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Dying Right in Theory and PracticeWhat Do We Really Know of Terminal Care?
Henry S. Perkins, MD;
Albert R. Jonsen, PhD
Arch Intern Med. 1985;145(8):1460-1463.
Abstract
• Despite the widely held belief that hospices treat dying patients differently than conventional hospitals do, few systematic comparisons exist. We reviewed medical charts to study the terminal care practice at one hospital and two inpatient hospices. As expected, hospital patients had more diagnostic tests and higher laboratory charges than patients in either hospice did. Yet physicians' notes about patients' families or nonmedical aspects of illness were infrequent at all three institutions. Furthermore, analgesic use and the frequency of nurses' notes about nonmedical or family issues differed between hospices: sometimes one hospice, sometimes the other, resembled the hospital closely. Hence, some common assumptions about hospice care appear inaccurate. We believe that health professionals who attend dying patients—whether in hospitals or hospices—have an obligation to examine their terminal care practices critically and to develop standards appropriate for their institutions.
(Arch Intern Med 1985;145:1460-1463)
Author Affiliations
From the Division of General Medicine, Department of Medicine, University of Texas Health Science Center, San Antonio (Dr Perkins); and the Institute for Health Policy Studies and the Department of Medicine, University of California, San Francisco (Dr Jonsen).
Footnotes
Accepted for publication Aug 21,1984.
Read before the national meeting of the American Federation for Clinical Research, Washington, DC, May 6, 1984.
The authors' opinions, conclusions, and proposals do not necessarily represent the views of the Johnson or Picker Foundations or the Coburn Trust.
Reprint requests to Division of General Medicine, Brady-Green, 527 N Leona, San Antonio, TX 78207 (Dr Perkins).
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