Bmj Usa

Describing the road to death

BMJ 2005; 331 doi: (Published 07 July 2005) Cite this as: BMJ 2005;331:E364
  1. Joanne Roberts, palliative medicine physician (
  1. Providence Everett Medical Center Everett, Washington

    We give hope to our patients when we describe the terrain of their demise

    A hundred years ago, more than 80% of Americans died of acute illnesses, mainly pneumonia, tuberculosis, and complications of infectious diarrhea and childbirth. Rapid death was common, and much of it occurred in the young.

    By 2000, more than 80% of Americans died of illnesses that were chronic and progressive, mainly heart failure, cancers, progressive lung diseases, and complications of stroke and dementia. Today, rapid death among the young is rare, while predictable death among the aged is the norm.

    As the pathway toward death has changed, the role of prognostication seems to have declined. From ancient times until very recently, it was the doctor who foretold the patient's future who was most valued by the community. For a myriad of reasons that are well described, physicians seem to have grown averse to predicting the future for patients and their families, even when asked directly.1,2

    And when physicians do attempt to prognosticate about life expectancy, …

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