Effectiveness of Long-Term Opioid Therapy for Chronic Pain in an Outpatient Palliative Medicine Clinic.

Despite widespread use of opioid therapy in outpatient palliative medicine, there is limited evidence supporting its efficacy and safety in the long term. We sought to improve overdose risk scores, maintain pain reduction, and preserve patient function in a cohort with severe chronic pain as we managed opioid therapy for a duration of four years in an outpatient palliative care clinic. Over four years, we provided ongoing goal-concordant outpatient palliative care, including opioid therapy, using quarterly clinical encounters for a patient cohort with chronic pain.

Criminal prosecutions of physicians providing palliative or end-of-life care.

Although medical malpractice suits commonly occur in medical practice, few physicians experienced criminal prosecution related to adverse clinical outcomes before 1990. Criminal prosecutions of physicians increased in frequency early in that decade, however, including a handful of cases involving palliative or end-of-life care. Reviews published around the end of the 1990s examined those prosecutions, listing causative factors and offering recommendations to prevent further cases.

Evolving medicolegal issues in palliative medicine.

The successful practice of hospice and palliative medicine requires basic knowledge of its medicolegal aspects. In this paper, we review several recent legal cases that highlight important, evolving legal issues in palliative medicine. These issues include efforts to change to advance directive laws after the Schiavo conflict, the Attorney General's challenge to Oregon's physician-assisted dying law, and the emergence of a tort for inadequate pain management.

Closing the Schiavo case: an analysis of legal reasoning.

The conflict surrounding Terri Schiavo, whom Florida's courts had determined wished not to be kept alive in a persistent vegetative state, played out on a national stage. The dispute between Schiavo's husband and parents engulfed America's legislative, executive, and judicial systems, raising profound questions about the laws and policies that govern advance directives. In this paper, we offer an analysis of the legal reasoning in Schiavo and offer predictions about the case's likely impact on law and policy in the future.