Friday, April 6, 2012

Medical Futility Legislation in Minnesota

Yesterday afternoon, on the floor of the Minnesota Senate (around 3:30:00), Senator Nienow proposed amendment A33 to HF2294 (the Omnibus Health and Human Services Finance bill).  The proposed amendment would require hospitals to disclose a futility policy.  The amendment otherwise would not restrict either the existence or content of such policies.  The amendment was adopted, but must now go to conference, since it was not in the original house bill.

2 comments:

Anonymous said...

Wouldn't a federal mandate that requires physicians to seek fotmal informed consent for both outpatient and inpatient palliative care be a more practical solution to the medical futility and overt unilateral and covert DNR problem?

The continuing Balkanization of state laws governing medical futility and EOL patient autonomy concerning CHOICE continues --primarily, because of the failure of the PSDA of 1991 to include physicians in the mandate that PROHIBITS DISCRIMINATION against patients who don't elect to shorten their lives under the provisions of the 1991 PSDA.

Doesn't this A33 amendment that requires the hospitals to assume the responsibility to disclose futility policy futher insulate treating physicians from any legal duty to seek informed consent from elderly and late-stage cancer patients for both OUTPATIENT and INPATIENT palliative care? ---when currative care is no longer either medically feasible or emotionally feasible for patients?

Wouldn't such a federal mandate work to make unilateral DNRs and medical futility decisions unnecessary in the majority of cases?

And, wouldn't such a federal mandate work to prevent the epidemic of unilateral and sometimes "covert" DNRs that are driven by the public policy initiative to encourage elderly patients at the end of their lives to take advantage of Hospice and Palliative Care which is a less expensive (but more comfortable) standard of care in both the inpatient and outpatient setting?

Anonymous said...

PS ---Ah! but perhaps the reason the physicians weren't put under the provisions of the 1991 PSDA is because "informed consent" to two different standards of care, i.e., "palliative or curative" would have put a very heavy legal burden on the treating physicians (when seeking informed consent) to identify the intent and effect of the outpatient and inpatient treatments when applied under the two different standards. And, in transitioning from one standard to another.

Under the status quo, the treating physician (or any physician) has only to make an educated guess as to whether or not the patient will live six months when admitting/approving patients for the lower standard of care, Hospice/Palliative --or when making "emergency" medical futility decisions in the hospital.

Perhaps hospital disclosure of their futility policies is the only way to protect patients' autonomy and end-of-life choices.