More doctor training could ease pain of dying

April 23, 1998
Web posted at: 8:48 p.m. EDT (0048 GMT)

From Correspondent Dr. Steve Salvatore

NEW YORK (CNN) -- When terminally ill patients are hanging on to the last days of life, many doctors administer potent narcotics to ease their pain and suffering. But even more doctors could order such drugs, experts say, if they had training in the practice of pain relief.

"Many physicians who practice medicine are fearful of giving these medications to patients who are dying," said Dr. Lauren Shaiova of New York's Beth Israel Hospital. "They're fearful because they don't know how to administer these medications, and they deem these medications as dangerous."

CNN's Dr. Steve Salvatore looks at the use of drugs in comforting terminally ill patients

There can be a fine line between making someone comfortable and assisting in suicide, a subject that many doctors are uncomfortable with. But at least one doctor says her colleagues might be more comfortable if they had been adequately trained in pain management for people suffering debilitating and terminal diseases.

"It is clear that there is inadequate training," said Dr. Diane Meier of Mount Sinai Medical Center. "I completed four years of medical school, an internship and residency in internal medicine, and a two-year fellowship in geriatric medicine without receiving a single lecture on the proper management of pain."

PCA machine

Patient-controlled anesthesia, or PCA, machines, have revolutionized pain management for many cancer patients. Doctors set the pumps to deliver a limited amount of medication per hour. Patients can give themselves additional doses, if necessary.

Doctors say the PCA pumps are very safe. But there is still a perception that a single injection of a medication, unlike a continuous infusion, could be dangerous during the last hours of life.

"Does (the PCA pump) exist so that the intent is to hasten someone's death? I'm not sure," Meier said. "I know that it exists to make somebody comfortable. Does it actually hasten someone's death? It's debatable."

Public opinion polls show that the majority of Americans favor doctor-assisted suicide. But experts say that if doctors were more adequately trained to treat pain and suffering, physician-assisted suicide wouldn't be necessary at all.

In-Depth Health:

• Cancer

Related stories:

• Study: Few doctors assist dying patients with suicide - April 22, 1998
• Cancer survivor shares her story - March 13, 1998
• New cancer drug 'something to celebrate on Thanksgiving' - November 26, 1997
• Assisted-suicide advocates trying new tack - June 27, 1997

Related sites:

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• Your American Cancer Society
• Journal of the National Cancer Institute
• Compassion In Dying

External sites are not endorsed by CNN Interactive.

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