Sunday, April 8, 2012

Idaho Anti-Futility Bill Signed into Law

Just a few years ago, Idaho was close to enacting Texas-style legislation permitting healthcare providers to refuse life-sustaining interventions that they deemed inappropriate.  This week, Idaho reversed course 180 degrees.  It has enacted legislation (here too) that directly prohibits providers from refusing requested life-sustaining treatment.  The following amendments are effective on July 1, 2012.

S.B.1348 adds a new section (3) to Idaho Code 39-4514:  
"Assisted feeding or artificial nutrition and hydration may not be withdrawn or denied if its provision is directed by a competent patient in accordance with section 39-4503, Idaho Code, by a patient's health care directive under section 39-4510, Idaho Code, or by a patient's surrogate decision maker in accordance with section 39-4504, Idaho Code. Health care other than assisted feeding or artificial nutrition and hydration may not be withdrawn or denied if its provision is directed by a competent patient in accordance with section 39-4503, Idaho Code, by a patient's health care directive under section 39-4510, Idaho Code, or by a patient's surrogate decision maker in accordance with section 39-4504, Idaho Code, unless such care would be futile care as defined in subsection (6) of this section. Except as specifically provided in chapters 3 and 4, title 66, Idaho Code, health care, assisted feeding or artificial nutrition and hydration, the denial of which is directed by a competent patient in accordance with section 39-4503, Idaho Code, by a patient's health care directive under section 39-4510, Idaho Code, or by a patient's surrogate decision maker in accordance with section 39-4504, Idaho Code, shall be withdrawn and denied in accordance with a valid directive. This subsection does not require provision of treatment to a patient if it would require denial of the same or similar treatment to another patient."


An amended section (6) defines "futile care" (should have stated "futile intervention") as a course of treatment:
"(a) For a patient with a terminal condition, for whom, in reasonable medical judgment, death is imminent within hours or at most a few days whether or not the medical treatment is provided and that in reasonable medical judgment will not improve the patient's condition; or
(b) The denial of which in reasonable medical judgment will not result in or hasten the patient's death."

2 comments:

Ronn said...

Do you know what the specific IMA amendments were and if they survived through the bill's final version?

Anonymous said...

The clarification of the "choice" to extend or shorten life that is an implied right of the patient or the surrogate in the law of the 1991 PSDA appears to be well satisfied by the Idaho Anti-Futility Bill,

Haven't the higher courts indicated that you can't, with premeditation, shorten the life of a patient without the patient's consent unless the medical futility presents itself in the form of sudden and imminent death, as defined by the state futility law.

Good for Idaho! They have taken a stand against unilateral DNRs and covert DNRs in hospital charts that shorten the lives of patients for fiscal reasons.

Idaho has preserved CHOICE for their constituents and this was the intent of the PSDA of 1991.

Perhaps this clarification of federal law and state law will result in more discussions and education by physicians as to the consequences and possible futility of treatment in the OUTPATIENT setting, as was intended by the 1991 PSDA ---and especially in view of the fact that CMS will not reimburse physicians/hospitals for futile outpatient tretment that precipitates futile inpatient treatment.

The compassionate rationing of expensive curative care by means of "elective" hospice and palliative care is a public policy goal that can only be attained with the cooperation of the physicians. But, the physicians have not cooperated with this goal ----why not?