Delegates focus on needs of terminally ill patients

Chicago -- More than a year after the Terri Schiavo controversy and less than six months after the U.S. Supreme Court rebutted a second challenge to Oregon's physician-assisted suicide law, the AMA House of Delegates adopted a host of initiatives at its Annual Meeting designed to make end-of-life planning and palliative care easier for physicians and patients.

The house adopted a Board of Trustees report, "Lessons from Terri Schiavo," calling on the AMA to encourage health plans and motor-vehicle departments to include advance-directive information when individuals enroll or obtain or renew their driver's licenses. A separate resolution directs the AMA to work with Medicare to give new enrollees information about advance directives.

"We want to maximize opportunities for patients to discuss end-of-life plans with other family members," said AMA Trustee Robert Wah, MD. "These opportunities should be used to prompt patients to think about advance directives and make the availability of advance directives more widespread."

The house also adopted a Board of Trustees report on palliative and end-of-life care that:

• Stresses an interdisciplinary approach to palliative care.
• Calls for subspecialty certification from the American Board of Medical Specialties.
• Encourages all physicians to become skilled in palliative medicine techniques and familiarize themselves with appropriate coding.
• Advocates for reimbursement of evaluation and management codes reflecting prolonged time spent on face-to-face care outside the hospital setting.
• Encourages research to ease symptoms for patients with advanced chronic illnesses.

The house also established an AMA Specialty Section Council on Pain and Palliative Medicine.

The council will deliberate and study scientific and educational interests and concerns related to pain and palliative care.

"When we've said we're opposed to physician-assisted suicide, we've argued that in place of that there needs to be a real place for palliative care," said AMA Trustee and Immediate Past-Chair Duane M. Cady, MD.

Dr. Cady said the Association's actions reflected its seriousness about giving suffering patients a compassionate alternative to asking their physicians to help them die.

Dr. Wah said palliative care's importance is growing in response to a simple but critical question: "How do we make sure our patients are having good pain relief at the end of life?"