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Discussions and decisions about care at the end of one’s life are some of the most difficult, but most important, that a patient can have. Health care providers play an important role in helping patients and families confront serious advancing illnesses. Massachusetts’ 2012 health reform law, Chapter 224, directed the Department of Public Health to adopt regulations requiring hospitals, skilled nursing facilities, health centers, and assisted living facilities to provide information regarding the availability of end-of-life care options to appropriate patients.

Last week, those regulations went into effect. Providers are now required to distribute information about palliative and end-of-life care to appropriate patients, defined as patients with a terminal illness who are in their last six months of life. This information must be provided in a culturally and linguistically suitable way so that all patients are able to understand.

To develop the regulations, the Department worked closely with providers who work in the fields of hospice and palliative care, including the Hospice and Palliative Care Federation of Massachusetts. Last November, the Department held a public hearing on the proposed regulations and received testimony from providers and advocates. All commentators expressed support for the regulations as a means of ensuring that patients are made aware of the full range of available care options. The Department took these comments into account when developing the final rules. The Department of Public Health also worked closely with the Executive Office of Elder Affairs, which regulates assisted living facilities, to put these regulations into effect.

In order to assist providers, the Department created an informational pamphlet regarding palliative and end-of-life care options, titled “Know Your Choices: A Guide for Patients with Serious Advancing Illness.” This pamphlet provides easy-to-understand information about advance care planning, palliative care, hospice care, and Medical Orders for Life-Sustaining Treatment. In order to make sure a majority of patients are able to access this information, the pamphlet was translated into nine languages: Arabic, Cape Verdean, Chinese, Haitian Creole, Khmer, Portuguese, Russian, Spanish, and Vietnamese. Providers are free to develop their own information, but distributing this pamphlet fulfills the requirements of the new regulation. All versions of the pamphlet, along with the regulations themselves, are available online at

These regulations are believed to be the first of their kind in the nation. The Department hopes that these rules, and more importantly the information that patients will now be guaranteed access to, will help patients and families make informed decisions about health care choices that reflect each person’s goals, values, wishes, and needs.

Written By:

Associate Commissioner

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