AMA Adopts New Policies Expanding Access to Palliative Care

New policies advocate for palliative care, at any age

The American Medical Association (AMA)’s House of Delegates has recently adopted new policies outlining physicians’ ethical obligations to provide or seek “optimal palliative care” for patients with serious illnesses. The most notable of several changes is that guidelines will now include a much broader range of people who need symptom relief, including those who don’t have a terminal illness or individuals on the precipice of death.  

The American Medical Association Purvue

The AMA is the largest association of physicians and medical students in the United States. Their mission is to promote the art and science of medicine, maintain codes of medical ethics, and improve public health. They most visibly do this by representing physicians in legislative and court bodies, but they also publish the Journal of the American Medical Association (JAMA), a publication often relied upon for medical guidance. In this way they help shape how many doctors practice medicine across the nation. 

The AMA’s House of Delegates (HOD) – consisting of those who convened to vote upon and establish these new policies – is the principal policymaking body of the AMA. Functioning much like a Congress, the AMA HOD is made up of representatives from state medical societies and national speciality societies, who advocate for resolutions and reports on a variety of issues relating to their fields. 

The New Palliative Care Policies

According to the article released by the AMA, the new policy will be incorporated into the AMA Code of Medical Ethics, one of the most comprehensive ethics guides available for physicians to use as reference. 

“Physicians have clinical ethical responsibilities to address the pain and suffering occasioned by illness and injury and to respect their patients as whole persons,” says one of the new policies adopted at the latest AMA Interim Meeting. “These duties require physicians to assure the provision of effective palliative care whenever a patient is experiencing serious, chronic, complex or critical illness, regardless of prognosis,” [emphasis ours].

The new policies also adjusted the definition of palliative care to read as: “sound medical treatment that includes the comprehensive management and coordination of care for pain and other distressing symptoms including physical, psychological, intellectual, social, spiritual and existential distress from serious illness.” The policy further notes that “palliative care is widely acknowledged to be appropriate for patients who are close to death, but persons who have chronic, progressive, or eventually fatal illnesses often have symptoms and experience suffering early in the disease course.”

“The clinical ethical responsibilities to address symptoms and suffering may therefore sometimes entail a need for palliative care before the terminal phase of the disease.” 

Why This Matters

As one of the trusted authorities doctors turn to when deliberating about a patient’s treatment course, the AMA holds massive sway in terms of what kind of care patients receive. They also wield formidable lobbying power across the nation, shaping healthcare policy and influencing legislation. So, by passing this change in official policy, the AMA is hoping to expand access to palliative care in terms of who receives it, and when. Instead of being offered as a last resort when people are actively dying, they are advocating that it be offered alongside treatments and management of symptoms, even for those whose prognosis isn’t terminal. 

As things stand currently, research shows that early integration of supportive and palliative care is woefully underused. For example, a recent study found that many patients with advanced cancer diagnoses received aggressive cancer care within six months of their death; treatment that came at the expense of palliative and hospice care. The study further found that only a quarter of patients received any palliative care, and when it did come, it was usually provided in the month they died. 

If palliative care is difficult to access by those who are actively dying from advanced disease, imagine how difficult it must be for people who suffer chronic illness but aren’t anywhere near death. Hopefully, these new policies will find their way into popular discourse, and effect some change for the better.