Unless the way healthcare is organized changes, most people will continue to suffer unnecessarily at the end. In the United States, many deaths are preceded by a surge of treatment, which is often pointless. The way healthcare is funded encourages over-treatment. Hospitals are paid for doing things to people, not for preventing pain. And not only patients, but those who love them, suffer.
The chief responsibility for the failures of end-of-life care lies with medicine. Doctors often neglect palliative care, which involves giving opioids for pain, treating breathlessness and counseling patients. (The name comes from the Latin term palliare, as in “to cloak” pain.)
The way healthcare providers are funded often sidelines palliative care. In America, hospitals suck up a big share of spending, even though the seriously ill are often better treated elsewhere.
In America, some insurers are realizing that what would be better for patients would be better for them, too. In 2015, Medicare announced that it would pay for conversations about end-of-life care between doctors and patients.
In 2010, Ellen Goodman, an American author, founded the Conversation Project, which started with people gathering to share stories of the “good deaths” and “bad deaths” experienced by their loved ones.
Experiences of death are being shared online. Dying Matters is a popular forum. In 2013, Scott Simon, a journalist, tweeted from his mother’s bedside as she died.
Bringing death “within the pale of conversation” is needed to overhaul end-of-life care.1