The AMA House of Delegates has adopted new policies outlining physicians’ ethical obligation to provide or seek optimal palliative care for patients with serious illnesses who can benefit from comprehensive management of pain and other distressing symptoms—not only those with terminal illnesses or on the precipice of death.
“Physicians have clinical ethical responsibilities to address the pain and suffering occasioned by illness and injury and to respect their patients as whole persons,” says one of the new policies adopted at the latest AMA Interim Meeting, held in Lake Buena Vista, Florida. “These duties require physicians to assure the provision of effective palliative care whenever a patient is experiencing serious, chronic, complex or critical illness, regardless of prognosis.”
The new policy, which will be incorporated into the AMA Code of Medical Ethics, defines palliative care as “sound medical treatment that includes the comprehensive management and coordination of care for pain and other distressing symptoms including physical, psychological, intellectual, social, spiritual and existential distress from serious illness.”
The new policy notes that “palliative care is widely acknowledged to be appropriate for patients who are close to death, but persons who have chronic, progressive or eventually fatal illnesses often have symptoms and experience suffering early in the disease course. The clinical ethical responsibilities to address symptoms and suffering may therefore sometimes entail a need for palliative care before the terminal phase of disease.”
The newly adopted ethical opinion says that when caring for patients, physicians should:
- Integrate palliative care into treatment.
- Seek or provide palliative care, as necessary, for the management of symptoms and suffering occasioned by any serious illness or condition, at any stage, and at any age throughout the course of illness.
- Offer palliative care simultaneously with disease modifying interventions, including attempts for cure or remission.
- Be aware of, and where needed, engage palliative care expertise in care.
In addition, says the policy, physicians as a profession should “advocate that palliative care be accessible for all patients, as necessary, for the management of symptoms and suffering occasioned by any serious illness or condition, at any stage, and at any age throughout the course of illness.”
Get the latest public health news
Get the tools and resources you need to face the latest public health issues.
Expanding access to palliative care
In a separate action, delegates also adopted the recommendations of an AMA Board of Trustees report recognizing palliative care’s vital role as part of optimal medical care and directing the AMA to advocate greater access.
With this new policy, the AMA recognizes that palliative care:
- Including hospice, is a human right.
- Is the comprehensive management and coordination of care for pain and other distressing symptoms, including physical, psychological, intellectual, social, psychosocial, spiritual and the existential consequences of a serious illness, which improves the quality of life of patients and their families or caregivers and that generalist and subspecialist palliative care evaluation and treatments are patient-centered and family-oriented, emphasizing shared decision-making according to the needs, values, beliefs and cultures of the patient and their family or chosen family.
- Can be offered in all care settings through a collaborative team approach involving all disciplines (e.g., , physicians, nurses, social workers, spiritual care providers, therapists, pharmacists) and should be available at any stage of a serious illness from birth to advanced age and may be offered simultaneously with disease modifying interventions.
- Can be offered alongside curative or life-prolonging treatments at any stage of illness, whereas hospice is a specific type of palliative care, typically reserved for individuals with a prognosis of six months or less.
- Differs from physician-assisted suicide in that palliative care does not intentionally cause death. In fact, palliative treatments that relieve symptom distress have been shown in numerous studies to prolong life.
Per the new policy, the AMA will:
- Work with interested state medical societies and medical specialty societies and vigorously advocate for broad, equitable access to palliative care, including hospice, to ensure that all populations, particularly those from underserved or marginalized communities, have access to these essential services.
- Oppose the imposition of criminal and civil penalties or other retaliatory efforts against physicians for assisting in, referring patients to, or providing palliative care services, including hospice.
“Caring for patients at the end of life is a privilege that draws deeply on physicians’ commitment to alleviate suffering,” says the AMA Code of Medical Ethics. “Physicians must help patients identify what matters most to them when cure is no longer possible and to negotiate difficult decisions about what trade-off to accept between quality and quantity of life, what interventions to accept, and when to refuse efforts to sustain life.”
Further explore opinions in the AMA Code of Medical Ethics on caring for patients at the end of life.
Read about the other highlights from the 2024 AMA Interim Meeting.
