New State Law Tackles End-of-Life Discussions

A new state law that takes effect this week wades into a national controversy about the government’s role in end-of-life care.

New York doctors and nurse-practitioners are now required to offer patients who have less than six months to live information about their options.

President Obama and Democratic lawmakers have gone back and forth on whether Medicare should pay doctors to initiate consultations with the terminally ill about things like hospice care and aggressive-versus-palliative treatment.

These delicate conversations – for which some Republicans supported funding but others labeled “death panels” – in the end won’t be covered by Medicare. At least not for the time being.

 But last year in Albany, lawmakers passed a law related to this debate that takes effect this week.

 Carol Levine, from the United Hospital Fund, said New York's law addresses a long-running problem.

 “People don’t want to talk about it. Doctors don’t want to talk about it,” said Levine, who leads the UHF’s “Next Step in Care” campaign. “The result is that people don’t get the kind of care that they really want at the end of life.”

She said the new state law will force care-givers to offer information, but patients don’t have to discuss anything they don’t want to.

“They can still say, ‘I don’t care. I’ll take any last chance I can get,’ ” she said. “But it’s the discussion that brings these things into the open -- the realistic options for the prognosis, the realistic options for cure, what's going to be available for you, what your preferences are.”

Medical guidelines for end-of-life conversations have existed for years, but Levine hopes the new law will give them some teeth.

“Physicians now have to take seriously their obligations to offer to discuss end-of-life situations with their patients,” she said. “They shouldn't just say, 'Oh, we'll leave that until two weeks before the patients is dead.' In order to provide the best quality of care, they have to discuss things that are very difficult to discuss.”

The statute requires care-givers who are uncomfortable with this conversation to refer patients to other people for counseling.

It’s not clear how the state will make sure care-givers are offering these consultations, and what authorities will do, if they don’t.