Pain Management

Pain relief has become a central issue in quality care of the dying and in the debate over assisted suicide. Among the chief reasons frequently noted for the inadequacy of the treatment of pain is that the legal system actually penalizes effective interventions to relieve pain while it leaves neglect of pain unthreatened. In response, several states have acted to reduce the treat of disciplinary action against physicians who appropriately treat pain. Similarly, professional and consumer organizations have all advocated more emphasis on improved communication between the physician and patient.

Over the past ten years, legislators and policy makers have also have paid great attention to the important issues surrounding assisted suicide and end of life care. In 1997, for example, the U.S. Supreme Court affirmed that state legislatures may decide whether or not to legalize physician assisted suicide. While the decision struck down a patient’s right to receive physician-assisted suicide, the Supreme Court arguments generated substantial interest in the care and treatment of patients at the end of life. In response, several state legislatures began to explore ways in which to improve the care of the seriously ill and dying patients. By early 1998, at least 20 states had established commissions or task forces to examine end of life care issues. Most of the task forces have focused on the themes that are highlighted in this report, including addressing barriers to improving end-of-life care services, discussing factors associated with physician-assisted suicide or encouraging better pain management by physicians.

The purpose of this guidebook is to provide information about the medical, ethical and legal issues at the end of life. Since the issues surrounding end of life care are complex, however, this guidebook is intended to serve as an introduction to the topic. Toward this goal, this report summarizes and analyzes legislation on intractable pain and barriers to effective pain relief. It also highlights the major policy considerations that must be addressed in order to reach consensus on future strategies. This report must be read in context with broader state health care reform and assisted suicide legislation, as well as important federal legislative and regulatory approaches that affect medical practitioners and the prescription of controlled substances.