American Indian Culture and Research Journal

During the past century, dramatic changes have occurred in the way death is experienced in the United States. A death in 1900 typically occurred as a result of sudden illness and injury among the young at home. Today, Americans are more likely to die from long-term, chronic illness in later life, often in institutional settings. In addition to the many cultural transformations and medical advances that occurred during the last century, new philosophies and responses to end of life (EOL) have also evolved. For example, the health care community may be more apt to approach death as a natural part of life instead of as the enemy or a sign of failure. Palliative care encompasses physical, psychosocial, and spiritual dimensions to promote quality of life at EOL, and by using a team approach, hospice care is typically provided during the last six months to terminally ill people and their families, whether in the home or an alternate setting. Previous research has been conducted to understand Americans’ preferences for EOL care. A nationwide study, A Means to a Better End, reported that 70 percent of Americans would prefer to die in their homes, free of pain, and surrounded by their loved ones. However, only 25 percent of Americans (and 19.3% of South Dakotans) actually die at home under these preferred conditions. It appears that what Americans want at EOL is not what they are getting.