As the authors in this Bulletin point out, the sorrow of parting is often anything but sweet for the dying. It is not only that death means the loss of relationships as we have known them, or that death threatens the meaning of life itself for many dying people. But such distress is magnified when care of those facing death takes place in medical settings where the sorrow and meaning of parting receive secondary attention, where the demands of technology and even bureaucracy are priorities. Care for the human spirit is still too often an afterthought in the medical environment.

Even some concerted efforts to promote better dying in the hospital have, by their designers' own admission, produced disappointing results. In the 1995 SUPPORT study, published in the Journal of the American Medical Association, patients' preferences about medical treatments still went unheard and unfollowed, despite interventions carefully crafted to improve physician-patient communication. Moreover, the study's own focus incorporated a shortcoming still widespread in hospitals. A singular focus on treatment preferences tends not only to medicalize dying—by attending mainly to the use or non-use of medical treatments—but also to "proceduralize" and "decisionalize" the dying process. Care of the dying is virtually reduced to communication of treatment choices—essentially, "Does the patient have an advance directive?"—and to physicians' implementation of those choices, such as writing no-CPR or "treatment limitation" orders.

Clearly, the process of dying—and of living until we die—involves far more than making and implementing medical decisions, vital as these are. As hospice caregivers have long known, a whole person lurks somewhere behind those treatment preferences, a person whose dying evokes yearnings of the spirit as well as needs of the body and hunger for relationship.

Our authors show that much more can be done to provide spiritual care and support to those who are dying. Yet increasingly, as these writers also point out, attention to the spirit during the dying process is more than an afterthought. Nurturing the spirit will not dispel the sorrow of death's parting, but it may sweeten that sorrow and help us find meaning in the parting.

Works Cited
SUPPORT Principal Investigators, "A Controlled Trial to Improve Care for Seriously Ill Hospitalized Patients: The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment (SUPPORT)," Journal of the American Medical Association 274 (1995): 1591-1598.