Responding to requests for hastened death in patients living with advanced neurologic disease

Palliative care to support the needs of adults with neurological disease

Neurological diseases cause physical, psychosocial, and spiritual or existential suffering from the time of their diagnosis. Palliative care focuses on improving quality of life for people with serious illness and their families by addressing this multidimensional suffering. Evidence from clinical trials supports the ability of palliative care to improve patient and caregiver outcomes by the use of outpatient or home-based palliative care interventions for people with motor neuron disease, multiple sclerosis, or Parkinson's disease; inpatient palliative care consultations for people with advanced dementia; telephone-based case management for people with dementia in the community; and nurse-led discussions with decision aids for people with advanced dementia in long-term care. Unfortunately, most people with neurological diseases do not get the support that they need for their palliative care under current standards of healthcare. Improving this situation requires the deployment of routine screening to identify individual palliative care needs, the integration of palliative care approaches into routine neurological care, and collaboration between neurologists and palliative care specialists. Research, education, and advocacy are also needed to raise standards of care.

Harmonizing conscience claims and patient access to assisted death

The rights of patients to receive legally permissible interventions sometimes conflict with enshrined rights of providers to object, for reasons of conscience, to providing those interventions. Getting the balance right is challenging. But reasonable balance to manage these conflicting imperatives can be achieved in the design of programs for assisted death. Rather than limiting the discourse to the platform of competing individual rights, health leaders are urged to consider the broader societal benefits and impacts of valuing conscience in the practice of medicine, the creation of regulation and policy, and the delivery of healthcare. A method to determine that conscience claims are "genuine," "reasonable," and "acceptable" needs developing. A list of criteria toward this determination is offered.