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In 2008, New York took an active approach to increasing the use of palliative care by educating health care professionals about this form of care and its potential benefits passing Senate Bill 2108. SB 2108 provided $4.5 million in grants from the state’s public health budget to recruit faculty for and develop programs in health settings specifically focused on palliative care.  The bill also includes a provision which creates an advisory panel for the state’s health commissioner to study palliative care services in the state and to discover and implement best practices. Illinois (HB 1066) also enacted legislation in 2008 to set up study committees to develop plans for coordinating and improving delivery of palliative care in its state.

In the 2009 legislative term, Vermont passed H.435 which sets a national standard for State efforts to empower patients by actively engaging them in health decision-making. The purpose of H. 435 is to improve the quality of palliative care and pain management available to all Vermonters, to ensure that Vermonters are aware of their rights and of the care options available to them, and to expand access to palliative care services for children and adults in Vermont. The bill is an offshoot of a legislative study committee which met in late 2008 and focused on improving palliative and end-of-life care and pain management in Vermont. North Dakota also made major revisions of its code to address legal construct import in palliative care like: durable power of attorney, healthcare proxy and living wills.

What H. 435 does:

  • defines and adds the word “pain” to the Vermont Statutes;
  • describes the responsibilities of doctors and nurses to patients accessing palliative care
  • creates a patient bill of rights for palliative care and pain management;
  • adds a definition of COLST (clinician’s orders for treatment) to the existing Advance Directive Statutes;
  • asks Vermont’s Agency of Human Services to create a report on the costs and effect of a waiver to allow Vermont to provide its Medicaid-eligible children who have serious medical conditions with concurrent palliative and concurrent curative care services;
  • calls for the creation of a task force on palliative care and pain management managed by Vermont Ethics Network;
  • and, creates a board of medical practice report on improving the knowledge and practice of health care professionals in Vermont with respect to palliative care and pain management.

(Courtesy: National Conference of State Legislature)

As healthcare consumers, it is essential that we actively engage in the medical decision-making process. Legal devices like: durable power of attorney, healthcare proxy and living wills help all of us better avail ourselves to the powers and privileges we are each entitled to as a matter of law. Also, using living wills, healthcare proxies and durable power of attorney improves the chances that your individual wants are respected as they are legally binding contracts which treators, and other family members are compelled to follow. Lastly, expressing in writing your specific intentions with respect to your individual care simplifies the demands on individual family members who might be pressed to make decisions about end of life care in lieu of a written declaration.

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