'Right-to-die' law won't affect HUP

A new federal "right-to-die" statute that took effect last week will not have a significant impact on HUP's day-to-day operations, University officials said this week. The new law requires all health institutions -- hospitals, nursing homes and HMOs -- to ask in-patients for "advance directives" in case they become incapacitated and are only being kept alive through life-support systems. Failure to comply with the regulation, passed in November 1990, may result in the loss of Medicare and Medicaid payments for the institution. "HUP has always been sensitive to patients' rights and autonomy," Forrest said. "In clinical practice there's been no real change at the hospital." She added that the law, formally titled the Patient Self-Determination Act, is intended to "increase patient autonomy and to reduce costs by withholding care to people who don't want it." Because the act was passed by Congress a year ago, hospitals have had over a year to implement programs which provide information about advance directives. The Act says that when patients are admitted to a hospital, the hospital must tell the patient about advance directives such as a living will, which indicates in writing the conditions under which the patients would refuse certain treatment. Another example of an advanced directive is a "durable power of attorney" document which gives another person the right to make medical decisions if the patient becomes unable to make decisions for themselves. "My personal opinion is that the proxy option is the safest way to carry on your autonomy," Forrest said. The new law also requires that the patient be told about hospital policy concerning advance directives and that hospital employees should be be educated about patients' rights. According to Forrest, HUP patients have shown a lot of interest in composing living wills. "Since Sunday, one-third of patients [at HUP] have asked for additional information," Forrest said. According to Associate Medicine Professor Paul Lanken, a former Chairman of the HUP Ethics Committee, the act was passed in response to a June 1990 U.S. Supreme Court decision which said that Missouri officials were correct to require "clear and convincing evidence" of the patient's wishes regarding the right-to-die. The family of the patient in the case, Nancy Cruzan, wanted to stop feeding Cruzan through a feeding tube which was sustaining her life, but doctors were prevented from carrying out their wishes by state law when she lapsed into a vegetable state without a living will. Although Cruzan's family eventually convinced the courts that she had previously requested life-support not be used, the Supreme Court decision indicated the need for patients to be encouraged to write living wills or grant proxies to ensure their wishes be fulfilled. "If you're in a state which requires evidence of your intentions, like Missouri, it's best to carry a living will to have it in writing," Lanken said. According to Forrest, Pennsylvania is the only state without a state law concerning patients' rights. Lanken said that such a bill is currently before the state legislature, but added that it has met strong opposition because it has a clause which prevents pregnant women from refusing life-support. The greatest impact of the new law will fall on nursing homes and HMO's, according to Lanken. "Nursing homes are not strong advocates of patient autonomy, but they will be required to comply," Lanken said. "Hospitals basically already respect patient autonomy."

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