Death and Dying in the United States

The Problem

Modern medicine has not only prolonged living but has also prolonged dying. Recent advances in biomedicine have converted grave illnesses like cancer into chronic illnesses. About 2 million Americans will die this year. Less than 10% of this population will experience a sudden or relatively rapid death due to cardiac diseases, trauma etc. Most will be diagnosed and live and endure life with a chronic illness for a prolonged period of time before transitioning into death.

Yet, the delivery of health care services has only just recently begun adapting to this reality (Lynn).

Dying in the Past

Causes of Death Comparison

Rank

Cause of Death in 1900

Percentage

Cause of death 1994

Percentage

1

Influenza, pneumonia 11.8% Heart disease 25.7%

2

Tuberculosis 11.3% Cancer 20%

3

Gastritis, Enteritis 8.8% Strokes 6%

4

Heart disease 8.0% Chronic Pulmonary Obstructive Disease 4.5%

5

Strokes 6.2% Accidents/trauma 3.4%
All others All others
Sources: Lerner M. When, why and where people die. IN: E. Sneiderman, ed. Death, Current Perspectives. 1976, Mayfield: Palo Alto.
Deaths: Preliminary Data for 2000, vol. 49. 2001, National Center for Health Statistics.

In the early 1900s, average life expectancy was around 50 years of age. Childhood mortality was high due to lack of antibiotics to treat infections. Only a few people lived to the ages that we regard as normal today (Buckman). Owing to the lack of antibiotics and other advanced biomedical interventions, the focus was directed on alleviating illness related suffering and provision of comfort.

Death and Dying Today

Antibiotics were introduced in the mid-19th century. The defibrillator was first introduced in 1953, when a dog named Knowsy (because he knew what was on the “other side”) was successfully resuscitated (Kouwenhoven). Improved sanitation, concerted efforts in public health, the development of advanced medical interventions has continued to increase life expectancies. Biomedicine in its efforts to conquer death has failed but has succeeded in postponing death and prolonging life with chronic illness.

Dr. Charles von Gunten on how end of life issues have changed in the last century:

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