End-of-Life Decision-Making

Document Type

Book Chapter


Faculty of Computing, Health and Science


School of Nursing, Midwifery and Postgraduate Medicine / WA Centre for Cancer and Palliative Care




Wilkinson, A., & Sim, M (2009). End-of-Life Decision-Making. In D. Carr (Ed). Encyclopedia of the Life Course and Human Development. (pp. 134-137) Detroit, MI USA: Macmillan Publishers. Available here.


Increased longevity and the aging of the baby boom generation are posing substantial challenges to society. The percent of the population aged 65 to 84 years is projected to increase from 10.9% to 15.7% by 2050, an absolute increase of over 35 million people. Those 85 and older will increase from 1.5% (approximately 4 million) to 5% of the population, or nearly 20 million people (President's Council on Bioethics, 2005). However, while average life expectancy at age 65 has increased to over 20 years, only 11.9 of those years are expected to be healthy. After age 85, only one person in 20 is still fully mobile (Sharma, Chan, Liu, & Ginsberg, 2001). Chronic illnesses, that is, conditions that tend to be long-lasting, persistent in their symptoms, and generally incurable, and including some cancers, organ system failure (primarily heart, lung, liver, or kidney failure), dementia, and stroke, are now the leading causes of death for Americans. Nearly all of the burden of illness and utilization of health care is now concentrated in the last few years of life when people generally live with established, serious chronic diseases and increasing disability that will eventually result in death.