Is End-of-Life Palliative Care Ever "Murder"?
Last updated: Mar 22, 2012
Palliative care -- the practice of keeping someone comfortable by relieving suffering -- is all about doing good. The patient's quality of life is improved (even in instances, as under hospice care, where that life is being measured in weeks or days). The stress on families who don't have to witness outright suffering is eased.
So why are some practitioners still being called murderers?
That's what a thought-provoking essay asks in the GeriPal blog on geriatrics and palliative care. A new study in the Journal of Palliative Medicine found that more than half of the 663 doctors surveyed had at least one experience in the last five years in which a patient's family, another physician, or another health care professional had characterized palliative treatments as being euthanasia, murder, or killing. One in four knew of a colleague who'd been similarly accused.
And yet many people request this kind of care through their living wills. Say your loved one has clearly and emphatically stated that she doesn't want to be kept alive by artificial measures. Her notarized advance directive says the same, specifically mentioning no artificial hydration or nutrition. Say she then has a devastating stroke but still manages to breathe on her own after the ventilator is turned off. Despite this, the damage has been done, and her prognosis is grim. Would you hook her up to an IV for hydration?
Dan Matlock, the GeriPal doctor-author argues that in the case above, such a "value discordant move" was against the wishes of the patient -- he doublechecked with her medical power of attorney, her sister, who agreed wholeheartedly that she wouldn't want the IV. But a prominent doctor at the hospital weighed in, saying, "You would have been hung in World War II for doing what you are doing now [recommending against artificial feeding and hydration]."
The new study, by Nathan Goldstein and others, reveals how persistent outdated thinking about end-of-life care and palliative measures still is. There's a lot of emotion swirling around end-of-life care, and it comes on top of misunderstanding about the uses and limits of, say, feeding tubes or the use of opiates (which have been found don't hasten death) to treat symptoms in the dying.
The study's conclusion says: "Commonly used palliative care practices continue to be misconstrued as euthanasia or murder, despite this not being the intention of the treating physician. Further efforts are needed to explain to the health care community and the public that treatments often used to relieve patient suffering at the end of life are ethical and legal."
And compassionate, too.