Dear Distinguished Committee, My name is Ian McIntosh, a resident of Virginia, and Executive Director for Not Dead Yet, a national disability rights organization that fights against assisted suicide legislation and for access to the gold standard of healthcare for everyone. On behalf of Not Dead Yet members in Virginia, we strongly urge the committee to vote Yes on Delegate Levere Bolling’s bill, HB 435. For your consideration, I refer you to the article, “Economic Benefits of Investment in Palliative Care: An Appraisal of Current Evidence and Call to Action,” published in the January 2026 issue of the Journal of Pain and Symptom Management, published on behalf of the American Academy of Hospice and Palliative Medicine. (https://tinyurl.com/2x3xr4sp) Contrary to popular belief, palliative care is not just for the dying. When accessed early in diagnosis, palliative care sustains lives as well as saves lives. Moreover, proven scalable models have shown that integrating palliative care into accessible healthcare coverage improves sustainable financing; A true win-win situation. A vote for HB 435 represents an imperative ethical and economic step towards strengthening and protecting Virginia’s most vulnerable in their time of need, and positioning healthcare resources for greater patient-centered success. An investment in palliative care in Virginia is a hedge against catastrophic health expenditures for all Virginians, especially by leveraging Virginia’s existing funding mechanisms to those most vulnerable in underserved urban and rural areas. By establishing The Palliative Care and Quality of Life Advisory Council in tandem with the Palliative Care Information and Education Program, HB 435 would afford Virginians access to clear, transparent, verifiable and authoritative information, which in turn enables informed decision making while enjoying the benefits of improving quality of care that simultaneously helps control health care cost for our great state. Sincerely, Ian McIntosh Executive Director Not Dead Yet - The Resistance

Distinguished Committee, I respectfully submit this written testimony in strong support of the palliative care provisions included in House Bill 435. These provisions represent evidence-based, patient-centered policy that will improve the quality of care delivered across the Commonwealth of Virginia while supporting patients, families, clinicians, and health care systems. Palliative care is a core component of high-quality modern medicine and is distinct from hospice care in that it may be delivered at any stage of serious illness. The palliative care additions in House Bill 435 appropriately reflect this reality and align Virginia law with established national standards of care. House Bill 435 establishes a statewide Palliative Care Information and Education Program to ensure that patients with serious illness and their families have access to accurate, standardized information regarding palliative care services. This provision addresses a well-recognized gap in health care delivery. Many patients and families mistakenly equate palliative care with end-of-life care, resulting in delayed referrals, unmanaged symptoms, and care that is misaligned with patient goals. A formal education program will promote earlier understanding of palliative care as supportive, patient- and family-centered care focused on quality of life. The bill establishes a clear definition of palliative care as patient- and family-centered care addressing physical, emotional, social, and spiritual needs and not limited by prognosis or life expectancy. This clarity is essential. By explicitly stating that palliative care may be provided at any stage of illness and concurrently with curative treatment, the bill removes ambiguity that often limits access to services. A clear statutory definition supports appropriate referrals, reduces variation in care delivery, and ensures patients receive symptom-focused support based on need rather than prognosis alone. House Bill 435 also requires licensed hospitals, nursing homes, and certified facilities to identify patients who may benefit from palliative care. This promotes proactive, systematic identification of patients with significant symptom burden or complex medical needs. Structured identification will improve equity in access and support earlier care planning and coordination. In addition, the bill requires facilities to provide information about palliative care and facilitate access to available services. This ensures that integration extends beyond recognition to meaningful action. Finally, the bill establishes a Palliative Care and Quality of Life Advisory Council to provide ongoing guidance and recommendations. This council will ensure that palliative care policy in Virginia remains informed by clinical expertise, evolving best practices, and the needs of diverse communities, including rural and underserved populations. In conclusion, House Bill 435’s palliative care additions represent prudent and compassionate policy that strengthens Virginia’s health care system while honoring patient dignity and autonomy. For these reasons, I respectfully urge support of the palliative care provisions in House Bill 435. Thank you, Dr John Daniel Markley Practicing Internal Medicine and Infectious Disease Physician, Richmond Virginia Medical Society of Virginia, Active Member

Please, vote for this bill. This bill will help educate patients of the benefits of palliative care and establishes standards that can help mitigate competitive practices. Often when patients here "palliative/hospice care" brought up by their doctor, it can create a sense of unease due to the perception that palliative/hospice care is for people "who have given up". For patients reaching the end of their journey, palliative care enhance the remaining time they have and often, prolong patient longevity. I urge you to vote for this bill.

The attached document is a public comment from the Virginia Association of Centers for Independent Living (VACIL) in support of HB 435, legislation focused on expanding access to palliative care. The comment explains how the bill improves education, informed choice, and access to palliative care for people with disabilities, while preserving self-determination and individual control over medical decisions. It highlights the alignment of the legislation with the Independent Living philosophy by promoting dignity, quality of life, and equitable access to information and services across the Commonwealth