On Wednesday, Wisconsin Medical Society President George Morris, MD, FAAN, testified in opposition to a bill that would alter the thresholds for determining whether a patient has a terminal condition or is in a persistent vegetative state (PVS).
Assembly Bill 287 has three provisions:
- Allow a physician assistant (PA) or nurse practitioner to make findings of incapacity so long as a physician also signs off. – Current law requires/allows either two physicians, or one physician and one psychologist to make determinations of incapacity.
- Allow attending PAs or advanced practice registered nurses (APRN) to issue do-not-resuscitate orders. – Only attending physicians are currently allowed to issue such orders.
- Change certifications of a terminal condition or a persistent vegetative state (PVS) from requiring two physicians, to requiring one physician and allowing a PA, APRN or physician to be the second examiner.
The bill’s proponents highlighted access issues and delays in care in rural areas, particularly where physicians are in short supply, underscoring the need to allow PAs and nurses to sign off on advance directives. Testimony in support of the bill focused on elderly patients and those in nursing homes or hospice care and stated that some PAs and APRNs have the capability and experience to make determinations of PVS or terminal condition, while others commented that neighboring states have similar requirements to the bill in their states.
The Society’s main objection to the bill is lowering the threshold for determining PVS and terminal conditions. Doctor Morris stated in his testimony that lowering the threshold for determinations of PVS or terminal conditions unnecessarily jeopardizes patient care, as the tools and methods used to make such determinations often can’t be interpreted or contextualized by advanced practice clinicians. Dr. Morris highlighted a patient story where the training and experience unique to a physician greatly benefitted the patient who suffered a traumatic brain injury. Questions from legislators about the Society testimony centered around issues related to supervision of PAs or collaborative arrangements with nurses as well as the rural access issues. Dr. Morris acknowledged these concerns, describing scenarios where requiring a physician’s evaluation could avoid potential conflicts. However, he reiterated the need for physicians to be the ones that make determinations of persistent vegetative state and terminal conditions.
Also testifying in opposition to AB 287 was the Wisconsin State Bar which stated that current PA supervision requirements could create the potential for confusion and that different documents cover different types of decisions. The Bar stated that there is not enough information in the bill to address these concerns. They also commented that the supervision requirements under current law could effectively result in only one examination of a patient when activating an advance care directive or health care power of attorney.
The Society will continue to track the progress of this bill. Please contact HJ Waukau with questions.
Back to October 17, 2019 Medigram