Until last year, most state legislative discussions over care for the terminally ill have turned into culture war battles over the propriety of physician assisted death. It is now clear that physician assisted death is just a small part of end of life care, and that most of the advocates on all sides of that issue want to help terminally ill patients live and die on their own terms, with their pain and suffering treated as those patients wish, and with their lives and dignity protected on the patient's own terms. This realization has come to advocates on all sides of these issues at the same time that new research confirms that terminally ill patients are rarely provided comprehensive information on the options available to them as death nears, and physicians continue to feel uncomfortable even informing patients about anything other than intense, curative treatment, even when those physicians would never choose that kind of care for themselves if they were in the positions of their patients.
As a result, two state legislatures, in California and New York, have abandoned high profile legislative warfare over physician assisted death, and, instead, have chosen to fly under the partisan political radar in establishing the legal requirement that terminally ill patients be told of all of the medical options actually available to them. First, a year ago California required providers who were asked by terminally ill patients to provide "comprehensive information and counseling regarding legal end-of-life options." Just a few months ago the New York legislature imposed this same requirement on providers whether or not there was a patient request; the obligation arises upon the diagnosis of terminal illness. Those palliative care options include the voluntary stopping of eating and drinking and terminal sedation, options which often make any need for physician assisted death unnecessary. The statutes are just beginning to have an effect on practice and on end of life care, but they could bring dramatic change to the way we treat the dying process in this country. These statutes could return control of the dying process in most cases from physicians and hospitals, where that control now resides, to patients and their families.
This panel will address the politics of the California and New York legislation, the process that led to the adoption of the legislation in each state, the effect on the legal environment surrounding end of life care in each state, and the consequences for the practice of medicine and the treatment of terminally ill patients. How did these states climb above the culture wars to address this issue and create this revolution in patients' control of their dying process? Might this provide a model for effective below-radar and non-political agreement to actually resolve other issues still caught in the grips of the culture war?