ABSTRACT

To effectively address death from the perspective of ethical and legal issues in assessment and intervention, attention must be given to end-of-life issues. As T.S. Eliot wrote, “… the mind of God in me shows what it is time to move on to and what it is time to let go of. What we call the beginning is often the end, and to make an end is to make a beginning; the end is where we start from” (1936, p. 86). Advances in managing and treating acute, life-threatening illnesses have led to greater longevity and have brought a lengthening of the typical dying trajectory giving the individual a prolonged period of disability. This change in dying and disability causes ethical and humane concern about the prospect of longer, medicalized, and impersonal deaths. Individuals in contemporary society are progressively more interested in a greater degree of self-determination in the dying process. With the current health care crisis and the high cost of end-of-life care, economics further confounds the proposition of self-determination.