Skip to main content
×
Home

US health care: the unwinnable war against death

  • Daniel Callahan (a1)
Abstract
Abstract

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
Corresponding author
*Correspondence to: Daniel Callahan, President Emeritus, The Hastings Center, 21 Malcolm Gordon Road, Garrison, NY 10706, USA. Email: callahand@thehastingscentre.org
References
Hide All
Bodenheimer T.Berenson J. M. (2007), ‘The primary care – specialty income gap – and why it matters’, Annals of Internal Medicine, 146(4): 301306.
California Health Care Foundation (2012), ‘Final Chapter: Californians’ Attitudes and Experiences With Death and Dying, Oakland, CA, USA: California Health Care Foundation.
Callahan D. (2003), What Price Better Health: Hazards of the Research Imperative, Berkeley: University of California Press.
Callahan D.Wasunna A. (2006), Medicine and the Market: Equity v. Choice, Baltimore: Johns Hopkins University Press.
Cutler D. (2004), Your Money Or Your Life: Strong Medicine for America's Health Care System, New York: Oxford University Press, 62.
Detsky A. S. (2011), ‘What patients really want from health care’, Journal of the American Medical Association, 306(22): 25002501.
Heath I. (2010), ‘What do we want to die from?’, British Medical Journal, 341: c3833.
Jonsen A. (1998), The Birth of Bioethics, New York: Oxford University Press, 233281.
Kim M., Blendon R.Benson J. (2001), ‘How interested are Americans in new medical technologies?’, Health Affairs, 20(5): 194201.
Meisl A., Snyder L.Quill M. (2000), ‘Seven legal barriers to end-of-life care: myths, realities, and grains of truth’, Journal of the American Medical Association, 284(19): 24952501.
Muller J. M.Koenig B. (1998), ‘The Boundary of Life and Death: The Definition of Dying by Medical Residents’, in M. Lock and D. Gordon (eds). Biomedicine Reconsidered, Dordrecht: Kluwer Academic Press, 369382.
Murray K. (2012), ‘How Doctors Die: It's Not Like the Rest of Us, But it Should Be’, in Remedies, Oakland, CA, USA: California HealthCare Foundation, 112.
Orzag P. R.Emanuel E. J. (2010), ‘Health care reform and cost control’, New England Journal of Medicine, 363(7): 459463.
Shim J., Ross A.Kaufman S. (2005), ‘Risk, life extension and the pursuit of medical possibility’, Sociology of Health and Illness, 38(4): 479502.
Spam P. (2011), ‘A conversation many doctors won't have’, The New York Times, 16.
Smith A., et al. (2011), ‘Discussing Overall Prognosis With the Very Elderly’, New England Journal of Medicine, 369: 2149.
Unroe K. T., et al. (2010), ‘Resource use in the last six months of life’, Archives of Internal Medicine, 156162.
Workman S. (2011), ‘Never Say Die–As Treatments Fail Doctors’ Words Must Not’, The International Journal of Clinical Practice, 65(2): 117.
Yourman L., et al. (2012), ‘Prognostic indices for older adults’, Journal of the American Medical Association, 307(2): 190197.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Health Economics, Policy and Law
  • ISSN: 1744-1331
  • EISSN: 1744-134X
  • URL: /core/journals/health-economics-policy-and-law
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 6
Total number of PDF views: 22 *
Loading metrics...

Abstract views

Total abstract views: 149 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 20th November 2017. This data will be updated every 24 hours.