By Stacey Kusterbeck
If a physician is practicing in primary care, pediatrics, or any other practice setting other than the intensive care unit (ICU) or hospice care, it is possible that physician has never carefully considered their obligation to provide palliative care. Yet, physicians are ethically obligated to provide palliative care in all care settings and at any stage of a serious illness, according to a new opinion in the Code of Medical Ethics from the American Medical Association (AMA).1,2
The new policy makes it clear that doctors should integrate palliative care into treatment when caring for their patients, regardless of the practice setting. Physicians also should provide palliative care “for the management of symptoms and suffering occasioned by any serious illness or condition, at any stage, and at any age throughout the course of illness,” says the AMA’s ethical opinion. The opinion also specifies that physicians should simultaneously offer palliative care along with disease-modifying interventions (including attempts for cure or remission).
For the palliative care field, the new policy is a watershed moment. “This is a formal recognition that palliative care needs to be part of the fabric of care that we provide to anyone. This is a really important tool, and ethicists can take it to healthcare leadership to say: ‘This isn’t an option, or something to cut that’s an embellishment. This is at the heart of what we need to provide to all patients,” says Kristina Newport, MD, chief medical officer at the American Academy of Hospice and Palliative Medicine.
Many physicians remain unaware of the need to incorporate palliative care into their clinical practice. Others know it is an ethical obligation but lack expertise in providing palliative care. “There really is not standard palliative care education in all specialties or even all curricula for undergraduate medical education,” explains Newport.
Most large hospitals and health systems do have palliative care teams. However, there is a deficit of palliative care providers in outpatient or home-based settings. As for smaller hospitals, even if there is some availability of palliative care specialists, it does not always include interdisciplinary team members. “For ethicists, it is important to recognize the need for palliative care and to be sure that the resource is available for any patient at any point in time,” says Newport.
Ethicists can ask these questions routinely to assess the need for palliative care involvement in a case, offers Newport:
- Are providers assessing patients for symptoms of distress, pain, and spiritual suffering?
- Should palliative care be involved in this case?
A small number of physicians may decide to obtain formal training through a postgraduate hospice and palliative medicine fellowship program. The number of programs, applicants, and positions increased in recent years but remain few in number. The number of fellowship programs rose from 122 to 185, and the number of positions increased from 280 to 451 from 2016-2024, found an analysis of data from the National Resident Matching Program for Hospice and Palliative Care fellowships.3
“Most physicians won’t do that. We are looking to incorporate this education further upstream, to include it in undergraduate medical education and residency and fellowship training,” says Newport. Residents often feel that their training in palliative care is inadequate.4,5 To gain more palliative care expertise without obtaining a fellowship, clinicians can attend educational sessions at their institutions or attend palliative care conferences. “Ethicists may see a need that arises during an ethics consult to partner with palliative care to provide education across the system,” suggests Newport.
If physicians are uncomfortable providing palliative care or lack expertise to do so, it causes distrust, dissatisfaction, and distress for patients, families, and surrogate decision-makers. “This can result in conflicts, wrong treatment choices, burnout, and compassion fatigue,” warns Nasreen Lalani, PhD, an assistant professor in the School of Nursing at Purdue University.
Settings such as the emergency department, ICU, special care units, hospice, and home care encounter palliative care issues frequently. For physicians in other settings that typically are not as familiar with palliative care (such as medical/surgical inpatient units, including cardiac, neurology, dialysis, oncology, and geriatrics, and also outpatient primary care settings and psychiatric units), there is a need for additional training, says Lalani. “Rural or underserved areas often lack palliative care resources. Early training of providers, in both inpatient and outpatient areas, can make a significant difference in terms of access in those areas,” adds Lalani.
Demand for palliative care has grown significantly over the past two decades. However, socioeconomic factors affect access to palliative care.6 “Despite this growth, minoritized populations do not necessarily have easier access to the service. And where palliative care is available, the care may not be provided in a way that is sensitive to their unique cultural and/or social background,” says Brandon Varilek, PhD, RN, assistant professor in the College of Nursing at University of Nebraska Medical Center.
Varilek and colleagues analyzed 37 articles on research study methods in which palliative/end-of-life interventions were developed with minoritized populations.7 Several articles mentioned that researchers used a community-based participatory research (CBPR) approach. However, the way the authors described their methods was inconsistent. The researchers questioned whether some of the interventions truly used a CBPR approach. “There needs to be greater consistency in reporting CBPR methods in manuscripts, to ensure the tenets of CBPR are being implemented for studies that claim to use CBPR,” says Varilek.
A study using the CBPR approach would include the target community in the research team to develop the intervention. “A community advisory board is a common feature of this kind of work. They are key in providing guidance to the development of palliative care interventions that are specific for their population. If researchers aren’t sensitive to people’s culture or social background, the care is not very effective, because it is missing a lot of what ‘makes’ the person,” says Varilek.
Clinicians across disciplines should not assume that a particular palliative/end-of-life intervention will work for everyone, cautions Varilek. Even when additional training is not possible or realistic, physicians can take the time to consider their patient’s unique needs and ensure their goals of care are being met. Doctors can do this regardless of prior palliative care training, says Varilek.
In a given practice setting, clinicians may not have the resources to adapt palliative care interventions to different populations. “What they do have is the power to be humble in their knowledge of other cultures and beliefs and seek additional information from their patients directly on different aspects of palliative and end-of-life care to individualize their approach,” says Varilek. Physicians should consider the patient’s spiritual or religious beliefs or cultural practices that promote healing, for example. Some of these practices could be challenging to do in a hospital setting (such as smudging sage, sweetgrass, or tobacco, which is common in some American Indian tribes as a prayer for healing and cleansing spiritual and physical spaces of negative energy). However, to the extent possible, “ethicists should work to accommodate spiritual or cultural practices that promote healing for all minoritized populations,” says Varilek.
Stacey Kusterbeck is an award-winning contributing author for Relias. She has more than 20 years of medical journalism experience and greatly enjoys keeping on top of constant changes in the healthcare field.
References
1. O’Reilly KB. Palliative care is essential for seriously ill patients — at any age. American Medical Association. Published Jan. 27, 2025. https://www.ama-assn.org/house-delegates/ama-policies/palliative-care-essential-seriously-ill-patients-any-age
2. Comer AR, Sulmasy D. Assuring the provision of palliative care as an ethical duty for all physicians. J Pain Symptom Manage. 2025;70(1):e25-e27.
3. Goyal A, Flesner SL, Shamim U, et al. Demographic variations and temporal trends in hospice and palliative care fellowship matches in the United States. Sci Rep. 2025;15(1):29101.
4. Meo N, Hwang U, Morrison RS. Resident perceptions of palliative care training in the emergency department. J Palliat Med. 2011;14(5):548-555.
5. Schmit JM, Meyer LE, Duff JM, et al. Perspectives on death and dying: A study of resident comfort with end-of-life care. BMC Med Educ. 2016;16(1):297.
6. Sodoma A, Naseeb MW, Greenberg S, et al. Socioeconomic trends in palliative care: A six-year study. Cureus. 2024;16(10):e71274.
7. Varilek BM, Doyon K, Vacek S, Isaacson MJ. Palliative and end-of-life care interventions with minoritized populations in the US with serious illness: A scoping review. Am J Hosp Palliat Care. 2025;42(1):112-120.
