The Institute of Medicine (IOM), Washington, expanded an ongoing study of end-of-life care in the United States.
The goals of the study were to strengthen public and professional understanding of what constitutes good care at the end of life and to encourage a stronger commitment to caring well for people as they die.
To complete the study, IOM assembled an expert committee that included practitioners, health services administrators, researchers, policy analysts, lawyers, ethicists, and patient advocates.
The committee met six times between January 1996 and March 1997 for a range of information-gathering activities.
In its report, entitled Approaching Death: Improving Care at the End of Life, the committee identified four broad deficiencies in the current care of people with life-threatening and incurable illness:
- Too many people suffer needlessly at the end of life, both from errors of omission (when caregivers fail to provide palliative and supportive care known to be effective) and errors of commission (when caregivers do what is known to be ineffective or even harmful).
- Legal, organizational, and economic obstacles conspire to obstruct reliably excellent care at the end of life.
- The education and training of physicians and other health care professionals fail to provide them with the attitudes, knowledge, and skills required to care well for the dying patient.
- Current knowledge and understanding are insufficient to guide and support the consistent practice of evidence-based medicine at the end of life.
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