The NCSL Blog


By Samantha Scotti

Baby boomers have always been known as the “activist generation.” Now that they are turning 65 at the rate of 10,000 people per day, their activism includes paying more attention to serious illness and end-of-life issues.

Doctor holding patient's hand on bedState legislatures have helped people take more control over their health care decisions through the creation of planning tools such as living wills, advance directives and health care powers of attorney.

A lesser known tool, Physician Orders for Life-Sustaining Treatment (POLST), provides individuals near the end of life with the opportunity to express their treatment preferences.

POLST forms are typically the result of a focused discussion or even series of discussions between a patient and physician about the patient’s values, beliefs and treatment preferences. Since a POLST form is considered a set of medical orders, it is likely to be honored by emergency medical technicians and other clinicians.

During NCSL’s legislative summit in Chicago last month, legislators, legislative staff and other key stakeholders came together to discuss a range of topics related to end-of-life decisions and policies that empower individuals to direct the care that they do or do not wish to receive at the end of life.

During the session, “Improving End-of-Life Care: The Better End,” attendees heard from Maryland Delegate Dr. Dan Morhaim, legislator, emergency room physician, end-of-life care expert and author, for an overview of issues facing a physician in providing quality end-of-life care and the implications for state policy.

Morhaim noted that while the majority of state legislatures have discussed the topic of advanced directives, advance care planning has not become a routine activity. He encouraged legislative leaders to make advance care planning more accessible for consumers and clinicians.

He was joined by Amy Vandenbroucke, executive director of the National POLST Paradigm, who echoed Morhaim’s sentiment on the benefits of advance care planning and its connection to providing better care for patients.

She explained that POLST forms, which have different names in different states, complement advance directives but are more specific and are intended solely for people who are seriously ill or frail. These forms document treatment preferences—allowing a patient to record whether he or she wants certain interventions, such as artificial feeding, antibiotics, cardiopulmonary resuscitation (CPR) and mechanical ventilation.

Currently, 47 states have or are developing POLST programs. Some states have enacted legislation to establish guidelines for POLST programs or remove barriers to implementation.

Bipartisan federal legislation pending in Congress would create a grant-making program to help states expand and improve their POLST programs. More information on that bill is available here.

The NCSL meeting was supported by The Pew Charitable Trusts’ Improving End-of-Life Care Project and provided policymakers and other stakeholders the opportunity to learn from experts about key ways to improve the care individuals receive at the end of their lives and ensure their care directives are honored.

While end-of-life decisions are ones that everyone will have to make eventually, this topic can often go undiscussed.

For more information on state roles in end-of-life planning please, see NCSL’s resources on end-of-life planning and The Pew Charitable Trusts’ Improving End-of-life Care resources. More information about Del. Morhaim’s book, The Better End: Surviving (and Dying) on Your Own Terms in Today’s Modern Medical World, can be found here.

Samantha Scotti is a research analyst covering health policy issues for NCSL.

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About the NCSL Blog

This blog offers updates on the National Conference of State Legislatures' research and training, the latest on federalism and the state legislative institution, and posts about state legislators and legislative staff. The blog is edited by NCSL staff and written primarily by NCSL's experts on public policy and the state legislative institution.