Assembly Panel Advances Bills To Assist With End-Of-Life Care Decisions

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TRENTON – On Monday, an Assembly panel approved a package of bills intended to make end-of-life care decisions easier for New Jersey families.

The first measure (A-3475), would require the state to create a form called the Physician Orders for Life-Sustaining Treatment (POLST) to enable New Jersey patients to indicate their preferences for health care.

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According to POLST.org, the POLST Paradigm program is designed “to improve the quality of care people receive at the end of life. It is based on effective communication of patient wishes, documentation of medical orders on a brightly colored form and a promise by health care professionals to honor these wishes.”

The POLST form would serve as a complementary measure to the use of an advance directive for health care, or in lieu of an advance directive if the patient has not executed such a document. Unlike an advanced directive, which varies in nature and is the responsibility of a patient to have prepared, the POLST form would be a standardized printed document made available to health care professionals and facilities to use with their patients.

Under the bill, the Commissioner of DHSS would be responsible for instituting the program and charged with, among other things:

  • promoting awareness among health care professionals and the general public;
  • encouraging ongoing training of health care professionals about the POLST form; and
  • prescribing additional requirements for the completion of a POLST form applicable to a patient with mental illness or a developmental disability;

Health care professionals and institutions would be required to treat a patient who has a completed POLST form in accordance with the information contained in the form.

The second bill (A-3839) would establish the New Jersey Advisory Council on End-of-Life Care in the Department of Health and Senior Services.

The advisory council would be charged with conducting a thorough and comprehensive study relative to the quality and cost-effectiveness of, and access to, end-of-life care services for all residents in New Jersey. The council would also be required to develop and present policy recommendations relating to state agencies, policymakers, health care providers, and third party payers.

In developing its recommendations, the advisory council’s overriding concern would be to promote an end-of-life care paradigm in which patients’ wishes are paramount and they are provided with dignified and respectful treatment that seeks to alleviate their physical pain and mental anguish as much as possible.

The advisory council would be comprised of 21 members, including: the Commissioners of Health and Senior Services and Human Services, or their designees; two members each from the Senate and the General Assembly to be appointed by the President of the Senate and the Speaker of the General Assembly, respectively, who in each case are to be members of different political parties; the Ombudsman for the Institutionalized Elderly or his designee; and 14 public members who are residents of New Jersey, to be appointed by the Governor with the advice and consent of the Senate, with a wide variety of specified backgrounds related to end of life care.

The advisory council would be required to report to the Governor and the Legislature no later than 18 months after the date of its organization on the results of its activities.

The third bill (A-4098) would create a system through which patients who lack decision-making capacity and have no one available to decide for them could receive care in the most appropriate setting, with minimal delay, and without unnecessary cost.

If enacted, New Jersey would become just the twelfth state to authorize non-judicial decisions about medical treatment for such patients.

This bill would allow healthcare facilities to make decisions for routine and major medical treatment for socially isolated, incapacitated patients, and for decisions to forgo life-sustaining treatment, when the treatment offers no medical benefit and violates accepted medical standards.

The bill provide explicit language authorizing facility-based transfer decisions as well as medical treatment decisions in order to expedite the healthcare decision-making process for these patients, reduce the time and expense of keeping these patients in inappropriate care settings, and eliminate the legal costs incurred by hospitals and nursing homes of securing a Special Medical Guardian to consent to medical treatment.

The bill would require that specially constituted ethics committees in hospitals and nursing homes would have the authority to decide to forgo life-sustaining treatment for incapacitated patients who are terminally ill or permanently unconscious, and have no other decision-maker available.

The bill would take effect on the first day of the seventh month following the date of enactment.

Eleven other states authorize non-judicial decisions about medical treatment for patients who are socially isolated and have lost decision–making capacity, with varying hospital-based procedures for the decisions, ranging from a decision by a single physician to a determination by two physicians, with review by an ethics committee. Five of these states allow non-judicial appointments or procedures for decisions about health care treatment and services in language that is broad enough to encompass a decision about transfer. Six states allow physicians to decide to forgo life-sustaining treatment for patients who lack capacity, have no other surrogate, and are terminally ill or permanently unconscious.


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  • alan cato md

    Thirty-four years as a family physician have convinced me that, in the nursing home population, much of the poor quality of care stems from physicians, and others in the healthcare industry, engaging in self-serving case management decisions—usually based either on defensive medicine, or convenience. Medically naïve and grief stricken consumers, when coupled with healthcare personnel engaged in self-serving case management decisions, create the perfect storm for guaranteeing medical mismanagement of end-of-life issues. As a result, that there is an expected and inevitable time for death to occur is being ignored entirely throughout our nation’s hospitals and nursing homes, resulting in needless additional days of suffering for patients, and needless excessive cost—borne, in the majority of instances, by an already financially struggling Medicare system.— Alan D. Cato MD, author of the book: The Medical Profession Is Dead and the Doctor Is “Critically ill!”