When a person nears the end of life, how much treatment should she or he get -- and who should decide?
''These are huge questions that go to the very core of healthcare,'' says Ken Goodman, director of the bioethics program at the University of Miami.
While the Dartmouth Atlas research emphasizes how the number of physician specialists in a locale will increase the amount of care, even in the last six months of life, Goodman focuses more often on the conflicts of desires between providers and family members.
''Even when everybody knows the dying process has begun, families routinely request very aggressive medical treatment that nobody believes is going to work,'' said Goodman.
''You want to work with families. You want to respect their grief, but there is a duty to be a responsible steward of resources, to act in the patient's best interest. and to be true to your profession,'' he said.
Some states such as Texas, but not Florida, have so-called futility laws, says Goodman, in which providers are not required to give care which they believe is futile.
Many people believe in medical miracles because they often see them on TV, says Goodman. He cites a study of television programs like ER in which heroic measures almost always bring a patient back to life.
``It's not that simple. What if you break some bones pounding on the heart to get it going again?
''What if a patient lives, but it's only for another six weeks and they're not conscious,'' Goodman said.
He describes the increasing interest in hospice programs as a ``beautiful example of a nonpartisan, nonsectarian agreement to pass away pain-free and with dignity.''
Still, ''what often happens,'' Goodman said, ``is that family members ask for a therapeutic frenzy.''
