2008 Woodie Awards
The Daily OrangeCalifornia requires discussion of end-of-life options
By Rebecca Strum
Posted: 11/3/08, 4:21 AM EST Section: News
California is the first state to grant patients the legal right to ask for information about end-of-life options, such as ending life support and refusing food and water. California's Gov. Arnold Schwarzenegger signed the Terminal Patients' Right to Know End-of-Life Options act into law Sept. 30.
The law followed similar legislation in Oregon, which allows for physician-assisted suicide. The new law mandates doctors to disclose all the options to patients, which still exclude physician-assisted suicide. Patients expect full disclosure from doctors, but disclosure has never been lawfully enforced.
Professors from Syracuse University explain the basics of what the new California legislation means.
Meet the experts:
-James Jacobs, director of Health Services at SU
-Thomas Dennison, professor of public administration at the Maxwell School of Citizenship and Public Affairs
-Douglas A. Wolf, professor of public policy at the Maxwell School of Citizenship and Public Affairs
-Madonna Harrington Meyer, director of SU's Gerontology Center's Lifelong Learning Institute and professor of sociology at the Maxwell School of Citizenship and Public Affairs
The Daily Orange: Why didn't patients have access before?
Jacobs: The only thing this law (Terminal Patients' Right to Know End-of-Life Options Act, AB 2747) does is to require conversations between physicians and patients/families that should already be occurring. Most health care providers who work with terminally ill patients are well versed in, and committed to, having these end-of-life conversations, but I suppose that this law will be used to hold providers accountable to ensure that the discussions occur and are documented.
The Daily Orange: Why did California pass this law?
Dennison: Many doctors are reluctant to bring up end-of-life options. We have, historically, not done a good job about end-of-life care. California has taken a step further. They're saying that, 'we don't think that doctors are providing patients with all their end-of-life options.' This law in California is another recognition that nothing should be left out of the information for patients. People have always had the right to information. To give medical consent is to agree under the conditions of having been given full information. When all the options aren't discussed, the patient is not fully informed.
The Daily Orange: Will this ever be New York?
Dennison: In New York, we have the long-term home health care program for people who are terminally ill. It was developed as an alternative to nursing home care. New York state passed a law to require every patient leaving the hospital to have the option of the long-term health care program. Locally, in Syracuse, St. Joseph's hospital has a well-developed program of palliative care. This is very recent. They are certified specialists in palliative care, consisting of a nurse, a social worker, and spiritual guidance, a chaplain. That team works with you and your family to determine the best option. Hospice is only paid for by Medicare if the patient is given a six-month prognosis. This can start much earlier than hospice care, sometimes for people that could live for another two or three years.
The Daily Orange: What are the implications of this new legislation?
Wolf: It's a good idea for patients to have a law that requires doctors to give out information, particularly end-of-life care. Now, the options offered are scary, so they have to be presented in a way that they (patients) understand it. There was a law passed, a federal law, about end-of-life termination that should have gotten started already. People should have the responsibility for their own care, if they can. I think there's obviously the perception that doctors feel that they're professionally obliged to recommend treatments; no matter how expensive they are or how risky they are, they don't want to leave any possibility out. They don't want to get themselves charged that they haven't done everything they could. The growing recognition is that most people don't necessarily want the most expensive or invasive treatment, and they only want to prolong a good life. I don't know if New York is planning on passing this law, but it certainly seems like a good idea.
The Daily Orange: What is your opinion of the new California legislation?
Meyer: Patients and their families have the right to full disclosure and full information to all aspects of their health and their right to die, and to have that information that will help them die more easily. California passed a law that mandated that responsibility. If there was to be similar legislation in New York, I would fully support it.
rastrum@syr.edu
The law followed similar legislation in Oregon, which allows for physician-assisted suicide. The new law mandates doctors to disclose all the options to patients, which still exclude physician-assisted suicide. Patients expect full disclosure from doctors, but disclosure has never been lawfully enforced.
Professors from Syracuse University explain the basics of what the new California legislation means.
Meet the experts:
-James Jacobs, director of Health Services at SU
-Thomas Dennison, professor of public administration at the Maxwell School of Citizenship and Public Affairs
-Douglas A. Wolf, professor of public policy at the Maxwell School of Citizenship and Public Affairs
-Madonna Harrington Meyer, director of SU's Gerontology Center's Lifelong Learning Institute and professor of sociology at the Maxwell School of Citizenship and Public Affairs
The Daily Orange: Why didn't patients have access before?
Jacobs: The only thing this law (Terminal Patients' Right to Know End-of-Life Options Act, AB 2747) does is to require conversations between physicians and patients/families that should already be occurring. Most health care providers who work with terminally ill patients are well versed in, and committed to, having these end-of-life conversations, but I suppose that this law will be used to hold providers accountable to ensure that the discussions occur and are documented.
The Daily Orange: Why did California pass this law?
Dennison: Many doctors are reluctant to bring up end-of-life options. We have, historically, not done a good job about end-of-life care. California has taken a step further. They're saying that, 'we don't think that doctors are providing patients with all their end-of-life options.' This law in California is another recognition that nothing should be left out of the information for patients. People have always had the right to information. To give medical consent is to agree under the conditions of having been given full information. When all the options aren't discussed, the patient is not fully informed.
The Daily Orange: Will this ever be New York?
Dennison: In New York, we have the long-term home health care program for people who are terminally ill. It was developed as an alternative to nursing home care. New York state passed a law to require every patient leaving the hospital to have the option of the long-term health care program. Locally, in Syracuse, St. Joseph's hospital has a well-developed program of palliative care. This is very recent. They are certified specialists in palliative care, consisting of a nurse, a social worker, and spiritual guidance, a chaplain. That team works with you and your family to determine the best option. Hospice is only paid for by Medicare if the patient is given a six-month prognosis. This can start much earlier than hospice care, sometimes for people that could live for another two or three years.
The Daily Orange: What are the implications of this new legislation?
Wolf: It's a good idea for patients to have a law that requires doctors to give out information, particularly end-of-life care. Now, the options offered are scary, so they have to be presented in a way that they (patients) understand it. There was a law passed, a federal law, about end-of-life termination that should have gotten started already. People should have the responsibility for their own care, if they can. I think there's obviously the perception that doctors feel that they're professionally obliged to recommend treatments; no matter how expensive they are or how risky they are, they don't want to leave any possibility out. They don't want to get themselves charged that they haven't done everything they could. The growing recognition is that most people don't necessarily want the most expensive or invasive treatment, and they only want to prolong a good life. I don't know if New York is planning on passing this law, but it certainly seems like a good idea.
The Daily Orange: What is your opinion of the new California legislation?
Meyer: Patients and their families have the right to full disclosure and full information to all aspects of their health and their right to die, and to have that information that will help them die more easily. California passed a law that mandated that responsibility. If there was to be similar legislation in New York, I would fully support it.
rastrum@syr.edu
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