Important Changes to California’s POLST Law

Credit: dailyfinance.com

As of Jan. 1, 2016, nurse practitioners and physician assistants acting under the supervision of a physician are authorized under California’s newly enacted Assembly Bill 637 to sign Physician’s Orders for Life Sustaining Treatment forms. Also known as POLST, the forms give seriously and chronically ill patients more control over end-of-life decisions and guide first responders and healthcare providers in choices regarding patient care.

An extension of (but not a replacement for) an Advance Directive, POLST provides guidelines as to an individual’s wishes regarding end-of-life care. The form addresses three main areas of concern — cardiopulmonary resuscitation, medical treatments and artificial nutrition — and allows patients to specify the level of care they wish to receive. If the patient is incapacitated, a designated healthcare decision maker can also fill out the form.

Modeled after laws in Oregon and several other states, it was designed as a means of giving terminally ill patients more autonomy and providing a structure for conversations between healthcare providers and patients about treatment options available at the end of life.

POLST was implemented in California on Jan. 1, 2009 under the auspices of the Coalition for Compassionate Care of California. Modeled after laws in Oregon and several other states, it was designed as a means of giving terminally ill patients more autonomy and providing a structure for conversations between healthcare providers and patients about treatment options available at the end of life. Initially, the forms required the signature or the patient and his physician. With the passage of AB 637, however, a doctor’s signature is no longer required.

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The law allowing advanced practice nurses and physician’s assistants to sign orders regarding care provided at the end of life is part of a nationwide move to acknowledge on a legislative level the key role played by non-physician healthcare providers in patient care. In collaboration with physicians, nurse practitioners and physician assistants are assuming an increasingly important role in the care of the elderly and the chronically ill. Oftentimes, they are patients’ main point of contact in the primary care setting and the professionals with whom patients spend the most time. Who better, then, to have a caring, compassionate and detailed discussion with those in failing health regarding their desires about what they want and do not want when they are approaching the end of their lives?

By allowing non-physician health care providers to sign POLST forms, California has taken a step forward towards the goal of implementing truly patient-centered palliative and end-of life care. 

Learn more about POLST and end-of-life decision making in our post, Get Informed: Physician Orders for Life Sustaining Treatment, or visit the Coalition for Compassionate Care of California’s online POLST information page.