Earlier this month I blogged about a New Yorker article that discussed the sorry state of end-of-life care in America. In an effort to address that problem, New York State last week signed the New York Palliative Care Information Act into law, which would require physicians to discuss prognosis and end-of-life options with their terminal patients (including hospice, palliative care, etc.).
Some research has shown that these conversations are beneficial to terminal patients:
For example, in a study published in the Journal of the American Medical Association in October 2008, Boston researchers found that patients who had end-of-life discussions with their physicians “were more likely to accept that their illness was terminal, prefer medical treatment focused on relieving pain and discomfort over life-extending therapies, and have completed a do-not-resuscitate order.”
When compared with patients who had no such discussion, they were also more likely to be enrolled in outpatient hospice for more than a week and less likely to be placed on mechanical ventilators, or to be resuscitated if their hearts stopped, or to be admitted to intensive care units.
Contrary to fears that such discussions cause emotional harm to patients, the researchers reported that there was no increase in serious depression or worry and that the worst psychological distress occurred in patients and family members when end-of-life talks had not taken place. The poorest quality of life and worst bereavement adjustment resulted when patients received aggressive care during the last week of life, the researchers found.
But there are also concerns about mandating such discussions by law. A similar measure was struck from the national health-care bill over concern about “death panels”; the Medical Society of the State of New York also objected to the measure, saying “the new law would intrude ‘unnecessarily upon the physician-patient relationship’ and mandate ‘a legislatively designed standard of care.'”
What struck me is that the assemblymen who sponsored the bill did so at the behest of Compassion and Choices of New York, “an organization that seeks to improve end-of-life comfort care” — but one that also supports physician-assisted suicide. PAS is certainly not what I’d consider end-of-life “care,” but clearly the two are linked for many people in the industry.
It would be a shame — to put it mildly — if palliative care and assisted suicide became synonymous in the minds of terminal patients. We need more conversations about end-of-life options, but we don’t need assisted suicide to be among them.