Suicide Prevention

Calls to legalize physician-assisted suicide reflect public concern that the current health care system does not adequately relieve suffering for people with certain medical problems. People suffering from terminal illnesses, chronic diseases, or disabilities may be especially vulnerable to suicide because their need or desire for palliative--or comfort--care may not be met in a health care system that stresses curative treatments. Palliative care embraces a range of approaches to manage the physical, psychological, social, and spiritual suffering that may accompany health conditions that do not respond to treatment. Its goal is to improve the quality of life for patients and their families by dealing with issues like depression and pain management. Concerned about the suicide rates among persons whose health problems are unresponsive to curative treatment, Congress has funded research into palliative care issues. This report discusses (1) the extent to which the physician training process currently teaches and tests student competency in palliative care issues, (2) the Department of Health and Human Services' plans to fund palliative care projects under section 781 of the Public Health Service Act, and (3) other federal and private palliative care research and education initiatives.

GAO noted that: (1) physicians receive varying amounts of instruction in palliative care topics as they progress through 4 years of medical school and 3 to 8 years of subsequent specialized training in a residence program; (2) each of the seven palliative care areas in GAO's survey was required by 56 percent or more of the 125 medical schools responding to its survey; (3) similarly, about half of the 7,787 specialty and subspecialty residency programs educated students in end-of-life care; (4) GAO's survey showed that many medical schools are interested in providing additional instruction and training in palliative care; (5) about one-third of the schools reported a need to change their curriculum for addressing palliative care for the chronically and terminally ill; (6) close to half reported a need to include more clinical training in managing pain and depression for these patient populations; (7) HHS officials plan to use $150,000 of the $452,000 specified for section 781 in the FY 1998 appropriations conference report to support seven medical education research projects, including one palliative care project; (8) officials from HHS and the medical education research center receiving these funds were not able to specify the amount being spent on the palliative care project because separate budgets are not developed for each project; (9) of the remaining section 781 funds, all $302,000 will be used to support research for improving the distribution and diversity of the health care workforce; (10) because of the higher priority that HHS has assigned to this other research, officials do not plan to use any funds for palliative care research, training, or demonstration projects in 1999; (11) nevertheless, a substantial amount of research related to palliative care is being funded in ways other than through section 781; (12) over the last few years, HHS and private entities have invested tens of millions of dollars into projects similar to those specified in the Assisted Suicide Funding Restriction Act; (13) some HHS agencies have more general projects, not specified in the act, that could also benefit palliative care in the areas of increasing health care access, improving quality of care, and advancing biomedical research; and (14) private foundations and other private organizations have spent millions of dollars to educate and train health care professionals in palliative care and improve the quality of care for the terminally and chronically ill.