Improving End-of-Life Care: Why Has It Been So Difficult?  The Hastings Center report features essays on subjects ranging from disability rights to public policy, examining where we have been, and where we have yet to go. Each essay asks us to consider what we believe to be true about end-of-life care, to consider what is actually true, and to envision a different approach to concerns such as personal autonomy, advance directives, disability rights, and the legal system. 

Cast Me Not Off in Old Age By Leon R. Kass, M.D., Eric Cohen Although growing old is a natural part of being human, the circumstances in which most Americans age and die are increasingly “unnatural” and surely unprecedented. Longer life expectancies and lower birth rates lead to the graying of society; smaller and less stable families weaken the ties that bind. Death comes on the doctor’s watch and in high-tech surroundings, almost always following years of chronic illness, typically preceded by decisions about further medical intervention, increasingly made on behalf of patients incapable of making decisions for themselves. Caregivers often do not know how to honor those who have lost their most human qualities. Thanks to medicine’s prowess in sustaining life on the edge, it is harder than ever to know when it is “time to die.”