With the availability of increasingly sophisticated health care technology, end-of-life care presents unprecedented ethical challenges for individuals, families, health care professionals, and policy makers. The role of health care professionals and the use of these technologies are changing how death, dying, and end-of-life care are viewed and managed.
Almost all adults have had some experience with the death of a spouse, a parent, a grandparent, or a child. The experience is rarely easy. Most deaths are the result of chronic disease. Compassionate and effective coordination of care is essential because health care and science are not close enough yet to finding cures for the major chronic diseases. This slow progress toward finding a cure means that sick individuals are living longer with their chronic disease. The resulting financial costs are unprecedented (Callahan & Lawler, 2012).
According to Callahan and Lawler (2012), one of the unexpected consequences of the unlimited use of technology in health care is that technological advances have made it harder and harder to determine with any precision when a patient is actually dying. There is almost always something that can be done to give dying people a few more hours, or days, or even weeks before they actually die
Dying patients face many challenges that affect their physical, psychosocial, and spiritual integrity (Tulsky, 2005). The Study to Understand Prognosis and Preferences for Outcomes and Risks of Treatment (SUPPORT) documented that many patients die a prolonged and painful death and that they receive expensive, unwanted, and invasive care during their last days. The emotional suffering of patients can be profound, and so, too, can the suffering of those who provide care for those patients at the end of their lives.
Yet, often, health care providers are ill-prepared to address the suffering experienced by dying patients and their families as they journey from serious illness to death (Tulsky, 2005). The SUPPORT study showed that many physicians behaved as though they were unaware their patients were dying and they rarely discussed prognosis and advance directives with their patients (Coll, Duffy, Micholovich, & Cohen, 2002). Many physicians do not know the extent of options for care at the end of life (Silveira, DiPiero, Gerrity, & Feudtner, 2000). As a result, end-of-life care has remains a high national priority (Steinhauser et al., 2000).