Intimations of Mortality: Medical Decision-Making at the End of Life

In Intimations of Mortality, Barbara Reich offers an empirically-based critique of the failures of end-of-life communication and decision-making in the United States. Using England and Canada as occasional foils, Reich explores why U.S. physicians, patients, and families struggle to have the conversations necessary to provide seriously ill and dying patients with medical care consistent with their preferences. Reich also shows how a number of different factors –including payment mechanisms, liability fears, cultural phenomena, communication avoidance, death denial, and clinical uncertainty –impact physician-patient communication and medical decision-making, leave patients and families without the tools they need to make informed choices, and instead leave the default practices in place. Ultimately, this groundbreaking analysis unveils the interconnectedness of the many obstacles to better communication and decision-making in end-of-life communications and offers much-needed suggestions for improvement.