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<p><strong >Assuring Patients</strong ><br /> Death is part of life. When appropriate processes have determined that the use of life prolonging measurers or invasive interventions will only prolong the dying process, it is incumbent on physicians to accept death “not as a failure, but the natural culmination of our lives.”*</p> <p>It is the position of the North Carolina Medical Board that patients and their families should be assured of competent, comprehensive palliative care at the end of their lives. Physicians should be knowledgeable regarding effective and compassionate pain relief, and patients and their families should be assured such relief will be provided.</p> <p><strong >Palliative Care</strong ><br /> Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification an impeccable assessment and treatment of pain and other physical, psychosocial and spiritual problems. Palliative care:</p> <ul class="bullet"><li>provides relief from pain and other distressing symptoms;</li> <li>affirms life and regards dying as a normal process;</li> <li>intends neither to hasten nor postpone death;</li> <li>integrates the psychological and spiritual aspects of patient care;</li> <li>offers a support system to help patients live as actively as possible until death;</li> <li>offers a support system to help the family cope during the patient’s illness and in their own bereavement;</li> <li>uses a team approach to address the needs of patients and their families,</li> <li>including bereavement counseling, if indicated;</li> <li>will enhance quality of life, and may also positively influence the course of illness;</li> <li>[may be] applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.**</li></ul> <p><strong >Opioid Use</strong ><br /> The Board will assume opioid use in such patients is appropriate if the responsible physician is familiar with and abides by acceptable medical guidelines regarding such use, is knowledgeable about effective and compassionate pain relief, and maintains an appropriate medical record that details a pain management plan. (See the Board’s position statement on the Policy for the Use of Controlled Substances for the Treatment of Pain for an outline of what the Board expects of physicians in the management of pain.) Because the Board is aware of the inherent risks associated with effective pain relief in such situations, it will not interpret their occurrence as subject to discipline by the Board.</p> <p>*Steven A. Schroeder, MD, President, Robert Wood Johnson Foundation.</p> <p>** Taken from the world Health Organization definition of Palliative Care (2002): (<a href="http:www.who.int/cancer/palliative/definition/en" title="http:www.who.int/cancer/palliative/definition/en">http:www.who.int/cancer/palliative/definition/en</a>)</p> <p> </p> <a href="http://www.ncmedboard.org/position_statements/detail/end-of-life_responsibilities_and_palliative_care/" title="End-of-life responsibilities and palliative care">Visit Article</a>

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