Observations Only Connect

Too quietly into the night

BMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a696 (Published 05 August 2008) Cite this as: BMJ 2008;337:a696
  1. Nicholas A Christakis, professor of medical sociology, Harvard Medical School, and attending physician, Mt Auburn Hospital, Cambridge, Massachusetts
  1. christak{at}hcp.med.harvard.edu

    As dying people aren’t able to make more noise about the poor state of end of life care, it is up to doctors to improve prognosis in this highly vulnerable group

    From time to time an intense flurry of media attention is given to an extraordinary case of a particular dying patient: someone in a persistent vegetative state; a family torn apart by disagreement about withdrawal of life support; a shocking case of a poor person dying neglected on the street or, worse, on the floor of an emergency room.

    What these cases really should do is highlight a much more thoroughgoing and worrisome reality. For every heartbreaking end of life story like these, there are more than two million others every year (in the United States) that should be just as much a matter for concern. The fact is that the everyday reality of death in the US—and elsewhere in the developed, let alone developing, world—is abysmal.

    Our best estimate is that 40% to 70% of Americans die in pain. A large minority of these have other symptoms, such …

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