Oncologists Not Having End-of-Life Discussions = Breach of Legal Duty

In a study published this week in the Annals of Internal Medicine, Jennifer Mack and colleagues found that "Although most patients have conversations with physicians about EOL care before they die, these discussions tend to take place in the hospital, with providers other than oncologists, and when death is imminent. . . .  [suggesting] that acute medical deterioration, and not the diagnosis of incurable cancer, triggers physicians to talk about EOL care."  

The lateness of the conversations matters because "patients who have discussed their preferences for EOL care with a physician are more likely to choose palliation over aggressive measures at EOL to die at home or under hospice care, and to receive care that is consistent with their preferences.  Less aggressive care at EOL is associated with better quality of life near death."

Under new laws in California and New York (one of which is now the subject of active litigation), it seems that oncologists have a legal duty to have (or at least refer patients for) these conversations.  But even without a specific "Palliative Care Information Act," it seems that failure to have these conversations is a breach of common law informed consent.  As raised in one California Supreme Court case, it deprives the patient of better quality of life at the end.  This is information that a reasonable patient would find significant.