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Published: Wednesday, 11/16/2005

Rethink end-of-life issues

DEATH is inevitable. Dying badly is not.

That's why end-of-life issues deserve the higher profile and broader perspective just recommended in a new report from the Hastings Center, a bioethics think tank.

The report cited substantial progress over the last 25 to 30 years in improving care people receive at life's end. People today, for instance, have more control over the kinds of medical technology that will be used to sustain life. And more people die without needless pain and surrounded by family and friends.

However, the report concluded that laws, litigation, and other measures from the past still leave too many Americans with poor care. These individuals are dying "bad" deaths - without having their wishes honored, and without all possible dignity and comfort.

The Hastings report was among many that have noted flaws in the existing approaches, which place heavy emphasis on laws and regulations.

States have rushed to pass legislation allowing living wills, for instance, and federal law requires all hospitals and nursing homes to provide information on these documents. However, experts agree that living wills have not met expectations.

Living wills enable individuals to indicate the kind of medical care they want if they are incapacitated and unable to communicate as death nears. Few people have them. And all too often these documents can't be found when needed or are ignored by health-care providers.

We need a more coordinated system for assuring each individual good end-of-life care. The Hastings report suggested new approaches that focus on helping family members and physicians become more effective decision makers. That role is especially important for people like the late Terri Schiavo, who no longer are capable of making their own decisions.

Just getting the topic of death out into the open and up for discussion is immensely important. The first step in assuring a good death is talking with loved ones and your own doctors to make your definition absolutely clear.

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