AMA Releases Position Statement on End of Life Care

The AMA today released its new Position Statement on End of Life Care and Advance Care Planning 2014.

AMA Vice President, Dr Stephen Parnis, said there should be open and frank discussion in the community about death and dying, including end of life care options, futile treatment, caring and bereavement, and advance care planning.
“Patients with a terminal condition, and their family members and carers where appropriate, should be empowered to participate in managing their treatment at end of life,” Dr Parnis said
“This requires effective, ongoing communication. “Good communication between the patient, their family members and carers, and the health care team should occur throughout the course of the patient’s illness.
“This will alleviate fear, confusion, and guilt over the patient’s condition, assist with decision-making, and reduce the potential for conflict over the patient’s care.
“Doctors should endeavour to meet the patient's care needs and uphold their care preferences, which should guide decision-making and planning.
“Doctors and health care teams will continue to provide care and support throughout a patient's illness, including when the patient moves from curative care to palliative care.
“Quality palliative care is focussed on symptom management and comfort measures that provide physical, psychological, social, emotional, and spiritual support for patients and their family members and carers.”
Dr Parnis said that advance care planning is an important means to elicit a patient’s wishes and their preference for end of life care in the event they lose decision-making capacity.
“An advance care plan is a process of ongoing reflection, discussion, and communication of health care preferences that may result in oral or written directives, such as an advance care directive.
“Legally competent patients have the right to make health care decisions, including the right to refuse interventions such as life-sustaining treatment.
“Patients with limited or impaired capacity should be encouraged and supported to participate in treatment decisions, consistent with their level of capacity at the time a decision is needed.
“There should be equity of access across Australia to appropriate services including palliative care, respite care, bereavement support, carers' support, and other relevant services for patients undergoing end of life care,” Dr Parnis said.
According to the AMA Position Statement, good quality end of life care should:

• ensure the patient is always treated as an individual, with respect, dignity and compassion in a culturally sensitive manner;


• endeavour to meet the patient’s care needs and uphold their care preferences, which should guide decision-making and planning;


• strive to ensure that the patient is free from suffering;


• endeavour to facilitate care in the patient’s environment of choice, where practical, recognising that a patient’s health care needs may change in the course of their condition;


• ensure that the patient’s goals and values for end of life care are respected;


• respect the patient’s privacy and confidentiality, even after death;


• support not only the physical needs of the patient but also the psychological, emotional, religious and spiritual needs of the patient and their family members and carers;


• empower patients and, where appropriate, their family members and carers, to participate in managing their treatment;


• provide counselling and other support to patients, their family members and carers throughout the patient’s condition, including support for family members and carers beyond the patient’s death;


• ensure patients and their family members and carers have access to good quality palliative care resources such as educational materials, as well as physical aids in a timely, easily accessible, and coordinated manner;


• recognise the role of doctors, allied health care professionals, carers, and the wider community in working together to meet the needs of patients; and


• facilitate continuity and coordination of care within and between medical, health and community services, including when the patient moves from medical care that is primarily focused on curative treatments to care that is focused on palliative treatments.