New York's Patient Right to Palliative Care Information Act

New York's Patient Right to Palliative Care Information Act passed the state Assembly in March (A.B. 7617) and the state Senate in June (S.B. 4498).  This week, it was sent to the Governor.  Once the Governor signs this bill, New York will join California and a small handful of states that mandate the disclosure of end-of-life treatment options.  The bill would add a new section 2997-C to the Public Health Law.  Here is the full text:

1. Definitions. As used in this section, the following terms shall have the following meanings, unless the context clearly requires otherwise:

(a) "appropriate" means consistent with applicable legal,  health  and professional  standards; the patient's clinical and other circumstances; and the patient's reasonably known wishes and beliefs.

(b) "attending health care practitioner" means a physician or nurse practitioner who has primary responsibility for the care and treatment of the patient. Where more than  one  physician or nurse practitioner share that  responsibility,  each of them has responsibility under this section, unless they agree to assign that responsibility to one of them.

(c) "palliative care" means health care treatment, including interdisciplinary end-of-life care, and consultation with  patients  and  family members, to prevent or relieve pain and suffering and to enhance the patient's quality of life, including hospice care under article forty of this chapter.

(d) "terminal illness or condition" means an illness or condition which can reasonably be expected to cause death within six months, whether or not treatment is provided.

2. If a patient is diagnosed with a terminal illness or condition, the patient's attending health care practitioner shall offer to provide  the patient  with  information  and counseling regarding palliative care and end-of-life options appropriate to the patient, including but not limited to: the range of options appropriate to the patient; the prognosis, risks and benefits of the various options; and the patient's legal rights to comprehensive pain and symptom management at the end of life.  The information and counseling  may be provided orally or in writing.  Where the patient lacks capacity to reasonably understand and make informed choices relating to palliative care, the attending health care practitioner shall provide information and counseling under this section to a person with  authority to make health care decisions  for  the patient.  The attending health care practitioner may arrange for information and counseling under this section to be provided by another professionally qualified individual.

3.  Where the attending health care practitioner is not willing to provide the patient with information and counseling under this  section, he or she shall arrange for another physician or nurse practitioner to do so, or shall refer or transfer the patient to another physician or nurse practitioner willing to do so.

Compulsory Euthanasia at 80: The Ad Campaign

The Gruen Transfer is a show on Australia's ABC1 about advertising, how it works, and how it works on us.  In one segment called 'The Pitch', agencies compete to fulfill a seemingly impossible brief.  Recently, two agencies pitched ads for compulsory euthanasia at 80.  These ads are actually really good and could be readily recast to support a more palatable message.      

Advance Care Planning Completed by 75% of Senior Citizens

A Thomson Reuters survey of more than 3,000 U.S. households found that 57 percent of Americans had made their end-of-life care choices known. Nearly three-quarters of people over 65 and about a third of individuals under 35 had voiced their wishes.  This is encouraging.  These figures are substantially higher than those traditionally reported in academic literature or even in similar surveys.

Among those respondents who conveyed their end-of-life preferences, 87 percent chose informal communication with family, friends, or loved ones to express their wishes. Sixty percent had created a living will, and 50 percent chose to employ a healthcare power of attorney.

People over 65 were more likely to chose a living will or healthcare power of attorney, while younger adults tended to opt for informal communication. Those who took formal steps over informal communication - particularly those in higher income brackets - received legal assistance preparing their document.

The survey found that about 10 percent of participants had made a medical decision for another person in the last 12 months, and in over half of those cases a living will or a medical directive was available. 

Dying with Dignity - on ABC 'Australia Talks'

On the ABC Radio National's Australia Talks series, this week, for listening or download:  In an ageing society, with science improving medical care, should we have the right to choose voluntary euthanasia?  What about those who are not sick, but simply too tired of life to go on?  And when should doctors withdraw the treatment keeping the dying alive?  ABC Radio National's Paul Barclay will explore these questions in a special live Australia Talks program in collaboration with the Australian Science Festival.

On the panel for this live radio discussion will be (1) voluntary euthanasia campaigner Dr Philip Nitschke, (2) Australian Catholic University's Associate Professor Patrick McArdle, (2) Palliative Care Australia's President Elect Dr Scott Blackwell, and (4) Dr Kaarin Anstey, Director of the Ageing Research Unit at the ANU's Centre for Mental Health Research.

Lundberg: Death Is Not the Enemy

Dr. George D. Lundberg is a former Editor in Chief of JAMA , 10 AMA specialty journals, AMA News, Medscape, The Medscape Journal and e-Medicine from Web MD.makes  He makes the case for palliative medicine and hospice on MedPage Today.

Expensive Patient? Ship Her Out of State.

Over the past few years a number of hospitals, for example in Chicago and Florida, have deported expensive patients without insurance.  They took illegal immigrant patients, put them on a plane, and flew them back to their home country.  Now, Hawaii is considering putting its homeless on flights back to the continental U.S.  With Medicaid costs devouring gigantic portions of global state budgets, will more and more states start bribing the expensive patients to move? 

Families' optimism often at odds with physicians' prognoses

 Today's American Medical News reports on a new study pre-published in the American Journal of Respiratory and Critical Care Medicine.  Family members of intensive care patients are likely to be more optimistic about their loved ones' chances of survival, regardless of how a physician presents a grim prognosis.  


"Surrogates on average estimated the patient was more than twice as likely to survive than the physician did."  "The most important is that it likely will lead to families requesting ongoing life-sustaining treatment, when a palliative pathway might be more appropriate."  "The other thing that could come up is conflict between doctors and families."