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January 15, 1997

The Last Refreshing Taste

Author Affiliations

Glendale, Ariz

JAMA. 1997;277(3):211-212. doi:10.1001/jama.1997.03540270037019

To the Editor.  —As Dr Bone continues his confrontation with mortality and metastatic renal cancer, his touching and eloquent writings1,2 incite us to provide compassionate and irreproachable care to severely ill and dying patients. Unfortunately, care of terminally ill people is a neglected aspect of medical care,1 despite the fact that most physicians come in close proximity to death during daily encounters with patients. To compound the neglect, the locale of the deathbed scene has migrated from a homebound environment to an institutional setting, with death frequently occurring alone and without family, friends,3 or physician in attendance, particularly in long-term care facilities. Regrettably, absence or withdrawal of a physician from terminal care negatively alters the physician-patient relationship during its final and vulnerable phase, and fosters familial discontent and an image of patient abandonment. However, such detachment may reflect a universal fear of death and an identification with