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Bill Addressing End-of-Life Issues Moves On to Christie

A new type of medical document lets the chronically or terminally ill decide how they want to spend their final days.

A bill to encourage individuals to make decisions about their end-of-life medical care, and to set lifestyle goals for their final days, was approved by the legislature Thursday and now goes to Gov. Chris Christie.

If signed into law, it will move New Jersey in the direction of more than 30 other states that now provide residents with a relatively new of end-of-life planning document, the “Physician Orders for Life Sustaining Treatment” or POLST.

Unlike living wills, typically created by individuals when they are in good health, POLST is intended for individuals facing a life-limiting or terminal illness. It encourages them to set specific goals for their end-of-life experience, and to decide whether or not they want aggressive medical treatment. POLST has to be signed by a physician or nurse practitioner, and unlike a living will, it has the authority of a physician order and becomes part of the patient’s medical record, following the patient from one healthcare setting to another: hospital, home, nursing home, hospice.

Bill sponsor Sen. M. Teresa Ruiz (D-Essex, Union) said “The critical issue is that we respect the individual’s will at this critical point in time of their life, at the very end of life.”

Kerry McKean Kelly, spokesperson for the New Jersey Hospital Association, said “We’re very pleased to see this bill come one step closer to Gov. Christie’s desk. POLST is intended to encourage meaningful conversations between individuals and their physicians to talk about end-of-life care wishes and then document those wishes as a physician order in the patient record. The goal is to empower patients and make sure their voice is the predominant one in those important decisions.”

Ruiz said the bill, “will create a program that allows patients to convey specifically how they would like to be treated in the event they lose the capacity to express their preferences regarding life-sustaining treatments. The POLST form will help to ensure that people are, in fact, able to decide how they want to live out their time here, and that their wishes are well-known by the medical professionals providing them care.”

Sen. Loretta Weinberg (D-Bergen), chair of the senate health committee, said “Patients who are suffering with chronic or terminal illnesses have the right to decide how and where they would like to live their final days. Whether someone wants to continue aggressive treatments or to receive minimal medical attention so they can live in comfort, it is our moral imperative to ensure their wishes are followed.”

She said POLST “Will create a mechanism that allows patients, whether they are in their home or in a healthcare facility, to communicate in specific terms how they would like to be treated by medical professionals at the end of life. It will ultimately ensure that people facing extreme circumstances, and the prospect of dying, are treated with care, dignity and respect.”

Under the legislation, a POLST form would only be valid if signed by the patient, or by the patient’s representative, as well as the attending physician or the advanced practice nurse, along with the date of signature. A patient at any time can amend or revoke a POLST form, or request treatment other than what was ordered on the form. On the POLST form, the patient would also spell out whether their healthcare representative or proxy has the authority to revoke or modify the POLST in the event the patient loses decision-making capacity.

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