Committee on Approaching Death: Addressing Key End of Life Issues
Until the final decades of the 20th Century, death was viewed as an expected part of living and most often took place at home with family and friends nearby. Today, death has all too frequently become a medical event, often involving the use of advanced technology and extraordinary procedures due to very different cultural, societal and individual expectations. Death typically occurs in hospital settings, with family and friends sometimes separated from the dying patient because of distance from home and community. Although advances in palliative care and hospice care have helped many patients to die with dignity and with family and loved ones nearby, many fears about dying along with expectations about prolonged living have had a profound impact on the end of life both from a cost and compassion perspective, especially in connection with the American health care system. These issues are not new and the IOM first examined the issue in its 1997 report Approaching Death: Improving Care at the End of Life.
While the 1997 IOM Report made important and wide sweeping recommendations, progress in implementing them has been slow. Given the rapidly changing environment for health care delivery, punctuated by the landmark passage of the Affordable Care Act in 2010, and the twin imperatives of improving the quality of health care while controlling costs, the time is ripe for a new examination of how individual values and preferences can be aligned while assuring compassionate care focused on the needs of individuals approaching death in an affordable and sustainable manner. These issues are made even more timely as life-expectancy increases, our population ages, and the matter of death and dying has become a political as well as an ethical, moral and societal one.
Given the importance of death and dying to our citizens and our nation, the IOM plans to examine the current state of end-of-life care with respect to delivery of medical care and social support; patient-family-provider communication of values and preferences; advance care planning; health care cost, financing and reimbursement; and education of health professionals, patients and their loved ones. The study will also explore approaches to advance the issues surrounding the end of life from a wide variety of perspectives including clinical care and delivery, resources and workforce, economics, spirituality and compassion.
For a list of committee members,