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November 22, 1995

Improving Care Near the End of LifeWhy Is It So Hard?

Author Affiliations

From the Program in Medical Ethics, the Robert Wood Johnson Clinical Scholars Program, the Center for AIDS Prevention Studies, and the Division of General Internal Medicine, University of California, San Francisco.

JAMA. 1995;274(20):1634-1636. doi:10.1001/jama.1995.03530200070042

A 56-year-old smoker with chronic obstructive pulmonary disease develops pneumonia and respiratory failure and is placed on mechanical ventilation. He dies 2 weeks later, after a stormy intensive care unit (ICU) course complicated by gastrointestinal bleeding and septic shock. The next morning, the ICU team questions how such a series of events occurred. Although each intervention could be justified as a response to a treatable complication, did the team truly consider the patient's overall prognosis or determine whether he really wanted such aggressive care?

See also p 1591.

The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT) intervention described in this issue of The Journal attempted to prevent such high-technology deaths.1 The SUPPORT investigators are to be congratulated on a rigorous, complex project. Yet, despite their best efforts in this multicenter randomized clinical trial, the intervention failed to improve any of the study outcomes.

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