Three major areas of concern can be identified in the relationship between health care providers and dying patients: a) the nature of the difficulties and stresses associated with terminal care, b) the education of providers for this kind of work, and c) the influence of organizational structure and institutionalized values on services for dying patients and their families. A review of the research literature indicates that obstacles to effective terminal care continue to exist at the personal, interpersonal, and social levels in the current American health care system. Particular attention is given to demonstrated differences among health care professionals in their sources of emotional support and to difficulties associated with innovations in terminal care. Recent developments such as the predetermined reimbursement for health care based on established diagnostic categories (DRGs) have the potential for generating further obstacles to the providers' efforts to function as one human being helping another.
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