Governor Chris Christie has vetoed A-4233/ S-2435 , which means that NJ doctors treating Medicaid can’t get paid for counselling their patients on end of life planning. Perhaps he’s pandering to the absurd claims made in the 2008 Presidential election that by paying doctors to assist their patients to understand the treatment alternatives and choices about foregoing treatment at the end of life, the government would be running “death panels.” Given that he signed the POLST law in 2011, this decision is inconsistent with what the state evidently wants.
New Jersey adopted the Advance Directives law back in 1991. Under the law — N.J.S.A. 26:2H-53 to 78 –, any person who has capacity can write up a statement of their wishes with respect to the use of life supports. The document was called a “Living Will” because it speaks for the person after they lose capacity to express their wishes. Essentially, these documents say that if the patient is mentally incapacitated AND is terminally ill, has severe and irreversible brain damage or is close to death, AND suffers a life-threatening condition (such as kidney failure, inability to swallow, respiratory failure) whereby their life can only be sustained by the use of artificial or mechanical means, THEN the person does not want those mechanisms to be used since they will prolong life but will not solve the underlying chronic condition.advance_directives
I have to say that the vast majority of my clients tell me that if they were at a stage of life that they no longer had capacity and were already terribly debilitated, they would not want their health care agents to initiate the use of such life support if one of their vital systems failed. I counsel clients on these issues all the time, and answer questions from their agents about just what a certain health care document means. Wouldn’t it be sensible to enable them to discuss these issues with their physician as well?
Medical visits are unfortunately getting shorter and shorter. A meaningful discussion of advance directives can’t happen within the ten or fifteen minutes often allocated to an annual checkup. Why would the Governor have disallowed payment to the doctor for an extended or special visit to help the patient understand these issues? The state’s fiscal estimate showed a truly negligible cost to the state, with full federal reimbursement likely.
Call us for advice and representation concerning advance directives and elder care … 732-382-6070