Death and Dying in California

Latest ethical debate in the California legislature–care for the dying. AB 2727 is worried that some health care providers, for religious or moral reasons, are not giving the dying all their options.

Terminally ill and dying patients rely on their health care providers to give them timely and informative data. Research shows a lack of communication between health care providers and their terminally ill patients can cause problems, including poor availability of, and lack of clarity regarding, advance health care directives and patients’ end-of-life care preferences. This lack of information and poor adherence to patient choices can result in “bad deaths” that cause needless physical and psychological suffering to patients and their families.

(g) Those problems are complicated by social issues, such as cultural and religious pressures on the providers, patients, and their family members. A recent survey found that providers that object to certain practices are less likely than others to believe they have an obligation to present all of the options to patients and refer patients to other providers, if necessary.

But they’ve eliminated paragraphs about “palliative sedation” and “Voluntary stopping of eating and drinking”, that some had interpreted as hinting at suicide, so currently the proposed list of information that is to be mandated includes:

  1. Hospice care at home or in a health care setting.
  2. A prognosis with and without the continuation of curative treatment.
  3. The patient’s right to refusal of or withdrawal from life-sustaining treatment.
  4. The patient’s right to continue to pursue curative treatment.
  5. The patient’s right to comprehensive pain and symptom management at the end of life, including, but not limited to, adequate pain medication, treatment of nausea, palliative chemotherapy, relief of shortness of breath and fatigue, and other clinical treatments useful when a patient is actively dying.
  6. The patient’s right to give individual health care instruction pursuant to Section 4670 of the Probate Code, which provides the means by which a patient may provide written health care instruction, such as an advance health care directive, and the patient’s right to appoint a legally recognized health care decisionmaker.

The California Catholic Conference is claiming victory; so it seems to me the concerns that someone voiced to Barbara are a bit overblown.