Ethics and the Medicalization of Death

Abstract

End-of-life care is not based on research-tested, evidence-based protocols because that research does not yet conclusively guide physicians to withhold care with absolutely certainty of the burden. According to Scott D. Halpern in the New England Journal of Medicine, the announcement by the Centers for Medicare and Medicaid Services regarding reimbursement rates for EOL care planning is a step in the right direction. However, the published research setting absolute standards for artificial support might change the culture dramatically. To determine which interventions actually improve outcomes, “more frequent and rapid conduct of large randomized trials and quasi-experimental studies” are necessary (p. 2001). A consensus needs to be reached about which outcome measures should be used in the studies to measure EOL intervention success. The urge to “do something” is leading healthcare organizations to implement policies and approaches that have not been tested. Slowing down and pursuing education and research before implementation can help achieve more successful outcomes in EOL care. EOL communication needs to allow patients and families to make fully informed treatment decisions that will lead to more successful long-term efforts and more telling results about quality outcomes.