Amendment Proposed to the Uniform DNR Advance Directive Physician Orders for Life Sustaining Treatment

May 16, 2014
SmithAmundsen Health Care Alert

Practice Areas


Senate Bill 3076 is currently pending before the Illinois House of Representatives. The bill includes changes to the Illinois Department of Public Health (IDPH) Uniform Do Not Resuscitate (DNR) Advance Directive. This bill would change the title of the form from a “Do Not Resuscitate” to “Physician order for life sustaining treatment.” The bill would also allow specific health care providers, other than the “attending physician” to sign the POLST order. The amendment would also allow the following individuals to execute a POLST form: (1) an Illinois licensed physician, advanced practice nurse, physician's assistant, or licensed resident after completion of one year in a program; (2) a person selected by or assigned to the patient; and (3) the individual with primary responsibility for treatment and care of the patient.

Another version of the amendment would require an annual review of the POLST order or a review any time there is a condition change, perhaps as frequently as each new diagnosis. This is a change from the current POLST form, which notes that the DNR should be reviewed: when, among other things, there is a substantial change in the patient’s health status. The POLST form should reflect the current preferences of persons with advanced or serious illness or frailty.

Of course, POLST should not replace an informed conversation between patients, families and providers to identify treatment goals and make informed choices. The Chicago End-of-Life Care Coalition notes that POLST is not intended to replace a Power of Attorney for Health Care form (POAHC) but to be used in addition to this form.

The POAHC and/or POLST form are to be honored by all health care providers, as are other valid forms of advanced directives and surrogate decision making. Patient advocates suggest that the informed consent discussion about end of life, should include more than medical information but also should include a discussion about psychosocial situations, such as taking time to put one’s affairs in order, making peace with others, and honoring religious faith values.

The proposed change in Illinois law to allow not just the attending physicians, but also physician’s assistant, advanced nurse practitioner and residents with one year training on implementing end of life orders (if they have primary responsibility for the care and treatment of the patient), would seem to allow a physician to delegate the informed consent discussion to other healthcare practitioners who have primary care responsibility for the patient.

Whether or not the amendments become law, health care providers in Illinois should be mindful of the importance of POLST and DNR orders. Health care providers should document discussions of patients’ unique medical, familial, psychosocial, spiritual, and whether the patient has received outside legal counsel. A POAHC is appropriate for all capable adults, and can encourage patients to seek independent medical and legal advice before deciding who they want as a surrogate decision maker if they become incapacitated. A POAHC can be listed on the POLST form to address any specific issues. A POLST order or other Advanced Directive seeks to have patients agree they have come to their own informed decision about their medical treatment choices or have their own trust in specified surrogate decision makers. Good documentation of the informed consent process validates the directives.