End of Life as a Public Health Issue: Setting the Ethics and Policy Making Agenda

With the aging of the US population, ethical issues associated with access and quality of end -of- life care become a priority as individuals, providers and systems struggle to address the need for a compassionate, cost effective, integrated way to address end of life issues (EOL). Approaching this as a public health matter provides both opportunities and challenges. Among the opportunities is to assure better mental and physical health as the inevitable end approaches for some who are dying. Among the challenges is the integration of existing and new policies within a collaborative and sustainable system of care while dealing with vocal public concerns about futility determinations and rationing. As the American Public Health Association and the Institute of Medicine urge to address the unmet needs of those at the end of life, we (1) provide an overview of what the states have done about the different aspects of EOL such as advance directives, POLST, Hospice/palliative care and aid in dying via their policies and laws; and (2) Explore to what extent, and in what order, public health authorities should be incorporated as one of the leading forces in assuring a functional and sustainable care system capable of supporting ethical patient choices at the end of life.