Thursday, November 23, 2006

PA Med Society to Gov: Sign SB 628

The Pennsylvania Medical Society publicly supports Senate Bill 628, which was adopted by both the Pennsylvania Senate and House during the 2005-2006 Legislative Session, and which is ready for signature into law by Governor Edward G. Rendell after the Thanksgiving holiday. The Society, on its website here, summarizes SB 628, and reiterates its members' support, as follows:

Health Care Decision-Making Bill Passes House

Senate Bill 628, which provides a comprehensive statutory framework governing health care decision-making for incompetent patients, was adopted unanimously by the House of Representatives on November 20, 2006. Governor Rendell is expected to sign it quickly. The state Senate passed the bill in October.

The Pennsylvania Medical Society supports this legislation because it provides greater clarity and protections for patients and physicians.

SB 628 would create a new law that provides for medical treatment decisions to be made for an adult patient through:
  • Instructions in a living will,
  • Health care agent appointed in a health care power of attorney,
  • Health care representative designated by the patient, or by default, based upon a statutory list of priorities.
The bill incorporates existing law provisions for out-of-hospital DNR orders.

Previously, applicable standards and procedures for health care agents and representatives were not clearly defined. As a result, physicians sometimes were faced with the dilemma of either ignoring patient autonomy or risking adverse legal ramifications. SB 628 provides both greater clarity and protections for patients and physicians.

The bill also requires the Department of Health to consider, in consultation with an advisory committee, adoption of a standardized form for a physicians-order-for-life-sustaining-treatment (POLST), which would provide for continuity of DNR and other life-sustaining treatment orders from one setting to another. The Medical Society has been working for a number of years to obtain a POLST order.

If Gov. Rendell signs SB 628 into law, the Society will provide a summary of the bill and will update its “Advance Directive” brochure and model form.
The Society is one of many organizations that provided input regarding the final form of SB 628, which is the product of compromises allowing a general consensus.

he Legislature, the Governor's Office, and the Department of Aging have also heard, during the past two years of this Legislative Session, from the Pennsylvania Bar Association, the Joint State Government Commission, a coalition of disabled persons advocates lead by the ARC of Pennsylvania, and the Pennsylvania Catholic Conference, among others.

The involvement of the Society, and the basic provisions of SB 628, were noted
here on November 22, 2006, by Medical News Today.

Update on 11/24/06:

An Associated Press news article, dated November 23, 2006, by Martha Raffaele, entitled "Bill aims to end disputes in absence of 'living wills'", was published statewide in Pennsylvania newspapers, including the Philadelphia Daily News and the Centre Daily Times. It stated, in part:

Legislation intended to provide better guidance for families whose loved ones lack either a living will or power of attorney is awaiting Gov. Ed Rendell's signature after being approved unanimously by the House of Representatives on Monday. It had earlier passed the Senate, also unanimously.

The measure, sponsored by Sen. Stewart J. Greenleaf, R-Montgomery, would give decision-making priority to a patient's spouse, unless a divorce is pending. That would be followed by adult children, parents, siblings, adult grandchildren, or another adult familiar with the patient's preferences and religious and moral values.

Greenleaf said the legislation has been several years in the making, long before the bitter end-of-life battle involving Terri Schiavo, a severely brain-damaged woman who formerly lived in Montgomery County, made national news. * * *

In his veto message, Rendell expressed concerns that the earlier bill would prevent families whose relatives suffer from advanced chronic diseases, such as Alzheimer's, but are not considered terminally ill, from seeking comfort care instead of life support for patients without a living will. He also praised the intent of the bill and encouraged the General Assembly to revise it. * * *

Rendell spokeswoman Amy Kelchner said Wednesday that the governor would need to review the bill before deciding whether to sign it.

Update on 11/27/06:

In an editorial, dated November 26, 2006, the Carlisle Sentinel urged Governor Rendell to sign SB 628. That newspaper stated here:

When Gov. Rendell in 2004 vetoed legislation intended to make end-of-life decisions more clear-cut for patients and families, he said that if the Legislature came back with a better bill, he would sign it.

State legislators clearly think they have crafted a bill that overcomes the reservations the governor had then. Last week both the House and Senate unanimously approved a measure now sitting on Rendell's desk awaiting his signature. * * *

This bill, predating [Terry Schiavo's] tragic situation, has been years in the making and involved the thoughtful efforts of advocates for the disabled, associations representing doctors and lawyers and faith-based groups. And as already mentioned, it was sent back once for further work.

It is apparent that Rendell made the right decision then. This new version allows flexibility for families caught in wrenching circumstances and also gives developmentally disabled patients faced with life-threatening illnesses greater say in their medical care.

No one wants government interfering in the most fundamental decisions regarding an individual's life and death. Nor does anyone want to have life-and-death decisions decided in the courts surrounded by a media circus, as was Schiavo's fate.

We urge the governor to study this bill carefully. If it does the job in defining where Pennsylvanians stand in making end-of-life decisions for loved ones without crossing the boundary of government intrusion, he should sign it.