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In recent years, support for patient-centered medical care has increased drastically. One aspect of patient-centered care focuses on allowing people to make educated decisions about their own end of life care. This has led to the development of the living will, the advanced directive, and most recently the Physician Orders for Life Sustaining Treatment (POLST). Today, most states have enacted legislation creating a POLST statute or its equivalent. However, enactment of a statute is insufficient to change the culture of medicine. Physicians are trained to save people, not to let them die. During the past three months, we have conducted interviews with residents and staff at long term care facilities to learn about their experiences with end of life care. The conversations took place as part of a larger discussion of unmet need for bereavement care. In this article, we have tried to give voice to their concerns.

Refusing To Admit Defeat: Physicians' Reluctance To Discuss End of Life Care