Study Says More Palliative Care Needed for the Dying

Bioethics   |   Steven Ertelt   |   Jul 14, 2003   |   9:00AM   |   WASHINGTON, DC

Study Says More Palliative Care Needed for the Dying

by Steven Ertelt Editor
July 14, 2003

New York, NY ( — A new study says patients who seek help from their doctors to hasten death are in significant physical pain and discomfort. Dr. Diane Meier, lead author of the study that appears in the July 14 issue of the Archives of Internal Medicine, says the finding shows an increased need for palliative care.

"It is physicians feeling that they have no other means of responding than refusing or agreeing to honor assisted suicide," Meier, director of the Center to Advance Palliative Care at the Mount Sinai School of Medicine in New York City, told HealthDayNews.

If nothing more is done to address pain control for patients, Meier said the country is in danger of having more states that, like Oregon, have legalized assisted suicide. However, Meier says doctors have the ability to do a better job at providing palliative care.

Bills regarding assisted suicide were introduced in four states this year. Three of the bills (in Arizona, Hawaii and Vermont) called for legalizing the objectionable practice, while a North Carolina bill (introduced by two physician legislators) called for banning it. None of the bills advanced.

David Goldberg, spokesman for the pro-assisted suicide Hemlock Society, disagrees with the findings.

"The vast majority of individuals who have made a request for physician-aided death under Oregon’s law are not in severe pain or physical discomfort," he says.

Caren Kossin, who has been diagnosed with ovarian cancer, says palliative care programs can be especially helpful.

"They’ve made a difference," Kossin said. "They’re willing to listen to any sort of problem that I have, anything that’s bothering me — because it’s not just the cancer, your whole life changes."

Kossin said this treatment gave her the support she needed. "When you have a serious illness, it’s very important to get this type of support. It gives you hope."

The study received responses from 1,920 physicians across the country and were in such specialized fields involving care for the seriously ill, including oncology, cardiology, family practice and pulmonary critical care.

Of the 1,902 respondents, 379, or approximately 20%, described 415 instances of being asked to help a patient die and refusing that request. Some 80 physicians they honored the request.

The latest figures from Oregon reveal that 30 patients ended their lives in 2002. Between 1998 and 2001, 91 people legally took their own lives in Oregon.

Patients who had asked for help in dying were mostly male (61 percent), 46 to 75 years old (56 percent), of white European descent (89 percent), Christian (78 percent), middle class (71 percent), and college graduates (50 percent).

About 47 percent had been diagnosed with cancer, 38 percent were experiencing sever pain, 42 percent experiencing other discomfort. More than half (53 percent) were dependent, 42 percent were bedridden and 28 percent were expected to live less than one month.

Forty-nine percent of the patients asking for help in dying were depressed. About half (52 percent) specifically requested a lethal prescription while 25 percent requested a lethal injection.

Of the 80 requests honored, 32 were for prescription drugs (40 percent), 43 for injections (54 percent) and five did not specify (six percent). Specific requests were more likely to be honored, the researchers found.

Meier says the focus on treating pain has been removed in medical school training. She said she completed nine years of medical school and never once had a lecture on how to help patients control pain.

"There was no attention to treatment of shortness of breath or agitation or issues of family burden and family support," she told HealthDayNews. "It wasn’t on the radar screen. The only things on the curriculum had to do with pulling people back from the brink of death. We have a medical education that is stuck in the past."

Polls show support for assisted suicide is on the decline.

The latest Gallup poll, which measured Americans’ views on "morally acceptable" and "morally wrong" conduct, indicates that support for assisted suicide is ebbing. "Doctor assisted suicide" is losing moral support — from moral to immoral, with 49 percent of those polled now viewing PAS as "wrong" and only 45 percent considering it "acceptable."