I was recently quoted in an American Medical News article about the growth of palliative care services and their relationship to ethics consultation service.
In this article, Kevin O’Reilly does a nice job of highlighting the relationship between palliative care services and ethics consultation services. I state in the article that the relationship is “almost symbiotic.” What I meant by this is that a good palliative care service can effectively address ethics issues, referring to an ethics consultation if needed, and similarly a good ethics consultation service will highlight the need for palliative care in certain cases, referring to a formal palliative care service in those cases that need them. Because the vast majority of the cases we see as ethics consultants involve patients who are critically (and often terminally) ill, palliative care can play a natural role. This begs the question as to whether palliative care fellowships do an adequate job of training their fellows in the nuances of end of life care counseling. According to this study published in 2007, “Fellows reported a general lack of training in EOL care, and only 41% rated their education as at least “somewhat” adequate.” A cursory search revealed a handful of programs that integrate formal ethics content into their palliative care fellowship programs (e.g. Pitt, OHSU, Memorial Sloan-Kettering). The question I pose is whether there should be more formal ethics curriculum in the way palliative care fellows are trained? And, similarly, do clinical ethics consultation fellowships need to more carefully integrate knowledge of palliative care into their training programs?