End of life-Who makes the decisions and how can we do better?

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Improved healthcare and nutrition are leading to ever longer lifespans, and most people at some point will have personal experience with being in the situation of trying to decide what is best for their ill loved one, or helping them decide what plans they want to make about their end of life care. Such experiences may give us pause, as we consider how we might want to prepare for such eventualities for ourselves in the best way possible. Although traditionally we would have depended on doctors to essentially make these decisions for the patient, at least in western societies, this is no longer the case.  As our society evolves and we become more aware and more demanding of information, we are also assuming more of the decision-making burden both as patients and family of patients.  This process must necessarily be shepherded by doctors, who we not only rely on to supply us with information, but also to further serve as impartial support when trying to determine the best course of action in a complex and distressing situation.

Linda Emanuel and Karen Glasser Scandrett have written a thought-provoking commentary entitled "Decisions at the end of life: have we come of age?" this month in BMC Medicine. In it they discuss the current decision making process at the end of life, as well as outlining the goals that we should be striving to meet in order to better achieve quality dying, both for the patient and to minimise distress for their loved ones. They particularly highlight the role that implementation of specific interventions like Dignity therapy and advance care planning should take and call for palliative care researchers to help us make specific conceptual advances and develop better tools for good dying.

Visit the BMC Medicine  website for the full article, and find out if Emanuel & Scandrett are able to leave you thoughtful on this important topic.