End of Life Care

VII. Key Issues: Regulation & Reform >> A. Bioethics >> End of Life Care  (last update 12.19.17)


Key Questions

What is the Cost of End-of-Life Care?

  • Aldridge and Kelley 2015. We estimated that in 2011, among those with the highest costs, only 11% were in their last year of life, and approximately 13% of the $1.6 trillion spent on personal health care costs in the United States was devoted to care of individuals in their last year of life. Aldridge, Melissa D., and Amy S. Kelley. The Myth Regarding the High Cost of End-of-Life CareAmerican Journal of Public Health 105.12 (2015): 2411–2415. PMC. Web. 20 Dec. 2017.

Medical Directives

  • MyDirectives.com lets consumers create and update advanced medical directives to help patients delineate a clear end-of-life plan, including audio and video messages. The directives are available online — anytime and anywhere in the world.
  • Patients who document their end-of-life wishes using a special medical form get the specific care they want in their final days, according to a study published online in the Journal of the American Geriatrics Society.The study by researchers at Oregon Health & Science University looked at the growing use of the voluntary form, called Physician Orders for Life-Sustaining Treatment, or Polst. The document lets patients request or refuse certain medical treatments such as CPR or intensive care. The study is the largest on the topic so far and the first to look at preferences stated in the form and where people actually die (Wall Street Journal, 6.9.14).


Assisted Suicide

International Laws

Netherlands. In 2001, the Netherlands became the first country in the world to legalize euthanasia for patients who were suffering unbearable pain and had no prospects of a cure. In 2015, euthanasia accounted for 5,516 deaths, or nearly 4 percent of all deaths in the country. In 2016 a controversial proposal was introduced that would allow people who are not suffering from a medical condition to seek assisted suicide if they feel they have “completed life.” The government hopes to draft the law by the end of 2017 in consultation with doctors and ethicists.

State Laws

Court Decisions

Public Opinion


  • Compassion & Choices. This advocacy group  provides advice on legal ways to reduce end-of-life suffering and perhaps hasten their deaths; the group counsels people who call for advice, “describing options but not encouraging them to end their lives or providing direct help.” Callers who seem to be mentally disturbed and suicidal, are referred to a suicide hotline. If they are facing imminent suffering and death and seek some control, the group urges them first to arrange for palliative or hospice care as they consider their next steps. Reportedly, about 3,000 patients, from every state, contact  the group each year.




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