In June, I blogged about a California bill addressing end-of-life rights for patients. A similar bill is currently stuck in committee in Vermont and a proposition for a federal bill is being brought to the Senate's attention. It would be the first act of its kind to gain national passage.

The California bill requires doctors to teach terminal patients about end-of-life options such as hospice homes and palliative care, so that the patients know they are not obligated to continue aggressive treatment regiments. Under the bill, doctors must give this straight talk to patients who are expected to survive less than a year.

This bill puts the patient in power of decision-making. Without this provision, physicians control how much patients knows. This bill ensures that the patient is fully informed and can make educated and knowledgeable choices regarding their health, treatment, and end-of-life environment.

Physicians are obligated to present options to patients, but not endorse any. Nevertheless, the bill has garnered opposition from politicians who believe that it is setting the stage for assisted suicide cases. While palliative care aims only to comfort a patient in their last days, it has been known hasten the process of dying.

California's measure is known as the "Terminal Patients' Right to Know End-of-Life Options Act." Under the bill, physicians who do not comply with the terminal patient's wishes must refer the person to a new doctor who will carry out his or her intentions.

Many doctors fear that compliance with the bill will be hard to guarantee, as it is often difficult to predict a patient's likelihood of surviving a year. To this point, some oncologists believe that discussing end-of-life options too early can cause the patient harm. Though this point was essentially debunked in a recent study, physicians struggle to find a balance between informing their patients and overwhelming them. Some doctors warn against divulging details too soon: "What most people want to know about are hospice and palliative care. They may not be asking about last-resort options like palliative sedation and stopping eating and drinking," said Dr. Quill, director of the University of Rochester Medical Center's palliative care program in New York.

Thomas J. Smith, MD, an oncologist and co-author of a Journal of the American Medical Association article on poor communication between cancer patients and doctors, said the California law "is something that could be tested in one state, and if it works, then it could potentially be applied to other states. It certainly raises awareness of the issues."

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For many mesothelioma patients, end-of-life treatment is a primary concern.  While some opt to maintain aggressive therapy, others elect to enter hospice care.  In the UK, one man took matters into his own hands: he arranged a wake-like gathering for family and friends before his death.

Nigel Phillips worked on docks for over 20 years.  The 61-year-old was recently diagnosed with mesothelioma and given only 12 months to live.  Upon receiving the news, he organized a small get-together with some friends for drinks.  A fellow dock-worker, however, spread the news of Nigel's party and his diagnosis.  What started out as a handful of guests turned into a group of 100 colleagues, coworkers, and friends who came to pay Nigel respect.

The part was gratifying for Nigel, who is unsure how the disease will progress.  Though he has been treated in Cambridge at excellent facilities, he knows mesothelioma can be unpredictable.  In seeing all his friends, Nigel was equipped with the emotional support and security needed to handle the cancer.

To read more about Nigel's story, click here.