OKLAHOMA CITY — Although 2006 changes to state law gave patients more control over end-of-life care, many patients and doctors didn’t know the changes had been enacted.
The Oklahoma Health Care Authority, which administers the state Medicaid program; the Oklahoma Attorney General’s Office; the Oklahoma State Department of Health and the Oklahoma Department of Human Services sent a joint letter to health care providers last week explaining the changes.
They include:
• Effective more quickly: The Oklahoma Advance Directive for Health Care now goes into effect any time two physicians declare that a patient is incapacitated and incapable of making an informed decision about his or her health care.
• Greater authority: Those who speak on behalf of the patient now may do so for more than end-of-life decisions.
• Clearer choices: Patients now may choose to receive no life-sustaining treatment except tube-feeding; receive no life-sustaining treatment of any kind; or receive all lifesustaining treatment, including tube-feeding.
• Expanded scope: The directive now covers an “end-stage condition” such as late-stage Alzheimer’s disease.
Space is provided to allow a person to indicate other conditions in which he or she would not want treatment, or to clarify instructions about receiving life-sustaining treatment. Older versions of the advance directive remain valid.
The changes remove the need for a power of attorney for most patients. Under federal law, the health care “proxy” as listed on the form is considered a personal representative and is entitled to all information needed to make decisions.
Patients also are given handouts that explain end-of-life rights and expectations.
“These are important and welcomed initiatives which should promote consumer education and enhance medical decision making by patients in Oklahoma,” said Marguerite Chapman, director of the University of Tulsa’s health law program. “Attorney General Edmondson and Linda Edmondson (who chairs the Attorney General’s Task Force on End-of-Life Care) are especially commended for their work on this and so many of their other initiatives to improve health care decision making and care, especially at the end of life.”
Chapman noted the letter and statement help providers comply with the federal Patient Self- Determination Act of 1990.
Chapman, whose law review article on the rights of the terminally ill was cited by former Chief Justice William Rehnquist in the U.S. Supreme Court’s landmark “Cruzan” decision, said anecdotal evidence suggests implementation of the “medical Miranda rights law” has been inconsistent.
“The 2006 legislative changes to the Oklahoma advance directive laws significantly enhanced the options of patients regarding health care decision-making when they no longer have capacity to speak for themselves,” she said.
Linda Edmondson, a licensed clinical social worker with experience in end-of-life care issues, said the task force’s 2005 report resulted in a series of attorney general opinions about the advance directive law, one of which invalidated part of the law. The Legislature in 2006 corrected the law to comply.
“I knew that health care professionals across the state were still using the old form and were unaware of the changes,” she said, noting that no state agency had informed providers of the differences until last week’s letter.
The most important change, she said, is the expansion of the health care proxy.
“Now the health care proxy that you choose to speak for you can make health care decisions for you any time you are incapacitated, not just when you are near death,” she said.
Links of interest:
www.oag.state.ok.us/oagweb.nsf/AdvanceDirective
www.nlm.nih.gov/medlineplus/advancedirectives.html
www.putitinwriting.org
http://charityadvantage.com/Senior_Law_Resource_CenterGEYIDZ/Home.asp
http://okpalliative.nursing.ouhsc.edu
