Contempo 1997: End-of-Life Care

To the Editor.  —In the end-of-life care article¹ in the 1997 Contempo issue of JAMA, Drs Sulmasy and Lynn note that the current funding for health professionals' education does not require attention to end-of-life care. Yet opportunities to make a significant improvement in this area abound. Many hospices are closely associated with acute care institutions, and the present day cost-conscious health care system would seem to encourage hospice use for both patient care and physician education, as noted by Christakis and Escarce² and others.^3,4We surveyed (unpublished data, 1996) 782 chief executive officers of hospices that were listed as a division of a hospital according to records provided by the National Hospice Organization. Based on data from 280 responders, hospices were deemed to improve the public's perception of the affiliated hospital (91%) and to foster better pain management (86%). Yet the value of the hospice for both