Removing Obstacles to a Peaceful Death

We all will die, but the American health care system often impedes a peaceful death. Instead of a quiet death at home surrounded by loved ones, many of us suffer through overutilization of sometimes-toxic therapeutic interventions long past the time when those interventions do more good than harm. This article proposes revisions to health professional training and payment policy to eliminate as much as possible physical and existential suffering while progressing through the terminal phase of illness. The solution lies in seamless progression from treatment with integrated palliative care to hospice before death, but provider attitudes and payor practices must change for that to occur. Thus, the article proposes increased training in communicating truthfully about prognosis and prospective benefit of therapies; further adoption of interprofessional practice, which would familiarize more professionals with the team-based approach characteristic of palliative care; and revision of payment mechanisms to incentivize high-quality care whether it is of low or high intensity.