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Contempo 1997: End-of-Life Care-Reply

Joanne Lynn, MD; Daniel P. Sulmasy, OFM, MD, PhD
JAMA. 1997;278(14):1151. doi:10.1001/jama.1997.03550140043033.
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In Reply.  —We agree with Drs Burke and Steele that opportunities abound for teaching medical students and resident physicians how to provide excellent care for the dying. However, these opportunities are ignored routinely in medical education, and pernicious financial barriers still provide disincentives for changing this situation.Patients nearing the end of life in hospitals should be a focus of special concern. However, it seems that these patients continue to be marginalized by educational programs and discounted as "uninteresting teaching material." End-of-life care often is miscategorized by medical educators as ethics. While ethical issues in the care of the dying might attract considerable attention, there is no ethical dilemma to be faced in response to questions about treatment, such as whether students should know equi-analgesic dosages of various narcotic drugs. Yet students learn quickly that they will be rewarded more for knowing the patients' serum potassium levels than for attending to the


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