Palliative Care | AMA-Code

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Physicians have clinical ethical responsibilities to address the pain and suffering occasioned by illness and injury and to respect their patients as whole persons. These duties require physicians to assure the provision of effective palliative care whenever a patient is experiencing serious, chronic, complex, or critical illness, regardless of prognosis. Palliative care is sound medical treatment that includes the comprehensive management and coordination of care for pain and other distressing symptoms including physical, psychological, intellectual, social, spiritual, and existential distress from serious illness. Evaluation and treatment are patient-centered but with an additional focus on the needs, values, beliefs, and culture of patients and those who love and care for them in decision-making accordingly.

Palliative care is widely acknowledged to be appropriate for patients who are close to death, but persons who have chronic, progressive, and/or eventually fatal illnesses often have symptoms and experience suffering early in the disease course. The clinical ethical responsibilities to address symptoms and suffering may therefore sometimes entail a need for palliative care before the terminal phase of disease. Moreover, the duty to respect patients as whole persons should lead physicians to encourage patients with chronic, progressive, and/or eventually fatal conditions to identify surrogate medical decision makers, given the likelihood of a loss of decisional capacity during medical treatment.

When caring for patients' physicians should:

Integrate palliative care into treatment.
Seek and/or provide palliative care, as necessary, for the management of symptoms and suffering occasioned by any serious illness or condition, at any stage, and at any age throughout the course of illness.
Offer palliative care simultaneously with disease modifying interventions, including attempts for cure or remission.
Be aware of, and where needed, engage palliative care expertise in care.

Physicians as a profession should:

Advocate that palliative care be accessible for all patients, as necessary, for the management of symptoms and suffering occasioned by any serious illness or condition, at any stage, and at any age throughout the course of illness.

AMA Principles of Medical Ethics: I, V, VIII

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Related Opinions

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Opinion 5.1

Advance Care Planning

Although often thought of primarily for terminally ill patients or those with chronic medical conditions, advance care planning is valuable for everyone, in order to ensure that their own values, goals, and preferences will inform care decisions when they cannot speak for themselves. Physicians should routinely engage their patients in advance care planning but should be sensitive to each patient’s individual situation and preferences when broaching this topic.

Opinion 5.2

Advance Directives

Advance directives are tools that give patients of all ages and health status the opportunity to express their values, goals for care, and treatment preferences to guide future decisions about health care. Advance directives also allow patients to identify whom they want to make decisions on their behalf when they cannot do so themselves. However, an advance directive never takes precedence over the contemporaneous wishes of a patient who has decision-making capacity.

Opinion 5.3

Withholding or Withdrawing Life-Sustaining Treatment

A patient who has decision-making capacity appropriate to the decision at hand has the right to decline or halt any medical intervention even when that decision is expected to lead to his or her death, When a patient lacks appropriate capacity, the patient’s surrogate may halt or decline any intervention. There is no ethical difference between withholding and withdrawing treatment. When an intervention no longer helps to achieve the patient’s goals for care or desired quality of life, it is ethically appropriate for physicians to withdraw it.

Opinion 5.6

Sedation to Unconsciousness in End-of-Life Care

When a terminally ill patient experiences severe pain or other distressing clinical symptoms that do not respond to aggressive, symptom-specific palliation, it can be appropriate to offer sedation to unconsciousness as an intervention of last resort.