End-of-Life Choice, Death with Dignity, Palliative Care and Counseling

Palliative Care Information Act will allow for better end-of-life choicesby Sonja


By David C. Leven
August 7, 2010

The end of life is a difficult time for patients, their families, physicians and other health-care professionals involved with patient care. It is also an important time for discussions to take place between physicians, willing patients and family members to determine the best course of care for the patient during the last chapter of patients’ lives.

Having these discussions empowers patients or health-care agents or surrogates to make informed decisions about treatment in accordance with the patient’s goals of care and wishes. Unfortunately, despite the fact that most patients want to have these conversations with their physicians, recent studies reveal that these discussions often do not occur. This results in unwanted treatment and diminished quality of care.

A bill that has passed both houses of the state Legislature will, if signed into law, correct this problem. The Palliative Care Information Act is designed to ensure that patients diagnosed with a terminal illness, or decision-makers for those patients who have lost decisional capacity, will have the opportunity to receive information and counseling, if desired, regarding palliative care and end-of-life options appropriate to the patient. This includes prognosis and risks and benefits of the various options.

When dying patients receive information and counseling about their palliative and end-of-life care treatment alternatives, the quality of their end-of-life care is better than when discussions do not take place, their wishes are more often respected and they are referred to hospice sooner. Unfortunately, despite all of our efforts in recent years, hospice referral rates have not changed much and patients are referred much too often, if at all, only when close to death. This is in part due to the lack of discussions between physicians and patients until patients are very near death. The median length of stay in hospice, which provides excellent end-of-life care, is, sadly, only 17 to 19 days, with 33 percent enrolled for just eight days or less and another 33 percent enrolled for 31 days or less. The Palliative Care Information Act should ensure that timely hospice referrals are made.

With some 8,000 people dying each year in this region, the bill could have a positive impact on the quality of deaths of thousands of our residents yearly. Introduced by the chairs of the Assembly and Senate health committees, the bill was also co-sponsored by local Assembly members Amy Paulin, D-Scarsdale, and Sandra Galef, D-Ossining. The Palliative Care Information Act (S. 4498, A. 7617) should be approved by Gov. David Paterson. Support the bill by writing him at Executive Chamber, Albany, N.Y. 12224.

David Leven, a resident of Pelham, is the executive director of Compassion & Choices of New York, Pelham. Learn more at www.compassionandchoicesofny.org.