By: Lisa George, MPH, CHES – Jewish Healthcare Foundation
A significant step has been made toward establishingPennsylvania Orders for Life-Sustaining Treatment (POLST) as law in the Commonwealth. On April 19, Senator Gene Yaw (R-23rd District) introduced Senate Bill 631, which would codify POLST for use by medical professionals across all healthcare settings to document treatment wishes for patients who voluntarily wish to execute a POLST order.
Although the bright pink POLST form has been used in Pennsylvania for decades to translate patients’ wishes for care into actionable medical orders, the lack of legislation on POLST has led to confusion and inconsistent use among providers. This bill aims to enhance clarity for providers regarding POLST usage and bolsters the protections for seriously ill patients to receive care that aligns with their care preferences regardless of the setting.
SB 631 amends Title 20 (Decedents, Estates, and Fiduciaries) of the Pennsylvania Consolidated Statutes), providing a legal basis for POLST forms to be used across care settings. It defines the appropriate population for POLST as “patients who are considered to be at risk for a life-threatening clinical event because they have a serious life-limiting medical condition, which may include advanced frailty.” It also clarifies for whom POLST is not appropriate and describes the elements of a properly executed POLST order. The lack of existing legislation poses particular challenges to EMS providers, who are presently only legally authorized to honor the state’s Out-of-Hospital Do Not Resuscitate order and must call Medical Command for authorization to follow a POLST. This can lead to patients having to endure medical interventions at the end of life that do not align with their wishes. SB 631 would allow POLST to be recognized and acted upon across care settings, inside and outside the hospital, and grants emergency medicine personnel the authorization to honor patients’ documented preferences for care without the need for Medical Command Physician authorization.
Further, this bill emphasizes the importance of POLST as part of a shared decision-making process involving a discussion of current clinical status and care preferences between a patient or surrogate and healthcare provider. The POLST conversation provides patients with an opportunity to speak with their loved ones and their providers about their preferences for care they wish to receive and not to receive. It gives providers clear direction regarding medical interventions, regardless of the care setting. Voluntary consent is essential, and patients have the right to refuse to execute a POLST, without consequences from a provider or insurer.
This bill also establishes a multistakeholder POLST Advisory Committee to advise the Pennsylvania Department of Health on POLST form revisions and POLST education.
POLST legislation is critical to ensure the appropriate use of POLST across the Commonwealth, in the appropriate populations, as part of a conversation about wishes for end-of-life medical care. It will benefit providers by contributing greater clarity and guidance on the POLST process.
Read the full text of SB 631 here. To voice your support for SB 631, contact your state senator. The Pennsylvania Medical Society supports this legislation and has launched an easy-to-use online form that allows you to contact your senator with just a few clicks.
If you haven’t checked out the PA POLST Learning Center a library of on-demand trainings on POLST—all of which offer free continuing medical education and continuing nursing education credits. Please consider sharing with your staff to ensure they are educated on proper POLST use.
To stay up to date on POLST legislation, education, and resources, subscribe to the POLST Notes newsletter. Visit www.papolst.org to sign up. For more information or answers to your questions about POLST, contact [email protected].
Lisa George, MPH, CHES is the PA POLST Coordinator and Senior Communications and Program Specialist at the Jewish Healthcare Foundation.