PA acts to sort out who makes end-of-life decisions
Law ends sometimes-contentious "family committees"
Pennsylvania physicians are hoping a new law will eliminate deathbed feuds among family members at odds over who may make end-of-life decisions for patients who aren't capable of speaking for themselves.
According to Christopher Hughes, MD, an intensive care specialist in Pittsburgh and a member of the Pennsylvania Medical Society's board of trustees, the new law sets out a hierarchy of family members who, in the absence of a living will or health care agent, are given priority when it comes to making end-of-life choices. Prior to the new law, which went into effect in January, when a dying patient had no living will or legal health care agent, was incompetent, and in an end-stage condition, the physician would gather family members together to discuss whether the patient would want certain types of resuscitative measures or artificial breathing or nutrition.
This led to conflicts among family members who could not agree.
"The new law clearly defines a chain of command within a patient's family," Hughes explains. "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."
Under the new law, 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 make the decisions.
"The new law handles most situations for legal purposes," Hughes says. "However, it doesn't handle hard feelings between family members."
Pennsylvania physicians are urging patients, even with the new law, to create living wills and designate health care agents, and to give copies of those documents to their physicians.
Medical and legal experts suggest physicians talk about end-of-life directives with their patients. Physicians should be familiar with their states' laws on patient rights and advance directives, and talk with patients about end-of-life situations they may encounter and what choices they would want made.
Conversations about end-of-life directives should be documented in the patient's chart to serve as a guideline for physicians and family in the event he or she does not create a living will or advance directive.
Pennsylvania physicians are hoping a new law will eliminate deathbed feuds among family members at odds over who may make end-of-life decisions for patients who aren't capable of speaking for themselves.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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