title: Palliative care services, patient abandonment, and the scope of physicians' responsibilities in end-of-life care.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: Cancer Prevention Fellowship Program, Basic and Biobehavioral Research Branch, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, Maryland 20892-7363, USA. hanp@mail.nih.gov
authors.forename: Paul K J
authors.initials: PK
authors.lastname: Han
authors.forename: Robert M
authors.initials: RM
authors.lastname: Arnold
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000458:organization & administration*; D010414:Pennsylvania; D010819:Physician's Role; D012017:Referral and Consultation / Q000592:standards; D016079:Refusal to Treat; D019452:Terminally Ill