Hostname: page-component-8448b6f56d-qsmjn Total loading time: 0 Render date: 2024-04-24T17:31:40.694Z Has data issue: false hasContentIssue false
  • English
  • Français

US health care: the unwinnable war against death

Published online by Cambridge University Press:  19 October 2012

Daniel Callahan
Daniel Callahan*
Affiliation:
President Emeritus, The Hastings Center, Garrison, NY, USA
*
*Correspondence to: Daniel Callahan, President Emeritus, The Hastings Center, 21 Malcolm Gordon Road, Garrison, NY 10706, USA. Email: callahand@thehastingscentre.org
Get access Rights & Permissions [Opens in a new window]

Abstract

For well over 40 years, the United States has struggled to improve end-of-life care. This effort, heavily focused on living wills, hospice and improved doctor–patient communications and palliative care, has been a modest success only. Both doctors and patients are often unwilling to accept the fact that death is on the way – only 25% of Americans have an advance directive. Advances in medical technology have provided more ways of keeping dying patients alive, making the line between living and dying harder to discern. The way physicians are paid promotes the use of technology not for talking with patients. Underlying these practical problems is a culture of American medicine with deep historical roots: that medical progress should be unending and is a moral imperative, that death is the greatest enemy and that cure, not care, is the primary goal. A better balance between care and cure is needed.

Type
Articles
Information
Health Economics, Policy and Law , Volume 7 , Issue 4 , October 2012 , pp. 455 - 466
Copyright
Copyright © Cambridge University Press 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bodenheimer, T.Berenson, J. M. (2007), ‘The primary care – specialty income gap – and why it matters’, Annals of Internal Medicine, 146(4): 301–306.Google Scholar
California Health Care Foundation (2012), ‘Final Chapter: Californians’ Attitudes and Experiences With Death and Dying, Oakland, CA, USA: California Health Care Foundation.Google Scholar
Callahan, D. (2003), What Price Better Health: Hazards of the Research Imperative, Berkeley: University of California Press.Google Scholar
Callahan, D.Wasunna, A. (2006), Medicine and the Market: Equity v. Choice, Baltimore: Johns Hopkins University Press.Google Scholar
Cutler, D. (2004), Your Money Or Your Life: Strong Medicine for America's Health Care System, New York: Oxford University Press, 62.Google Scholar
Detsky, A. S. (2011), ‘What patients really want from health care’, Journal of the American Medical Association, 306(22): 2500–2501.Google Scholar
Heath, I. (2010), ‘What do we want to die from?’, British Medical Journal, 341: c3833.Google Scholar
Jonsen, A. (1998), The Birth of Bioethics, New York: Oxford University Press, 233–281.Google Scholar
Kim, M., Blendon, R.Benson, J. (2001), ‘How interested are Americans in new medical technologies?’, Health Affairs, 20(5): 194–201.CrossRefGoogle ScholarPubMed
Meisl, A., Snyder, L.Quill, M. (2000), ‘Seven legal barriers to end-of-life care: myths, realities, and grains of truth’, Journal of the American Medical Association, 284(19): 2495–2501.CrossRefGoogle Scholar
Muller, J. M.Koenig, B. (1998), ‘The Boundary of Life and Death: The Definition of Dying by Medical Residents’, in M. Lock and D. Gordon (eds). Biomedicine Reconsidered, Dordrecht: Kluwer Academic Press, 369–382.Google Scholar
Murray, K. (2012), ‘How Doctors Die: It's Not Like the Rest of Us, But it Should Be’, in Remedies, Oakland, CA, USA: California HealthCare Foundation, 1–12.Google Scholar
Orzag, P. R.Emanuel, E. J. (2010), ‘Health care reform and cost control’, New England Journal of Medicine, 363(7): 459–463.Google Scholar
Shim, J., Ross, A.Kaufman, S. (2005), ‘Risk, life extension and the pursuit of medical possibility’, Sociology of Health and Illness, 38(4): 479–502.Google Scholar
Spam, P. (2011), ‘A conversation many doctors won't have’, The New York Times, 16.Google Scholar
Smith, A., et al. (2011), ‘Discussing Overall Prognosis With the Very Elderly’, New England Journal of Medicine, 369: 2149.Google Scholar
Unroe, K. T., et al. (2010), ‘Resource use in the last six months of life’, Archives of Internal Medicine, 156–162.Google Scholar
Workman, S. (2011), ‘Never Say Die–As Treatments Fail Doctors’ Words Must Not’, The International Journal of Clinical Practice, 65(2): 117.Google Scholar
Yourman, L., et al. (2012), ‘Prognostic indices for older adults’, Journal of the American Medical Association, 307(2): 190–197.Google ScholarPubMed