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US health care: the unwinnable war against death

Published online by Cambridge University Press:  19 October 2012

Daniel Callahan*
President Emeritus, The Hastings Center, Garrison, NY, USA
*Correspondence to: Daniel Callahan, President Emeritus, The Hastings Center, 21 Malcolm Gordon Road, Garrison, NY 10706, USA. Email:


For well over 40 years, the United States has struggled to improve end-of-life care. This effort, heavily focused on living wills, hospice and improved doctor–patient communications and palliative care, has been a modest success only. Both doctors and patients are often unwilling to accept the fact that death is on the way – only 25% of Americans have an advance directive. Advances in medical technology have provided more ways of keeping dying patients alive, making the line between living and dying harder to discern. The way physicians are paid promotes the use of technology not for talking with patients. Underlying these practical problems is a culture of American medicine with deep historical roots: that medical progress should be unending and is a moral imperative, that death is the greatest enemy and that cure, not care, is the primary goal. A better balance between care and cure is needed.

Copyright © Cambridge University Press 2012

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