Americans want to die at home, free from pain, but often the opposite happens, report finds

Americans suffer needless discomfort and undergo unwanted and costly care as they die, in part because of a medical system ruled by “perverse incentives” for aggressive care and not enough conversation about what people want, according to a report released Wednesday.

WEST PALM BEACH, Fla. — Americans suffer needless discomfort and undergo unwanted and costly care as they die, in part because of a medical system ruled by “perverse incentives” for aggressive care and not enough conversation about what people want, according to a report released Wednesday.

Though people repeatedly stress a desire to die at home, free from pain, the opposite often happens, the Institute of Medicine found in its “Dying in America” report. Most people do not document their wishes on end-of-life care and even those who do face a medical system poorly suited to give them the death they want, the authors found.

The result is breathing and feeding tubes, powerful drugs and other treatment that often fails to extend life and can make the final days more unpleasant. The report blamed a fee-for-service medical system in which “perverse incentives” exist for doctors and hospitals to choose the most aggressive care; inadequate training for those caring for the dying and physicians who default to life-saving treatment because they worry about liability.

“It’s not an intentional thing. It’s a systemic problem,” said David Walker, the former U.S. comptroller general, who co-chaired the committee that issued the report.

Advance directives including living wills have been unpopular and ineffective, the report said. It urged repeated conversations about patients’ wishes beginning far earlier than many would think — perhaps as teenagers — and continuing the talks throughout life.

“The fee-for-service model, the lack of co-ordination between medical and social services, the challenges that individuals face in finding a provider who’s willing and knowledgeable to speak with them about death and dying all conspire against them coming up with the right individual plan,” said Dr. Philip Pizzo, a co-chair with Walker.

The report praised programs in palliative care, which focuses on treating pain, minimizing side effects, co-ordinating care among doctors and ensuring concerns of patients and their families are addressed. This type of care has expanded rapidly in the past several decades and is now found in a majority of U.S. hospitals, but the report said many physicians have no training in it.

In many ways, the report is a repudiation of the controversy created by the term “death panel” in response to the President Barack Obama’s health care law. The claim centred on the government saving money by deciding who would live and who would die.

In fact, the 500-page report authored by 21 experts said the very type of end-of-life care Americans say they want would shrink medical bills and reduce the governmental burden.

Just Posted

Alberta Premier Jason Kenney arrives at the 2021 budget in Edmonton, Thursday, Feb. 25, 2021.
Kenney distances himself from caucus vote to turf dissidents with ‘personal agendas’

EDMONTON — Alberta Premier Jason Kenney is distancing himself from a decision… Continue reading

Rental units in Red Deer continued to be some of the most affordable in Canada, according to the National Rent Report from Rental.ca. (THE CANADIAN PRESS/Chris Young)
Red Deer rent up year over year, still among lowest in Canada

Rent in Red Deer is up nearly six per cent but is… Continue reading

Rebels logo.
Red Deer Rebels trade last year’s first overall selection in U.S. Prospects Draft

The Red Deer Rebels have traded their first overall selection from the… Continue reading

Bo’s Bar and Grill owner Brennen Wowk said the hospitality industry is looking for more clarity from the province around what conditions must be met to allow for restaurants reopening. (Advocate file photo)
Frustated restaurant owners want to know government’s reopening plan

Restaurant owners feel they are in lockdown limbo

A used protective face mask is seen discarded on the ground in Vancouver, B.C. in May 2020. (Ashley Wadhwani/Black Press Media)
Medical exception letters required for Albertans who don’t wear masks in public areas

EDMONTON — Alberta has moved to close loopholes people might use as… Continue reading

Team Canada’s head coach Troy Ryan talks with players before the start of the of the Rivalry Series at the Save-On-Foods Memorial Centre in Victoria, B.C., on Monday, February 3, 2020. Ryan of Spryfield, N.S., has been named head coach of Canada’s women’s hockey team for the 2022 Winter Olympics in Beijing.THE CANADIAN PRESS/Chad Hipolito
Troy Ryan to coach Canadian women’s hockey team in 2022 Winter Olympics

Ryan was Canada’s assistant coach from 2016 to 2019

FILE- In this April 19, 2021, file photo, people wearing masks as a precaution against the coronavirus wait to test for COVID-19 at a hospital in Hyderabad, India. Misinformation about the coronavirus is surging in India as the death toll from COVID-19 rises. Fueled by anguish, distrust and political polarization, the claims are further compounding India’s crisis. (AP Photo/Mahesh Kumar A, File)
Misinformation surges amid India’s COVID-19 calamity

Distrust of Western vaccines and health care also driving misinformation

FILE - In this Friday March 6, 2020, file photo, Britain’s Prince Harry visits the Silverstone Circuit, in Towcester, England. In an episode of the “Armchair Expert” podcast broadcast Thursday, May 13, 2021, Prince Harry compared his royal experience to being on “The Truman Show” and “living in a zoo.” (Peter Nicholls/Pool Photo via AP, File)
Prince Harry thought about quitting royal life in his 20s

Feared his family would have to deal with the same spotlight that was on his late mother

Opinion
Mental health: Gossiping, backbiting and forming factions is unhealthy

We all know of dysfunctional organizations, which can be as troublesome as… Continue reading

Family practice physician Christina Tuomi, D.O., (right) gets Homer's first dose of Pfizer's COVID-19 vaccine from Emergency Department nurse Steve Hughes (left) on Thursday, Dec. 17, 2020 at South Peninsula Hospital in Homer, Alaska. Tuomi has been the hospital's medical lead throughout the pandemic. (Photo courtesy Derotha Ferraro/South Peninsula Hospital)
Alberta physicians: Vaccines are our path forward

As the AMA representatives for Alberta’s family physicians, we were immensely relieved… Continue reading

Vancouver Canucks' Nils Hoglander, right, is checked by Calgary Flames goalie Jacob Markstrom during third-period NHL hockey action in Calgary, Thursday, May 13, 2021.THE CANADIAN PRESS/Jeff McIntosh
Lindholm, Tkachuk lead Calgary Flames in 4-1 win over Vancouver Canucks

Lindholm, Tkachuk lead Calgary Flames in 4-1 win over Vancouver Canucks

Most Read