Serving Patients Who May Die Soon and Their Families

In February 2001¹ Joanne Lynn, MD, discussed the case of Mr M, a 47-year-old musician living for the previous 3 years with a recurrence of advanced rectal carcinoma initially diagnosed 8 years ago. At the time of the interviews with Mr M and his longtime partner, Ms L, an interdisciplinary palliative care team had helped Mr M with pain control and home services. An around-the-clock paid attendant supplemented volunteer help from friends. Interviews with Mr M and his partner illuminated their frustrations and distaste for the available hospice programs. His primary care physician described the complicated care and treatment plans that had been suggested and abandoned—including Mr M's enrollment and disenrollment from hospice twice—as Mr M and Ms L came to terms with the close of Mr M's life. Dr Lynn described the 4 necessities of treatment that Mr M's clinicians should provide: (1) prevention and relief of symptoms, (2) assessment of treatments, (3) advance planning and designation of a surrogate decision-maker, and (4) preparation for the time near death. Dr Lynn further explored the process of enrolling in hospice, and the need for changes in the organization and financing of end-of-life care to better match the changing trajectories of patients living with—and dying from—serious, chronic illness, whether one with a short period of obvious decline (eg, cancer), a long-term disability (eg, congestive heart failure), or a slowly dwindling course (eg, dementia).