stage of life, even in the face of terminal or irreversible illnesses,
we confront choices that define ourselves and determine how happy
our days will be. Education is key to making free and informed choices,
which is the reason we are launching the Physician Assisted Living
(PAL) initiative here in Connecticut.
While most recent attention has focused
on assisted suicide, our purpose in physician assisted living is
to offer other choices, without criticizing or condemning any particular
individual's decision. Very simply, the PAL program offers a means
for people to become more aware of their optionsdiscussing
them with their physicians, family, clergy, and othersand
to indicate their desires and preferences about the kind of care
they choose to receive.
Through a document distributed to
them in advance of the most severe state of their illnesses, patients
would have am opportunity to choose hospice care before experiencing
the depression and anxiety that may accompany terminal illness and
cloud or confuse their judgment.
Such planning for deathperhaps
repugnant in concept, but sometimes vitally necessary in practicealready
is done through many documents that are legally binding, including
the living will. The PAL document would be different: it would have
no binding legal weight, but would be a statement of preference
and a means of patient education, so that people will be able to
make more informed choices.
The initiative is a joint effort
between my office, the John Thompson Hospice Institute, Connecticut
Bar Association members, and is supported by clergy, professional
leaders, and others, demonstrating the kind of broad power elicited
by this idea and concept.
Planning for end-of-life decisions
is increasingly critical for all of us, regardless of our age, income,
or state of health. Attorneys advise us to make wills so as to avoid
conflicts and confusion in the disposition of our assets after death,
and accountants tell us to take steps that will reduce taxes paid
by ourselves and our beneficiaries.
Yet, planning for our own health
care in our last days before death is often doneif at allhaphazardly
and usually without wise, caring advice from physicians and others
with expertise. Too often, elderly friends and relatives struggle
at the end of their days, linked to complex life support systems
and without hope of recovery.
PAL offers the opportunity to avoid
situations that would be abhorrent to people if they could foresee
them, but avoidable if they simply could plan or think ahead to
those last days. Connecticut has been
a leader in developing planning documents for end-of-life decisionsthe
living will and power of attorney for health care decisions. These
important initiatives have helped countless individuals to continue
in control of their lives, even as they face death.
The living will enables an individual
to determine what forms of life support and other extraordinary
life-sustaining measures, if any, will be instituted when he or
she can no longer communicate those instructions explicitly or directly.
The living will and power of attorney
for health care decisions, however, address only end-of-life withdrawal
of life support decisions.
RICHARD BLUMENTHAL, ESQ., Attorney General, State
of Connecticut. Previously, he was a member of the Connecticut
State Senate from 1987 to 1990 and the Connecticut House of
Representatives between 1984 and 1987. He served as United States Attorney
for Connecticut from 1977 to 1981.
volume 61, no. 12
the PAL initiative, individuals may express a preference for hospice
care, before the onslaught of pain and depression, through a document
similar to the living will and power of attorney for health care
instruments Hospice care is designed to address the medical and
emotional needs of patients with terminal illnessesthe needs
of both patients and their familiesas they endure the horrendous
physical, emotional, and psychological toll often imposed.
PAL includes a document entitled,
"Notice of Desire for Hospice Care." This form is clearly
drafted and explains the basic tenets of hospice. It states that
the patient should talk with the physician, friends, and relatives
about hospice; it does not carry the legal weight of the living
will or attorney for health care decisions, and clearly states that
the decision for hospice care may be overridden by the physician
and the patient's relatives if circumstances change and hospice
care seems no longer to be the appropriate choice.
PAL also includes a consumer brochure
that explains the need for end-of-life planning and offers various
planning alternatives for the patient. The PAL initiative will be
publicized through articles, symposiums, discussion groups, and,
of course, a WEB site.
Plainly, the PAL document is in the
best traditions of consumer educationencouraging and facilitating
frank, open conversation and awareness about the advantages, downsides,
costs, and benefits of hospice care. As attorney general, I have
fought for better consumer education about many goods and services
offered in the marketplace, because an informed consumer is less
likely to become a victim of fraud or misinformation, and more likely
to be satisfied with goods and services bought for the lowest possible
price. Consumer education about the
choices for end-of-life care is no less important. The PAL initiative
is based on this principle. PAL recognizes that hospice is not for
everyone, just as the living will and durable power of attorney
for health care decisions is not universally sought. Nonetheless,
consumers should be aware of their choices and have the opportunity
to make them.
At some point, Connecticut should
decide whether the Notice of Desire for Hospice Care or a similar
notice should enjoy the legal weight given to the living will and
power of attorney for health-care decisions. Why should only certain
end-of-life decisions be incorporated into a legally-binding document?
As the PAL initiative spreads, perhaps it will provide the critical
impetus to General Assembly action.
The PAL initiative should not be
limited to Connecticut. I hope that other state public officials
will be encouraged by our success to implement a similar initiative
in their states. I am contacting all 50 state attorneys general
to urge their consideration of a PAL initiative, which will give
millions of people, regardless of geographic, ethnic, or other background,
an enhanced ability to plan for their last days.
With the PAL initiative, patients,
and their physicians will be encouraged to make a concerted effort
to plan ahead for their end-of-life decisions.