‘Right-To-Die’ Law Highlights Need for Palliative Care in California

Palliative care doctors say a new California law (ABX2-15) that legalizes physician-assisted death highlights the need to bolster awareness about the services they provide, Kaiser Health News reports.

Background

Gov. Jerry Brown (D) signed the bill in October.

Assembly member Susan Eggman (D-Stockton) introduced the legislation during a special session on health care financing after a similar measure (SB 128) stalled in July amid a lack of support in the Assembly Committee on Health.

ABX2-15 will allow some dying patients to end their lives through lethal doses of medication, as long as:

• Medication is self-administered;
• The patient is mentally competent; and
• Two physicians confirm the prognosis that the patient has six months or less to live.

Several amendments were added to the bill in the special session, including one that requires patients to reaffirm their consent within 48 hours prior to taking the lethal dose of medication.

The bill's authors also added an amendment to sunset the law after a decade, making it effective only until Jan. 1, 2026. However, the state Legislature could vote to extend it.

Terminally ill patients likely will have to wait until at least April before they can use the law because it cannot take effect until 91 days after the special session ends (California Healthline, 10/22).

Access to Palliative Care

According to KHN, palliative care has grown in recent years, as more doctors, nurses and social workers are being trained to provide it.

In California, state law requires Medi-Cal managed care plans to offers access to palliative care programs. Medi-Cal is California's Medicaid program.

However, some gaps remain. For example, a February California HealthCare Foundation report found that residents in:

• 22 California counties lack access to community-based palliative care; and
• 19 counties lack access to in-patient palliative care programs.

CHCF publishes California Healthline.

Need for Awareness

Some providers say more awareness is needed among patients and other physicians about palliative care in light of the new right-to-die law, KHN reports.

Sean Morrison -- a professor of geriatrics and palliative care medicine at Mount Sinai's Icahn School of Medicine in New York --  said California's law should serve as a "wake-up" call, noting that it shows "how terrified patients are of what they will experience at the end of life."

Meanwhile, Ira Byock, head of the Providence Institute for Human Caring in Torrance, said that some patients forgo end-of-life discussions in the absence of palliative care programs.

According to a poll by the Kaiser Family Foundation, just 17% of patients have had end-of-life discussions with their providers, even though 90% said doctors should be conducting such talks (Gorman, Kaiser Health News, 12/1).