The California Department of Health has issued a new All Facilities Letter regarding end-of-life care, which took effect on January 1, 2009. The letter outlines the requirements for healthcare providers, including physicians, nurse practitioners, and physician assistants, to provide comprehensive information and counseling on legal end-of-life care options for patients diagnosed with a terminal illness. These options include hospice care, the patient's right to refuse or withdraw life-sustaining treatment, and comprehensive pain and symptom management. If a healthcare provider prefers not to comply with these requirements, they must refer or transfer the patient to an alternative provider who will provide the requested information. The information may be provided in writing but is not required to be. Facilities must refer to the full text of the legislation to ensure compliance, and any questions should be directed to the local district office.

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