Legislation a Major Step Forward for Advance Health Care Directives and Health Care Decision-Making for Incompetent Patients

On Nov. 30, 2006, Gov. Ed Rendell signed into law Act 169, which provides a comprehensive statutory framework governing advance health care directives and health care decision-making for incompetent patients.  It became effective Jan. 29, 2007.

The Pennsylvania Medical Society supported enactment of this landmark legislation, culminating more than 10 years of sustained efforts to adopt  revised legislation that is in the best interest of patients and physicians.

Outline of Act 169

The new law provides for medical treatment decisions to be made for an adult patient through:

  • Instructions from the patient in a living will
  • Directions from a health care agent appointed in a health care power of attorney
  • Directions from a close family member or other health care representative designated by the patient or by default based upon a list of priorities

The act also provides for out-of-hospital do-not-resuscitate (DNR) orders, which direct emergency medical services providers to withhold cardiopulmonary resuscitation from the patient in the event of respiratory or cardiac arrest.

Physicians have relied on health care agents and close family to make decisions for incompetent patients for a number of years.  However, the standards and procedures for health care agents and representatives were not clearly defined. As a result, physicians sometimes were faced with the untenable dilemma of ignoring patient autonomy or risking adverse legal ramifications.

Act 169 provides both greater clarity and protections for patients and physicians.

It also requires the Department of Health to consider, in consultation with an advisory committee, adoption of a standardized physician-order-for-life-sustaining-treatment (POLST) form.

POLST orders provide for continuity of DNR and other life-sustaining treatment orders from one setting to another, such as when a patient is transferred from a nursing facility to a hospital.

The Medical Society has been working for a number of years to obtain a POLST program and views the advisory committee mandate to be a positive step forward.  

Patient materials on advanced health care directives, including example forms, can be found on the My Family Health and Wellness website.

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Comments: 1


Currently, POLST is stalled within the Department of Health (partly due to its focus on the H1N1 virus issues). What can we do to stimulate interest in this very necessary change in law to include POLST which empowers patients and families to work with healthcare providers to ensure their decisions are honored? As an emergency department nurse, I often perform aggressive treatments on patients at the end of their lives instead of providing comfort care because of the lack of POLST. Donna Kapes kapes@ptd.net

Donna Kapes at 2/28/2010 1:02:08 PM

Last Updated: 7/18/2008
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