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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Facing mesothelioma or losing a loved one to the disease can cause feelings of severe loss and grief. The ways which individuals cope with this sorrow differ greatly, even on a physiological level. A new study out of UCLA suggests that individuals with "complicated grief" experience increased brain activity in surprising areas.

"Complicated grief" refers to sorrow that does not diminish over time, as may be expected. In the UCLA study, 23 women who had lost a mother or sister to breast cancer were examined. Twelve of them had noncomplicated grief, while the other 11 suffered from complicated grief. The subjects without complicated grief demonstrated the expected brain activity on a functional MRI test when shown pictures of their lost relatives. In both subject groups, the brain regions associated with physical and emotional pain were active. In the women with complicated grief, however, brain activity also occurred in the nucleus accumbens-- an area of the brain associated with earning rewards.

Researchers were initially puzzled by this discovery; the brain activity seemed to indicate that the grief was pleasurable, thus stimulating the "reward" area of the mind. Upon further testing, the doctors concluded that the nucleus accumbens also reacts when individuals desire or crave something, such as a reward. In the subjects suffering from complicated grief, the nucleus accumbens became active because they physically yearned for their lost relative. In a survey, these women were more likely to say they longed for the deceased.

These new results will help counselors better assess their clients who suffer from complicated grief by attuning them to the physical yearning they experience. This is the first study to determine a neurological explanation for the persistent longing that occurs in about 10-20% of people who lose loved ones. For more information on the study, go here.