Medical care in the last year of life: a review of economic and ethical issues.

This review article evaluates available data bearing on economic and ethical aspects of medical care in the last year of life. It analyzes limitations in the current literature and identifies areas where more research is needed. Available evidence indicates that medical expenditures in the last year of life are high. However, until studies are undertaken--analyzing the type of care dying patients receive and the appropriateness of care--one cannot conclude that the high cost of dying is due to overutilization of medical resources. Indeed, there is only a limited understanding of the factors influencing physicians' decisions to forgo or maintain life-sustaining treatments when caring for dying patients. Ethical questions posed by these decisions are identified. More comprehensive studies of these decisions - conducted in clinical practice settings and incorporating the nature and influences of patient and family preferences - are needed. Such studies would expand the current knowledge base and clarify the resolution of complex ethical dilemmas inherent in caring for dying patients.