In a new edition of How We Die: Reflections on Life's Final Chapter, Sherwin B. Nuland, M.D., Hastings Center board member and Fellow, discusses the state of end-of-life care today, progress in palliative care, and areas in need of improvement.

The book, which was originally published in 1994 and won the National Book Award for nonfiction that year, aims to "demythologize the process of dying" by describing the physical deterioration that occurs with heart attack, cancer, and other common causes of death. It also explores the resistance that doctors, patients, and family members have about discussing death honestly and openly.

In a new chapter, Coda: 2010, Nuland cites ways that care of the dying has improved in the 16 years since his book was first published, especially the growth of palliative and hospice care. However, Nuland says that end-of-life care is still not a priority in medicine and the "failure to acknowledge futility remains an unsolved problem." He calls for a culture change in medicine, which would include training more family physicians and marrying the art and science of medical care - finding "ways to restore the pastoral role of the physician, and to teach that such a role is not in the least incompatible with the most advanced form of scientific medicine, if the two are wisely melded."

Nuland retired as Clinical Professor of Surgery at Yale University in 2009 but continues to teach bioethics and medical history to Yale undergraduates. He was named the 2011 recipient of the Jonathan Rhoads Medal for Distinguished Achievement in Medicine by the American Philosophical Society.