Sunday, November 16, 2008

Legislating the Doctor-Patient Relationship

I read an article recently in the AMA News about some new legislation in California. Read here:

They have made it a law (the Terminal Patients' Right to Know End-of-Life Options Act) that doctors are required to talk to patients "at the patient's request" about end-of-life care, specifically hospice, but they do not have to talk about those "grey areas" (ie, withholding nutrition and water, palliative sedation) that may hasten death.

Now, anybody who knows me might think that I'd be excited about this legislation, given that I have an interest in Advance Directives and informing patients about options near the end of life, the limitations and uncertainties of the medical system, as well as just opening up communication lines regarding death and dying.

My first response though was to scoff at the idea. I realize that this is all in patients' interests--to be informed and to have understanding, and I don't want anything to get in the way of that. BUT SERIOUSLY? Making it a law? These discussions should be happening anyhow--they're part of a responsible doctor's job to make sure that patients are as well-prepared as possible for what may lie ahead.

What good does it do to say that doctors are required to provide this information "at the patient's request"? This is still putting the responsibility upon the patient.

Legal Rep: "Doctor, why didn't you talk to this patient about dying?"
Doctor: "Well, he didn't know he was dying, and didn't ask me about dying, so I didn't need to bring it up."
Legal Rep: "Oh, ok, then, well, as long as they didn't ask about it...I guess we don't have a beef."

And honestly, those doctors who aren't talking to their patients with a terminal condition about end-of-life care.... does anybody think that having it written down as a law somewhere will make them any more apt to talk about it with their patients? This isn't a conversation that you have because you're "required" to do it--it's a conversation you have because it's a privilege and it's what's right to do for your patients.

Another thing.... nothing in the article mentions what the "penalty" under law is--so it would seem just another worthless piece of paper that tax dollars were spent buying....a distraction to the lawmakers so that they might be able to say that they are "contributing to the health care system" all the while the other problems are sitting around, stewing, because, well, who knows.... "Pay no attention to that man behind the curtain."

Lesson Learned: You can't legislate the doctor-patient relationship.... it would seem legislators are a bit clueless in this realm.

What it's Worth: It's worth being able to keep a true sense of what the doctor-patient relationship is built upon.

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