sis, the field of palliative medicine focuses on patients with life-threatening medical problems for which cure is not seen as possible.^5,6 Instead, it focuses on the prevention and relief of suffering through the meticulous management of symptoms from the early through the final stages of an illness; it attends closely to the emotional, spiritual, and practical needs and goals of patients and those close to them. These goals underscore two important realities: first, that a lot more happens to most dying people than the specific event of their death and, second, that helping people live well while dying requires sophisticated strategies and tools for measuring and monitoring symptoms, functional status, emotional well-being, and burdens associated with terminal illness and treatment. Thus, good palliative care is more than symptom management or management of patients with cancer, although both figure prominently in its practice. A fuller description of the dimensions of palliative care is presented in Chapters 3 and 4.

This IOM study arose in an environment of growing awareness of deficiencies in care at the end of life and growing conviction that steps to improve care were essential. In the years since the study was first contemplated, the environment seems to have become more favorable to positive change and more open to discussion of the dying process. Even the contentious and often bitter debate over the legality or morality of physician-assisted suicide has had positive benefits in forging agreement that deficiencies in care for dying patients may contribute to demands for assisted suicide and that such deficiencies need to be remedied.

When he was approaching death, Joseph Cardinal Bernadin reflected, "As you enter the dying process, that process prepares you for death as you slow down…So when I talk about being at peace, I'm talking not only about peace at the level of faith, but also humanly speaking. Before too long, I'm going to go, and I think I will be ready for it" (Bernardin, 1996, p. 115). Communities, too, need to be ready, that is, prepared to support people through the dying process. The rest of this report examines how individual and collective changes in attitudes, knowledge, policies, and practices can create and sustain such readiness.