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Palliative Care: 10 Facts To Know

By News

What Is Palliative Care?

Palliative care is an approach that improves the quality of life of patients (adults and children) and their families who are facing problems associated with life-threatening illness. It prevents and relieves suffering through the early identification, correct assessment and treatment of pain and other problems, whether physical, psychosocial or spiritual.

This care is a crucial part of integrated, people-centered health services, at all levels of care: it aims to relieve suffering, whether its cause is cancer, major organ failure, drug-resistant tuberculosis, end-stage chronic illness, extreme birth prematurity or extreme frailty of old age.

Fact 1: Palliative care improves lives

Worldwide, only about 14% of people who need care currently receive it. The quality of life of patients and their families who are facing problems associated with life-threatening illness, whether physical, psychosocial or spiritual are greatly improved by palliative care.

Fact 2: Pushing policy will drive palliative care forward

World Health Assembly resolution 67.19 on strengthening palliative care, adopted in 2014, emphasizes the need to create national care policies, to ensure secure access to opioids for pain relief, training for all health care staff in palliative care, and the integration of palliative care services into existing health care systems.

Fact 3: Most people in need of palliative care are in their own homes

Therefore, the most effective models of palliative care link supervised home care and care at community health centres to hospitals with more palliative care expertise.

Fact 4: Palliative care benefits everyone

Patients during treatment for serious illnesses, not only patients at the end of their lives, can take advantage of what palliative care can offer. For example, it can improve the quality of life of patients receiving radiation therapy for cancer or chemotherapy for cancer or drug-resistant tuberculosis.

Fact 5: Oral immediate-release morphine is an essential palliative medicine

Opioid laws and prescribing regulations must balance the prevention of illegal use of opioids with ensuring accessibility to morphine to relieve moderate and severe pain.

Fact 6: Children have little access to palliative care

They are at a higher risk than adults to face inadequate pain relief. For children, 98% of those needing palliative care live in low- and middle-income countries with almost half of them living in Africa.

Fact 7: Palliative care is “people-centered”

For example, it respects the values and confidentiality of patients, seeks to protect patients and their families from financial hardship due to the illness, and provides emotional support both during the illness and for the bereaved.

Fact 8: Palliative care shows global disparity

Lack of access to palliative care and pain control is one of the largest inequalities in global health. Most people in high-income countries have access, but only a small percentage of people in low- and middle-income countries do. Each year an estimated 40 million people are in need of palliative care, 78% of whom live in low- and middle-income countries.

Fact 9: The need for palliative care has never been greater

It continues to grow with the increase of chronic diseases and people living to an older age.

Fact 10: Integrating home care has multiple benefits

Palliative care that includes home care can improve the quality of life of patients and their families while also saving money for health care systems by reducing unnecessary hospital admissions.

Long Term Care

End of Life Option Act

By Uncategorized

What is the End of Life Option Act?

As of June 9, 2016, California joins Oregon, Vermont, and Washington in permitting terminally-ill residents to request a lethal prescription under its End of Life Option Act.

 A Brief History of Options at End of Life: The Right to Refuse Treatment

Do Not Resuscitate Orders

death_with_dignityIn 1976, the decision by a patient to decline resuscitation was fought all the way to the New Jersey Supreme Court, where the court upheld the rights of Karen Ann Quinlan’s parents to order her removal from artificial ventilation. In 1987, New York became the first state to pass a law allowing patients to file a “Do Not Resuscitate” order with their medical team. In Rhode Island the Department of Health recognizes Medical Orders for Life Sustaining Treatment (“MOLST”) which are instructions to follow a terminally ill patient’s wishes regarding resuscitation, feeding tubes and other life-sustaining medical treatments. The MOLST form can be used to refuse or request treatments and are completely voluntary on the part of patients. These orders can supplement Do Not Resuscitate (DNR) instructions or a COMFORT ONE bracelet.

Advance Health Care Directives

In 1991, Congress passed the Patient Self-Determination Act, requiring hospitals to honor a patient’s decisions with regards to their own health care, including decisions to withhold treatment.

Rhode Islanders have the right to control decisions related to their medical care and to authorize others to make medical decisions for them if they become unable to do so themselves.

Living Wills

The Rights of the Terminally Ill Act allows individuals to instruct their physicians to withhold or withdraw life-sustaining procedures in the event of a terminal condition. If you wish to establish a Living Will, as part of your estate plan, we would prepare a form that reflects your goals and wishes compliant with the requirements of the Act.

Durable Power of Attorney for Health Care

Rhode Island law allows an individual to authorize another person to make decisions affecting their health care if they become unable to do so. You do not have to have a terminal condition to activate the Durable Power of Attorney for Health Care. If you wish to name an agent for these purposes, you must use the statutory that we prepare and complete as part of our estate planning services for our clients.

Organ Donation

The Office of State Medical Examiners supports the donation of organs and tissue. Organ donation can help families through the grieving process and give others a second chance at life.

End of Life plan

 “End of Life Options Act” in California

Patients must make two oral requests, at least 15 days apart, and a written request. Their attending physician must make a determination that they have a terminal illness with a life expectancy of less than six months, and must make a determination that the patient has the mental capacity to make the request for aid-in-dying medication; a consulting physician must make the same determinations. The patients must be able to ingest the medication themselves, although they may have assistance in preparing it.

The cause of death may not be listed as suicide; any insurance benefits, wills, or contracts shall be treated as if the person died a natural death from their underlying terminal illness.

At least one challenge has already been filed, seeking a preliminary injunction against the implementation of the Act. The California Department of Public Health shall release annual reports, beginning July 1, 2017, with statistics on prescriptions issued and deaths resulting from those prescriptions, so it will be a year before we know if anyone has availed themselves of this Act.

Does Rhode Island Have an End of Life Option?

Rhode Island currently does not have similar End of Life Option legislation, though there have been several bills similar to the Oregon-style physician-assisted dying bills that have been considered in the Rhode Island state legislature before, in 1995, 1998, 2001, 2006 (H 7428, S 2766) and 2007 (HB 6080). Most recently, Representative Ajello’s submitted a bill, H 7659, the Sapinsley Compassionate Care Act, which was heard in a House Committee on March 23, 2016, and held for further study.

The citizens of Oregon passed Measure 16, “Oregon Death with Dignity”, in November 1994, by a slim margin of 51.31% to 48.69% which authorizes physicians to provide aid-in-dying to terminally ill patients.

Other States

Four states now have aid-in-dying statutes: Oregon, created by voter initiative in 1994; Washington, created by voter initiative in 2008; Vermont, created by the state legislature in 2013; and California, created by the state legislature in 2015, effective June 9, 2016. Three states have statutes prohibiting aid-in-dying: Arkansas, Idaho, and Georgia.

Concerned with your Medical Directive and want to discuss further?

Contact our office to discuss drafting a Medical and Health Care directive that reflects your wishes.

Portions of this article were cited from LISI Estate Planning Newsletter #2440 (August 4, 2016).