BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                  AB 2139
                                                                  Page  1

          CONCURRENCE IN SENATE AMENDMENTS
          AB 2139 (Eggman)
          As Amended August 18, 2014
          Majority vote
           
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          |ASSEMBLY:  |46-28|(May 29, 2014)  |SENATE: |29-7 |(August 21,    |
          |           |     |                |        |     |2014)          |
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           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
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               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
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          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