Oral arguments before the U.S. Supreme Court last week on two state laws banning physician-assisted suicide spurred calls for healthcare providers to improve the quality of their care of dying patients.
No matter which side it takes, the Supreme Court's decision in cases challenging the constitutionality of assisted-suicide bans in New York and Washington is likely to force hospitals, physicians and other providers to reassess how they deliver end-of-life care. A decision is expected by July.
If the justices uphold the state bans, which have been struck down by lower courts, providers must search for new ways to relieve the pain of patients who unnecessarily suffer in the final days before death, as well as delivering the end-of-life care and support they need.
Some justices questioned whether choosing lethal medication might be in the patients' best interest. They cited the fact that 25% of patients die in severe pain, even though better use of medication could alleviate pain for all but 1% to 2% of them.
Attorneys arguing in favor of the state bans said that only demonstrates that providers need to improve end-of-life care. The American Hospital Association, American Medical Association, American Nurses Association and Catholic Health Association submitted friend-of-the-court briefs to the Supreme Court to reject physician-assisted suicide.
"The fact that 25% unnecessarily die in pain shows the task facing the medical profession" but does not justify helping that person to die, said Walter Dellinger, acting U.S. solicitor general, who argued before the Supreme Court in favor of both state bans.
Jonathan Lord, M.D., senior adviser for clinical affairs at the AHA, said the visibility of the cases has prompted new discussions of how dying patients are treated, including pain management.
Arguing that patients would not ask to die if providers better relieved their pain and suffering, 40 other provider and advocacy groups urged the Joint Commission on Accreditation of Healthcare Organizations and the National Committee for Quality Assurance to develop ways to measure the quality of end-of-life care.
The groups called for development of quality measures in 10 "domains," such as patient and family satisfaction, overuse of life-sustaining treatment, and pain and depression management.
But Nancy Dickey, M.D., chairwoman of the AMA's board of trustees, added that providers still must overcome such barriers to better pain management as state laws that limit how much pain-relieving medication, particularly narcotics, doctors can prescribe.
Providers and attorneys arguing on behalf of the states raised the specter of insurers, in pursuit of cost savings, openly encouraging patients to choose suicide over life-sustaining medication.
"I'm sure payment issues will enter into it," Dickey said.
But Karen Ignagni, president and chief executive officer of the American Association of Health Plans, responded: "Are we going from the business of keeping people well to killing them? I don't think so."