Where You Live Influences the Quality of Your End-of-Life Care


Over 80% of Americans desire to die at home, according to a New England Journal of Medicine article. They also want to determine the type of care received at the end of their life. JoNel Aleccia of Kaiser Health News reports on a news analysis of the outcomes resulting from the state of Oregon’s death-with-dignity law. And, its lessons for American healthcare consumers.

A New England Journal of Medicine article co-authored by Dr. Tolle and Dr. Teno, found nearly two-thirds of Oregonians who died did so at home, compared with fewer than 40 percent of people elsewhere in the U.S.

Oregon and twenty-two states have promoted ways to indicate end-of-life treatment preferences. They include advance directives, which provide guidance for future care, and medical directives such as Physician Orders for Life-Sustaining Treatment.  “Obviously, if you’ve spent decades trying to improve your end-of-life care, it’s pretty rewarding to see that something changes,” said Dr. Susan Tolle, director of the Center for Ethics in Health Care at the Oregon Health & Science University in Portland.

Dr. Scott Halpern, a medical ethics and health policy expert at the Perelman School of Medicine at the University of Pennsylvania, is critical of the analysis. He contends there is insufficient evidence showing medical orders improve quality of life near death.  “Good end-of-life care involves physicians eliciting patients’ values, hopes and fears and making treatment decisions that align,” Halpern said.

Dr. Tolle and Dr. Teno acknowledge that medical orders do not take care of all the complex factors which determine the quality of end-of-life care.  For example, Dr. Tolle cautions that “the level of care you receive near the end of life depends more on the state you live in and the systems they have in place than your actual wishes.”

To learn more about this important topic read the full article here:
Where You Live May Determine How You Die. Oregon Leads The Way.