New Pennsylvania Law Defines End-of-life Care Decision Making Process

Main Category: Palliative Care / Hospice Care
Article Date: 25 Jan 2007 - 0:00 PDT

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A new Pennsylvania law helps define who could be making your end-of-life care decisions if you do not have a living will or health care agent. But, according to the Pennsylvania Medical Society, it's still better for you to have a living will and a health care agent.

While those who already have a living will or a health care agent may not notice the new law, those without particularly their family members will.

In the past, when a patient did not have a living will or a health care agent, was incompetent, and had an end-stage medical condition, doctors would gather the patient's family members to discuss whether or not the patient would want certain types of treatments such as CPR, a ventilator, or a feeding tube.

But sometimes the patient's family members do not agree with one another, and disputes can happen.

Although no law may ever avoid litigation and family disputes, Pennsylvania's new law on end-of-life care decision-making attempts to clear up the debate over who will make the final decision when a loved one is incompetent and doesn't have a living will, health care agent, and or guardian.

"The new law clearly defines a chain-of-command within a patient's family," said Christopher M. Hughes, MD, an intensive care specialist from Pittsburgh, Pa., and a member of the Pennsylvania Medical Society's board of trustees. "For most families, there's not a problem, but you do occasionally have situations in which there are strong disagreements among family members about what our patient, their loved one, would want."

According to Dr. Hughes, the patient's spouse generally is first in line among family members to be given the responsibility of end-of-life care decision-making through the new law. An adult child is next in line, followed by a parent, an adult brother or sister, and finally an adult grandchild. In situations where these family members do not exist, an adult with knowledge of the patient's preferences and values would be designated as the decision-maker.

But Dr. Hughes urges Pennsylvanians to take care of matters while you are competent.

"The new law handles most situations for legal purposes," Dr. Hughes said. "However, it doesn't handle hard feelings between family members. I'd encourage everyone to have a living will and a health care agent who knows your wishes. And make sure your doctor has a copy of your living will. Communicating your wishes with your loved ones and your doctor is the key. That's the best case scenario, and it will more than likely avoid family disputes."

Five Recommended Steps from the Pennsylvania Medical Society

1. Talk to your doctor. Your doctor can help you understand important medical determinations that affect your rights. Your doctor can also explain the good and bad features of various medical measures and artificial life-support.

2. Decide who you want to make health care decision for you and the powers you want this person to have.

3. Decide your wishes regarding your end-of-life and other future care.

4. Write down your decisions and make an advance health care directive.

5. Make your wishes known. Keep an original copy of your advance health care directive in a safe place, but also ask your doctors to put a copy in your medical records. Also give a copy to your health care agent. And be sure to talk about your advance directive with family and friends who you expect to attend to your needs when you can't speak for yourself.

For more information and an advance directive sample, visit the Pennsylvania Medical Society's Family Health & Wellness Web site at http://www.myfamilywellness.org.

http://www.pamedsoc.org/

Pennsylvania Medical Society
777 East Park Dr., PO Box 8820
Harrisburg, PA 17105
United States
http://www.pamedsoc.org/

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