How Gravely Ill Becomes Dying

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Abstract
The concerted efforts to improve end-of-life care that are now burgeoning in the United States are focused on better provisions of palliative care. Some dying patients do suffer unnecessarily because physicians lack the skills, temperament, or motivation to provide good palliative care. This is a serious failure. An ardent focus on technical aspects of symptom control, however, could distract broader efforts to improve care of those near death. Symptom control is often not the most difficult aspect of management. In caring for a severely, progressively ill patient, what may be most difficult is moving through the transition from gravely ill and fighting death to terminally ill and seeking peace, shifting the goals of treatment from cure or longer survival to preservation of comfort and dignity.