Opioid Agreements and Drug Screens: Adapting Tools From Chronic Nonmalignant Pain Management to the Palliative Care Clinic (515)

Abstract

In recent years there have been several major legal and policy developments concerning palliative options of last resort. These developments have important implications for the standards of practice applicable to those health care institutions and professionals who provide hospice and palliative care. A primary example is the promulgation of guidelines and policies governing the provision of palliative sedation for intractable terminal suffering. Some of these guidelines are based upon the proposition that not only is suffering a diagnosis, but that such a diagnosis can be sufficiently fine-grained as to identify distinct types or categories of suffering, some of which are designated as ‘‘clinical’’ and others as ‘‘nonclinical.’’ These guidelines then delineate when palliative sedation may be offered for refractory ‘‘clinical’’ symptoms while at the same time proscribing palliative sedation for ‘‘nonclinical’’ terminal suffering, even when it is severe and refractory to other palliative measures. Strict adherence to such guidelines presents serious issues of law, ethics, and professionalism. This session will also focus on recent evidence of a major shift in public and professional opinion on the nature and legitimacy of lethal prescriptions for terminally ill patients with decisional capacity, who wish to assert greater control over the timing and manner of their death. An impressive array of health professional organizations have issued policies or position statements opposing the characterization of this practice as ‘‘physician-assisted suicide.’’ We will review the rationale offered for this emerging public policy stance, and consider the implications of it for the provision of hospice and palliative medicine in the growing number of jurisdictions where it is now legal or may be authorized in the near future. Special consideration will be given to the data that has emerged from Oregon and Washington, as well as the reasoning of the Supreme Court of Montana on this issue.