N.C House Debates End of Life Issues

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N.C. House Debates End of Life Issues

Special Report - July 20, 2007
A bill currently pending before the State House Judiciary 1 Committee has raised significant issues regarding end of life care. SB 1046—Advance Directives/Health Care Power of Attorney involves a rewrite of North Carolina’s health care power of attorney and living will laws. It also introduces an additional instrument—the “MOST” form—through which an individual may document their wishes regarding the level of care they desire to receive in an end of life situation. Concerns have been raised that enactment of this bill in its current form could result in a state policy that allows individuals and physicians to end life before natural death occurs.

Essentially, SB 1046, which has passed the State Senate and the House Health Committee, would re-codify a law that allows an individual to name a health care power of attorney, who has the authority to make health care decisions for the individual if they are unable to make or communicate those decisions on their own. The bill would also establish a revised living will statute through which an individual is able to direct their health care provider to withhold or withdraw “life-prolonging measures” in certain circumstances. Additionally, the bill would authorize the use of a new Medical Order for Scope of Treatment (MOST) form, which is a Physician Order Sheet listing the patient’s desired level of care for such treatments as CPR, mechanical ventilation, antibiotics, fluids and nutrition including feeding tubes, etc. By way of this form, a patient, or the patient’s representative, along with their physician, could elect to receive the full scope of treatment, a limited level of treatment, or no treatment at all.

The North Carolina Family Policy Council has expressed concern that state law does not define the standard level of care a patient is expected to receive in an end of life situation. Despite the fact that SB 1046 seems to be written in a manner that presumes all patients will receive the full scope of treatment unless they elect otherwise through their health care power of attorney, living will or MOST form, and although SB 1046 specifies that, “Nothing in this Article shall be construed to authorize any affirmative or deliberate act or omission to end life other than to permit the natural process of dying,” the absence of a codified standard of care creates significant ambiguity in the law. The bill also fails to define a number of important terms used in the bill and lacks a mechanism to ensure that a patient receives the treatment they desire in a circumstance where the attending physician feels further care would be “futile.”

Clearly, the sensitive nature of these issues and the complexity of this 30-page bill have resulted in a whole host of questions and concerns about SB 1046. A number of amendments to the bill have been drafted and are expected to be discussed when it comes before the Judiciary 1 Committee again on Monday, July 23.