A perfect storm: fear of litigation for end of life care

摘要

A perfect storm arises from a rare confluence of adverse meteorological factors, and is a metaphor for an especially bad situation caused by a combination of unfavourable circumstances (www.oed.com). Health care at the end of life has been significantly disturbed by two converging fronts. The first is very public conversations relating to opioid overuse. The second is the current tension between standard end-of-life care and voluntary assisted suicide. The top 20% of opioid prescribers in Australia — including almost 5000 general practitioners — were recently sent letters warning them that their clinical practice was being scrutinised. This warning was an attempt to arrest an increasing number of deaths caused by overuse of prescription opioids. An unintended but predictable consequence appears to have arisen: anecdotal reports of some practitioners choosing to abandon end-of-life care altogether rather than risk professional ruin should they persist in the use of any opioid therapy. While this is still anecdotal information, when added to an overcautious attitude towards prescribing higher dose opioids among some medical practitioners even when it is clinically warranted, the consequences for patient care could be serious.