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

Compassion & Choices

California Assembly to Vote on Medical Aid-in-Dying Bill

Second Assembly Committee This Week Approves Bill Inspired by Brittany Maynard

CA Health Committee group shot(Los Angeles, CA – Sept. 4, 2015) The California Assembly will soon vote on a bill approved by two committees this week that would give terminally ill adults the option to request and take prescription medication to painlessly and peacefully die in their sleep if end-of-life suffering becomes unbearable.

The Assembly Finance Committee today paved the way for the full Assembly vote by approving the legislation, the End of Life Option Act (ABX2-15), by a vote of 5 to 3. On Tuesday, the Assembly Public Health and Developmental Services Committee approved the bill on bipartisan vote of 10 to 3. If the full Assembly passes ABX2-15, two Senate committees and the full Senate would have to approve the legislation. The Senate approved a similar version of the bill, SB-128, in June. The deadline to pass all bills in the California legislature before the end of this year is September 11.

“Based on the growing legislative support for the End of Life Option Act, we are confident the Assembly will quickly pass the End of Life Option Act, so the Senate can vote on it,” said Toni Broaddus, California Campaign Director. “Dying Californians should have all possible options at the end of life.  They can’t wait for another legislative session to get relief. The public overwhelmingly agrees — new polling makes it clear that Californians think medical aid in dying should be an option for those few who need it.”

Three out of four Californians (76% percent) support the End of Life Option Act, including 82 percent of Democrats, 79 percent of independents and 67 percent of Republicans, according to a new poll released Thursday by the Institute of Governmental Studies (IGS) at the University of California, Berkeley. Yet, two decades after Oregon voters passed our nation’s first death-with-dignity law in 1997, California still has not authorized this end-of-life option.

“Polling show a strong, growing majority of all Californians support this bill,” said Senate Majority Whip Lois Wolk, a coauthor of the End of Life Option Act. “As we now move to the Assembly floor with bipartisan support, I am confident that these voices will be heard. I am grateful that my colleagues in the Assembly have recognized the urgency in passing a medical aid-in-dying bill this year.”

“I am very appreciative of my Assembly colleagues for supporting this important legislation,” Senator Monning said.  “This bill will give terminally ill Californians the option to determine the quality of their final days of life based on their own personal beliefs.  Over 75 percent of Californians support this bill, and it is an issue that deserves to be considered by the entire Legislature.”

Hundreds of End of Life Option Act supporters have crowded the State Capitol halls clad in yellow T-shirts throughout the week, making last minute visits to urge their assemblymembers to support the bill.

The End of Life Option Act was inspired by Brittany Maynard, a 29-year-old Californian with terminal brain cancer who moved to Oregon to utilize its death-with-dignity law last year. The End of Life Option Act is closely modeled after the death-with-dignity law in Oregon, which has worked well for 17 years, without a single documented case of abuse or coercion. Currently, three other states authorize medical aid in dying: Washington, Montana, and Vermont. These states’ aid-in-dying policies have been proven to be good, safe medical practice.

Dan Diaz, the widower of Brittany Maynard praised the Assembly Finance Committee members for “listening to their constituents.”

“The careful and pragmatic approach by our elected officials in the special session hearing exemplifies their dedication to improving the lives of our citizenry,” he said.

Group Proposes Strengthening Medicare Plan to Pay Docs for End-of-Life Care Conversations

Conversations Should Start Early, Take Place At Least Once a Year on As Needed Basis

(Washington, DC – Sept. 4, 2015) Compassion & Choices today suggested two ways to improve a proposal by the Centers for Medicare & Medicaid Services (CMS) to reimburse doctors for communicating with patients about whether and how they would want to be kept alive if they become too sick to speak for themselves.

Compassion & Choices offered the following recommendations to strengthen the CMS proposal:

  1. The initial conversation about a patient’s healthcare treatment preferences should take place during the “Welcome to Medicare” preventive visit to ensure an early start to these conversations, before the diagnosis of a terminal illness.
  2. CMS should give physicians the flexibility and autonomy to engage in additional conversations as needed. Ideally, these conversations should take place at least once a year as a part of a patient’s annual medical review. However, the patient and physician should be given the autonomy to engage in these conversations as needed. For example, they may need additional conversations based on a patient’s disease diagnosis, prognosis and trajectory.

The suggestions are in response to a Sept. 8 deadline to submit comments to the Federal Register about a July 8 proposal to make advance care planning a separate payable service under Medicare codes 99497 and 99498 starting in 2016.

Kim-Callinan“Funding these two Medicare advance planning codes removes a barrier for doctors to initiate and engage in conversations that ensure healthcare providers honor patients’ treatment goals, preferences and values,” wrote Kimberly Callinan, Chief Program Officer for Compassion & Choices, a national end-of-life choice advocacy organization. “We encourage CMS to enact this regulation, provide the necessary funding, and continue to look for and address other potential barriers to these critically important discussions between patients and healthcare professionals.”

“These conversations can help patients understand their treatment options, recognize the need to plan ahead for the care they choose, avoid unwanted medical treatment and better ensure their end-of-life healthcare wishes are carried out if they are unable to speak for themselves,” Callinan concluded. “Evidence-based research overwhelmingly shows the need for more and higher-quality doctor-patient conversations about the patient’s healthcare goals, preferences and values.”

The evidence-based research supporting the CMS proposal includes:

  • According to a Sept. 2014 report by the Institute of Medicine (IOM), “Dying in America, Improving Quality and Honoring Individual Preferences Near the End of Life” (http://books.nap.edu/openbook.php?record_id=18748): “Most people nearing the end of life are not physically, mentally, or cognitively able to make their own decisions about care. Approximately 40 percent of adult medical inpatients, 44-69 percent of nursing home residents, and 70 percent of older adults facing treatment decisions are incapable of making those decisions themselves. The majority of these patients will receive acute hospital care from physicians who do not know them. As a result, advance care planning is essential to ensure that patients receive care reflecting their values, goals, and preferences” (Kim et al., 2002; Nelson et al., 2006; Raymont et al., 2004; Silveira et al., 2010).
  • The IOM reports’ “Key Findings and Recommendations” (https://iom.nationalacademies.org/~/media/Files/Report%20Files/2014/EOL/Key%20Findings%20and%20Recommendations.pdf) includes: “Frequent clinician–patient conversations about end-of-life care values, goals, and preferences are necessary to avoid unwanted treatment. However, most people—particularly younger, poorer, minority, and less-educated individuals, do not have these conversations. Clinicians need to initiate conversations about end-of-life care choices and work to ensure that patient and family decision making is based on adequate information and understanding.”
  • The Journal of the American Medical Association (JAMA) published an article in December 2014, “Communication about serious illness care goals: a review and synthesis of best practices” (JAMA Intern Med. 2014 Dec;174(12):1994-2003. doi: 10.1001/jamainternmed.2014.5271, ncbi.nlm.nih.gov/pubmed/25330167) that concluded: “An understanding of patients’ care goals in the context of a serious illness is an essential element of high-quality care, allowing clinicians to align the care provided with what is most important to the patient. Early discussions about goals of care are associated with better quality of life, reduced use of non-beneficial medical care near death, enhanced goal-consistent care, positive family outcomes, and reduced costs. Existing evidence does not support the commonly held belief that communication about end-of-life issues increases patient distress.”
  • According to a study published in the January 2014 edition of The American Journal of Preventive Medicine, “Completion of Advance Directives Among U.S. Consumers” (Jaya K. Rao, MD, Lynda A. Anderson, PhD, Feng-Chang Lin, PhD, Jeffrey P. Laux, PhD, DOI: http://dx.doi.org/10.1016/j.amepre.2013.09.008, http://www.ajpmonline.org/article/S0749-3797(13)00521-7/fulltext), only one out of four Americans (26%) have completed an advance directive to ensure their end-of-life healthcare wishes are carried out if they are unable to speak for themselves.

New Poll: 3 out of 4 Californians Support End of Life Option Bill

HQ6FJe5P_400x400Three out of four Californians support “a bill under consideration before the California State Legislature [that] would allow terminally ill people to be able to voluntarily end their own lives by taking drugs prescribed by a physician.”

That is the conclusion of a new poll released today by the Institute of Governmental Studies (IGS) at the University of California, Berkeley.

This overwhelming support includes strong majorities in both major political parties and among independent voters, and crosses most other demographic categories, including race/ethnicity.

A large majority of respondents (76 percent) supported that idea, including 82 percent of Democrats, 79 percent of independents and 67 percent of Republicans.

Support levels of at least 69 percent were registered across all other demographic categories, from gender to educational, income and age levels.

Among age groups, support was weakest among 18- to 19-year-olds (70 percent) and stronger among older groups: 86 percent among those in their 40s, 79 percent among those in their 50s and 81 percent among those over 65.

Background

The poll was conducted for IGS by Survey Sampling International, using online questionnaires. There were 1,097 respondents sampled between Aug. 11 and Aug. 26. The margin of error is 2.5 percent. Responses for the entire sample were weighted to reflect the statewide distribution of the California population by gender, race/ethnicity, education and age.

Appendix

A bill under consideration before the California State Legislature would allow terminally ill people to be able to voluntarily end their own lives by taking drugs prescribed by a physician. Do you favor or oppose this bill?

Question

 

Percent

Favor

75.5%

Oppose

24.5%

By Partisanship

 

Democrats

Independents

Republicans

Favor

82.4%

78.7%

67.1%

Oppose

17.6%

21.3%

32.9%

 

By Income

 

Less than $25,000

$25,000-$49,999

$50,000-$74,999

$75,000-$99,999

$100,000-$149,999

$150,000+

Favor

74.8%

75.2%

77.6%

74.8%

83.7%

78.7%

Oppose

25.2%

24.8%

22.4%

25.2%

16.3%

21.3%

By Age

 

Age 18-29

Age 30-39

Age 40-49

Age 50-65

Age 65+

Favor

70.1%

74.8%

86.4%

78.9%

81.5%

Oppose

29.9%

25.2%

13.6%

21.1%

18.5%

 

By Race/Ethnicity

 

Asian

Black

Latino

White

Favor

78.9%

52.3%

74.9%

79.5%

Oppose

21.1%

47.7%

25.1%

20.5%

 

By Education

 

Less than high school

High school degree or equivalent

Some college

Bachelor’s degree

Advanced degree

Favor

75.0%

69.1%

74.6%

79.8%

83.25%

Oppose

25.0%

30.9%

25.4%

20.2%

16.75%

 

By Gender

 

Female

Male

Favor

77.7%

76.4%

Oppose

22.3%

23.6%

 

CA Assembly Public Health Committee Clears Medical Aid-in-Dying Bill

Emotional Hearing on Brittany Maynard-Inspired Bill Draws Hundreds of Supporters

(Sacramento, CA – Sept. 1, 2015) The California Assembly Public Health and Developmental Services Committee today approved a bill with bipartisan support by a 10 to 3 vote to give terminally ill adults facing unbearable suffering the option of medical aid in dying. The legislation, called the End of Life Option Act (ABX2-15), now moves to the Assembly Finance Committee, and if that committee approves it, the full Assembly will vote on it.

IMG_1066The approval of the End of Life Option Act comes a week after California legislators re-introduced the legislation as one of a handful of health-related bills in special session. While the special session operates under different rules than the full legislature, it is expected that it will run through Sept. 11 and adjourn at the same time as the legislature.

“The Assembly Public Health Committee’s stamp of approval of the End of Life Option Act is a major step toward passing a law to give terminally ill Californians the option to shorten an unbearable dying process,” said Toni Broaddus, California campaign director for Compassion & Choices. “The compelling stories of people touched by this issue clearly won over the committee. We hope Assemblymembers will continue to listen to the impassioned voices of terminally ill Californians who desperately need medical aid in dying as an end-of-life option.”

Nearly seven out of 10 California voters (69%), including 70 percent of Latinos and 60 percent of Catholics voters, support the End of Life Option Act, according to a bipartisan statewide poll.

The End of Life Option Act would give mentally capable adults with a terminal prognosis of six months or less to live the option to request a doctor’s prescription for medication that they could take to painlessly and peacefully shorten their dying process.

The bill includes the strongest safeguards of any law or legislation of its kind in the country.

The dying person is required to make two oral requests for the medication, 15 days apart, followed by a written request. In addition, two witnesses must confirm in writing that the dying person is acting voluntarily and is not being coerced into requesting aid-in-dying medication. Prior to providing a prescription, doctors are required to confirm that the applicant is fully informed about alternatives to medical aid in dying, including comfort care, hospice care and pain control, also known as palliative care.

“I appreciate the support from my Assembly colleagues on the Public Health and Developmental Services Committee who passed this important piece of legislation,” said Senator Monning. “Every successful milestone moves us one step closer to providing a compassionate alternative for terminally ill patients who have run out of other treatment options.”

Senator Wolk thanked her colleagues in the Assembly for demonstrating “their compassion for those facing the end of life.”

The End of Life Option Act was inspired by Brittany Maynard, a 29-year-old Californian with terminal brain cancer who moved to Oregon to utilize its Death with Dignity Act last year.

According to a new study published by the Journal of Palliative Medicine, the Oregon law “has resulted in or at least reflects more open conversation and careful evaluation of end-of-life options, more appropriate palliative care training of physicians, and more efforts to reduce barriers to access to hospice care and has thus increased hospice referrals and reduced potentially concerning patterns of hospice use in the state.”

Only three other states authorize the medical option of aid in dying: Washington, Montana and Vermont. In the final weeks of her life, Maynard partnered with Compassion & Choices to launch a campaign to make aid in dying an open and accessible medical option in California and other states nationwide.

Hundreds of End of Life Option Act supporters, clad in yellow T-shirts, heard testimony by Christy O’Donnell, a single mom with terminal lung cancer that has metastasized to her brain, liver, spine and rib.

“I have excruciating headaches. I’m nauseous, I have intense neck and back pain, she said. “I have painful shingles and excruciating neuropathy in my hands and feet. As I am morphine intolerant my palliative care doctor has struggled in finding any pain medications that work.”

During the hearing, Assemblymembers also heard testimony from Dan Diaz, the widower of Brittany Maynard.

“It is offensive to hear people judge those of us who want the option of having a gentle and peaceful dying process,” he said. “There are certain diseases that produce horrific and needless suffering at the end of life; Brittany’s case was one of those.”

Diaz fought back tears as he recalled the painful death of his friend, Jennifer Glass, who stood next to him during a January news conference to announce the bill introduction.

“My wife Brittany passed away gently; Jennifer’s death was not as gentle,” he said.  “In either case it was the individual determining that it was their time, and in either case the result was the same, death.  But the manner of getting there was quite different.   Shouldn’t the individual have the option of which they would choose for themselves?”

An oncologist from Palo Alto, Dr. Mike Turbow, whose disabled son died three years ago, testified about the thousands of dying patients he treated in hospice and palliative care during his medical career of nearly 40 years.

“This law does not target the disabled; it is about relieving suffering in terminally ill patients,” said Dr. Turbow. “So long as a patient with a terminal illness, whether disabled or not, can make a rational decision, medical aid in dying should be an option, along with palliative care and hospice, available to all Californians.”

Libertarian, Washington Post syndicated columnist George Will Endorses Death With Dignity!

By Sean Crowley

g willThe [Maryville, TN] Daily Times pre-empted The Washington Post by publishing a column today by WP syndicated columnist George Will, a self-described libertarian, endorsing death with dignity, also known as medical aid in dying, for terminally ill adults who want to the option to peacefully end unbearable suffering. Yesterday, Will’s research assistant confirmed to Compassion & Choices that this column will be published in Sunday’s The Washington Post.

To put this endorsement in perspective, The Wall Street Journal called Will “perhaps the most powerful journalist in America.”

Will’s column quotes death-with-dignity advocates Brittany Maynard (“I’m not killing myself. Cancer is killing me.”), who died last Nov. 1, and Jennifer Glass (“I’m doing everything I can to extend my life. No one should have the right to prolong my death.”), who died on Aug. 11.

Doctors_0358It also extensively quotes Dr. Lynette Cederquist, the physician plaintiff in a suit filed by Compassion & Choices asserting an 1874 California law prohibiting assisted suicide does not apply to physicians who offer medical aid in dying. She is a board certified physician in internal medicine, hospice and palliative medicine, and a clinical professor of medicine from La Jolla, California.

Physician-assisted dying has been done surreptitiously “as long as we have been practicing medicine,” Cederquist tells Will.

The column is timely because the California legislature is considering whether to pass the End of Life Option Act that would authorize medical aid in dying in the Golden State during its special session on healthcare that ends on September 11. New York is among the 23 others states that are considering or have introduced death-with-dignity legislation this year, along with the District of Columbia.

Will’s column concludes:

britt and dog-001“There is nobility in suffering bravely borne, but also in affirming at the end the distinctive human dignity of autonomous choice. Brittany Maynard, who chose to be with loved ones when she self-administered her lethal medications, was asleep in five minutes and soon dead.”

It will be interesting to see if Will discusses his column endorsing death with dignity on Fox News Sunday at 2pm ET.

You can read the full column by clicking here.