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Conrad Notes
a timely medical meeting newsletter
K.M. Foley, MD, Memorial Sloan-Kettering Cancer Center (MSKCC), New York City, opposes PAS. Dying, in Foley's view, is a societal and not a physician issue. Patients deserve more personal autonomy and physicians need to improve palliative care delivery. Foley finds it inconsistent for the United States to provide a constitutional right for PAS before having one for universal healthcare.

Competent care for the dying The editorial (N Engl J Med 1997:336:54-58) authored by Foley notes attitudinal, behavioral and economic barriers as factors holding back physicians from caring compassionately for dying patients. Physicians need to better understand themselves and their patients to provide improved care during the closing days of life. Foley cautions, "If legalized...(PAS) will be a substitute for rational therapeutic, psychological, and social interventions that might otherwise enhance the quality of life for patients who are dying."
An update on PAS Foley encourages more death talk for society and physicians to gain a better understanding of dying. The dialogue ought to include the present level of patient autonomy on personal healthcare. Patients coming to oncologists usually have little or no choice of caregiver, doctors, hospital, medications (especially pain relievers), homecare, and place of death. This must change to assure real patient autonomy during the closing days of life. Should not the right to universal healthcare be honored before that for PAS?
End-of-life training survey Foley's editorial (op cit) includes results from Blank's survey on physicians in 55 internal medicine residency programs. The American Board of Internal Medicine sought the perceptions of 1400 residents on the adequacy of their training for end-of-life care. The results show adequacy of training ranging from 32% to 72% and appear below:

  • 72% for managing pain and other symptoms

  • 62% for telling patients that they were dying

  • 38% for describing what the process would be like

  • 32% for talking to patients who request assistance in dying or a hastened death

The data support Foley's call for better training of physicians on end-of-life issues.

Comments What if the U.S. Supreme Court overturns the appeals courts on the constitutional right to PAS? Will organized medicine take the lead in developing guidelines for the care of the dying? Society deserves more than double speak from physicians.

An opposing view, appears as "Physician-Assisted Suicide (PAS) - Ultimate Right" in this issue of CONRAD NOTES.

Eugene A. Conrad

Presented at the Annual Meeting of the American Society of Clinical Oncology (ASCO) on May 17-20, 1997
CONRAD NOTES, © 1997 All Rights Reserved
Eugene A. Conrad, PhD, MPH / ISSN 1078 / June 1997

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