Remarkable advances in public health, nutrition and medical and surgical care have led to steady increases in the life expectancy of Americans. The average age exceeds 78 years.
In our aging society, more than 2.5 million of us will die each year, some from acute illness and injury, others from malignancies or chronic disease. Some of us will die abruptly. Most of us will die more gradually, sometimes sustained by a variety of life-support systems. All of us hope that we can spend our final days free of pain, conversant with our loved ones and in control of our mental faculties.
Because the issues surrounding care during our final months can be so complex, it is easier to postpone them to another day. Only a minority of adult Americans have completed advance directives that spell out preferences for end-of-life care and name a person to assure that these are honored should our judgment be disabled.
The Institute of Medicine, established by the National Academy of Science, addressed these concerns in its 2014 publication Dying in America (iom.edu/Reports/2014/Dying-in-America). The report highlights current barriers to obtaining desired end-of-life care.
* Poor and disadvantaged people, along with racial and ethnic minorities, lack access to information and resources for care as they approach death.