Thursday, April 5, 2012

Oklahoma Anti-Futility Legislation

Oklahoma has pending legislation titled the "Nondiscrimination in Treatment Act" (SB 1695).  This is very similar to pending Idaho legislation about which I have blogged several times.  The Idaho bill has passed both houses and is sitting on the governor's desk.  The Oklahoma bill has passed the Senate and has been passed out of the house public health committee.  


The purpose of the Oklahoma bill is to prohibit the denial of life-preserving health care services from a requesting patient on the basis of a view that extending the life of an elderly, disabled or terminally ill individual is of lower value than extending the life of someone who is younger, nondisabled or not terminally ill.


It also prohibits the denial of services on the basis of disagreement with how the patient or their representatives value the tradeoff between extending the length of the patient’s life and the risk of disability.  Affected patients or their representatives may maintain injunctive relief against a health care provider who violates or is about to violate these provisions.


The key language from the bill is the following:
A health care provider shall not deny to a patient a life-preserving health care service the provider provides to other patients, the provision of which is directed by the patient or a person authorized to make health care decisions for the patient: 
1. On the basis of a view that treats extending the life of an elderly, disabled, or terminally ill individual as of lower value than extending the life of an individual who is younger, non-disabled, or not terminally ill; or
2. On the basis of disagreement with how the patient or person authorized to make health care decisions for the patient values the tradeoff between extending the length of the patient's life and the risk of disability.

5 comments:

Anonymous said...

It is good to know that Oklahoma is taking steps to clarify the prohibition of discrimination as mandated by the Federal Patient Self Determination Act of 1991.

Hopefully, the Oklahoma clarification of the mandate in federal law (PSDA 1991) that is implemented by CMS/HHS will work to slow the placement of unilateral and covert DNRs in the hospital charts of elderly Medicare/Medicaid patients that is now driven by public policy goals to encourage elderly persons to die outside of expensive ICUs and CCUs.

Hopefully, the clarification of the 1991 federal mandate (1991 PSDA) that prohibits discrimination will work to encourage EOL conversations between physicians and patients and AGREEMENT by each indidual patient as to the futility or the feasibility of end- of- life treatments that either shorten or extend life. The autonomy of the patient to CHOOSE should continue to be protected under law.

Ronn said...

A health care provider shall not deny to a patient a life-preserving health care service the provider provides to other patients...

Does this bill specifically define what a life-preserving health care service is?

Taken literally, a life-preserving health care service could include almost anything which would radically extend the EMTALA safety net! (I guess we could then simply refer to it as TALA.) Of course, there is the issue of constitutionality...

My question was serious. My commentary? Not so much. :)

Ronn said...

1. ...On the basis of a view that treats extending the life of an elderly, disabled, or terminally ill individual as of lower value than...

2. ...how the patient or (authorized) person...values the tradeoff between extending...the patient's life and the risk of disability.
-------------------------
The verbiage used in this bill is striking if I am interpreting it correctly.

1. The comparative "value" of the person's (patient's) life itself constitutes a very clear turn away from the commonly used notion "quality of life" favored by clinicians. The latter corresponds to substituted judgement and best interests; the former trades heavily upon a third-person perception of the person's sanctity of life.

2.The burdens associated with prolonged critical or terminal illness are described here (potentially) as "disability" - a very loaded moral and legal term - and one that when applied too broadly is disingenuous. In the case of many ICU patients, I don't believe the term disabled can be appropriately substituted for or conflated with terminally ill or critically ill.

Anonymous said...

We have only "words" to describe the "intent" of the law and only words to "circumvent" or "obscure' the intent of the law --if this is the intent!

Any unilateral DNR authorized by law requires that "medical futility" be very narrowly defined in the interests of preserving the patient's "right to live" OR the patient's "right to die" when the patient, himself, finds further life to be emotionally and painfully futile (very broadly defined under law! --

healthgrades said...

Oklahoma clarification of the mandate in federal law (PSDA 1991) that is implemented by CMS/HHS will work to slow the placement of unilateral and covert DNRs in the hospital charts of elderly Medicare/Medicaid patients



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