Perspectives on Care at the Close of Life Section
Editor: Margaret A. Winker, MD, Deputy Editor, JAMA.
Author Affiliation: Stanford University School
of Medicine, Palo Alto, Calif.
Providing care to actively dying patients presents unique challenges
for the clinician. Patients in their final days require careful symptom management.
Families need support and coaching as death approaches. Care does not end
with the death of the patient but continues through death pronouncement, family
notification of the death, discussion of autopsy, and immediate bereavement
support. Skills in these and related areas are discussed in the context of
one man’s death, as illuminated by comments made after death by his
daughter and his physician. This case also highlights the often differing
perspectives of families and clinicians as they work to deal with a patient’s
death. A goal of mastering the palliative skills necessary to competently
care for an actively dying patient is to enable a patient to die peacefully
and relatively free of discomfort. Achieving such competency should also help
to relieve clinician stress attendant to caring for dying patients.
Hallenbeck J. Palliative Care in the Final Days of Life“They Were Expecting It at Any Time”. JAMA. 2005;293(18):2265-2271. doi:10.1001/jama.293.18.2265