Pain, Suffering and Physician-Assisted Death: Oregon Hospice Responses
Courtney Campbell, PhD, Hundere Professor in Religion and Culture; and Hunter Davidson, graduate student in applied ethics, Oregon State University
A central aim of hospice programs is the provision of palliative care for symptom relief, pain control and alleviation of suffering. Eight U.S. jurisdictions now permit legalized physician assisted death, in which a terminally ill patient can request of their attending physician a prescription to hasten their death. This process allows patients to control the timing of their death, ensure an acceptable quality of life, and avoid undesired pain and suffering. Significantly, state-compiled reports indicate that ~90% of patients who request physician assisted death are enrolled in hospice care.
Prompted by a National Academy of Medicine workshop in February 2018 that examined empirical studies on physician assisted death, we initiated a study of policies on physician-assisted death by hospice programs affiliated with the Oregon Hospice and Palliative Care Association. We are in the early stages of examining several features of these policies including convergences and differences on nomenclature, appeals to hospice philosophy, program mission and values, referral processes, accommodation for conscientious objection by staff, and procedures for permitting and restricting hospice staff presence when a patient ingests medication.
Our presentation focuses on this latter issue, considering the different boundaries and lines diverse hospice programs draw regarding staff presence at medication ingestion. These include specification of staff roles, distinctions between medical and comfort needs, distance from direct staff involvement, and staff responsibilities in the event the patient experienced complications from ingestion.
This focused analysis reveals the ethical tensions experienced by hospice programs in addressing patient requests to relieve pain and suffering by a procedure that ends the life of the suffering person. These tensions are rooted in conflicts between core hospice values, including avoiding hastening death, non-abandonment, respect for the pre-existing physician-patient relationship, and conscientious accommodations.
Prompted by a National Academy of Medicine workshop in February 2018 that examined empirical studies on physician assisted death, we initiated a study of policies on physician-assisted death by hospice programs affiliated with the Oregon Hospice and Palliative Care Association. We are in the early stages of examining several features of these policies including convergences and differences on nomenclature, appeals to hospice philosophy, program mission and values, referral processes, accommodation for conscientious objection by staff, and procedures for permitting and restricting hospice staff presence when a patient ingests medication.
Our presentation focuses on this latter issue, considering the different boundaries and lines diverse hospice programs draw regarding staff presence at medication ingestion. These include specification of staff roles, distinctions between medical and comfort needs, distance from direct staff involvement, and staff responsibilities in the event the patient experienced complications from ingestion.
This focused analysis reveals the ethical tensions experienced by hospice programs in addressing patient requests to relieve pain and suffering by a procedure that ends the life of the suffering person. These tensions are rooted in conflicts between core hospice values, including avoiding hastening death, non-abandonment, respect for the pre-existing physician-patient relationship, and conscientious accommodations.