|In the near future, I will be reintroducing legislation, previously SB 142 of the 2019-20 session, updating and revising Pennsylvania law (Title 20) to include the codification of "Pennsylvania Orders for Life Sustaining Treatment (POLST)" to be used by medical professionals across all health care settings for patients who voluntarily wish to execute a POLST order.
POLST orders are different from advance directives in that POLST orders convert an individual’s wishes regarding health care into a medical order that is immediately actionable and applicable across all health care settings. In contrast, advance directives often only name a surrogate decision-maker to make health care decisions for the individual or often lack specificity as to the individual’s goals and preferences for a medical condition that subsequently develops because it was not foreseen by the individual.
In 2006, Title 20 was amended by Act 169 to update the procedures for living wills, health care powers of attorney and out-of-hospital do not resuscitate (OOH-DNR) orders. In addition, Act 169 created a committee to assist the Department of Health (DOH) in determining the advisability of using a standardized form containing orders by qualified physicians that detail the scope of medical treatment for patients’ life-sustaining wishes. However, Act 169 did not mandate the use of a POLST form as a medical order.
My legislation will codify a POLST form that may be used by individuals wishing to designate end of life wishes and discontinue the use of OOH-DNR orders following the effective date of my legislation.
The first part of my legislation will update Chapter 54 of Title 20 to include the recognition of POLST orders. The majority of the legislation will create a new Subchapter F known as the Pennsylvania Order for Life Sustaining Treatment Act. The new Subchapter will:
Individuals should have the right to dictate end-of-life decisions in a manner that is sensitive to the situation at hand while also providing clear direction to medical professionals making treatment decisions on behalf of the individual.
- Make clear that POLST forms are not to be used to advance or support euthanasia, suicide or health care practitioner-assisted suicide.
- Health insurer prohibitions: Prohibit insurers from certain actions regarding POLST orders, including requiring an individual to consent to a POLST order or to have a POLST order as a condition for being insured, prohibit insurers from charging an individual a different rate whether the individual consents to a POLST order or has a POLST order, and prohibit an insurer from requiring a health care provider to have a policy to offer a POLST order to any individual.
- Health care provider restrictions: Prohibit health care providers from adopting policies that require individuals to have a POLST order as a condition for treatment or admission to a facility.
- DOH responsibilities: Create a POLST Advisory Committee headed by the Secretary of Health to advise DOH on POLST-related matters, including but not limited to the format and content of the POLST form and education about POLST orders. DOH would be required to adopt and update a POLST form as needed; develop an update basic education materials on POLST orders; and make the POLST form and its educational materials available and accessible through the Internet.
- Requirements for a valid POLST order: Require specific information be provided on the POLST form, including: completion of the medical order section regarding CPR, the individual and health care practitioner’s signatures, and procedures when a verbal POLST order shall be accepted as a valid POLST order.
- Portability and transfer requirements: Ensure that POLST orders are valid anywhere within the Commonwealth, including health care facilities, the individual’s residence, vehicle transits from one health care facility to another and other care settings outside of a health care facility.My bill will also require a health care facility that transfers an individual to another health care facility to provide a copy of the POLST order to the receiving health care facility.
- Emergency medical services: Set forth requirements for EMS providers in complying with POLST orders.
- Immunity: Provide immunity for health care providers and other persons for complying with a POLST order based upon a good faith assumption that the order was valid.
I hope you will join me in co-sponsoring this legislation.