of Internal Medicine, Philadelphia, PA 19106 (Snyder)American College of Physicians-American Society of Internal Medicine, Philadelphia, PA 19106 (Sox), and Harold C. Sox, MDUniversity of California, San Francisco, San Francisco, CA 94143 (Lo)American College of Physicians-American Society of Internal Medicine, Philadelphia, PA 19106 (Snyder)American College of Physicians-American Society of Internal Medicine, Philadelphia, PA 19106 (Sox)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-130-9-199905040-00018 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Throughout the ages, people have sought a "good death" in which they are physically as comfortable as possible, are treated with compassion and respect, and find closure in their lives. 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.This editorial announces a new series of articles on end-of-life care in Annals whose goal is to provide practical advice and other guidance to clinicians who are not specialists in palliative care ...References1. Ethics manual. Fourth edition. American College of Physicians. Ann Intern Med. 1998; 128:576-94. Google Scholar2. Cleeland CS, Gonin R, Hatfield AK, Edmonson JH, Blum RH, Stewart JA, et al . Pain and its treatment in outpatients with metastatic cancer. N Engl J Med. 1994;330:592-6. CrossrefMedlineGoogle Scholar3. A controlled trial to improve care for seriously ill hospitalized patients. The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment (SUPPORT). The SUPPORT Principal Investigators. JAMA. 1995; 274:1591-8. Google Scholar4. Tulsky JA, Chesney MA, Lo B. 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Washington, DC: National Academy Pr; 1997. Google Scholar12. Lynn J. An 88-year-old woman facing the end of life. JAMA. 1997;277:1633-40. CrossrefMedlineGoogle Scholar13. Doyle D, Hanks GW, MacDonald N, eds. Oxford Textbook of Palliative Medicine. 2d ed. New York: Oxford Univ Pr; 1998. Google Scholar14. Quill TE, Billings JA. . Palliative care textbooks come of age. Ann Intern Med. 1998;129:590-4. LinkGoogle Scholar15. Byock I. Dying Well: The Prospect for Growth at the End of Life. New York: Riverhead Books; 1997. Google Scholar16. Lo B, Jonsen AR. . Ethical dilemmas and the clinician. Ann Intern Med. 1980;92:116-7. LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: University of California, San Francisco, San Francisco, CA 94143 (Lo)American College of Physicians-American Society of Internal Medicine, Philadelphia, PA 19106 (Snyder)American College of Physicians-American Society of Internal Medicine, Philadelphia, PA 19106 (Sox)Corresponding Author: Lois Snyder, JD, Center for Ethics and Professionalism, American College of Physicians-American Society of Internal Medicine, 190 N. Independence Mall West, Philadelphia, PA 19106.Current Author Addresses: Dr. Lo: Program in Medical Ethics, University of California, San Francisco, Room C126, 521 Parnassus Avenue, San Francisco, CA 94143-0903.Ms. Snyder: Center for Ethics and Professionalism, American College of Physicians-American Society of Internal Medicine, 190 N. Independence Mall West, Philadelphia, PA 19106.Dr. Sox: American College of Physicians-American Society of Internal Medicine, 190 N. Independence Mall West, Philadelphia, PA 19106. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoDiscussing Palliative Care with Patients Bernard Lo , Timothy Quill , James Tulsky , and Metrics Cited ByPhysicians' End of Life Discussions with Patients: Is There an Ethical Obligation to Discuss Aid in Dying?Association of Communication Interventions to Discuss Code Status With Patient Decisions for Do-Not-Resuscitate OrdersAmerican College of Physicians Ethics Manual Seventh EditionLois Snyder Sulmasy, JD and Thomas A. 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ApproachesOpportunities and Challenges to Improving End-of-Life Care for Seriously Ill Elderly Patients: A Qualitative Study of Generalist PhysiciansThe Internal Morality of Medicine in the Contexts of Implicit Religion and SpiritualityReligion, Spirituality, and Medicine: Research Findings and Implications for Clinical PracticeAdvance Care PlaningNational Consensus Project for Quality Palliative Care: Clinical Practice Guidelines for Quality Palliative Care, Executive SummaryTruth-TellingBarriers to excellent end-of-life care for patients with dementiaQuality of DeathImproving Communication Among Attending Physicians, Long-Term Care Facilities, Residents, and Residents' FamiliesUsing population death rate to predict rate of admissions to the intensive care unitEuthanasia, Ethics and Public Policy: An Argument Against LegislationQuality indicators for end-of-life care in the intensive care unit*Results of a clinical trial on care improvement for the critically illHealth Care in America: Lost Opportunities Amid PlentyHospice Benefits and Phase I Cancer TrialsIra Byock, MD and Steven H. 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Puchalski, MD, MS, and David B. Larson, MD, MSPHCommunication in Caring for Terminally Ill PatientsGoals and Strategies for Teaching Death and Dying in Medical SchoolsEvolving Resources to Support Improvement of Pain and Symptom Control at End of LifeLearning Empathy: Medical School and the Care of the Dying PatientAccess to HIV and AIDS CareMaintaining Hope: Communication in Palliative Care 4 May 1999Volume 130, Issue 9Page: 772-774KeywordsCancer treatmentEnd of life careFearForecastingMedicarePalliative carePatientsSub-specialty careSuicideTraditional medicine Issue Published: 4 May 1999 CopyrightCopyright © 1999 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...