Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life by Institute of Medicine

For patients and their loved ones, no care decisions are more profound than those made near the end of life. For the millions of Americans who work in or with the health care sector -- including clinicians, clergy, caregivers, and support staff -- providing high-quality care for people who are nearing the end of life is a matter of professional commitment and responsibility. Health system managers, payers, and policy makers, likewise, have a responsibility to ensure that end-of-life care is compassionate, affordable, sustainable, and of the best quality possible.
A substantial body of evidence shows that broad improvements to end-of-life care are within reach. In "Dying in America," a committee of experts finds that improving the quality and availability of medical and social services for patients and their families could not only enhance quality of life through the end of life, but may also contribute to a more sustainable care system. "Dying in America" is a study of the current state of health care for persons of all ages with a serious illness or medical condition who are likely approaching death. This report provides a detailed description of important aspects of the current U.S. health care system as they affect Americans nearing the end of life.
"Dying in America" evaluates strategies to integrate care into a person- and family-centered, team-based framework. According to this report, the current health care system of rendering more intensive services than are necessary and the lack of coordination among programs increases risks to patients and creates avoidable burdens on them and their families. This report makes recommendations to create a system that coordinates caregiving and supports and respects the choices of patients and their families.
All people with advanced illnesses who may be approaching the end of life are entitled to access to high-quality, compassionate, evidence-based care, consistent with their wishes, that has a reasonable expectation of protecting or improving quality and length of life. The findings and recommendations of "Dying in America" will address the needs of patients and their families and assist policy makers, clinicians and their educational and credentialing bodies, leaders of health care delivery and financing organizations, researchers, public and private funders, religious and community leaders, advocates of better care, journalists, and the public to provide the best care possible for people nearing the end of life.