AB 2139, as amended, Eggman. End-of-life care: patient notification.
Under existing law, the State Department of Public Health licenses and regulates health facilities, including hospice facilities, and the provision of hospice services. Existing law establishes the Medical Practice Act, which provides for the regulation and licensure of physicians and surgeons by the Medical Board of California.
begin delete Existing law authorizes an adult to give an individual, known as an agent, authority to make health care decisions for that individual in the event of his or her incapacity pursuant to a power of attorney for health care.end delete
When a health care provider, as defined, makes a diagnosis that a patient has a terminal illness, existing law requires the health care provider to provide the patient, upon the patient’s request, with comprehensive information and counseling regarding legal end-of-life options, as specified, and provide for the referral or transfer of a patient, as provided, if the patient’s health care provider does not wish to comply with the patient’s request for information on end-of-life options.
This bill would apply these provisions to
begin delete an agent under a power of attorney for health careend delete for a patient with a terminal illness diagnosis. The bill would additionally require the health care provider to notify the patient or, when applicable, the begin delete agent,end delete when the health care provider makes a diagnosis that a patient has a terminal illness, of the patient’s right to comprehensive information and counseling regarding legal end-of-life care options. begin delete The bill would define the term “terminal illness” for these purposes.end delete
Vote: majority. Appropriation: no. Fiscal committee: no. State-mandated local program: no.
The people of the State of California do enact as follows:
Section 442 of the Health and Safety Code is
2amended to read:
For the purposes of this part, the following definitions
5(a) “Actively dying” means the phase of terminal illness when
6death is imminent.
7(b) “Agent” means an individual designated in a power of
8attorney for health care, as provided in Article 1 (commencing
9with Section 4670) and Article 2 (commencing with Section 4680)
10of Chapter 1 of Part 2 of Division 4.7 of the Probate Code, to make
11a health care decision for the patient who has been diagnosed with
12a terminal illness, regardless of whether the person is known as
13an agent or attorney in fact, or by some other term.
14(c) “Disease-targeted treatment” means treatment directed at
15the underlying disease or condition that is intended to alter its
16natural history or progression, irrespective of whether or not a cure
17is a possibility.
18(d) “Health care provider” means an attending physician and
19surgeon. It also means a nurse practitioner or physician assistant
20practicing in accordance with standardized procedures or protocols
21developed and approved by the supervising physician and surgeon
22and the nurse practitioner or physician assistant.
23(e) “Hospice” means a specialized form of interdisciplinary
24health care that is designed to provide palliative care, alleviate the
25physical, emotional, social, and spiritual discomforts of an
26individual who is experiencing the last phases of life due to the
27existence of a terminal disease, and provide supportive care to the
P3 1primary caregiver and the family of the hospice patient, and that
2meets all of the criteria specified in subdivision (b) of Section
4(f) “Palliative care” means medical treatment, interdisciplinary
5care, or consultation provided to a patient or family members, or
6both, that has as its primary purpose the prevention of, or relief
7from, suffering and the enhancement of the quality of life, rather
8than treatment aimed at investigation and intervention for the
9purpose of cure or prolongation of life as described in subdivision
10(b) of Section 1339.31. In some cases, disease-targeted treatment
11may be used in palliative care.
12(g) “Refusal or withdrawal of life-sustaining treatment” means
13forgoing treatment or medical procedures that replace or support
14an essential bodily function, including, but not limited to,
15cardiopulmonary resuscitation, mechanical ventilation, artificial
16nutrition and hydration, dialysis, and any other treatment or
17discontinuing any or all of those treatments after they have been
18used for a reasonable time.
19(h) “Terminal illness” means a medical condition resulting in
20a prognosis of a life expectancy of one year or less, if the disease
21follows its normal course.
Section 442.5 of the Health and Safety Code is
24amended to read:
When a health care provider makes a diagnosis that
26a patient has a terminal illness, the health care provider shall
begin delete notifyend delete
28 the patient of his or her right to, or when applicable,
begin delete agent of the patient’s right to, comprehensive information and
30counseling regarding legal end-of-life options and, upon the patient
31or agent’s request, provide the patient or agentend delete
37 with comprehensive information and
40counseling regarding legal end-of-life care options pursuant to this
P4 1section. When a terminally ill patient is in a health facility, as
2defined in Section 1250, the health care provider, or medical
3director of the health facility if the patient’s health care provider
4is not available, may refer the patient or
begin delete agentend delete to a hospice provider or private or public agencies and
6community-based organizations that specialize in end-of-life care
7case management and consultation to receive comprehensive
8information and counseling regarding legal end-of-life care options.
begin delete the patient or agent indicates a desire to receive the the
11information and counseling,end delete
14comprehensive information shall include, but not be limited to,
16(1) Hospice care at home or in a health care setting.
17(2) A prognosis with and without the continuation of
19(3) The patient’s right to refusal of or withdrawal from
21(4) The patient’s right to continue to pursue disease-targeted
22treatment, with or without concurrent palliative care.
23(5) The patient’s right to comprehensive pain and symptom
24management at the end of life, including, but not limited to,
25adequate pain medication, treatment of nausea, palliative
26chemotherapy, relief of shortness of breath and fatigue, and other
27clinical treatments useful when a patient is actively dying.
begin deleteIf the patient has not appointed an agent under a power of patient’s right to give individual
29attorney for health care, the end delete
30health care instruction pursuant to Section 4670 of the Probate
31Code, which provides the means by which a patient may provide
32written health care instruction, such as an advance health care
33directive, and the patient’s right to appoint a legally recognized
34health care decisionmaker.
36 The information described in subdivision
begin delete (a)end delete may, but
37is not required to, be in writing. Health care providers may utilize
38information from organizations specializing in end-of-life care
39that provide information on factsheets and Internet Web sites to
40convey the information described in subdivision
begin delete (a).end delete
P5 1(c)end delete
2 Counseling may include, but is not limited to, discussions
3about the outcomes for the patient and his or her family, based on
4the interest of the patient. Information and counseling, as described
begin delete (a),end delete may occur over a series of meetings with
6the health care provider or others who may be providing the
7information and counseling based on the patient’s needs.
9 The information and counseling sessions may include a
10discussion of treatment options in a manner
11that the patient and his or her family, or, when applicable,
begin delete the can easily understand. If the patient or
begin delete agentend delete requests information on the costs of treatment
15options, including the availability of insurance and eligibility of
16the patient for coverage, the patient or
begin delete agentend delete shall be referred to the appropriate entity for that
Section 442.7 of the Health and Safety Code is
27amended to read:
If a health care provider does not wish to comply with
29his or her patient’s request or, when applicable, the
begin delete agent’send delete request
32information on end-of-life options, the health care provider shall
33do both of the following:
34(a) Refer or transfer a patient to another health care provider
35that shall provide the requested information.
36(b) Provide the patient or
begin delete agentend delete with information on
P6 1procedures to transfer to another health care provider that shall
2provide the requested information.