Legal briefing: Advance care planning

Journal of Clinical Ethics

Volumn 20, Issue 4, 2009, Pages 362-370

  Pope, Thaddeus Mason ^a  

^a WIDENER UNIVERSITY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; EUROPE; GOVERNMENT; HOME FOR THE AGED; HUMAN; INFORMED CONSENT; LEGAL ASPECT; NURSING HOME; PATIENT CARE; TERMINAL CARE; UNITED STATES;

ADVANCE CARE PLANNING; ARIZONA; EUROPE; FEDERAL GOVERNMENT; HOMES FOR THE AGED; HUMANS; INFORMED CONSENT; NEW YORK; NURSING HOMES; STATE GOVERNMENT; TERMINAL CARE; UNITED STATES; VIRGINIA;

EID: 77649223378     PISSN: 10467890     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Article

References (142)

1. "Advance care planning is a broader, less legally focused concept than that of advance directives. It encompasses not only preparation of legal documents but also discussions with family members and physicians about what the future may hold for people with serious illnesses, how patients and families want their beliefs and preferences to guide decisions (including decisions should sudden and unexpected critical medical problems arise), and what steps could alleviate concerns related to finances, family matters, spiritual questions, and other issues that trouble seriously ill or dying patients and their families." Institute of Medicine, Committee on Care at the End of Life, Approaching Death: Improving Care at the End of Life (Washington, D.C.: National Academy Press, 1997), 198-199
2. R. Miller, "Physician Orders to Supplement Advance Directives: Rescuing Patient Autonomy," The Journal of Clinical Ethics 20, no.3 (Fall 2009): 212-219
3. "Life Panel? Death Panel?" PBS Now, 9 October 2009, http://www.pbs.org/now/shows/541/index.html, accessed 12 October 2009.
4. K. O'Reilly, "End-of-Life Care Provision Stirs Angst in Health Reform Debate," American Medical News, 24 August 2009;
5. D. Whelan, "Obama Care Dives into End-of-Life Debate," Forbes, 24 July 2009.
6. Gonzales v. Oregon, 546 U.S. 243, 272 (2006). Indeed, Medicare regulations implementing the Patient Self Determination Act are designed to assure compliance with substantive patient rights protected under state law. 42 C.F.R. §482.13(b). In October 2008, the Center for Medicare and Medicaid Services issued new interpretive guidelines for these regulations.
7. State Operations Manual Appendix A - Survey Protocol, Regulations and Interpretive Guidelines for Hospitals, 17 October 2008, http://www.cms.hhs.gov/ manuals/down-loads/soml07ap-a- hospitals.pdf, accessed 14 October 2009.
8. While this article focuses on developments in 2009, it is worth noting that many states - notably North Carolina, Pennsylvania, and Utah - recently enacted comprehensive revisions to their healthcare decisions statutes. N.C. H.B. 634 (2007), enacted as Session Law 2007-502;
9. Pa. S.B. 628 (2006), enacted as Act 169;
10. Utah S.B. 161 (2008) (Christensen), enacted as Utah Laws Ch. 107.
11. N.Y. S.B. 3164-A (2009) (Duane);
12. N.Y. A.B. 7729-C (2009) (Gottfried).
13. H.L. Davis, "Health Care Proxy Bill May Finally Be Enacted," Buffalo News, 21 July 2009;
14. N. Dubler et al., "The Family Health Care Decisions Act and Other Developments in New York End-of-Life Law," Health Law Journal (N.Y. State Bar Association] 14 (2009).
15. This year, Missouri also considered legislation authorizing default surrogates. Mo. H.B. 196, 95th Gen. Assembly (2009) (Brandom).
16. Similar legislation authorizing surrogates to make decisions for incapacitated persons without guardians or agents will be introduced in the Missouri Assembly in 2010. Missouri End-ofLife Coalition, 2009 5th Annual Public Policy Summit, 1 Oct. 2009, http://www.mo-endoflife.org/about/events.php, accessed 14 October 2009.
17. R. Olick, J. Potash, and A.T. Campbell, "Taking the MOLST (Medical Order for Life Sustaining Treatment) Statewide," Pace Law Review 29, no.3 (2009): 545-62, 551-3;
18. J. Freer and S. Wear, "Culture Wars in New York State: Ongoing Political Resistance by Religious Groups to the Family Health Care Decisions Act," Christian Bioethics 8, no. 1 (2002): 9-24.
19. In re Storar, 52 N.Y.2d 363 (1981);
20. In re Westchester County Medical Center on Behalf of O'Connor, 72 N.Y.2d 517 (1988).
21. Va. H.B. 2396 (2009)
22. (Bell) & Va. S.B. 1142 (2009) (Whipple),
23. enacted as Va. Laws Ch. 211 & Ch. 268,
24. codified at Va. Code §§ 54.1-2982 to 54.1-2992;
25. Medical Society of Virginia, Revisions to the Virginia Health Care Decisions Act Governing Advance Directives and Durable Do Not Resuscitate (DDNR) Orders, 1 July 2009, http://prod-msv.syscomservices.com/MainMenuCategories/ MemberCenter/PressRoom/News/Revisions-to-the-Virginia-Health-.aspx, accessed 29 October 2009.
26. A separate bill amends the state's Durable Do Not Resuscitate Order (DDNR), providing that an expression of a desire to be resuscitated constitutes a revocation of the DDNR order. Va. S.B. 1085 (2009), enacted as Va. Laws. Ch. 549,
27. codified at Va. Code §54.1-2987.1.
28. Ariz. H.B. 2823, 48th Leg. (2008), codified at Ariz. Rev. Stat. § 36-3203.
29. Ariz. H.B. 2616, 49th Leg. (2009), codified at Ariz. Rev. Stat. §§ 36-3211 & 36-3212.
30. D. Childs, "Pulling the Plug: Ethicists Debate Ramirez Case: Case May Reignite End-of-Life Debate," ABC News, 28 June 2007.
31. http://www.law.upenn.edu/bll/archives/ulc/dpoaa/2008-final.htm, accessed 14 October 2009.
32. L.A. Stiegel and E.V. Klem, Power of Attorney Abuse: What States Can Do about It, AARP Public Policy Institute, 2008, http://assets.aarp.org/rgcenter/ consume/2008-17-poa.pdf, accessed 14 October 2009.
33. -2008 Idaho Laws Ch. 186;
34. N.M. Stat. Ann. §§ 45-5-601 to -617
35. Colo. H.B. 1198 (2009).
36. Me. S.P. 507/L.D. 1404 (2009), enacted as Me. Pub. L. Ch. 292,
37. codified at Me. Rev. Stat. §§ 5-901 to 5-964
38. Nev. S.B.314 (2009), enacted as Nev. Laws Ch. 64.
39. Va. S.B. 855 (2009), enacted as Va. Laws Ch. 836.
40. Ill. H.B. 3886 (2009),
41. Ind. H.B. 1541 (2009) (Foley);
42. Md. S.B. 150 (2009);
43. Minn. SF0369/HF1228, 86th Leg. Sess. (2009);
44. Mont. H.B. 457 (2009) (Cohenour),
45. Ore. H.B. 2537, 75th Leg. Assembly (2009) (Schaufler).
46. Comprehensive information about PADs is available from the National Resource Center on Psychiatric Advance Directives, http://www.nrc-pad.org, accessed 14 October 2009.
47. L.D. Zerman and J. Swanke, "Variations in Consumer Self Determination within U.S. Psychiatric Advance Directives," International Journal of Mental Health and Addiction 6, no.4 (2008): 484-93;
48. K.A. Menninger, "Advance Directives for Medical and Psychiatric Care," 102 American Jurisprudence Proof of Facts § 95 (2009).
49. Ga. S.B. 224 (2009);
50. Ga. H.B. 339 (2009).
51. Ore. Rev. Stat. § 127.540.
52. Oregon also has a separate statute authorizing PADs. Ore. Rev. Stat. §§ 127.700-.995.
53. Ore. S.B. 16 (2009), codified at Ore. Rev. Stat. §§ 127.505 & 127.535.
54. Tex. C.S.H.B. 2585 (2009). Some states had already established the status of electronic signatures. Maryland, for example, enacted such a provision in 2008.
55. Md. H.B. 510 (2008), enacted as Md. Laws Ch. 79.
56. Kan. H.B. 2109 (2009). For a brief description of the UHCDA and citations to the other states that have adopted it,
57. see T.M. Pope, "Medical Futility Statutes: No Safe Harbor to Unilaterally Refuse Life-Sustaining Treatment," Tennessee Law Review 71, no.1 (2007): 1-81.
58. Ill. S.B. 2258 (2009), enacted as Ill. Pub. Act 96-492, codified at Ill. Stat. ch. 755 §40/25 (defining the circumstances when a surrogate ceases to have decision making authority);
59. Ga. H.B. 742 (2009) (authorizing additional surrogates and amending procedures for appointing guardians);
60. Mont. H.B. 504, 61st Leg. (2009), enacted as Mont. Laws Ch. 237,
61. codified at Mont. Code. Ann. § 72-5-101 & 72-5-321 (prohibiting a guardian from withdrawing life support contrary to the patient's known wishes);
62. N.M. H.B. 161 (2009), enacted as N.M. Laws Ch. 159 (clarifying the role and authority of guardians).
63. Ill. S.B. 2256 (2009), enacted as Ill. Pub. Act 96-765, codified at Ill. Stat. ch. 755 § 40/65.
64. Utah S.B. 117 (2009) (Christensen).
65. Minn. S.F. 1887, 86th Leg. Sess. (2009), enacted as Minn. Laws 108.
66. R. Adorno et al., "Advance Health Care Directives: Toward a Coordinated European Policy," European Journal of Health Law 16, no.3 (2009): 207-227
67. C Hawley, "Living Will Law 'Strikes Successful Balance'," Spiegel Online International, 19 June 2009, http://www.spiegel.de/international/ germany/0,1518,631447,00.html, accessed 14 October 2009.
68. Law Reform Commission of Ireland, Report 942009 - Bioethics: Advance Care Directives, September 2009, http://www.lawreform.ie/publications/Report.%20ACD. pdf, accessed 14 October 2009.
69. "Bill Will Boost Govt-Vatican Ties," ANSA.it 7 September 2009, http://scarane.blogspot.com/2009,http:/bill-will-boost-govt-vatican-ties.html, accessed 14 October 2009;
70. "Court Ruling Revives Polemics: Rightto-Die Issue Back in the Spotlight," ANSA.it, 18 September 2009, http://temporeale libero.it/libero/news/2009-09-18-118423521.html, accessed 14 October 2009.
71. A. Gabbatt, Doctors Acted Legally in 'Living Will' Suicide Case, Guardian, 1 October 2009;
72. S. Brealey, "Norfolk Coroner Speaks Out over 'Right to Die' Case," Norwich EveningNews 24,10 October 2009.
73. "Planning Ahead: Your Health, Your Money, Your Life: First Report of the Review of South Australia's Advance Directives: Proposed Changes to Law and Policy," http://www.agd.sa. gov.au/news/pdfs/2009/AG-Report-1 -final-300808.pdf, accessed 14 October 2009;
74. "Planning Ahead: Your Health, Your Money, Your Life: First Report of the Review of South Australia's Advance Directives: Stage 2 Proposals for Implementation and Communication Strategies," http://www.agd.sa.gov.au/ news/pdfs/2009/Stage-2-report- final.pdf, accessed 14 October 2009.
75. T. Shepherd, "End in Sight for Life Reform," Adelaide Now, 9 October 2009.
76. See. e.g., Cronin v. Jamaica Hosp. Med. Center, No.2007-05447 (N.Y.A.D. 17 March 2009);
77. M. Fass, "Panel Dismisses Claim against Hospital over Resuscitations," New York Law Journal, 23 March 2009.
78. Tex. S.B. 1663 (2009) (Wentworth).
79. Del. H.B. 112 (2009).
80. Ill. H.B. 0748 (2009), enacted as Ill. Pub. Act 96-0448,
81. codified at Ill. Stat. ch. 210 § 45/2-104.2.
82. C.P. Sabatino, "Advance Directives and Advance Care Planning: Legal and Policy Issues," Report for U.S. Department of Health and Human Services Office of Disability, Aging and Long-Term Care Policy, October 2007.
83. Cal. A.B. 2747 (2009) (Berg), codified at Cal. Health & Safety Code § 442.5.
84. Vt. H.B. 435 (2009) (Patient Bill of Rights for Palliative Care and Pain Management), enacted as Vt. Laws No. 25, codified at Vt. Stat. tit. 18 § 1871.
85. Ariz. S.B. 1311, 49th Leg. (2009).
86. Md. H.B. 30 (2009) (Bobo & Manno). The bill was later amended to simply propose the formation of a working group to study and make recommendations regarding end-of-life counseling. A separate bill proposed that healthcare facilities inform individuals of their policies on advance directives and DNR orders.
87. Md. S.B. 221 (2009) (Lenett).
88. N.Y. S.B. 4498 (2009) (Duane);
89. N.Y. A.B. 7617 (2009) (Gottfried).
90. See, e.g., Ariz. Rev. Stat. § § 36-3291 to -3297;
91. Cal. Prob. Code §§4800-4806;
92. Md. Code [Health-Gen.] §§ 5-619 to 5-626;
93. Code Md. Regs. §§ 10.23.01.00 to .11;
94. N.C. Gen. Stat. § 130A-465;
95. Nev. Rev. Stat. § 449.900-.965;
96. Vt. Stat. Ann. tit. 18 § 9719;
97. Rev. Code Wash. § 70.122.130-.140. The other statutes include Hawaii, Illinois, Louisiana, Minnesota, Michigan, and South Dakota.
98. Nevada, Vermont, and Washington use U.S. Living Will Registry. Washington State Department of Health, Living Will Registry: A Report to the Legislature, January 2009; "State Registries," http://liv-will. uslivingwillregistry.com/state.html, accessed 14 October 2009.
99. N.D. S.B. 2237 (2009), codified at N.D. Cent. Code tit. 23.
100. Okla. S.B. 346 (2009) (Crain/Ritze), enacted as Okla. Laws Ch. 236.
101. Va. S.B. 290 (2008) (Barker) & Va. H.B. 805 (2008) (Englin), enacted as Va. Acts Ch. 696.
102. Alaska H.B. 71, 26th Leg. (2009);
103. Mich. H.B. 4942 (2009). Oregon passed legislation.
104. H.B. 2009, 75th Assembly (2009), enacted as Ore. Laws Ch. 595.
105. The Oregon Department of Human Services has proposed regulations to establish the registry. Oregon Bulletin, 1 November 2009.
106. N.C. H.B. 1114 (2009).
107. Kathy Glasmire, POLSTin California Communities: First Year Experience and Lessons Learned, California Coalition for Compassionate Care, March 2009.
108. S.E. Hickman et al., "Use of the Physician Orders for Life-Sustaining Treatment (POLST) Paradigm Program in the Hospice Setting," Journal of Palliative Medicine 12, no.2 (2009): 133-41;
109. S.E. Hickman et al., "The POLST (Physician Orders for Life-Sustaining Treatment) Paradigm to Improve End-of-Life Care: Potential State Legal Barriers to Implementation," Journal of Law Medicine and Ethics 36, no. 1 (2008): 119-140
110. Cal. A.B. 3000 (2009) (Wok), codified at Cal. Prob. Code § 4780.
111. Haw. H.B. 1379 (2009), enacted as Haw. Act 186.
112. Idaho Code Ann. §§ 39-4501 to -4515. Regulations implementing the statute are available at http:// www.healthandwelfare.idaho.gov/site/3344/ default. aspx, accessed 14 October 2009.
113. Md. Code Ann. [Health-Gen.] §§ 5-602(f), 5608.1, 5-619 & 19-344. Maryland's legislation is distinct from, yet very similar to, POLST.
114. N.Y. Pub. Health Law § 2977(13), amended by 2008 Sess. Law Ch. 197 (A. 10764). While statewide legislation dates only to 2008, New York MOLST began as a voluntary program in 2003, and was approved by the New York State Department of Health for use in all healthcare facilities in 2005.
115. P.A. Bomba and C.P. Sabatino, "POLST: An Emerging Model for End-of-Life Planning," ElderLaw Report 50, no.7 (2009): 1-5.
116. N.C. Gen. Stat. § 90-21.17. Regulations implementing the statute are available at http://www.ncdhhs.gov/dhsr/EMS/dnrmost.html, accessed 14 October 2009.
117. Or. Admin. Rule § 847-035-10030
118. Tenn. Code. Ann. § 68-11-224. Regulations implementing the statute are available at http://health.state.tn.us/Boards/AdvanceDirectives, accessed 14 October 2009.
119. Utah Admin. Code §§ R432-31-4(3) & R432-1-3(69).
120. The POLST is referred to as a "life with dignity order." Utah Code Ann. §§ 75-29-103(17) & -106.
121. Rev. Code Wash. § 43.70.480.
122. WV. Code Ann. §§ 16-30-3(u); 16-30-5 & 16-30-125
123. A pre-bill was filed in Colorado. 2010 Colo. Draft 246, 67th Assembly, 2d Sess. (2009). Research on these issues was greatly facilitated by the excellent resources provided both by the American Bar Association Commission on Law and Aging, and by the Center for Ethics in Healthcare of the Oregon Health and Science University, http://www.abanet.org/aging/, accessed 14 October 2009;
124. http://www.ohsu.edu/polst, accessed 14 October 2009.
125. La. S.C.R. 43 (2009) (McPherson) (creating a commission to make recommendations).
126. Neb. L.B. 452 (2009) (Avery) (Advance Directives Identification Act).
127. Ohio H.B. 241, 128th Assembly (2009) (Garland).
128. Alaska, Colorado, Florida, Georgia, Iowa, Kansas, Louisiana, Maine, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Dakota, Texas, Utah, and Wisconsin, and Wyoming. Glasmire, see note 60 above.
129. Sabatino, see note 47 above.
130. While there is not a specific, devoted code, physicians can now bill Medicare for ACP using office visit codes 99211 to 99215, so long as the time spent in discussion comprises more than one-half of the office visit. Therefore, the current question is not whether to cover ACP, but rather to cover it at a sufficient level to change physicians' behavior. American College of Physicians, "Coding 101," http://www.acponline.org/private/pmc/coding101.ppt, accessed 14 October 2009.
131. H.R. 3962, 111th Cong., 1st Sess. (2009) (Dingell, D-Mich.).
132. The provision was also a part of H.R. 3200, 111th Cong., 1st Sess. (2009) (Dingell DMich.).
133. H.R. 1898, 111th Cong., 1st Sess. (2009) (Blumenauer, D-Ore.).
134. H.R. 3238, 111th Cong., 1st Sess. (2009) (Levin, D-Mich.). In 2008, the Medicare Improvement Act for Patients and Providers added end-of-life counseling as a component of the "Welcome to Medicare" Initial Preventive Physical Exam. H.R. 6331 (2008), enacted as Pub. L. No.110-275, codified at 42 U.S.C. § 1395x(ww).
135. H.R. 1844, 111th Cong., 1st Sess. (2009) (Capps, D-Calif.).
136. H.R. 2911, 111th Cong., 1st Sess. (2009) (Blumenauer, D-Ore.). This bill is related to S. 1772, 111th Cong. 1st Sess. (2009) (Landrieu, D-La).
137. H.R. 3172, 111th Cong. 1st Sess. (2009) (Baldwin, D-Wisc).
138. S. 1150, 111th Cong., 1st Sess. (2009) (Rockefeller, R-W.V.).
139. S. 1251, 111th Cong., 1st Sess. (2009) (Warner, R-Va.); S. 1263, 111th Cong., 1st Sess. (2009) (Warner, R-Va.).
140. H.R. 2705, 111th Cong., 1st Sess. (2009) (McDermott, D-Wash.).
141. Vt. S.B. 131 (2009).
142. La. H.C.R. 102 (2009) (Baldone).