Policy issues in end-of-life care.

The purpose of this policy brief is to bring attention to the urgent systems-level matters that impede progress in improving end-of-life care in the United States. Despite advances in care of the dying over the last 20 years, many recalcitrant system-level barriers prevent high-quality end-of-life care that is consistent with clinical and ethical standards and reasonably adheres to patient and family wishes for care and compassion. A major barrier is the orientation of health care toward rescue medicine despite the fact that most deaths today result from long-standing chronic disease. Recommendations for policy changes are suggested, and nursing's role in advocating for policy change is explored.