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Tough topics: living wills and medical directives

A few of my bills have left the House, bound for consideration and, hopefully passage, in the Senate. To be headed for the Senate, the bills have to have been successfully voted out of a committee, called the committee of reference, and then are brought up on two different days on the House floor for debate and voting.

Along the way, amendments can be added to the introduced bill, either by the sponsor or by other legislators. The same process is then repeated over in the Senate, with the work there to be done by the sponsoring senator.

Two of my bills that left the House chamber recently have to do with end of life care. These two bills, HB 1025 and HB 1122, deal with guiding health care providers on a patient’s wishes when the patient is unconscious or otherwise unable to speak directly to them.

HB 1025 updates Colorado’s living will statute to make it clear that there’s not only one kind of form to be used for a terminally ill patient’s desires to be expressed in writing. We also changed some of the wording in the statute to be consistent with more commonly used medical terms. This bill was recommended by the Hospice and Palliative Care Interim Committee that I was a part of last year.

HB 1122 brings into Colorado law a new form, this one signed by a health care provider who has discussed with the patient what his or her preferences for care are, given the patient’s current medical condition. Different than the advance medical directives such as the living will mentioned above, the Medical Orders Scope of Treatment (MOST) form is essentially a summary sheet of the patient’s advance medical directives, signed off on by a health care provider after consultation with the patient.

One of the challenges of advance medical directives is they are legal documents and not medical orders. They may not be physically present with the patient when the patient arrives at an emergency room. When the patient isn’t able to talk the EMTs or physicians, they often must guess what the patient would want done and may go further in life saving measures than the patient wanted and were otherwise medically indicated.

The MOST form is voluntary and used primarily for the frail elderly or terminally ill patient, but there are some non-terminal conditions where the MOST form should be available. Completing the MOST form in advance of a medical crisis gives the patient and his or her physician an opportunity to have the discussion that many times people want, but don’t know how to start with each other.

During the course of the interim committee on hospice and palliative care, we heard testimony from physicians and other health care providers that often they struggle with lack of clear direction in the moment of a patient’s medical crisis. We also heard that considerations of quality of life as determined by the patient are either unknown or left unheeded due to a fear of being sued for not going medically far enough to save a patient.

Colorado isn’t breaking new ground in considering adopting the MOST form as Alaska and North Carolina already utilize the MOST form. Other states recognize in law a similar form that is referred to as the Physicians Orders for Life-Sustaining Treatment (POLST) form.

Given the mobility of Americans, whether moving to a new home or just for travel, using the same or very similar documents will help patients get the care they want or need, regardless of where they are when a medical crisis occurs.

These are tough topics, especially in a country where so many life saving procedures are available, but as we talk about health care reform, we must consider patient centered and patient directed care. These two bills are an effort to do that.