ASSISTED SUICIDE: Fewer Oncologists Support Practice
Only 22% of New England oncologists surveyed recently support physician-assisted suicide, down sharply from the 45% support they voiced in 1994. Despite the drop in support, the American Society of Clinical Oncology-sponsored survey found cancer specialists "complain of many obstacles to making dying cancer patients as comfortable as possible." Only four percent of the 3,200 oncologists surveyed said they had "assisted in patient suicide or euthanasia in the past year," while 13% said they "had done so in their careers." Dr. Ezekiel Emanuel of the Dana-Farber Cancer Institute said oncologists "'are doing a better job overall' in referring terminal patients to hospices and bringing in pain specialists to help manage dying patients."
Barriers To End-Of-Life Care
The survey noted a number of barriers to obtaining adequate end-of-life-care, including the fact that "most cancer specialists do not receive formal training in medical school in caring for dying patients, and 25% of the respondents said it was the worst part of their professional lives." More than half of the respondents "said they found it difficult to get consultations with palliative-care experts." While 40% of "patients are clinically depressed when they die," almost half of the respondents "admitted they were not confident in their ability to manage patients' mental depression." The Boston Globe notes that "questions designed to reveal how well" oncologists treated terminal-cancer pain "suggested that 25% of the oncologists fail to comply with guidelines for the best pain management." The survey also found that "oncologists sometimes feel they have failed when a patient dies -- an attitude that can interfere with high-quality end-of-life care," according to experts. One thing the survey did not find is fear among oncologists about being disciplined by regulators for prescribing high doses of pain medication to dying patients. The Globe notes that the survey "found little evidence that doctors consider this a major problem."
Recommendations For Change
Oncologists voiced concern about lack of insurance coverage "for unskilled home health services" for dying patients. This finding led the ASCO Task Force on Cancer Care at the End of Life (which funded the survey) to recommend changes to "health care policies and insurance incentives so that doctors are more likely to refer patients to hospices and other forms of end-of-life care. The task force also recommended "more-intensive education of doctors about the need for expert palliative care, and the establishment of palliative-care programs at major cancer centers." In addition, the panel called for research into "depression and other mental health symptoms of dying patients" and better communication by doctors about end-of-life issues (Saltus, 5/17).