PITT PROFESSOR AUTHORS JAMA ARTICLE ON END-OF-LIFE CARE
PITTSBURGH, Nov. 14 -- Legal myths about end-of-life care can undermine good care and ethical medical practice, say researchers in an article to be published in the Nov. 15 Journal of the American Medical Association (JAMA) special issue.
"Seven Legal Barriers to End-of-Life Care: Myths, Realities, and Grains of Truth," was written by Alan Meisel, University of Pittsburgh School of Law professor and director of Pitt's Center for Bioethics and Health Law; Lois Snyder, director of the Center for Ethics and Professionalism at the American College of Physicians-American Society of Internal Medicine (ACP-ASIM); and Timothy Quill, an internist at the University of Rochester.
The paper is the result of the ACP-ASIM End-of-Life Care Consensus Panel convened in 1997 to identify clinical, ethical, and policy problems in end-of-life care; to analyze critically the available evidence and guidelines; and to offer consensus recommendations on how to improve care of the dying.
A significant barrier to good end-of-life medical care is that some doctors believe various myths about the law, and specifically that the law requires them in some situations to practice bad medicine. The authors argue that this is definitely not the case. Most significantly in light of the current debate about the legalization of physician-assisted suicide, it is essential that doctors understand that prescribing high doses of medication to relieve pain or other discomfort in a terminally ill patient is legal even if it results in the patient's death as long as the doctor's intent was to relieve the patient's pain. Similarly, when a terminally ill patient's suffering is overwhelming despite palliative care, it is not illegal for doctors to withhold artificial fluids and nutrition and sedate the patient.
The authors conclude that while many legal barriers to end-of-life care are more mythical than real, sometimes a grain of truth does exist. Ultimately, it is necessary for physicians to know state law where they practice medicine.
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