Models & Research

How Hospitals Shape End of Life Care
Summary of Sharon. Kaufman, PhD Presentation to
California Coalition for Compassionate Care
Steering Committee Meeting June 3, 2005
Excerpted from Minutes of Meeting

Sharon Kaufman, Ph.D. Professor of Medical Anthropology at UC San Francisco recently published a book entitled, And a Time to Die: How American Hospitals Shape the End of Life. (2005, NY: Scribner). Dr. Kaufman said in her role as a medical anthropologist she “makes the strange, familiar; and makes the familiar, strange.” She described her recent research about the culture of hospitals and how they influence the “problem of death,” which she defined as people dying with too much technology and not enough humanity.

A Framework For Thinking Ethically
Markkula Center for Applied Ethics, Santa Clara University
This document is designed as an introduction to thinking ethically. We all have an image of our “better selves” - or of how we are when we act ethically or are “at our best.” We probably also have an image of what an ethical community, an ethical business, or an ethical government is - and maybe even an ethical society as a whole. Ethics really has to do with all three levels - acting ethically as individuals, creating ethical organizations and governments, and making our society as a whole ethical in the way it treats all.

Americans for Better Care of the Dying goals are to: build momentum for reform; explore new methods and systems for delivering care; and shape public policy through evidence-based understanding.

Every dying person needs to be able to count on excellent care. Americans for Better Care of the Dying (ABCD) aims to improve end-of-life care by learning which social and political changes will lead to enduring, efficient, and effective programs. ABCD works with the public, clinicians, policymakers, and other end-of-life organizations to make change happen.

ABCD President Joanne Lynn, MD is one of the foremost national leaders in this movement and the author of Handbook for Mortals: Guidance for People Facing Serious Illness; and Improving Care for the End of Life. Extensive excerpts from both of these books are accessible via the ABCD website

California HealthCare Foundation’s online resource for independent research, analysis, and news on issues affecting health care delivery and financing with including in depth looks at Chronic Disease Care, Long Term Care and End of Life Care.

Attitudes Toward End-of-Life Care in California
Lake Research Partners, November 2006

While it’s true that Americans are living longer, there is a flip side. The aging population is grappling with new challenges, including an increasing number of chronic illnesses and a range of sensitive issues brought about by modern medicine and end-of-life medical care.

This important study and related reports released by the California Healthcare Foundation in March 16, 2007 reports that: In California, the most populous and diverse state in the country, significant racial and ethnic differences exist at the end of life. These reports – the first in a new series of CHCF-supported projects focusing on end-of-life issues - found significant variations in the expectations, experiences, and decisions of patients and their families in the months preceding death.

“As California’s diverse population grows older, ensuring quality care at the end of life for everyone takes on even greater significance,” Mark D. Smith, M.D., M.B.A., president and CEO of CHCF, said Thursday at the Association of Health Care Journalists conference in Los Angeles. “By supporting research and projects to improve the quality of end-of-life care, CHCF sees an opportunity to help make California a national example of best medical practices and culturally appropriate care.”

Care of the Patient with Severe Chronic Illness-An Online Report on the Medicare Program is a key critical report completed in 2006 by the Dartmouth Atlas Project. It reports that: “Almost one-third of Medicare spending for chronically ill is unnecessary… A fundamental problem, and one that contributes to both overspending and worse outcomes, is that most acute care hospitals have become first-line providers of services to chronically ill elderly people, whose care would be better managed, safer and less expensive outside the hospital setting. . . . Staggering variations in how hospitals care for chronically ill elderly patients indicate serious problems with quality of care and point toward unnecessary spending by Medicare. Lower utilization of acute care hospitals and physician visits could actually lead to better results for patients and prolong the solvency of the Medicare program.” The study calls for overhauling how the nation manages chronic illness, and proposes that hospitals take leadership in redesigning how they care for the chronically ill.