BILL NUMBER: AB 2747	INTRODUCED
	BILL TEXT


INTRODUCED BY   Assembly Members Berg and Levine

                        FEBRUARY 22, 2008

   An act to add Part 1.8 (commencing with Section 442) to Division 1
of the Health and Safety Code, relating to end-of-life care.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 2747, as introduced, Berg. End-of-life care.
   Existing law provides for the licensure and regulation of health
facilities and hospices by the State Department of Public Health.
Existing law provides for the regulation and licensing of physicians
and surgeons by the Medical Board of California.
   This bill would provide that when an attending physician makes a
diagnosis that a patient has a terminal illness or makes a prognosis
that a patient has less than one year to live, the health care
provider shall provide the patient with the opportunity to receive
information and counseling regarding legal end-of-life options, as
specified, and provide for the referral or transfer of a patient if
the patient's physician does not wish to comply with the patient's
choice of end-of-life options.
   Vote: majority. Appropriation: no. Fiscal committee: no.
State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  The Legislature finds and declares all of the
following:
   (a) Palliative and hospice care are invaluable resources for
terminally ill Californians in need of comfort and support at the end
of life.
   (b) Palliative care and conventional medical treatment should be
thoroughly integrated rather than viewed as separate entities.
   (c) Even though Californians with a prognosis of six months or
less to live are eligible for hospice care, nearly two-thirds of them
receive hospice services for less than one month.
   (d) Many patients benefit from being referred to hospice care
earlier, where they receive better pain management and have an
improved quality of life.
   (e) Significant information gaps exist between health care
providers and their patients on end-of-life options. These gaps
include significant delays to, or lack of, referrals to hospice care
for terminally ill and dying patients. The sharing of important
information regarding specific treatment options in a timely manner
by health care providers occurs unevenly. Missing information
includes, but is not limited to, the availability of hospice care,
the efficacy of continued curative treatment, withholding or
withdrawal of life sustaining treatments, voluntary stopping of
eating and drinking, and palliative sedation.
   (f) Terminally ill and dying patients rely on their health care
providers to give them timely and informative data. Unfortunately,
research shows a lack of communication between health care providers
and their terminally ill and dying patients. Problems resulting from
that lack of communication include poor availability of, and health
care provider adherence to, patients' advanced health care
directives. This lack of information and poor adherence to patient
choices results 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
health care providers failing to inform patients about certain
options at the end of life on personal conscience grounds. A recent
random survey of 2000 United States physicians found that 17 percent
of them object to the practice of palliative sedation, defined as
administering sedation that leads to unconsciousness in dying
patients. The survey also found that providers that object to these
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.
   (h) Informed patient choices will help dying patients and their
families cope with one of life's most challenging situations.
  SEC. 2.  Part 1.8 (commencing with Section 442) is added to
Division 1 of the Health and Safety Code, to read:

      PART 1.8.  End-Of-Life Care


   442.  For the purposes of this part, the following definitions
shall apply:
   (a) "Hospice" means a specialized form of interdisciplinary health
care that is designed to provide palliative care, alleviate the
physical, emotional, social, and spiritual discomforts of an
individual who is experiencing the last phases of life due to the
existence of a terminal disease, and provide supportive care to the
primary caregiver and the family of the hospice patient, and that
meets all of the criteria specified in subdivision (b) of Section
1746.
   (b) "Palliative care" means medical treatment, interdisciplinary
care, or consultation provided to a patient or family members, or
both, that has as its primary purpose the prevention of, or relief
from, suffering and the enhancement of the quality of life, rather
than treatment aimed at investigation and intervention for the
purpose of cure or prolongation of life as described in subdivision
(b) of Section 1339.31.
   (c) "Palliative sedation" means the use of sedative medications to
relieve extreme suffering by making the patient unaware and
unconscious during the progression of the disease leading to the
death of the patient.
   (d) "Refusal or withdrawal of life sustaining treatment" means
forgoing treatment or medical procedures that replace or support an
essential bodily function, including, but not limited to,
cardiopulmonary resuscitation, mechanical ventilation, artificial
nutrition and hydration, dialysis, and any other treatment or
discontinuing any or all of those treatments after they have been
used for a reasonable time.
   (e) "Voluntary stopping of eating and drinking" or "VSED" means
the voluntary refusal of a patient to eat and drink in order to
alleviate his or her suffering, and includes the withholding or
withdrawal of life-sustaining treatment at the request of the
patient.
   442.5.  When an attending physician makes a diagnosis that a
patient has a terminal illness or makes a prognosis that a patient
has less than one year to live, the physician, or in the case of a
patient in a health facility, as defined in Section 1250, the health
facility, shall provide the patient with the opportunity to receive
information and counseling regarding all legal end-of-life options.
If the patient indicates a desire to receive the information and
counseling, the information shall include, but not be limited to, all
of the following:
   (a) (1) Written materials that list all available medical options
at the end of life, including, but not limited to, all of the
following:
   (A) Hospice care at home or in a health care setting.
   (B) A prognosis with and without the continuation of curative
treatment.
   (C) The refusal or withdrawal from life-sustaining treatment.
   (D) VSED and palliative sedation.
   (2) The written materials described in paragraph (1) shall provide
detailed explanations of the patient's options, and shall include a
list of resources that are available to the patient for further
research on options.
   (b) Counseling that shall include, but not be limited to,
discussions about the outcomes on the patient and his or her family,
based on the interest of the patient.
   442.7.  If a physician does not wish to comply with his or her
patient's choice of end-of-life options, the health care provider
shall do both of the following:
   (a) Refer or transfer a patient to an alternative health care
provider.
   (b) Provide the patient with information on procedures to transfer
to an alternative health care provider.