Whatever the Supreme Court decides this summer on physician-assisted suicide, the United States urgently needs to improve end-of-life care for millions of Americans, a National Institute of Medicine panel declared Wednesday.
“Too many people suffer needlessly at the end of life,” the committee said.
The panel did not take a position on whether Americans should have a legal right to help to end life in the face of incurable suffering. But it acknowledged that support for physician-assisted suicide reflects anxiety about aggressive treatment at the end of life or abandonment by caregivers who decide that “nothing can be done.”
“We felt the issue of optimal care at the end of life is a bigger issue than physician-assisted suicide,” said Dr. George Thibault of Brigham and Women’s Hospital in Boston, one of 12 committee members who labored more than a year on the report.
Dr. Christine K. Cassel of Mount Sinai Medical School in New York, who chaired the panel, agreed. “If, as is likely, the Supreme Court does not uphold a constitutional right to physician-assisted suicide, the issue will go back to the states. It is not going to go away,” Cassel said in an interview.
Cassel’s committee said major obstacles need to be cleared to make dying less painful and more humane. For instance, health care payment systems need to recognize the cost of pain control, counseling and palliative or “comfort” care.
“Palliative care is an invisible service in our hospitals now,” Cassel said in an interview. “It tells you something about the culture of our hospitals that nowhere in the whole elaborate payment coding system is there any explicit identification that a patient is dying.”
The panel also recommended an overhaul of restrictive state laws and medical licensing boards to free doctors to prescribe adequate pain medication without fear of being investigated for prescribing addictive drugs. “Addiction to opioids appropriately prescribed to relieve pain and other symptoms is virtually nonexistent, whereas underuse of these medications is a well-documented problem,” the report said.
The group strongly urged medical schools and hospitals to train doctors in end-of-life care. Current programs do not prepare professionals “to recognize the final phases of illnesses, understand and manage their own emotional reactions to death and dying, construct effective strategies for care and communicate sensitively with patients and those close to them,” it said.
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