A “Good Death” for All: The Need to Teach Racially Sensitive End-of-Life Care

Abstract

A s first-year medical students during the COVID-19 pandemic, we hear about death every day. In between zoom classes on asthma and diabetes, we also learn about racial and e t h n i c d i s p a r i t i e s i n m o r t a l i t y f o r t h e s e s a m e diseases-inequities that have been further amplified by the COVID-19 pandemic. While learning about death is an expected part of medical school training, when we hear stories from our preceptors about the difficult conversations they have had with patients and families making urgent end-of-life care decisions, we worry that we are not learning as much about dying. As we train during a pandemic that has disproportionately affected people of color, we also know that Hispanic patients are less likely to complete advance directives that express their end-of-life care wishes, 1 and Black, Native American, and Asian patients are less likely to die in hospice facilities. 2 Just as the HIV epidemic transformed the medical training of many of our preceptors, we hope that the COVID-19 pandemic will similarly change the way we approach death and dying, especially for our most vulnerable patients. Given the disparities we see in how our patients experience illness in life, how can we ensure that the care we provide does not also lead to differences in how our patients die? How should our medical school curriculum prepare us to provide our patients with equitable and culturally humble care not only during the prime of their lives, but also during their final days?While end-of-life care training is integrated as a longitudinal theme across all four years of our Harvard Medical School curriculum, like most other US medical schools, our medical training will not include a required palliative care clerkship. 3 Since the Liaison Committee on Medical Education (LCME) only requires a vague, "baseline level" of end-of-life training, it is unsurprising that our third-year colleagues at our medical school reported rarely or never caring for dying patients in their core clerkships, and if