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.
