A new state law taking effect today will determine how end-of-life decisions are made for Pennsylvanians who don't leave a living will or other instructions should they become incapacitated.

Supporters of the law, which Gov. Rendell signed in November, said an existing state statute on end-of-life care did little to help guide those decisions.

"We came to rely on families, and friends if there were no families around, to help us with these decisions," said Chris Hughes, an intensive-care doctor near Pittsburgh and a member of the board of the Pennsylvania Medical Society. "That worked out pretty well, but we had no legal basis for this."

It also led to family arguments and misunderstandings, he said.

Under the new law, if a person has not designated someone in advance, the decision-maker will generally be a spouse, adult child, parent, adult sibling, adult grandchild or close friend, in that order.

Hughes said many problems arise when patients' wishes - such as orders not to resuscitate - are clearly indicated on their chart, but those patients then are transferred to a hospice or nursing home and then back to the hospital with the records not transferred with them.

The new law requires that a panel be established to address the problem and possibly implement a system already in use in states including Oregon and West Virginia. Known as the POLST - Physician Orders for Life-Sustaining Treatment - paradigm, the system involves filling out a brightly colored form signed by the patients or their surrogates that clearly spells out their wishes. The form, or a copy of it, stays with the patients wherever they go.

Judith Black, medical director of senior products for Highmark Inc., a health-insurance company, said dozens of organizations have been working collaboratively with Highmark since 2000 to voluntarily implement the program. The goal is to make sure patients are getting the treatments they want and not getting treatments they don't want.

"What this program does is it really puts to the forefront that advanced care is really a process," Black said. "People think they do a living will and they're done, but that's really not the case. It's a process."

Hughes said people with living wills must make sure their relatives and their doctors know about it and know their wishes before they become ill.

"Communicating your wishes with your loved ones and your doctor is the key," Hughes said. "That's the best-case scenario, and it will more than likely avoid family disputes."

The Pennsylvania Medical Society has posted information about the new law and end-of-life care planning at www.myfamilywellness.org.

The law was crafted with input from advocates for the disabled, associations representing doctors and lawyers, and faith-based groups. Disabled people, in particular, were concerned about making sure they had a say in their care decisions.

"We wanted to make it clear that their lives are valued," Hughes said.

Some Guidelines

The Pennsylvania Medical Society recommends doing the following to prepare for end-of-life care:

Talk to your doctor so that 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.

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

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

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

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.

SOURCE: Associated Press

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