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US health care: the unwinnable war against death

  • Daniel Callahan (a1)

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.

Corresponding author
*Correspondence to: Daniel Callahan, President Emeritus, The Hastings Center, 21 Malcolm Gordon Road, Garrison, NY 10706, USA. Email:
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This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

A. Meisl , L. Snyder M. Quill (2000), ‘Seven legal barriers to end-of-life care: myths, realities, and grains of truth’, Journal of the American Medical Association, 284(19): 24952501.

T. Bodenheimer J. M. Berenson (2007), ‘The primary care – specialty income gap – and why it matters’, Annals of Internal Medicine, 146(4): 301306.

M. Kim , R. Blendon J. Benson (2001), ‘How interested are Americans in new medical technologies?’, Health Affairs, 20(5): 194201.

S. Workman (2011), ‘Never Say Die–As Treatments Fail Doctors’ Words Must Not’, The International Journal of Clinical Practice, 65(2): 117.

I. Heath (2010), ‘What do we want to die from?’, British Medical Journal, 341: c3833.

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Health Economics, Policy and Law
  • ISSN: 1744-1331
  • EISSN: 1744-134X
  • URL: /core/journals/health-economics-policy-and-law
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