Profession

California law mandates discussing end-of-life options

Physicians must talk about hospice, at the request of dying patients, but they are not required to discuss palliative sedation or refusal of food and water.

By — Posted Nov. 10, 2008

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

A new California law requires physicians and health care organizations to provide terminally ill patients with "comprehensive information and counseling" about their legal end-of-life care options upon request.

The measure -- known as the Terminal Patients' Right to Know End-of-Life Options Act -- says such patients have a right to be told about hospice care and advance directives, and their right to refuse life-sustaining treatment and to continue treatment while receiving palliative care. Patients also must be informed of their "right to comprehensive pain and symptom management at the end of life," including "clinical treatments useful when a patient is actively dying."

The law, which backers said is the first of its kind nationally, was supported by the California Medical Assn. after it was substantially changed. Gov. Arnold Schwarzenegger signed the bill Sept. 30; the law takes effect Jan. 1, 2009.

An earlier version required doctors to tell patients whose prognosis suggested less than a year to live about alternatives such as palliative sedation and refusing food and water to speed the dying process. Although palliative sedation is an attempt to relieve a patient for whom pain control efforts have failed, it can, in rare instances, hasten death. (See Clarification)

"Patients have not been having completely candid conversations with doctors about end-of-life options," said Barbara Coombs Lee, president of Compassion & Choices, which sponsored the legislation and also supports legal access to physician-assisted suicide. "When patients ask the question, it means they are ready and eager to know the answers. We don't think physicians need to be afraid of overwhelming patients with too much information when they are following the patients' lead."

A Feb. 8, 2007, New England Journal of Medicine study of more than 1,000 physicians found that nearly one in 10 objected to palliative sedation and did not feel obligated to refer patients to another doctor willing to offer the service. Several recent studies have found that patient-physician communication about end-of-life care leads to more use of hospice and better symptom control during the dying process.

The Assn. of Northern California Oncologists opposed the earlier version of the bill but changed its position to neutral after modifications were made. Robert S. Miller, MD, the group's past president, said the law unduly interferes with the patient-physician relationship. But he said it is far better than the earlier version that he believed rushed the discussion of last-resort options, such as palliative sedation, that patients might find upsetting.

"I don't think [the law] changes any of the physician behaviors already happening," Dr. Miller said. "Now it just codifies it, saying you have to do it."

Lee said other states should follow California's lead.

"It's good legislation," she said.

Back to top


Clarification

This article stated the law does not require physicians to tell terminally ill patients specifically about palliative sedation and voluntary refusal of water and food. However, the law does require doctors to give patients "comprehensive" information about legal end-of-life choices, which could include discussing those options.

Back to top


ADVERTISEMENT

ADVERTISE HERE


Featured
Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story


Read story

Goodbye

American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story


Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story


Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story


Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story


Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story


Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story


Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story