Delineation of the end of life stage

Principal Investigators: Prof. Jiska Cohen-Mansfield & Dr. Shai Brill

We commonly think of death as a single moment, which delineates clearly between the living and the dead. This moment, we are accustomed to believe, can be determined with medical and legal precision and has distinct social and cultural implications. The aim of the project is to re-examine this common assumptions and show how death takes place in multiple stages.

Nowadays, modern medicine faces the necessity of coping with long-term grave illnesses.  Consequently, the end of life constitutes, today more than ever before, a prolonged stage in modern life, which presents needs in the social, medical and legal realms. Despite the increase in the population that experiences this stage of life and the importance of the problems surrounding it, studies in this topic mainly focus on the death process itself or on life-extending treatments, rather than on comprehending the stage preceding death and its definition.

Thus, end of life has become a distinct phase of human existence, which is often prolonged.  In this phase, preparation for one's end of life often becomes a primary concern. Defining when precisely “end of life” begins is difficult since predicting the time left to live is inexact for most terminal conditions. Accordingly, the definition varies from patient to patient and depends on the professional decision maker.

Research is therefore needed to elucidate when end of life begins and what trajectories it entails. Such research may have important implications for forming life-priorities and for evaluating the necessity of medical treatments in face of mortality. Several avenues for such research may be considered, including trajectories of decline, significant events indicative of entering end of life stage, family perceptions of them, and their prevalence. The proposed project is conceived as a feasibility and pilot study of these issues. The study will clarify which research directions are most fruitful in elucidating alternative conceptualizations of the period of decline which can be termed ‘end of life’.

Objective: to characterize the beginning and trajectory of end of life as a life stage using multiple parallel approaches, including a thorough review of the literature on trajectories of end of life, interviews with caregivers and analyzing medical databases.