BILL NUMBER: AB 2747	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  MAY 15, 2008
	AMENDED IN ASSEMBLY  APRIL 24, 2008
	AMENDED IN ASSEMBLY  APRIL 7, 2008
	AMENDED IN ASSEMBLY  MARCH 25, 2008

INTRODUCED BY   Assembly Members Berg and Levine
   (Coauthors: Assembly Members Bass, Jones, Mullin, Salas, Torrico,
and Wolk)

                        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 amended, 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 a health care provider, as
defined, 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, upon the patient's request, provide the
patient with 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 health care provider 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 and symptom management and
have an improved quality of life.
   (e) Significant information gaps may exist between health care
providers and their patients on end-of-life care options potentially
leading to delays  to   in  , or lack of,
referrals to hospice care for terminally ill patients. The sharing of
important information regarding specific treatment options in a
timely manner by health care providers is a key component of quality
end-of-life care. Information that is helpful to patients and their
families includes, but is not limited to, the availability of hospice
care, the efficacy and potential side effects of continued curative
treatment, and withholding or withdrawal of life-sustaining
treatments.
   (f) 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,  advanced
  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 for 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.
   (h) Every medical school in California is required to include
end-of-life care issues in its curriculum and every physician in
California is required to complete continuing education courses in
end-of-life care.
   (i) Palliative care is not a one-size-fits-all approach. Patients
have a range of diseases and respond differently to treatment
options. A key benefit of palliative care is that it customizes
treatment to meet the needs of each individual person.
   (j) Informed patient choices will help terminally ill 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) "Curative treatment" means treatment intended to cure or
alleviate symptoms of a given disease or condition.
   (b) "Health care provider" means an attending physician and
surgeon, nurse practitioner, or physician assistant  in
accordance with standardized procedures or protocols developed and
approved by the supervising physician and surgeon and the nurse
practitioner or physician assistant  .
   (c) "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.
   (d) "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.
   (e) "Palliative sedation" means the  use of sedative
medications to relieve extreme suffering by making the patient
unaware and unconscious, and in some cases, involves the withholding
of artificial food and hydration. A patients death however, is caused
by his or her disease processes and his or her complications, and
not from palliative sedation.   administration of
sedative medication to the point of unconsciousness in a terminally
ill patient. It is an intervention of last resort to reduce severe,
refractory pain or other distressing clinical symptoms that do not
respond to aggressive, symptom specific palliation. Palliative
sedation is not intended to cause death or shorten life. 
   (f) "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.
   (g) "Voluntary stopping of eating and drinking" or "VSED" means
the patient's choice to voluntarily refuse 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   a  health care
provider 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  , upon the patient's request,
 provide the patient with comprehensive information and
counseling regarding legal end-of-life care options  , upon the
patient's request and pursuant to this section  . When a patient
is in a health facility, as defined in Section 1250, the health care
provider or medical director may refer the patient to a hospice
provider or private or public agencies and community-based
organizations that specialize in end-of-life care case management and
consultation to receive information and counseling regarding legal
end-of-life care options.
   (a) If the patient indicates a desire to receive the information
and counseling, the information shall include, but not be limited to,
the following:
   (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
while receiving palliative care.
   (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, VSED, and
palliative sedation.
   (b) The information described in subdivision (a) may, but is not
required to be, in writing. Health care providers may utilize
information from organizations specializing in end-of-life care that
provide information on factsheets and Internet Web sites to convey
the information described in subdivision (a).
   (c) Counseling may include, but not be limited to, discussions
about the outcomes  on   for the patient
and his or her family, based on the interest of the patient. 
These discussions   Information and counseling as
described in subdivision (a)  may occur over a series of
meetings with the health care provider or others who may be providing
the  information and  counseling based on the patient's
needs.
   442.7.  If a health care provider 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 another health care provider.
   (b) Provide the patient with information on procedures to transfer
to another health care provider.