An Assembly panel on Monday approved a package of bills sponsored by Assembly Democrats Annette Quijano, Connie Wagner, L. Grace Spencer and Herb Conaway, Jr., M.D. to make end-of-life care decisions easier for New Jersey families.
The first measure (A-3475), sponsored by Quijano and Wagner, 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.
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.”
“This bill would help ensure that people receive the medical treatment they desire toward the end of their lives,” said Quijano (D-Union). “The POLST form is a simpler, easier way for families to know what type of medical decisions their loved one would prefer, especially when they’re incapacitated.”
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.
“The POLST paradigm is a smart, efficient way for individuals to communicate their medical wishes,” said Wagner (D-Bergen). “It not only helps physicians understand the wishes of their patients, but eases the burden on families who might be overwhelmed during understandably emotional circumstances.”
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), sponsored by Spencer, 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.
“End of life care decisions are often very difficult for loved ones to make, and even more difficult for many to discuss,” said Spencer (D-Essex). “Hopefully this council will help offer the necessary guidance to make this process easier for families.”
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), sponsored by Conaway, 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.
“This bill would ensure that those individuals who have no one else in their life to make medical decisions on their behalf, still receive the appropriate care and dignity during critical times,” said Conaway (D-Burlington/Camden). “These directives employ a compassionate, yet efficient, model for administering care to some of our most vulnerable residents.”
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.