ACP-ASIM Explores Seven Legal Myths that Undermine Good End-of-Life Care
November 14, 2000
Philadelphia—(November 14) Legal myths about end-of-life care can undermine good care and ethical medical practice, says a paper from the American College of Physicians-American Society of Internal Medicine (ACP-ASIM) Consensus Panel on End-of-Life Care.
Myths about current law can keep patients from considering legal and ethical actions, such as refusing fluids and nutrition. Myths can keep physicians and other caregivers from good medical practice, such as prescribing adequate pain medication, for fear that the patient might die and the physician might be held liable for murder or assisted suicide.
The paper, "Seven Legal Barriers to End-of-Life Care: Myths, Realities, and Grains of Truth," published in the November 15 issue of the Journal of the American Medical Association, sets the record straight about these myths.
"There have been many developments in end-of-life care law in the 25 years since the Karen Ann Quinlan case," says Bernard Lo, MD, chairman of the ACP-ASIM panel. "Physicians need to be able to separate fact from fiction in determining how to care for patients and respect patient rights."
Among the most common legal myths the ACP-ASIM consensus panel identified are:
- Forgoing life-sustaining treatment for patients without decision-making capacity requires evidence that this was the patient's actual wish.
- Withholding or withdrawing artificial fluids and nutrition from terminally ill or permanently unconscious patients is illegal.
- Oral advance directives are unenforceable.
- Physicians who prescribe or administer high doses of medication to relieve a terminally ill patient's pain, resulting in death, will be criminally prosecuted.
- When a terminally ill patient with unrelenting suffering requests a hastened death, there are no legal options to ease suffering.
- The 1997 Supreme Court decision outlawed physician-assisted suicide.
The paper discusses each of these misconceptions but often finds a grain of truth that keeps the myths alive. "State laws on end-of-life care differ, so physicians should know the law of the state in which they practice," says Lois Snyder, director of ACP-ASIM's Center for Ethics and Professionalism and an author of the paper. "Also, sometimes ethics, clinical judgment and the law conflict. Physicians need to know how to proceed."
This is the eighth of 14 papers that the ACP-ASIM Consensus Panel is developing. The papers explore clinical, ethical and policy problems in end-of-life care and recommend improvements in care of the dying. The papers are to provide practical guidance primarily to practitioners who are not specialists in palliative care.
ACP-ASIM is the nation's largest medical specialty society, with a membership of more than 115,000 internal medicine physicians and medical students. Internists are specialists in the prevention, detection and treatment of illnesses that primarily affect adults.
Contact: Susan C. Anderson, 215-351-2653 or 800-523-1546, ext. 2653