New End-of-Life Guidelines

Abstract

149 IN 1996 REPRESENTATIVES from American medical specialty societies convened to share their organizations’ existing or proposed policies concerning decision-making at the end of life and the quality of clinical management of dying patients. From this meeting emerged a consensus document, Principles for Care of Patients at the End of Life: An Emerging Consensus Among the Specialties of Medicine, published by the Milbank Memorial Fund.1 Fourteen societies and the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) have adopted policies that embrace the Core Principles. The Joint Commission reported that its standards for care at the end of life are aligned with the Core Principles. The following organizations have formally adopted the Core Principles exactly as written: the American Medical Association, Academy of Psychosomatic Medicine, American Academy of Hospice and Palliative Medicine, American Board of Hospice and Palliative Medicine, American College of Chest Physicians, American Pain Society, and the National Kidney Foundation. Four societies have formally adopted the Core Principles with modifications: the American Academy of Pediatrics, the American College of Surgeons, the American College of Physicians— American Society of Internal Medicine, and the American Geriatrics Society. In addition, the American Society of Bioethics and Humanities unanimously agreed that its members would support these principles, although the organization does not officially support specific policy statements. Moreover, both the American Academy of Neurology (AAN) and the American Society of Clinical Oncology (ASCO) drafted their own specific statements on palliative care and/or end-oflife care that embody all the Core Principles. The AAN statement, drafted by its Ethics and Humanities Subcommittee, was approved by the AAN executive board in July 1995; the final version was published in the Academy’s journal the following spring, reinforced by an editorial that appeared in the same issue.2,3 The ASCO statement was adopted in February 1998 and published in May as a special article in its journal.4 Special Article