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Who Should Decide About Your Death?

Carl M. Kjellstrand, MD, PhD, FRCPC
JAMA. 1992;267(1):103-104. doi:10.1001/jama.1992.03480010111036.
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In our technological hubris, we have mismanaged dying: the only certain ultimate outcome of all our busy efforts.

Most of us would like to die a quiet, dignified death.1 Anyone who works in a hospital knows that this reasonable wish is almost never fulfilled and most of us now die in hospitals. The last rites of respirators, dialysis machines, nasogastric tubes, and gastrostomy tubes along with cardiopulmonary resuscitation and the nth round of chemotherapy are wonderful when prolonging useful life but have changed death to a mechanized spectacle in which no sane person would like to be the main actor.

See also p 59.

To the patients, it often appears as if there is nobody in charge of the myriads of nurses and technicians, of attending physicians, consultants, residents, fellows, interns, administrators, and lawyers. They are right: no one is in charge. Scared physicians and cowardly hospital administrators


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