North Carolina Falls In Middle Nationally For End-of-Life Care

The study, "Means to a Better End: A Report on Dying in America," rated states on eight criteria using grades A through E. The study was conducted by Last Acts, a national campaign to improve care for end-of-life patients.

Judith Peres, the campaign's deputy director, said the study's objective was to rate the availability and use of U.S. end-of-life health care.

North Carolina received mostly C's and D's, getting its only A for allowing doctors to administer pain medication without undue scrutiny. "North Carolina scored in the middle," Peres said. "It's not the worst state, but it's not the best."

Most states consistently scored low on the measures, which include encouraging people to use advanced directives, a strong pain management policy and use of hospice care, she said.

Almost every state, including North Carolina, scored low on availability of care programs that seek to improve a terminal patient's quality of life.

But some health officials said the results of the study do not reflect accurately the quality of care offered in North Carolina.

"The study focused on usage of care, not quality of care," said Gwynn Sullivan, director of N.C. Community Outreach and The Carolinas Center for Hospice and End-of-Life Care. "There is quality end-of-life care in North Carolina. People don't know what resources are available to them."

Peres said that in most states, advanced care planning, not government measures, is the best way to ensure that sick patients get the care they want. The planning creates a legal document that outlines a person's desired care.

Paul Malley, president of Aging With Dignity, said advanced directives are essential to end-of-life care because they allow people to decide exactly what kind of care they want long before they get sick. This can include the location where people want to receive care -- usually at home -- and who they want to be with.

"Dying is more than a medical moment," he said. "When we ask people what kind of care they want at the end of life, it needs to be more than a ventilator."

Although the study found the state deficient in advanced-care planning, Malley said North Carolina's advanced-care planning law is strong because it recognizes the directives as legal documents and allows people to put their directives in their own words.

Peres said that ultimately she hopes the study will stimulate change in public policy by forcing people to recognize that the quality of end-of-life care in the United States is not where it should be. "Despite the hard work many groups have done, end-of-life care in America is fair to poor. We're hoping this study is a wake-up call."

The State & National Editor can be reached at stntdesk@unc.edu.