DEATH AND DYINGPhase Two, consequently, called for experimenta-
tion. The 9,000 cases were randomized and an
experimental intervention consisting of a protocol
designed to sensitize doctors to attend more close-
ly to psychosocial needs was administered to one-
half of the cases and withheld from the other half,
which had served as a control group. The experi-
ment was continued for two years and expecta-
tions were high. Much to the chagrin of the study
directors, when the two groups were compared,
no differences were found! The experimental in-
tervention showed no effects. This negative find-
ing was so shocking that a number of evaluation
panels were enlisted to reanalyze the data and
scrutinize the research design. Their efforts, how-
ever, only served to corroborate the original analy-
sis and Daniel Callahan (1995), then president of
The Hastings Center, concluded with this state-
ment, ‘‘This painstaking scrutiny into how people
die only goes to show how difficult it is to make the
process any better... We thought that the care of
dying patients could be set right by... some good
talk between doctor and patient... we thought
that we just needed reform... it is now obvious
that we need a revolution’’ (Callahan 1995).
Callahan’s dramatic statement had the effect
of nourishing a spate of organizations and propos-
als that had sprung up to improve the care of dying
patients. For example ‘‘Project Death in America’’
(PDIA), centered at Sloan Kettering Hospital in
New York was funded by the billionaire George
Soros; the ‘‘Center to Improve Care of the Dying’’
(CICD), based in the George Washington Medical
School and originally funded by the Retirement
Research Foundation in 1995, enjoys wide institu-
tional support and in 1997 launched a program for
individual advocacy, ‘‘Americans for Better Care
of the Dying’’ (ABCD); the American Board of
Internal Medicine (ABIM) began publishing edu-
cational materials on techniques to improve care
of the dying in 1996; and the American Medical
Association (AMA) began alerting its members to
the most recent developments in end-of-life care.
And finally, the Robert Wood Johnson Founda-
tion, which has long served as the collective voice
for issues on dying, launched ‘‘Last Acts’’ in 1997,
which is designed to involve the public through
such participating organizations as the Institute of
Medicine, the American Hospital Association, the
Health Care Financing Administration, the Na-
tional Hospice Organization, the Veterans Health
Administration, the American College of Physi-
cians, and a host of specialized associations such as
the American Pain Society, the American Cancer
Society, Choice in Dying, Partnership for Organ
Donation, Memorial Societies of America, Wellness
Councils of America, and on and on. Former First
Lady Roslyn Carter, in a nationally broadcast
speech, proclaimed that, ‘‘We need this coalition
so that fewer people will die alone, in pain, and
attached to machines, with the result that more
people... can experience dying for what it ought
to be... the last act in the journey of life.’’ The
President of the Robert Wood Johnson Founda-
tion was both optimistic and enthusiastic:
With all that is going on... we are seizing the
moment, ‘‘Last Acts’’ will be much more than
platitudes about a good death... it will
undertake to improve care at the end of life...
If the campaign succeeds... we will find a
significant decrease in the number of people
dying in pain, an increase in referrals to
hospice, more people dying at home outside the
hospital, and fewer requests for physician-
assisted suicide (1997).
If, however, the campaign does not live up to
expectations, the foundation will work with the
American Medical Association ‘‘on helping physi-
cians to work with patients on advance care plan-
ning, and providing opportunities for physicians
to increase their skills in palliative medicine and
comfort care.’’ It is too early to estimate the long-
term effects of this blizzard of efforts to improve
the way people die, but it is not too early to predict
that any improvements in the quality of dying
based only on comfort care are likely to be short
term. But change is in the air. Dying persons are
pressing for more participation in when and how
they die, and caregivers are coming under increas-
ing criticism of the limitations of their caring
regimens.AN EVOLVING PERSPECTIVEAs indicated by this review of past research and
current issues, the limitations of both legal and
medical approaches to the problems of dying in
contemporary society mean that the perspectives
of sociology will be brought to bear. Perhaps
future sociological attention will focus on the
uniquely sociological principle that the dying proc-
ess is not understandable in individual terms. This,