Honoring Our Patients’ Last Wishes

By State Representative Tarik Khan, PhD, CRNP

As printed in the Chestnut Hill Local and East Falls Forward

I still serve as a family nurse practitioner at Abbotsford Falls Health Center once a week.

My Friday morning shifts have greatly informed my legislative advocacy. For example, my clinical work influenced my bills expanding school-based health centers and allowing nurse practitioners to practice to the fullest extent of their license.

Another legislative issue I've frequently considered, due to my continued nursing service, is ensuring that patients are the primary decision-makers in their care.

For insurance, I've seen patients with hypertension tell me they do not wish to start blood pressure medication. Some with high cholesterol don't want to be prescribed Lipitor or other similar medicines. And some with diabetes don't want to take insulin or check their blood sugar.

While I share with patients from my perspective what is most clinically appropriate, part of my role is to be an educator and an advocate.

Not a judge.

Not the primary decision-maker for patients.

As a healthcare provider, I am a part of the patient's care team and duty-bound to ensure we follow a patient's healthcare decisions.

And no time is more crucial to ensure a patient's wishes are carried out than when they are at the end of their life.

Recently, a constituent at my Manayunk office came to advocate for a PA Senate bill 631 by a Republican Senator Eugene Yaw called POLST, or Pennsylvania Orders for Life-Sustaining Treatment. The POLST is different from an advance directive (or living will). It requires a thoughtful conversation between healthcare providers and patients regarding their treatment goals when they are near the end of life and results in clinical orders designed to be honored across all healthcare settings.

This bill ensures a standardized process to ensure that a patient's healthcare team consistently follows their wishes as they near the end of life.

Because some may desire to have every possible intervention— tube feeding, CPR, and a ventilator.

But others may wish their treatment to focus on making them comfortable: nasal oxygen, oral suctioning, and medicine for pain, anxiety, and symptom relief— but not lifesaving IV medications or interventions.

Still others may wish to have limited medical interventions, such as antibiotics, in addition to comfort care. 

After I met with this constituent, I decided to introduce a House companion to the Senate bill to help ensure POLST becomes law. I am introducing House Bill 1212 with several of my colleagues, including Representative Arvind Venkat, a physician from Allegheny County, Representative Bridget Kosierowski, a nurse from the Lehigh Valley, and Representative Brian Munroe, a former EMT and police officer from Bucks County.

So far, we've passed five of my bills out of the Pennsylvania House this legislative session. Of the nearly five dozen or so I've helped to author and introduce in this session, I'm very hopeful about the chances of this bipartisan legislation getting passed this fall. My staff has been working with stakeholders this summer to build support and consensus on this critical bill. House Bill 1212 is now in the PA House Health Committee. And I'm continuing to seek new inspiration in my clinical practice to help improve our neighbors' lives.

Let me know your thoughts on POLST or other policy issues by calling us at (215) 482-8726 or emailing reptarik@pahouse.net. For more detailed information about the POLST in Pennsylvania, go to https://www.papolst.org. Hopefully, we can soon make POLST a reality in Pennsylvania!