Southern California health care providers call for more compassionate end-of-life care
Major institutions issue guidelines aimed at ensuring that medical decisions support patients' individual wishes, reduce suffering
Uniting around a vital cause, nine of Southern California's leading health care providers, including UCLA, have jointly issued a set of recommendations to reduce suffering and promote greater dignity for patients approaching the end of life.
The guidelines call on doctors and other health care professionals work with adult patients to plan in advance for end-of-life care that respects each patient's values and goals and avoids treatments that can do more harm than good.
The recommendations were unveiled May 22 at a conference sponsored by nine private and public health care providers that together serve more than 5 million Southern Californians. In addition to the UCLA Health System, they include Cedars-Sinai, HealthCare Partners Medical Group and Affiliated Physicians, Huntington Hospital in Pasadena, Kaiser Permanente Southern California, Los Angeles County-USC Medical Center | Keck School of Medicine, MemorialCare Health System, Olive View-UCLA Medical Center, and Providence Health and Services.
"Medical advancements, the explosion of information availability, and economic pressures have created unprecedented ethical issues in health care and end-of-life care," said Dr. Neil Wenger, director of the UCLA Health Ethics Center and a professor in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA. "Academic medical centers such as UCLA's often confront complex life-and-death questions. We must help patients and their families through the process of negotiating difficult end-of-life decisions."
Medical experts and government leaders have supported the initiative, since most people do not engage in end-of-life planning, leaving them vulnerable to medical care that does not reflect their wishes when their health takes a serious turn. Research from the nonprofit California HealthCare Foundation, for example, shows that nearly 80 percent of Californians say they want to speak with their doctor about end-of-life care, but fewer than one in 10 have. In addition, 82 percent say it is important to put their wishes in writing, but less than one-quarter have done so.
"This coordinated effort by so many Southern California health care providers shows the kind of leadership that can help many people in the communities they serve get the care that they want," said Sandra R. Hernández, president and CEO of the California HealthCare Foundation.
The nine health care providers presented in detail their advance care-planning recommendations at Thursday's conference, titled "Better Planning, Better Care: Promoting Dignity, Reducing Suffering at End of Life," held at Cedars-Sinai.
The guidelines call on doctors and medical systems to:
- Encourage all patients to engage in advance care-planning and to make this approach standard so that providers can deliver appropriate care reflecting each patient's values and preferences.
- Facilitate timely access to palliative care and other support services, such as hospice care, for patients with chronic and progressive illnesses.
- Advise patients on the potential benefits and drawbacks of medical treatments and whether such care can deprive them of a peaceful death.
- Engage in shared-decision making with patients to reach conclusions about what constitutes optimal care in particular situations.
For more information on the UCLA Health Ethics Center, visit their website.
Roxanne Moster and Enrique Rivero