Palliative care services, patient abandonment, and the scope of physicians' responsibilities in end-of-life care

Background: Palliative care consultation services are being established at a growing pace in medical centers throughout the country. The intervention of these services may improve the quality of end-of-life care in many ways, but it may also promote an unintended outcome of patient abandonment by primary physicians. Objective: To discuss the nature of patient abandonment in end-of-life care, the moral problems that it poses for palliative care clinicians in their consultative activities, and the implications of patient abandonment for palliative care services. Design: Case study and conceptual analysis of two cases from the experience of the University of Pittsburgh Medical Center Palliative Care Service. Conclusions: The problem of patient abandonment raises deep questions about the proper scope of physicians' responsibilities to dying patients, and unmasks inherent tensions between the goals and functions of palliative medicine services. We offer suggestions on how palliative care services might deal effectively with these tensions, to minimize patient abandonment, and more effectively realize their moral mission.