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Berg end-of-life information bill goes to governor PDF Print E-mail
Written by Lake County News reports   
Tuesday, 09 September 2008

SACRAMENTO – Assembly member Patty Berg's end-of-life information bill is waiting – along with numerous other bills by the legislature – for the governor's signature, but a state senator is calling for the bill to be vetoed.


On Aug. 28 the state Assembly approved AB 2747, the Terminal Patients End of Life Information Act,” which Berg's office reported is meant to give patients the right to receive a candid assessment of what to expect when they are dying of a terminal disease.


Berg, D-Eureka, wrote the bill to require health care providers to answer their patients questions, and to tell them about their rights and options when in their final months of life.


“I fully expect we’ll see better pain management, more use of hospice, and fewer people in a panic at the end of life,” Berg said in a statement.


The measure, previously approved by the Senate, passed the Assembly in a 42-33 vote. It now waits to be signed by Gov. Arnold Schwarzenegger, who said last month he won't sign any more bills until the budget is done, although he made an exception for a high-speed rail bill.


A recent nationwide study by cancer doctors found that only one in three terminally ill patients were told about their treatment and pain-management options by their doctors, even when their doctors knew the patients were dying.


Those patients who did receive frank information were less likely to die in intensive care, more likely to receive hospice; and their families were better prepared for their loss than were the families of patients who were uninformed. according to the study.


The California Medical Association and many other health care organizations, as well as senior citizens’ groups, civil liberties advocates and others supported AB 2747.


It has, however, drawn opposition from groups that believe it is a back-door route to the kind of death-with-dignity bill that Berg authored in previous years. The opposing groups include California Disability Alliance, California Family Council, California Nurses for Ethical Standards, Mercy San Juan Medical Center, Sierra Nevada Memorial Hospital, and St. Mary's Medical Center, San Francisco.


“This bill is about information and nothing else,” Berg maintained.


Sen. Sam Aanestad (R-Grass Valley) says he's urging Schwarzenegger to veto the bill.


Aanestad, a licensed oral surgeon and vice-chair of the Senate Health Committee, said he has deep concerns about the effects of AB 2747 on patient care.


“The so-called end of life options act interferes with the medical care of people who just received the worst news of their lives,” Aanestad said in a written statement. “State government has no business intruding upon the doctor-patient relationship at that time, yet that is exactly what this bill does.”


His office reported that AB 2747 is sponsored by an organization called Compassion and Choices, formerly known as the Hemlock Society, which has strongly advocated for physician-assisted suicide legislation in the past. The founder of this group, Derek Humphry, once praised Dr. Jack Kevorkian for assisting in the deaths of 130 people.


Dozens of opponents testified against this measure during a recent marathon hearing of the Senate Health Committee. They included disability rights advocates, nursing organizations, doctors who care for cancer patients, minority rights groups, members of religious communities, hospitals and individuals whose lives and families are affected by this issue.


He said the measure is cloaked as compassion but actually opens the door to further “end of life” intrusions.


Aanestad said that patients facing terminal illness need information based on who they are as individuals, not an intrusion into their relationship with their doctor.


“Patients don’t need their doctors to dispense a laundry list developed by Sacramento politicians,” he said. “It’s downright cruel to take a list of treatments that may not even apply to a patient and have the doctor say, ‘Here, this is what the state of California legislates I must tell you when you find out that you’re dying and you ask me what to do.’”


Will Shuck, Berg's chief of staff, told Lake County News they're still awaiting the outcome.


“Hopefully the governor will give greater weight to the California Medical Association and all the other health organizations in support of the bill than to the opinion of a dental surgeon who may never have to tell a patient that they have a terminal illness,” Shuck said.


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Donna Christopher - Only a republican Author | 09-09-2008 10:39:36
would think knowing all your options is a bad thing.
PatientsFirst - AB 2747: Terminally ill can't IP:192.234.214.xxx | 09-09-2008 13:02:35
I regret the sarcasm with which Mr. Shuck treats Senator Sam Aanestad, the oral surgeon who is only one among many who oppose this bill.

If Mr. Shuck's criteria for legitimate criticism of AB 2747 is that it can't come from those "who may never have to tell a patient they have a terminal illness," I guess he would consider me qualified to comment.

I spent five years as a Spanish-speaking surgeon in a rural California town caring for women with breast cancer. Because of cultural views on illness, language barriers and lack of resources, many of my patients did not seek medical attention until after the cancer had spread outside of the breast.

I was the one in the exam room with women, some in their thirties and forties with young children. I had to find a way to make the worst news of her life somehow less painful--or at least not add to her pain.

To do this, I had to learn about who she was and what she valued and loved. I had to treat her physical and emotional pain, to answer her questions, to sit with her through a terrifying and lonely time.

But AB 2747 says that the California Legislature knows better what she needs than she does. The text of AB 2747 mandates a list of "legal options" she has to get from her doctor at the time she is diagnosed and asks, "What can I do?"

The language of the bill says it all. As her doctor, I have to tell her that she can choose death by starvation or dehydration. I have to tell her she has a "right" to chemotherapy whether or not it will help her feel better or live longer--even if the treatment itself is likely to kill her.

I can't, as her doctor, offer hospice care when she would benefit from it. Instead, I have to tell her about her death while she's still in shock and denial of the news she just heard for the first time.

The bill doesn't admit that doctors can be wrong about terminal illness, that a judgement of "how long" a person has is just a guess and that patients defy the odds and enjoy years of life after the diagnosis. I have seen this so many times that I can't justify robbing hope from any patient. As doctors, we just don't know.

Unbelievably, AB 2747 says that the cost of treatment should be included in the discussion. The impact of this type of discussion on the treatment decisions of my patients would be devastating.

No State Legislator or staffer with taxpayer-funded Cadillac health insurance should ever have the right to coerce vulnerable low-income patients into giving up on treatment solely because of cost. That, by itself, is reason enough to reject AB 2747.

I regret that Mr. Shuck failed to mention (among his mention of "all the other health organizations in support") the massive opposition that testified against this bill.

Disability and minority rights groups, patient advocates, doctors and nurses (including hospice nurses), faith communities and organizations representing the terminally ill are unified in opposing this bill. They continue to reject the denial of patient choice and the ugly lack of compassion in AB 2747.

This bill is a painful example of the consequences of bad legislation from those with a hidden agenda disguised as "just information."

The Governor may be contacted to request a veto:

Governor Arnold Schwarzenegger
State Capitol Building
Sacramento, CA 95814
Phone: 916-445-2841
Fax: 916-558-3160 (new number)
bearer Registered | 09-09-2008 17:48:14
If you do not have a good enough relationship with your doctor to get the truth from them then you need to find a better doctor.

Read the fine print in the bill instead of being spoonfed party politics and the world will be much clearer.
Donna Christopher - Patients first -are you Author | 09-09-2008 18:26:20
telling me that Hospice will be closing if this bill passes? If a doctor is not allowed to discuss Hospice then there is no way they can refer a patient to Hospice and to my knowledge and experience and Dr recommendation is how you get Hospice.
jmadison IP:12.218.155.xxx | 09-09-2008 19:16:56
I have not read the bill, but wish to comment on your approach to practicing medicine.

Treat the patient like a person, be as specific as possible and give the multiple treatment options which are available. It is fair to say which one of the options you would do for yourself, but there are always other options.
For example: "Mrs. Jones, your lymph node biopsy came back as a very aggressive form of lymphoma. I think you should talk with an oncologist about current chemotherapy options, but I can give you some broad numbers. Without any treatment the mean survival time is 6 months. With the more aggressive chemotherapy protocols the mean survival time is 3 years with an x% chance of living 5 years..." Then you talk about the side effects, risks, and other downsides to treatment. If there are other treatment options which aren't main stream, but may have merit, bring them up, give them your opinion but offer to refer them to someone who may know more.
If they end up deciding that they just want to drink 'Mona Vis' or Noni Juice, thinking that it cures everything, give them your honest opinion.
When there are NO good treatment options left, or the patient chooses not to be treated, just tell them what to expect. Let them know about hospice, pain management, end of life decisions to be made. Don't sugar coat it. Be honest but compassionate. Answer questions accurately, not just to make them feel good. You are right. You don't know WHEN exactly an individual will die, but you do know the likely progression of disease and can generalize.
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