Courage, Leadership, and End-of-Life Care

When Courage Counts

Karlene M. Kerfoot, PhD, RN, CNAA, FAAN


Nurs Econ. 2012;30(3):176-178. 

In This Article

Abstract and Introduction


"When death opens the back door, you'll put on your carpet slippers and stride out.
– Sexton (2001, p. 246).


When Death comes knocking now, it usually happens in a hospital or nursing home. We can't just put on our bedroom slippers and slip out the back door because we are too often hooked to machines with innumerable tubes invading our bodies, and are infused with mind and body-altering drugs in order to "try just one more thing." Unfortunately, all too often we die alone in sterile health care facilities. The cost of dying this way is so much more complicated than the poetic "striding" out the back door. Estimates for the cost of end-of-life care include numbers such as 27% of the Medicare budget, 10%-12% of the total health care budget, and 25%-40% of the cost can be saved during the last month of life with advance directives and hospice care (Emanual, 1996). Byock (2012) notes only 25% of patients eligible for hospice care actually receive it and the average time spent in hospice is 3 weeks.

Missing in these financial data is information about what it means to patients, family, and caregivers to be participants in futile end-of-life measures. There are better ways. The literature is rich with evidence of practices that reduce the toll and suffering of patients, families, and the nursing staff. It takes extreme courage as a leader to implement evidence based practices, and end-of-life is no exception.


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