Doris Hawks, a Los Altos, Calif., lawyer and co-chair of the National Academy of Elder Law Attorneys Health Care Decisionmaking Section, prefers this advance directive, which became legally valid in California under the new law. Though most states let physicians or hospitals decline care based on reasons of conscience, Texas is the only other state with language similar to that in California's statute. Ill. Scott Rae, PhD, professor of bioethics at Biola University in La Mirada, Calif., said it reinforces the moral value of the proper stewardship of scarce medical resources and might prevent terminal patients from undergoing ineffective and painful treatments. But Robert Orr, MD, chair of CMA's Council on Ethical Affairs, is less optimistic. There is no medical consensus on a definition of futility nor empirical basis for deciding that further care would be futile, says an article in the July 27 New England Journal of Medicine .
Many hospitals also lack futile-care policies.
California's new law also enables patients to orally designate a surrogate for a particular health care episode. It also allows a surrogate to be designated as the decision-maker even when patients retain the capacity to speak for themselves. But the law lacks the rigid surrogate hierarchy that some had advocated for in the absence of an advance directive. Despite an increased recognition of written advance directives' value, experts said that ongoing communication remains essential. Back to top.