|BILL AS INTRODUCED||2007-2008|
Introduced by Representatives Zuckerman of Burlington, Bray of New Haven and Frank of Underhill
Subject: Health; medication; palliative care
Statement of purpose: This bill proposes to create a pain patient’s bill of rights to ensure that patients with severe chronic intractable pain have access to opiate medications. It would also establish a patient’s right to know end-of-life care options and to require health care providers to disclose to patients with less than one year to live their options for care and counseling. And it would direct the state board of medical practice to make recommendations to the general assembly for the adoption of statewide standards for pain management.
AN ACT RELATING TO PALLIATIVE CARE AND PAIN MANAGEMENT
It is hereby enacted by the General Assembly of the State of Vermont:
Sec. 1. 18 V.S.A. chapter 95 is added to read:
CHAPTER 95. PALLIATIVE CARE AND PAIN MANAGEMENT
Subchapter 1. Pain Patient’s Bill of Rights
§ 4801. LEGISLATIVE FINDINGS
The general assembly finds:
(1) The state has a right and duty to control the illegal use of opiate drugs.
(2) Inadequate treatment of acute and chronic pain originating from cancer or noncancerous conditions is a significant health problem.
(3) For some patients, pain management is the single most important treatment a physician can provide.
(4) A patient suffering from severe chronic intractable pain should have access to proper treatment of his or her pain.
(5) Due to the complexity of their problems, many patients suffering from severe chronic intractable pain may require referral to a physician with expertise in the treatment of severe chronic intractable pain. In some cases, such pain is best treated by a team of clinicians in order to address the associated physical, psychological, social, and vocational issues.
(6) In the hands of knowledgeable, ethical, and experienced pain management practitioners, opiates administered for severe acute and severe chronic intractable pain can be safe.
(7) Opiates can be an accepted treatment for patients in severe chronic intractable pain who have not obtained relief from any other means of treatment.
(8) A physician treating a patient who suffers from severe chronic intractable pain may prescribe a dosage deemed medically necessary to relieve severe chronic intractable pain as long as the prescribing is in conformance with standards of medical practice in this state.
§ 4802. PAIN PATIENT’S BILL OF RIGHTS
(a) A patient suffering from severe chronic intractable pain has the right to request or reject the use of any or all modalities in order to relieve his or her severe chronic intractable pain.
(b) A patient who suffers from severe chronic intractable pain has the right to choose opiate medications to relieve severe chronic intractable pain without first having to submit to an invasive medical procedure, which is defined as surgery, destruction of a nerve or other body tissue by manipulation, or the implantation of a drug delivery system or other device, as long as the prescribing physician acts in conformance with standards of medical practice in this state.
(c) A patient’s physician may refuse to prescribe opiate medication for a patient who requests treatment for severe chronic intractable pain, but such physician shall inform the patient that there are physicians who specialize in the treatment of severe chronic intractable pain with methods that include the use of opiates.
(d) A physician who uses opiate therapy to relieve severe chronic intractable pain may prescribe a dosage deemed medically necessary to relieve severe chronic intractable pain, as long as that prescribing is in conformance with standards of medical practice in this state.
(e) A patient may voluntarily request that his or her physician provide an identifying notice of the prescription for purposes of emergency treatment or law enforcement identification.
(f) Nothing in this section shall be deemed to:
(1) Limit any reporting or disciplinary requirements applicable to licensed physicians and surgeons who violate prescribing practices established by the state board of medical practice; or
(2) Limit the applicability of any federal statute or federal regulation or any other statute or regulation of this state concerning regulation of dangerous drugs or controlled substances.
Subchapter 2. Patient’s Right to Know End-of-Life Options
§ 4803. LEGISLATIVE FINDINGS
The general assembly finds as follows:
(1) The withholding or withdrawal of life-prolonging treatments, voluntary cessation of eating and drinking, and palliative sedation are all permitted under current law and well-accepted in medical practice. None of these options is considered to be “suicide” and no health care provider facilitating a patient in exercising these options is considered to be “assisting a suicide.”
(2) The lack of communication between care providers and patients regarding treatment options at the end of life is a continuing problem, despite the introduction and use of advance directives for health care, and many patients are not aware of all their legally available options at the end of life.
(3) The problem of lack of communication is exacerbated by the fact that some providers fail to inform patients about certain options at the end of life on personal grounds of conscience. A recent random survey of 2,000 U.S. physicians found that 17 percent object to the practice of terminal sedation, defined as administering sedation that leads to unconsciousness in dying patients. The survey also found that providers who object to these practices are less likely than others to believe that providers have an obligation to present all options to patients and refer patients to other providers if necessary.
(4) When a dying patient is suffering in the final stages of a terminal illness, he or she should be able to receive counseling regarding a full range of information about end-of-life care options, including withholding or withdrawal of life-prolonging treatments, the voluntary cessation of eating and drinking, and palliative sedation.
§ 4804. PATIENT’S RIGHT TO KNOW END-OF-LIFE OPTIONS
(a) Upon diagnosing any patient with a terminal illness or upon a prognosis of less than one year to live, a health care provider or health care institution shall provide to the patient counseling and written information about all
end-of-life options legal in this state, including:
(1) a list of all legally available end-of-life care options in Vermont, including refusal or withdrawal of life-sustaining treatment, voluntary cessation of eating and drinking, and palliative sedation;
(2) information about each legally available option, including a detailed definition of each option, a detailed description of the process involved if the patient were to choose each option, and a discussion of the impacts of such decisions on the patient and the patient’s friends and family;
(3) a description of counseling services available to the patient with respect to end-of-life care options and detailed information on how to obtain such counseling;
(4) a list of further resources available to the patient to explore independently the legally available end-of-life care options; and
(5) information on obtaining a referral or transfer to an alternative health care provider or health care institution in the event that the patient’s current health care provider or health care institution refuses to comply with the patient’s wishes with respect to end-of-life care options.
Sec. 2. PAIN MANAGEMENT EDUCATION
The board of medical practice of the Vermont department of health, in consultation with the Vermont Medical Society and other interested stakeholders, shall create recommendations for statewide standards on pain management. In developing their recommendations, the board of medical practices and stakeholders shall consider the recommendations included in the 2005 “Report to Attorney General William H. Sorrell from the Committees of the Attorney General’s Initiative on End of Life Care” and other state and national resources. No later than January 1, 2009, the board of medical practice shall report to the senate committee on health and welfare and the house committees on health care and on human services their recommendations for the adoption and implementation of statewide standards for pain management.
The Vermont General Assembly
115 State Street