Articles Posted in Advance health care directives

Published on:

loneliness-2308923_640-300x200A few months ago, the New York Times published an article entitled, “Single? No Children? No Will? Big Mistake.” I’ve been meaning to write about it ever since. The author writes, “Certain people never reach one of those obvious points in their lives to write one. If you are unmarried in middle age, do not have children and have never had a devastating disease or brush with death, making plans for what happens to your stuff if you’re not around may not feel pressing.”

The author is so right. I have met many people who somehow feel that, because they don’t have children, they don’t need an estate plan. But here’s the thing — people without children may have even MORE need to make a plan that those with kids.

For one thing, all of us, at some point, are going to get sick or otherwise incapacitated, and need someone to act on our behalf — to pay bills, maintain our homes, or make medical decisions. Estate planning is not just about transferring assets when you die, it is also about planning for incapacity. And everyone needs to do that.

Published on:

shutterstock_265887227On October 5, 2015, Governor Brown signed the End of Life Option Act into law. The law requires that two doctors determine that a patient has six months or less to live before the lethal drugs can be prescribed. Patients also must be mentally competent to make medical decisions and be able to swallow the medication themselves and must affirm in writing, 48 hours before taking the medication, that they will do so.

But the law, when passed, wasn’t to become effective until 91 days after the adjournment of a special legislative session on health care, and no one knew exactly when that was going to happen. Now we do.  That session ended on March 10, 2016, which means that the law will be effective as of June 9, 2016.

Since this is a new law and a new policy for the state, it is going to take time for both the public and doctors to fully understand how the process is going to work and what the legal requirements are for compliance.

Published on:

shutterstock_265887227In October, California became one of five states to permit medical aid in dying with the passage of the End of Life Option Act. The bill is modeled after one passed in Oregon in 1997.

Governor Brown signed the bill, with a signing statement that said, in part, “I do not know what I would do if I were dying in prolonged and excruciating pain. I am certain, however, that it would be a comfort to be able to consider the options afforded by this bill. And I wouldn’t deny that right to others.”

The bill allows doctors to prescribe lethal drugs to terminally ill patients who are expected to live six months or less. A patient must make two oral requests, at least 15 days apart, and one written request, signed in front of two witnesses. The signer must have the capacity to understand what they are requesting, the request must be voluntary, and a physician has to discuss feasible alternatives that would also be available to the patient.

In addition, a patient must self-administer the drug (in other words, no one else can administer the drug) and no one can request such drugs on another’s behalf (in other words, no one can act for a patient to make such a request through a power of attorney, an advance health care directive, or as a conservator, health care agent, surrogate, or any other legally recognized health care decisionmaker.) A patient can rescind such a request at any time.

The bill provides a form for the request for lethal drugs that reads in part:

REQUEST FOR AN AID-IN-DYING DRUG TO END MY LIFE IN A HUMANE AND DIGNIFIED MANNER I, ………………………………………………, am an adult of sound mind and a resident of the State of California.
I am suffering from ……………., which my attending physician has determined is in its terminal phase and which has been medically confirmed.
I have been fully informed of my diagnosis and prognosis, the nature of the aid-in-dying drug to be prescribed and potential associated risks, the expected result, and the feasible alternatives or additional treatment options, including comfort care, hospice care, palliative care, and pain control.
I request that my attending physician prescribe an aid-in-dying drug that will end my life in a humane and dignified manner if I choose to take it, and I authorize my attending physician to contact any pharmacist about my request.

The Bill takes effect 90 days after the Legislature adjourns its special session on health care, which will be sometime in 2016. To read more about the End of Life Option Act, here’s a good summary from the LA Times.

Published on:

yellow-sunflower-403172_640For the first time since 2007, legislation has been introduced in this year’s State Senate that would legalize physician-assisted suicide in California. The bill, SB 128,  The End of Life Option Act, is modeled on Oregon’s Right to Die law. It allows a person with a terminal disease and a prognosis of death within six months to obtain a physician’s prescription for a lethal dose of medication.

Two doctors would have to agree that the patient meets certain criteria, such as mental competence, that they’ve been made aware of alternatives, and that they be able to take the dose without help.  There’s a fifteen-day waiting period and doctors who don’t want to write that prescription can opt out. A patient can change their mind at any time. California’s law has two different provisions from Oregon’s law: it requires a translator for non-English speaking patients and pharmacists are given legal immunity for participating in these deaths.

There are currently only three states that permit physician-assisted death laws: Oregon, Vermont, and Washington and court-rulings make the procedure available in New Mexico and Montana. According to the San Jose Mercury News, 12 other states have introduced right to die legislation.

Published on:

hospital

The tragic case of the Oakland twelve-year old girl, declared brain dead after a routine surgery by the hospital, and her parent’s plea to keep her connected to a ventilator nonetheless, reminds me yet again of the value and importance of completing an Advance Health Care Directive.  

This document allows you to name agents to act on your behalf with respect to health care decisions and to state your wishes for end of life care. 

In the immediate case, of course, the girl was a minor, and would not have been able to make her own advance health care directive, so it is her parents who are making those choices for her. For the rest of us, this case is a cautionary tale–it is important to let people know what your choices would be at the end of life if you are not going to be able to communicate your wishes yourself, otherwise you won’t have any control over how that decision gets made.