BILL NUMBER: AB 2747	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  MARCH 25, 2008

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 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 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  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 
options. These gaps include significant   care options
potentially leading to  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   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  ,
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   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   patients can cause problems,
including  poor availability of, and  health care
provider adherence to, patients'   lack of clarity
regarding,  advanced health care directives  and patients'
end-of-life care preferences  . 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   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.  

   (h) 
    (j)  Informed patient choices will help  dying
  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.  
   (a) 
    (b)  "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) 
    (c)  "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) 
    (d)  "Palliative sedation" means the use of sedative
medications to relieve extreme suffering by making the patient
unaware and unconscious  , while artificial food and hydration
are withheld,  during the progression of the disease leading to
the death of the patient. 
   (d) 
    (e)  "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) 
    (f)  "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
 comprehensive  information and counseling regarding
 all  legal end-of-life  care  options.
 If 
    (a)     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) 
    (1)  Hospice care at home or in a health care setting.

   (B) 
    (2)  A prognosis with and without the continuation of
curative treatment. 
   (C) 
    (3)  The  patient's right to  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.  
   (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.  
   (b) 
    (c)  Counseling  that shall   may
 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.