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  • Introduction
  • 1. Advance Care Planning
  • 2. Communicating Bad News
  • 3. Whole Patient Assessment
  • 4. Pain Management
  • 5. Assisted Suicide Debate
  • 6. Anxiety, Delirium
  • 7. Goals of Care
  • 8. Sudden Illness
  • 9. Medical Futility
  • 10. Common Symptoms
  • 11. Withholding Treatment
  • 12. Last Hours of Living
  • 13. Cultural Issues
  • 14. Religion, Spirituality
  • 15. Legal Issues
  • 16. Social and Psychological
  • More About:

  • Hospice Care
  • Clergy and Faith Communities
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    Legal Issues

    Appropriate Use of Opioids in End of Life Care: Developing Consensus
    • Palliative care and hospice concepts developed in response to ethical mandate that patients and families should receive care that
      • Relieves suffering
      • Improves the quality of their lives
    • Both depend on the appropriate use of opioids to relieve pain, shortness of breath, and other symptoms
    • The federal Drug Enforcement Agency and state licensure and drug regulation agencies charged with enforcing laws concerning controlled medical substances, such as opioids
      • Traditionally, these agencies monitored physicians’ prescriptions for opioid use

      • In the past, many physicians and regulators were overly concerned about problems associated with substance abuse and addiction

      • Today, growing awareness by regulatory bodies of the role of opioids in medical practice

        • Lessening concerns about addiction when physicians prescribe opioids
    • Principle of double effect recognizes the difference between
      • Provision of adequate treatment that unintentionally hastens death

    • Physicians have responsibility to be aware of realistic risks associated with treatments (e.g., the minimal risk of death associated with opioids when prescribed appropriately for pain relief)
    • Physicians should feel comfortable providing medication, including opioids
      • Using accepted dosing guidelines to alleviate a patient’s pain and suffering
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