November 24, 1999

Caring for Patients at the End of LifeCall for Papers

Author Affiliations

Author Affiliations: Dr Winker is Deputy Editor and Ms Flanagin is Managing Senior Editor, JAMA.

JAMA. 1999;282(20):1965. doi:10.1001/jama.282.20.1965

Medical advances and increasing life expectancy have paradoxically distanced physicians and nurses from their roles early in the century, when they focused on helping dying patients but had little else to offer. Now, effective treatments discovered through research on middle-aged adults apply to older adults, bringing health promotion and prevention to adults in their late years. This success raises important new questions.1 At what point should clinicians shift from a preventive focus to a palliative one? How can the uncertainties of prognosis at the end of life be managed? Why do dying patients continue to suffer pain and other symptoms that can be effectively managed with contemporary knowledge and treatments, while others suffer a high-tech overtreated death?

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