By Chris Adams

People don’t go to an oncologist wanting to die.

When it comes to the care of cancer patients, end-of-life discussions need to be had – and the American health care system is poorly equipped to do so, says Carol Taylor, an ethicist at Georgetown University and professor in its School of Nursing and Health Studies.

Taylor told National Press Foundation fellows there is a shortage of doctors proficient in palliative care; there also is a reluctance among providers to have direct and honest conversations about end-of-life issues. Beyond that, there’s inadequate financial and organizational support to help those at the end of their lives.

It’s a problem for many advanced cancer patients, who receive aggressive treatments in the last weeks of their lives even as hospice care is not discussed until it’s too late, Taylor said. Her conversation with fellows went through the range of palliative interventions, ranked from least to most ethically controversial:

  • Standard pain management,
  • Forgoing life-sustaining therapy,
  • Voluntarily end to eating and drinking,
  • Heavy sedation to escape pain,
  • Assisted suicide,
  • Non-voluntarily stopping eating and drinking,
  • Voluntary active euthanasia.

Taylor also pointed to the National Consensus Project for Quality Palliative Care, which gives clinical practice guidelines for the field.