End-of-life care: Welcome focus on eternal issue

Some recent developments have given new life to end-of-life care.

Editorial. Oct. 16, 2000.

Attention to end-of-life care has had its ups and downs. September was an up month. The Bill Moyers four-part series on PBS, "On Our Own Terms," took an in-depth look at end-of-life issues and by public television standards was a hit, drawing ratings more than half again as much as PBS's usual prime-time fare. The Sept. 18 issue of Time, published to coincide with the Moyers program, devoted the cover and 14 pages to end-of-life issues. If experience is any guide, it will likely linger in physician waiting rooms for months.

This welcome attention follows a slow season of media exposure on end-of-life matters. Assisted suicide, either in spite of or because of the fact that it is so sensational and superficial, is typically the issue that the media latch onto -- all the more reason that the fuller views offered by Moyers and Time are noteworthy. But Jack Kevorkian, MD, assisted suicide's biggest cheerleader, has been in prison since April 1999.

Also, the states have been slow to take up the Supreme Court's offer to decide the matter for themselves. Even that is set to change: Maine will vote on allowing physician-assisted suicide next month. One mid-September poll predicts the referendum will pass..

Patient self-determination and the good practice of medicine are the core issues in end-of-life care. Advance directives and effective palliative treatment provide the right answers; physician-assisted suicide is the sham version.

Fortunately, the upswing of proper attention to end-of-life matters didn't end when last month did. Here are more items that warrant the attention of the medical community:

Closest to home, look to our Health & Science section this week to find an in-depth look at what's being done to teach physicians about pain management -- and how to break some bad habits that medicine has developed over the years. There is also a companion story about access to pain management in minority communities.
This month, the American Bar Assn., working with the Dept. of Health and Human Services, will present National Health Care Decisions Week. Local legal groups will host community meetings in which the public will be informed on advance directives, living wills and organ donation. Volunteer lawyers will be on hand to help people fill out the forms. It is currently believed that only about 20% of adults have advance directives. The official dates are Oct. 22-28, but this initiative is expected to last until late November.
Now available from the AMA Press is Advance Care Planning: A Practical Guide for Physicians. This concise guide explains the options patients have for advance directives, living wills and proxies. Samples of each are included. The book can be ordered by phone, (800) 621-8335, or online (http://www.ama-assn.org/catalog) and costs $32 for AMA members and $40 for nonmembers.
Next month, the Journal of the American Medical Association will devote a theme issue to end-of-life care. Article titles for this Nov. 15 issue have yet to be announced, but in its call for papers, JAMA described its intent as an examination of "the time in a patient's life when the appropriate focus of care shifts from prevention to palliation," and an exploration of "the patient's role in helping determine when that shift occurs and the role that health care professionals have in helping patients."

The more up times like these, when medicine and society honestly confront end-of-life issues, the better the chances for patients to get what they want and need at the end of life.