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December 01, 2013

2013 Overview: Health Decisions and Advance Planning

(Note: The pdf for the issue in which this article appears is available for download: BIFOCAL Vol. 35, Issue 2.)

Commission staff have worked with Congressional staff to implement ABA policy strengthening the Patient Self-Determination Act. The Act supports patients’ health care advance planning options and promotes the adoption by states of protocols known as “Physician Orders for Life Sustaining Treatment (POLST). Key legislative outcomes during 2013 have been the introduction of the “Personalize Your Care Act” (HR 1173) by Rep. Earl Blumenauer (D-OR) and the “Care Planning Act” (S 1439) by Senator Mark Warner (D-VA) and Johnny Isakson (R-GA). A Senate Aging Committee hearing in June on advance care planning attracted the active participation of several senators, suggesting a growing interest in advance care planning legislation.

National Health Decisions Day
The ABA, through the Commission, is one of the original co-sponsors of National Health Decisions Day (April 16). This year we succeeded in orchestrating a joint article by the presidents of the American Bar Association and the American Medical Association which was distributed via the McClatchy-Tribune news service and published in a number of their local/regional papers. We also drafted a news piece on advance care planning that was published under ABA President Laurel Bellows’ byline in the AARP Bulletin, which has a readership of 40 million. Finally, the Commission and ABA Media Relations collaborated on a radio news release that was aired nearly two thousand times and was heard by an estimated seven million listeners. If we had to pay advertising dollars for that audience, it would have cost more than $1 million.

Advance Care Planning Smartphone App
After several months work on a collaboration agreement with the developer of the My Health Care Wishes smartphone application, the ABA Board of Governors approved a Commission proposal to reconfigure and distribute the app as an ABA-branded product. As of the end of 2013, the final details of the agreement and project implementation were ironed out and the projected release date of the application will be spring 2014. The app provides a health care advance directive personal management tool.

The Commission continued to serve as the legislative/legal consultant to the National POLST paradigm Task Force which is made up of representatives from states that have established POLST programs in conformity with endorsement standards adopted by the Task Force. The number of states that have adopted POLST programs reached 23 this year with 15 of those states, plus one sub-state program, achieving endorsed status by the Task Force. The majority of remaining states have POLST programs in various stages of development.

Electronic Health Records
The Commission drafted comments on behalf of the ABA responding to respond to a request for comments from the federal Health Information Technology Policy Committee on its draft recommendations for “meaningful use” criteria under Stage 3 of the HITECH Act. Our comments sought to strengthen the extremely weak criteria proposed for the handling of advance care planning documents in electronic medical records. Subsequently, the Commission was asked to testify at a virtual hearing on the same subject, held by the Health Information Technology Policy Committee held in September. We expect our ABA comments to make a significant difference when final Stage 3 criteria are announced in 2014.

Educational efforts on health decisions and advance care planning included 12 professional conference presentations during the year; publication of the article “Eight Advance Care Planning Lessons that Took Me 30 Years to Learn;” updating of “Medico-Legal Issues,” a special subjects chapter in The Merck Manual; and serving as a consulting editor for the 2013 edition of The Health Care Power of Attorney and Living Will, by Harvard Health Publications. ■