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The Connecticut Initiative


     At every 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 options—discussing them with their physicians, family, clergy, and others—and 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 death—perhaps repugnant in concept, but sometimes vitally necessary in practice—already 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 done—if at all—haphazardly 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 decisions—the 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

     Through 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 illnesses—the needs of both patients and their families—as 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 education—encouraging 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.

The Hospice Institute for Education, Training and Research, Inc.
100 Double Beach Road
Branford, CT 06405