Introduction
A century ago, most people who suffered traumatic injuries or contracted serious infections died soon afterward. Even those who developed heart disease or cancer had little expectation of a long life after the disease was diagnosed. Most people expected little more than comfort measures from doctors.
Today, death is often seen as an event that can be deferred indefinitely rather than as an intrinsic part of life. Medical procedures commonly extend the lives of people who have such diseases as heart disease, cancer, stroke, chronic obstructive pulmonary disease, pneumonia, and dementia, often giving them many years in which quality of life and function are quite good. Other times, procedures extend life, but the quality of life and function decline.
Talking about the likely outcomes of illness, including death and dying, is an important part of health care. Doctors and patients vary in the language they use and their comfort regarding such discussions. People should generally try to understand their situation and likely future course and to make any preferences about treatment and family support known (see Section 1, Chapter 9). People who do not wish to talk about death and dying with their doctor should understand that major decisions may be made without their input.
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