Do Ask – Do Tell

After steadfastly opposing a 1992 state ballot measure and multiple bills that would have permitted physician-assisted suicide, the California Medical Association (CMA) fully supported the Terminal Patients’ Right to Know End-of-Life Options Act which was signed into law in May, 2008. Under the law, terminally ill patients in California have the legal right to information from their doctors about end-of-life options. Doctors are required to provide information about hospice care, palliative care and sedation, refusing or withdrawing life-prolonging treatments, and making the choice to refuse food and hydration – but only if the patient specifically requests the information.

CMA explained their insistence on the provision that patients must ask for the information with the reasoning that a physician who volunteers end-of-life information - or even raises the subject unbidden - could be exerting undue influence on patient choice. Doctor’s who want to avoid influencing patient choice? Something about that sounds a little hokey to me.

Isn’t it my physician’s job to be my advocate and partner? Am I naïve to expect full and complete information about treatment options if I develop some condition or disease? And that includes a bad prognosis and the possibility of addressing end-of-life choices. Quite frankly, I prefer my physician to volunteer all relevant information and try to influence the heck out of me. If I don’t like what I hear - or it’s actually something significant - I would get a second option. And maybe a third if I need a tie-breaker. Ultimately, I make my own decisions.

I can only speculate on why CMA felt it imperative to require patients to ask before they tell. There is also a provision in the law that if doctors are uncomfortable complying with a patient’s wishes (say to refuse a ventilator, to abandon chemotherapy or antibiotics, or to stop eating and drinking); they can recuse themselves and assign the patient to a doctor who will comply. This provision could suggest that a significant portion of physicians in California are opposed to end-of-life care. It could suggest that they believe aggressive medical intervention is always the best answer. On the other hand, requiring patients to bring up the subject of the futility of continued aggressive treatment could suggest a fear of litigation over end-of-life decisions and this law is meant to immunize physicians.

In my opinion, it is a sad statement that this law was necessary for terminally ill patients in California to get complete information about their end-of-life choices.

PJM