PALLIATIVE CARE: No Penalty for Large Painkiller Doses

      In a new policy attempting to support palliative care efforts, the North Carolina Medical Board determined that physicians who prescribe large doses of painkillers to terminally ill patients will not receive disciplinary action, even if the drugs hasten death. The Raleigh News & Observer reports that the decision is a coordinated effort by the state medical board and the state nursing and pharmacy boards, which adopted identical policies. The policy discusses the physician's role in the end of life, stating, "It is the position of the North Carolina Medical Board that patients and their families should be assured of competent, comprehensive palliative care at the end of their lives. Physicians should be knowledgeable regarding effective and compassionate pain relief, and patients and their families should be assured such relief will be provided." While it does not have a written policy regarding physician-assisted suicide, the North Carolina Medical Board said "it does not condone" such practices. Hospice for the Carolinas president Judi Lund Person said, "I think this is sending a message. What we have all been trying to do is quell real or perceived fear that if 'doctors' prescribe what they think is enough pain medication, the medical boards may go after them." President-elect of the Federation of State Medical Boards Dr. George Barrett said that physicians "were taught to control pain. But there was this fear of overtreating and creating addicts. Well, that's illogical. If you have six months to live, so what if you become addicted as long as you are comfortable." Rules concerning pain medication and chronic illness were drafted three years ago, but the new policy marks the board's first attempt to address the treatment of the terminally ill. In recent years, "consensus has developed" among pain experts that "any amount of medication is reasonable to make the life of a terminally ill patient more comfortable," provided the side effects do not cause additional pain. Last month, an Oregon physician was reprimanded by the state licensing board for not providing adequate palliative care for a terminal patient. Dr. Charles Trado, one of the policy's drafters, notes, "There can be inconsistencies in treatment as a result of 'fear.' What we're saying is that the board shouldn't be a reason to inadequately treat patients" (Obermayer, 10/26).