The Pennsylvania Senate has passed legislation that would create a legal framework for Pennsylvania Orders for Life Sustaining Treatment (POLST) directives and ensure that a patient’s wishes for end-of-life care follow the patient across health care settings.
The bill – Senate Bill (SB) 623, introduced by Sen. Gene Yaw – was approved by the Senate by a vote of 47-1. It now moves to the House for committee consideration.
The Pennsylvania Medical Society (PAMED) strongly supports SB 623. We are part of a multi-year, collaborative effort of nearly 30 health care and patient advocacy organizations, with the goal of easing the difficult clinical decisions patients and their family members encounter when end-of-life circumstances present themselves.
What Is POLST?
The POLST process was created to translate a patient's specific goals for end-of-life care into a concise medical order that can follow the patient across all care settings. POLST directives are entirely voluntary and often developed through communication between a patient, their caregiver, and their physician following a terminal diagnosis. Directives typically include specifications about out-of-hospital do-not-resuscitate preferences, use of antibiotics, certain comfort measures, and other end-of-life considerations.
Without these clear directions ensuring the patient's wishes are followed and the level of care desired by the patient is delivered – healthcare providers may be left with conflicting directions. POLST helps to eliminate that confusion.
How Does POLST Differ from Advance Directives?
POLST orders differ from advance directives in that POLST directives make clear an individual's wishes regarding treatment measures via a legal medical order that is applicable across all health care settings – applicable in emergency medical services, health care facilities, home care and hospice settings. Advance directives often only identify a surrogate health care decision-maker and lack specificity regarding a patient's end-of-life treatment preferences.
Although POLST forms are currently available in Pennsylvania, these forms presently are not recognized by Pennsylvania law. SB 623 seeks to codify these orders and require that physicians, nurses, emergency medical technicians, and other medical professionals deliver care consistent with a patient's end-of-life preferences.
PAMED thanks Sen. Yaw for his leadership on this issue. On Oct. 1, shortly before the Senate vote, Sen. Yaw spoke on the Senate floor to ask his colleagues to support the bill. “This is a way to provide death with dignity,” he said. Watch a video of Sen. Yaw’s speech.
We also thank Rep. Bryan Cutler who is the sponsor of a POLST bill (HB 1196) in the Pa. House.