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friend's grief and anger at being unable to save a loved one from being tethered to medical devices, violated by resuscitation maneuvers with little prospect of success, or maintained in the unknowable depths of catastrophic brain damage.
These news stories, even if not typical, may nonetheless significantly affect public anxieties. This is especially likely when the stories are presented in sensational or emotional terms that give the impression that poor care results from arrogance and callousness rather than from flaws in general systems of care or from uncertainties about the prognoses for gravely ill patients, the consequences of alternative treatments, the preferences of patients and families, and the applicable ethical and legal standards for care. In addition, the news and entertainment media may mislead and misinform through their frequent and persistent emphasis on violent or sudden death, death at a young age, and dramatic medical resuscitations that are, in real life, rarely successful (Baer, 1996; Diem et al., 1996). Television, in particular, is both saturated with spectacular death and largely uninterested in the everyday realities of dying as it is experienced by most people.
While an overtreated dying is feared, the opposite medical response—abandonment—is likewise frightening. Patients and those close to them may suffer physically and emotionally when physicians and nurses conclude that a patient is dying and then withdraw—passing by the hospital room on rounds, failing to follow up on the patient at home, and disregarding pain and other symptoms. Abandonment is also a societal problem when friends, neighbors, co-workers, and even family avoid people who are dying. As this report documents, the neglect of dying extends to medical curricula and research agendas that emphasize medicine's curative goals with little attention to the prevention and relief of distress and suffering for those people who, inevitably, will die of their illnesses or injuries. It is a dual perversity that interest in assisted suicide sometimes reflects anxiety about overly aggressive medical treatment, sometimes dread about abandonment, and sometimes fear that dying people may suffer simultaneously or sequentially from both misfortunes.
As will be described further in this report, the biomedical advances and health care practices that have institutionalized death and sometimes prolonged suffering and dying have not gone without notice or response by policymakers, clinicians, ethicists, and communities. For example, since the first U.S. hospice was founded in Connecticut in 1974, clinicians, patients, families, community volunteers, and policymakers have mobilized under the hospice banner to design and implement ways of reducing suffering and improving the quality of life for dying patients and those close to them. Within the health professions, the developing field of palliative medicine has helped focus biomedical and clinical research on the biological mechanisms of pain and other symptoms, the methods for assessing symptoms,