End-of-Life Care Issues

A Personal, Economic, Public Policy, and Public Health Crisis

Dan K. Morhaim, MD; Keshia M. Pollack, PhD, MPH


Am J Public Health. 2013;103(6):e8-e10. 

In This Article

End-of-Life Care Decision-makers

Advance directives are critical to designating when, where, how, and how much care a person wants at the end of life. We believe this care is or should be primarily determined by individuals, and not by government, insurance companies, hospitals, or other outside entities.

Americans are concerned about end-of-life care.[9] Health care professionals should be involved in discussing these issues with their patients and honoring advance directives when presented with them. This aspect of medical practice needs to be supported and should be viewed as another aspect of preventive care. It is ironic that this was the intent of the so-called "death panel" clause in the 2009 health care reform debate. The clause would have given physicians modest but fair compensation for discussing this important issue with Medicare patients upon their request.

The reality is that the subject of advance directives is not yet a standard part of most medical examinations. It is important that advance directive discussions become routine between doctors, nurses, and other key health providers and their patients, because the more normal the topic is, the less scary it will become.[11]