BILL ANALYSIS Ó AB 2139 Page 1 CONCURRENCE IN SENATE AMENDMENTS AB 2139 (Eggman) As Amended August 18, 2014 Majority vote ----------------------------------------------------------------- |ASSEMBLY: |46-28|(May 29, 2014) |SENATE: |29-7 |(August 21, | | | | | | |2014) | ----------------------------------------------------------------- Original Committee Reference: HEALTH SUMMARY : Requires a health care provider, when making a diagnosis that a patient has a terminal illness, to notify the patient of his or her right to comprehensive information and counseling regarding legal end-of-life options. Extends the right to request information to a person authorized to make health care decisions for the patient and specifies that the information may be provided at the time of diagnosis or at a subsequent visit with the health care provider. The Senate amendments clarify that the provisions of this bill are not intended to interfere with the clinical judgment of a health care provider in recommending the course of treatment. EXISTING LAW : 1) Requires a health care provider, when he or she makes a diagnosis that a patient has a terminal illness, to provide the patient comprehensive information and counseling regarding legal end-of-life options, upon request. Requires the provider, if he or she does not wish to comply with a patient's request, to refer the patient to another provider who will. Defines "health care provider," for these purposes, as an attending physician and surgeon or a nurse practitioner or physician assistant, as specified. 2) Requires comprehensive information about end-of-life options to include: a) hospice care at home or in a health care setting; b) a prognosis with and without the continuation of disease-targeted treatment; c) the patient's right to refusal of or withdrawal from life-sustaining treatment; d) the patient's right to continue to pursue disease-targeted treatment, with or without concurrent palliative care; e) the patient's right AB 2139 Page 2 to comprehensive pain and symptom management at the end of life; and, f) the patient's right to give individual health care instructions under current law, including advance health care directives. AS PASSED BY THE ASSEMBLY , this bill required health care providers to notify patients with terminal illnesses of their right under current law to comprehensive information and counseling regarding legal end-of-life options. FISCAL EFFECT : None COMMENTS : The author states that the need for this bill arises from the discrepancy between the care that most Californians prefer at the end of life and that which they are receiving. The author cites three reports from 2012 and 2013 prepared by the California HealthCare Foundation (CHCF) that raise serious concerns with the care Californians receive at the end of life. One report provides evidence that most Californians would prefer to die at home, avoid pain, and be comfortable as they approach the end of life. However, an additional study finds great disparity in end-of-life care in California across regions and institutions, with California, compared to the nation as a whole, trending toward providing more inpatient care and more intensive care in the last six months of life. Similarly, in a third study specific to cancer care, CHCF finds that, compared to the country as a whole, California's patients with advanced cancer are more likely to die in the hospital, spend time in an intensive care unit, and receive aggressive life-saving measures in the final weeks of life. Finally, while 80% of Californians indicate they would definitely or probably like to talk with a doctor about end-of-life care, only about 7% have had these important conversations. The author writes that these concerns have persisted despite the passage of AB 2747 (Berg), Chapter 683, Statutes of 2008, which gives patients with a terminal diagnosis the right to be informed, upon request, about their legal end-of-life care options. The author indicates this bill would ensure that patients with a terminal illness are notified about this right. Supporters of this bill, including the Alzheimer's Foundation of America, the American Cancer Society Cancer Action Network and the California Hospice and Palliative Care Association, among others, write that people with terminal illnesses are often AB 2139 Page 3 unprepared for end-of-life decision making and consequently receive treatment that is not consistent with their wishes. The supporters argue that this bill will ensure that patients are offered an opportunity for patients to have a conversation with their physicians about the course of a terminal disease and the full range of expected treatment options. The California Right to Life Committee opposed the April 2, 2014, version of this bill because they believe it does not create a more informed and supportive environment, but makes a vulnerable patient more anxious and even feeling unwanted or unworthy to continue living. Analysis Prepared by : Lara Flynn / HEALTH / (916) 319-2097 FN: 0005069