Palliative care debate continues in New York – it ought to be a law
The State of New York last year addressed a growing concern that patients who are terminally ill are not routinely offered options for palliative and end-of-life care by passing legislation that requires such a discussion. The New York Palliative Care Information Act requires physicians to adequately inform patients diagnosed with a terminal condition of their palliative and end-of-life care options. Physicians argued vehemently that this restricted their patient-provider relationship. They said that the legislation does not take into account individual circumstances. The New York State legislature countered saying if physicians were truly concerned about the quality of care for terminal patients, they would be offering such information without the need for such a law. This debate continues months after the law’s February 2011 implementation.
Hospice care is becoming far more accepted and utilized than it was in decades past; but, it is all too often being used ineffectively. The average length of stay in a hospice setting (including home hospice) is about two weeks. Generally speaking, this is because the medical provider waited to discuss available end-of-life options with the patient. An effective hospice care program should include a holistic approach for the patient and for the family. The ideal timeframe for such care would be months, not weeks. Such a program includes support services, symptom management, chaplain and/or counseling services, preparation and planning. The patient is always the decision-maker about the components of his or her care.
Physicians who continue drastic treatment of terminal conditions until the prognosis is clearly evident are doing patients a disservice. Let us not doubt their motives. Physicians are trained to preserve life, and often translate this into continuing treatment for as long as possible. An alternative viewpoint should prevail, however. A true continuum of care for the terminally ill patient will include a compassionate discussion with the patient about his or her options for comfort and support services, as well as available options to continue treatment. Quality patient care requires no less than this.
What do you think – should the State of New York have passed a law requiring physicians to adequately inform patients of their end-of-life options? Should it have had to?
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