PCMS_Philadelphia_Medicine_Spring2018 - 24

p h i l a m e d s o c  .org

Feature

Pennsylvania legislation would bolster
POLST end-of-life planning process
By: Heather Stauffer | Staff Writer

Pennsylvania Republican Rep. Bryan Cutler has introduced House Bill 1196
that we believe would be a step forward in end-of-life care in Pennsylvania.
There is also a Senate version, Senate Bill 623.
Nothing new
POLST forms have been in use in
Pennsylvania for more than a decade and
are approved by state regulators, but not
specifically authorized by law.

E

nd-of-life planning would take a
step forward in Pennsylvania under
legislation introduced Tuesday, local
doctors and legal experts say.

PA Senate Bill 623 and House Bill 1196
focus on a voluntary process that turns
patient goals and preferences for end-of-life
care into medical orders.

The bills would change that.
Marian Kemp, the POLST coordinator
for Pennsylvania, said POLST is used
regularly in parts of the state including
Lancaster County, but that some institutions
and providers "will not offer POLST to
their patients because there's no legislation
to back it up."

a co-sponsorship memo on it with state Rep.
David S. Hickernell - and state Sen. Gene
Yaw (R-23). Cutler (R-100) and Hickernell
(R-98) serve districts in Lancaster County.
Dr. Leon Kraybill, chief of the geriatric
division at Lancaster General Health, and
Margaret Costella, general counsel for
Lancaster General Hospital, were among
those in a broad coalition of medical
organizations who helped develop the
legislation.

"There is a perception that these
discussions are morbid," Kraybill said, but
he's found the opposite, with people showing
"satisfaction, contentment, relief" when they
The legislation would also allow have their wishes documented for providers.
It's called Pennsylvania Orders for
Life-Sustaining Treatment, aka POLST. ambulance crews to follow POLST, which
Recommended for people in their last year they currently can't, and give legal immunity
POLST, he said, "is a vehicle to elicit the
of life, it requires a doctor's involvement to to providers who follow POLST, according wishes of the individual based on discussion
to Kemp.
authorize the form.
and understanding of health condition, and
a way to document and share those wishes
Dr. Joan Harrold, medical director at with loved ones, medical providers, and
By contrast, living wills, health care
power of attorney forms and other end-of- Hospice & Community Care, said in an caregivers."
life planing documents known collectively email Tuesday that POLST "is a proven tool
as advance directives are recommended for to help people direct their health care to live
Dr. Lauren J. Van Scoy, who works in
all adults, often don't involve doctors and the way they want - and avoid things that the intensive care unit at Penn State Health
they don't want - when they are seriously Milton S. Hershey Medical Center, said
are not medical orders.
ill or quite frail in the last year or so of life. documents are important, but the process
"Advance directives often only identify a
of communicating values and wishes that
"We very much need POLST to be fully guide treatment decisions is even more vital.
surrogate health care decision-maker and lack
specificity regarding a patient's preferences approved and implemented in Pennsylvania,"
should unforeseen medical conditions arise," she wrote.
"The most valuable thing you can do is
said Pennsylvania Medical Society President
talk to your family," she said. "Talking about
Dr. Charles Cutler. "With the passage of Local/regional support
what you want is important to reduce their
this bill, an individual's wishes regarding
The legislation was endorsed by numerous stress and burden at the end of life. It's a
treatment would be applicable in emergency groups including the Pennsylvania Medical gift to your family because 70 percent of
medical services, health care facilities, home Society. It was introduced by state Rep. end-of-life decisions are made by family
care and hospice settings."
Bryan Cutler - who earlier this year wrote members."
24 Philadelphia Medicine : Spring 2018


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