Objectives
- 1.Discuss the results of a national survey of hospice and palliative medicine (HPM) physicians to determine what actions they consider put them at risk of being accused of hastening a patient's death.
- 2.Discuss the results of a national survey of HPM physicians to determine the prevalence and outcomes of being formally accused of hastening a patient's death.
- 3.Discuss the results of a national survey of HPM physicians describing anonymous scenarios in which physicians were investigated about allegations of hastening a patient's death.
Background. While many palliative medicine clinicians are concerned that their clinical activities may be misconstrued, it isn't known how often and under what circumstances they are accused of hastening death.
Research objectives. Determine the prevalence, outcomes, and scenarios under which palliative medicine physicians are accused of hastening a patient's death.
Methods. We conducted an Internet-based survey on a random 50% sample of physician members of a national palliative medicine professional society. Subjects were contacted by e-mail and if they didn't respond, they were then contacted by regular mail.
Results. After correcting for unreachable or ineligible subjects, the final sample consisted of 663 physicians (response rate 53.5%). Fifty-five percent of respondents were male, and the median age was 50 years. When asked which actions might be misperceived as hastening death, subjects rated palliative sedation as the most risky, followed by stopping artificial hydration/nutrition. When asked if over the last five years anyone had characterized a palliative treatment provided by the respondent as “euthanasia” or “murder,” 25% answered that a patient had done so, 60% reported that a patient's friend or family had, and 55% reported another physician had stated this. Overall, 25 subjects (3.8%) had been formally investigated for hastening a patient's death. In 13 of these, using opioids for symptom treatment was the source of the investigation, and in six investigations it was medications used while discontinuing mechanical ventilation. Fourteen accused physicians had been cleared of charges, investigations were ongoing in five, and none were found guilty.
Conclusion. About 4% of physician-respondents had been formally investigated for hastening a patient's death. Behaviors physicians consider the most risky are different than those for which they are most commonly investigated.
Implications for research, policy, or practice. By understanding more about when and why physicians were formally accused, clinicians may be able to change their practice to reduce their risk of being perceived as hastening a patient's death.
Domain
Structure and Processes of Care; Ethical and Legal Aspects of Care
Article info
Footnotes
(All speakers for this session have disclosed no relevant financial relationships with the exception of: Cohen is an author and receives book royalties from HarperCollins.)
Identification
Copyright
© 2011 Published by Elsevier Inc.
