LEGAL AND LEGISLATIVE EFFORTS

      The state and national legislatures have recognized the need for health care professionals and the public to be better informed regarding end-of-life issues and palliative care. On the state level, the Florida legislature has encouraged professional regulatory boards to adopt guidelines regarding end-of-life care, pain management and education for professionals. On a national level, Florida Senator Bill Nelson has proposed a bill entitled “The Advance Directives Improvement and Education Act of 2005.” The objectives of the proposed bill are to (1) improve access to information about health care options, (2) promote advance care planning via funding for a national public education campaign, (3) engage health care providers in disseminating information via Medicare coverage for end-of-life planning consultation, and to (4) study the establishment of a national advance care directive registry. 

End-of-life issues, particularly “curative” or life-prolonging treatments in patients with medically futile illnesses or extremely advanced age, are commonly encountered and addressed in hospitalized patients through specific treatment orders (or a decision to withhold or withdraw treatments). The same issues are typically not addressed in outpatients, and routinely must be faced in crisis situations by paramedics and emergency department physicians, commonly leading to the initiation of inappropriate or unwanted aggressive treatment.  Patients and families and physicians frequently go through the emotionally difficult process of deciding that CPR is inappropriate in the hospital only to have the patient automatically return to full CPR status upon discharge. Several states have adopted a set of standardized orders to implement Advance Directives and other appropriate end-of-life measures based on patient medical conditions and wishes, known as Physician Orders for Life-Sustaining Treatment, or POLST (Figure 2 POLST form). These standing orders encourage the patient and the patient’s personal physician to deal with issues such as CPR, ICU admission, antibiotics, and feeding tubes and  apply to both the inpatient and outpatient setting. Inclusion of whether or not the patient has an Advance Directive as an “official” part of the standard medical record has been suggested as another means of not only facilitating implementation of the Advance Directive, but also promoting advance care planning by physicians and patients.(1)

^[1] Fl. Stat. § 765.104.

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