A Better Death in Britain?

In the United States, terminally ill patients and their physicians often avoid discussing the inevitability of death and planning for it. As a result, these patients miss opportunities to make choices that comport with their values and preferences. In the absence of such decisions, the default model is to err on the side of which often results in overtreatment, inappropriate prolongation of life, and avoidable suffering. This Article discusses trends in end-of-life care in the the United States and compares these trends with the the U.K.'s Liverpool Care Pathway and its approach to end-of-life care. Although the Liverpool Care Pathway generated clearly superior outcomes compared with the United States' model in all dimensions - care availability, quality, and cost - it nevertheless generated controversy. Poor physician-patient communication represents the shared barrier to high quality end-of-life care in both countries. Although the United States' medical community and other interested groups have begun serious work into methods to improve the quality of communication and care at the end of life, they are a long way from understanding how best to bridge the gap between theory and practice across a vast and diffuse health care system.