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Institute of Medicine ‘Dying in America’ report sparks discussion and debate

Four commentaries published in discuss the recent report from the Institute of Medicine (IOM) titled “Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life.” Each commentary offers a different perspective on the topic of end-of-life care.

on Approaching Death co-chair, , MD, discusses the importance of compassionate care that is respectful of patients’ end-of-life preferences. He suggests that physicians, such as oncologists who care for seriously ill patients, should be open and honest with patients when discussing their treatment options and should remain fully present after palliative or has begun (DOI: 10.7326/M14-2399).

Drs. and Ezekiel Emanuel from the Department of Medical Ethics & Health Policy at the at the University of Pennsylvania recognize that sweeping overhauls in the delivery of end-of-life care are greatly needed. However, reimbursing physicians for engaging patients in advance care planning may not be the best approach. They explain some of the opportunities outside of physician incentives to improve the quality of end-of-life care (DOI: 10.7326/M14-2476).

Debra L Ness, MS, from the National Partnership for Women and Families and Beverley H. Johnson, BSN, from the Institute for Patient- and Family-Centered Care, applaud the IOM for initiating a national conversation about end-of-life care. However, they argue that the report needs an authentic patient-and family-centered approach that focuses on working with rather than for patients and families (DOI: 10.7326/M14-2537).

Annals of Internal Medicine Deputy Editor, Jaya K. Rao, MD, MHS, praises the IOM report for suggesting that end-of-life care is a public health issue, a concept she championed while working for the Centers for Disease Control and Prevention (CDC) from 2000 to 2008. According to Dr. Rao, end-of-life care meets the criteria to be a public health priority. She hopes that members of the IOM Committee and health professionals will build on the report recommendations to educate and engage the public about this serious issue (DOI: 10.7326/M14-2479).


Source: American College of Physicians