Care of the Dying: Clinical and Financial Lessons from the Oregon Experience

Is there a consensus about the right to compassionate care for all terminally ill Americans? Quill and colleagues, in this issue [1], highlight seven specific areas of converging opinion in this area. For example, the fierce debates about physician-assisted suicide have focused the attention of all of us, whatever our views on that contentious issue, on our inadequacies in practicing comfortable and respectful end-of-life care [2, 3].

In Oregon, the public discussion leading up to the 1994 and 1997 votes to legalize physician-assisted suicide was intense and polarized. During both campaigns, media advertisements obscured the substantial common ground between the two sides. The 1994 vote, however, did serve as a wake-up call to medicine and fueled progress in improving the quality of end-of-life care [4]. The resulting major improvements in Oregon's end-of-life care are the work of hundreds of persons and a variety of programs and health systems from all parts of the “assisted suicide” spectrum.

Quill and colleagues [1] highlight the consequences of inadequate planning for end-of-life care by reviewing the results of the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT), which confirm that most Americans die in acute-care hospitals with high utilization rates for invasive medical technology [3]. These procedures and treatments are sometimes performed against the patient's expressed wishes [1, 3]. National interest is therefore keen in developing and implementing “signalling” mechanisms, including such things as standardized order forms and bracelets, that can help ensure respect for patient wishes to limit life-sustaining treatments [5]. Over a 5-year …