AMA Code of Medical Ethics' Opinions Related to End-of-Life Care

Caring for patients at the end of life (EOL) can be emotionally and ethically challenging for patients, families, and physicians and other health professionals. In accordance with the principle of respect for patient autonomy, patients should feel comfortable expressing their preferences for the EOL care they would like to receive, setting goals for treatment, and choosing surrogate decision makers as appropriate. Physicians are responsible for assisting patients in creating plans for EOL care, encouraging discussion of this subject with sensitivity to patients' situations, and respecting patients' preferences for EOL care. In many cases, compassion and clear communication are important in providing optimal EOL care, as discussed in Chapter 5 of the Code of Medical Ethics, "Opinions on Caring for Patients at the End of Life." Advance Care Planning Opinion 5.1, "Advance Care Planning," encourages physicians and patients to plan "in advance for decisions about care in the event of a life-threatening illness or injury." 1 Advance care planning is an effective way to engender discussions among patients, health professionals, surrogate decision makers, family members, and other close contacts about end-of-life (EOL) care. These discussions can support patients in determining their values and preferences regarding the goals of care and the types of services they want to receive as they approach death. Physicians can also take this opportunity "to address patients' concerns and expectations and clarify misunderstandings individuals may have about specific medical conditions or interventions." 1 However, such discussions should not begin only after a potentially fatal illness or injury has befallen a patient. Physicians should "regularly encourage all patients, regardless of age or health status" to consider these issues, "periodically review" with them their "goals, preferences, and chosen decision maker," and include notes from these conversations in medical records. 1 Physicians should make an effort to discuss advance care planning with patients across the age spectrum, encouraging them to think proactively about issues in EOL care, as any patient can find himself or herself afflicted with a potentially fatal condition. For example, medical literature indicates that young adults, who may become caregivers for aging family members, and adolescent oncology patients in particular need to be engaged in advance care planning. 2-4 However

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