442-442.7

HEALTH AND SAFETY CODE
SECTION 442-442.7




442.  For the purposes of this part, the following definitions shall
apply:
   (a) "Actively dying" means the phase of terminal illness when
death is imminent.
   (b) "Disease-targeted treatment" means treatment directed at the
underlying disease or condition that is intended to alter its natural
history or progression, irrespective of whether or not a cure is a
possibility.
   (c) "Health care provider" means an attending physician and
surgeon. It also means a nurse practitioner or physician assistant
practicing in accordance with standardized procedures or protocols
developed and approved by the supervising physician and surgeon and
the nurse practitioner or physician assistant.
   (d) "Hospice" means a specialized form of interdisciplinary health
care that is designed to provide palliative care, alleviate the
physical, emotional, social, and spiritual discomforts of an
individual who is experiencing the last phases of life due to the
existence of a terminal disease, and provide supportive care to the
primary caregiver and the family of the hospice patient, and that
meets all of the criteria specified in subdivision (b) of Section
1746.
   (e) "Palliative care" means medical treatment, interdisciplinary
care, or consultation provided to a patient or family members, or
both, that has as its primary purpose the prevention of, or relief
from, suffering and the enhancement of the quality of life, rather
than treatment aimed at investigation and intervention for the
purpose of cure or prolongation of life as described in subdivision
(b) of Section 1339.31. In some cases, disease-targeted treatment may
be used in palliative care.
   (f) "Refusal or withdrawal of life-sustaining treatment" means
forgoing treatment or medical procedures that replace or support an
essential bodily function, including, but not limited to,
cardiopulmonary resuscitation, mechanical ventilation, artificial
nutrition and hydration, dialysis, and any other treatment or
discontinuing any or all of those treatments after they have been
used for a reasonable time.


442.5.  When a health care provider makes a diagnosis that a patient
has a terminal illness, the health care provider shall, upon the
patient's request, provide the patient with comprehensive information
and counseling regarding legal end-of-life care options pursuant to
this section. When a terminally ill patient is in a health facility,
as defined in Section 1250, the health care provider, or medical
director of the health facility if the patient's health care provider
is not available, may refer the patient to a hospice provider or
private or public agencies and community-based organizations that
specialize in end-of-life care case management and consultation to
receive comprehensive information and counseling regarding legal
end-of-life care options.
   (a) If the patient indicates a desire to receive the information
and counseling, the comprehensive information shall include, but not
be limited to, the following:
   (1) Hospice care at home or in a health care setting.
   (2) A prognosis with and without the continuation of
disease-targeted treatment.
   (3) The patient's right to refusal of or withdrawal from
life-sustaining treatment.
   (4) The patient's right to continue to pursue disease-targeted
treatment, with or without concurrent palliative care.
   (5) The patient's right to comprehensive pain and symptom
management at the end of life, including, but not limited to,
adequate pain medication, treatment of nausea, palliative
chemotherapy, relief of shortness of breath and fatigue, and other
clinical treatments useful when a patient is actively dying.
   (6) The patient's right to give individual health care instruction
pursuant to Section 4670 of the Probate Code, which provides the
means by which a patient may provide written health care instruction,
such as an advance health care directive, and the patient's right to
appoint a legally recognized health care decisionmaker.
   (b) The information described in subdivision (a) may, but is not
required to, be in writing. Health care providers may utilize
information from organizations specializing in end-of-life care that
provide information on factsheets and Internet Web sites to convey
the information described in subdivision (a).
   (c) Counseling may include, but is not limited to, discussions
about the outcomes for the patient and his or her family, based on
the interest of the patient. Information and counseling, as described
in subdivision (a), may occur over a series of meetings with the
health care provider or others who may be providing the information
and counseling based on the patient's needs.
   (d) The information and counseling sessions may include a
discussion of treatment options in a manner that the patient and his
or her family can easily understand. If the patient requests
information on the costs of treatment options, including the
availability of insurance and eligibility of the patient for
coverage, the patient shall be referred to the appropriate entity for
that information.


442.7.  If a health care provider does not wish to comply with his
or her patient's request for information on end-of-life options, the
health care provider shall do both of the following:
   (a) Refer or transfer a patient to another health care provider
that shall provide the requested information.
   (b) Provide the patient with information on procedures to transfer
to another health care provider that shall provide the requested
information.