A Kinder, Gentler Death

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Graduate schools could also teach more about how we die, particularly medical and nursing schools as well as seminaries. Current managers of nursing homes and geriatric wards could inquire about the A.M.A.'s course on end-of-life care and subscribe to the three-year-old Journal of Palliative Medicine. They can learn a lot from Veterans Affairs hospitals, many of which have made improvements in end-of-life treatment in the past five years.

Doctors could speak more openly with patients about prognosis and mention comfort care when a serious illness is first diagnosed--even as traditional treatments are explored. Then, if a cure isn't found, advises Dr. Fred Meyers, who chairs the department of internal medicine at the University of California at Davis, "be honest and say, 'I don't think I can cure you, but I'm not going to abandon you; you're going to get good consultation, we'll take care of your symptoms and take care of your family.'"

The most challenging reform may be to get patients to become their own advocates for better death. That would require frank talk about a somber subject. That's not an entirely unreasonable expectation, reformers contend. They point out that Americans successfully changed birth in the 1960s and '70s by getting fathers more involved and focusing more on mothers' well-being. Byock believes that the boomers, who demanded many of the changes in the way we come into the world, will be equally insistent on changing the way we leave. "The baby boomers are the most self-centered, arrogant, willing-to-try-new-things generation ever," says the 49-year-old, who drives a Saab. "They're going to bring the same collective raising of expectations to the care we give people who are living through the end of their lives."

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