Tuesday, October 21, 2008

Terminal patients' rights law in California gives "right to know" end-of-life options

From Jane Gross' The New Old Age blog for the NY Times:

Terminally ill patients in California are the first in the nation to have a legal right to information from their doctors, upon request, about end-of-life options, including hospice, palliative care, refusing or withdrawing life-prolonging treatments, and making the choice to refuse food and hydration.

The new legislation, called the Terminal Patients’ Right to Know End-of-Life Options Act and championed by the advocacy group Compassion and Choices, was signed into law last month by Gov. Arnold Schwarzenegger with the backing of the California Medical Association (C.M.A.), which had staunchly opposed a 1992 state ballot measure and a 2005 bill that would have permitted physician-assisted suicide, which is currently legal only in Oregon. (Voters in Washington state will cast ballots on a measure comparable to Oregon’s on Nov. 4.)

The C.M.A.’s support of the new law came only after the legislation was tweaked so that physicians were not required to volunteer such information unless asked, lest raising the subject unbidden seem like undue influence. The association also insisted that health care providers who are not comfortable complying with a patient’s wishes — say, to refuse a ventilator, to abandon chemotherapy or antibiotics, or to stop eating and drinking — be able to recuse themselves from hands-on care, provided they see to it that the patient is assigned to another professional who will support their wishes.

“Too many patients make the most important decision of their lives without being fully informed of their legal rights,” said Barbara Coombs Lee, president of Compassion and Choices. “This law serves as a national model for patients to receive the necessary information and power to influence the manner of death. It shifts physician-patient communication from a paternalistic model to a cooperative one.”

The law’s most likely effect will be to increase participation in hospice and palliative care and to move Californians into such programs earlier, since at present they often are unaware or poorly informed about these options. More controversial will be a patient’s right to refuse or discontinue medical treatment, along with food and water, with the goal of hastening death.