Medical advances and increasing life expectancy have paradoxically distanced
physicians and nurses from their roles early in the century, when they focused
on helping dying patients but had little else to offer. Now, effective treatments
discovered through research on middle-aged adults apply to older adults, bringing
health promotion and prevention to adults in their late years. This success
raises important new questions.1 At what point
should clinicians shift from a preventive focus to a palliative one? How can
the uncertainties of prognosis at the end of life be managed? Why do dying
patients continue to suffer pain and other symptoms that can be effectively
managed with contemporary knowledge and treatments, while others suffer a
high-tech overtreated death?
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