New Law Requires End-of-Life Discussion

By Holly Hayes

Over opposition of the New York State’s medical society, last week, Gov. David A. Paterson signed a bill — the New York Palliative Care Information Act — which requires physicians treating patients with a terminal illness to “offer them or their representatives information about prognosis and options for end-of-life care, including aggressive pain management and hospice care as well as the possibilities for further life-sustaining treatment”. See the New York Times article here.

A study last week in The New England Journal of Medicine found that among 151 patients newly diagnosed with metastatic lung cancer, those who chose to receive palliative care, or care focused on symptoms, as well as standard cancer therapy reported they had a better quality of life, they experienced less depression, they were less likely to be given aggressive end-of-life care and they lived approximately three months longer than patients who received only cancer treatment.

In the August 2 issue of The New Yorker, Atul Gawande, authored an article titled, “Letting Go, What should medicine do when it can’t save your life?” See the full article here. Gawande is a surgeon and a writer, and is a staff member of Brigham and Women’s Hospital, the Dana Farber Cancer Institute, and the New Yorker magazine. Read more about Dr. Gawande here. His article gives riveting, detailed examples of our current approach to end-of-life care in the US.

In April, we wrote about being able to say no to costly end-of-life care to improve end-of-life comfort care. See more here. We referenced William Ury’s book, The Power of a Positive No whose preface begins with a discussion of his daughter’s illness and his family’s “long journey through the medical system.” He says, “I realize the process has called on all of the skills I have learned over the years in helping others get to Yes with their negotiation issues. I also realized that, for me personally, the key skill I needed to develop to protect my daughter and our family was saying No.” Everyone says no, the difference for Ury was that “my Nos needed to be nice.”

The New York law appears to be one step in the process of promoting open discussion about care options between physicians and patients.

According to one palliative care expert, the law is not enough. Dr. Diane E. Meier, director of the Hertzberg Palliative Care Institute at Mount Sinai School of Medicine in New York, said in an interview that the law does not help doctors and nurses acquire the expertise they need to hold meaningful end-of-life discussions with their patients. To increase competency in palliative care, she said, courses in medical and nursing schools and a continuing-education requirement for practicing physicians are essential.

“Doctors need to know how to identify when patients are on the decline, be able to initiate conversations with patients and/or family members, discuss what to expect in the future and the pros and cons of alternative care options, and know how to provide support as a patient’s illness progresses,” Dr. Meier said.

Perhaps there is a role for dispute resolution experts in helping our nation’s caregivers develop “the expertise they need to hold meaningful end-of-life discussions with their patients”. We welcome your comments on this topic.

Holly Hayes is a mediator at Karl Bayer, Dispute Resolution Expert where she focuses on mediation of health care disputes. Holly holds a B.A. from Southern Methodist University and a Masters in Health Administration from Duke University. She can be reached at holly@karlbayer.com.