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Legal aspects in palliative and end of life care in the United States

Author
Thaddeus M Pope, JD, PhD
Section Editor
Robert M Arnold, MD
Deputy Editor
Diane MF Savarese, MD

INTRODUCTION

Caring for patients at the end of life is a challenging task that requires not only the consideration of the patient as a whole but also an understanding of the family, social, legal, economic, and institutional circumstances that surround patient care. Unfortunately, there are many myths and misconceptions about what may or may not be ethical and legal in this setting [1].

In the United States, fear of litigation may prompt unnecessary interventions or hinder clinicians from acting completely ethically when they are faced with a patient with life-threatening illness [2]. One study found that as many as 93 percent of clinicians in high-risk medical specialties (ie, emergency medicine, general surgery, orthopedic surgery, neurosurgery, obstetrics/gynecology, and radiology) report practicing defensive medicine in that they did testing beyond what they felt was clinically necessary [2].

Acting in a manner that does not comply with the law can have serious consequences for both the patient and physician. Negative consequences for patients include receiving unwanted treatment or not receiving treatment that is wanted. Both scenarios could potentially result in civil and criminal sanctions for physicians [3]. Importantly, the mere absence of explicit legal authorization for an action does not mean that action is prohibited. Medicine remains a largely self-regulated profession. There is comparatively more law regarding end of life care. But, the law does not and cannot directly address all interventions and procedures.

Understanding the legal aspects of end of life care should give the practicing clinician the confidence and freedom to act ethically and reasonably. Some of the legal standards regarding end of life care in the United States vary by state, but there are specific legal precedents surrounding end of life care that generalize. When in doubt, clinicians should consider an ethics consultation, seek legal counsel, or seek assistance from risk management.

Different hospitals will have different structures and roles for these different departments. Most hospitals have an ethics consultation service available 24 hours a day, seven days a week. This service helps clinicians navigate conflict and uncertainty and helps determine which actions should or should not be taken. Many of the issues most frequently handled by ethics consultants are end of life issues. (See "Ethical issues in palliative care" and "Palliative care: Medically futile and potentially inappropriate therapies of questionable benefit" and "Ethical issues in the care of the patient with end-stage renal disease" and "Ethics in the intensive care unit: Responding to requests for potentially inappropriate therapies in adults".)

                                
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Literature review current through: Sep 2017. | This topic last updated: Jul 24, 2017.
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