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PROFESSIONAL ISSUESLines between palliative, regular, aggressive care blurringEthics Forum. March 7, 2005. Scenario: How can physicians help patients with hospice and end-of-life care? An elderly patient who has lived for 11 years with ovarian cancer presents to the emergency department with renal failure, hypotension and infection. All three can be treated aggressively, but should they be? And how will physicians decide? Reply: By many measures, palliative medicine and hospice are becoming increasingly accepted aspects of medical care. The number of patients being cared for by hospices reached 885,000 in 2002, representing about one-third of all deaths in the United States. The number of hospices in this country now exceeds 3,200. The number of physicians being certified in hospice and palliative medicine by the American Board of Hospice and Palliative Medicine has now exceeded 1,500, and membership in the main professional society for physicians, the American Academy of Hospice and Palliative Medicine is similarly expanding. Unlike many specialists, physicians who practice palliative medicine come from a variety of fields -- internal medicine, oncology and geriatrics -- but there are palliative care physicians from psychiatry, emergency medicine, neurology, nephrology and surgery. Despite this increasing physician acceptance, the median length of stay in hospice has remained at just over 20 days for almost a decade, and hospice is frequently seen by physicians and by patients and families as "giving up." As the husband of a terminally ill patient said, "It's where you go when everything else hasn't worked ... like you throw in the towel." [...]Full text of AMNews content is available to AMA members and paid subscribers.
Copyright 2005 American Medical Association. All rights reserved.
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