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Joanne Lynn, MD

JAMA. 2000;284:2508-2511.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Until the last few generations, most people died quickly, following an infection or an injury, or soon after the initial symptoms of an advanced and untreatable condition like cancer, diabetes, or heart disease. After higher mortality in infancy, deaths were arrayed evenly across the life span. In developed countries, the scourges of a century ago have long been tamed. Modern living conditions and health care have ensured that most will die slowly, and mostly in old age. Seventy-eight percent of people in the United States live past their 65th birthday, and more than three quarters of them will contend with cancer, stroke, heart disease, obstructive lung disease, or dementia during their last year of life.¹

The end of life, which once was the province of sudden fate, has come to be shaped by deliberate choices and by services provided to the chronically ill by each person's community.^2-3 . . . [Full Text of this Article]

Author Affiliation: Center to Improve Care of the Dying, RAND, Arlington, Va.

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