In 1991, the National POLST Paradigm is formed in Oregon as a result of medical ethicists discovery that patients end-of-life wishes were not consistently honored.  POLST stands for Practitioner Orders for Life Sustaining Treatment.  The initiative quickly spread to other states and some of the first states to form their own programs included New York, Pennsylvania, Washington, West Virginia and Wisconsin.

In September of 2004 the National POLST Paradigm Task Force (NPPTF) convened on an informal basis with original members from New York Oregon, Pennsylvania, Washington, West Virginia and Wisconsin.  Thereafter, talks began on an informal basis with the purpose of exchanging ideas for state programs.  Standards for state POLST programs were developed and the National POLST Office offers support and resources to all state POLST programs. More information about POLST programs across the country can be found here: http://www.polst.org/

New Jersey’s POLST program is currently a “Developing” program.  It was signed into law by Governor Chris Christie in December 2011.  The New Jersey Program website can be found here:  http://www.njha.com/quality-patient-safety/advanced-care-planning/polst/  The site contains training materials, sample forms, educational materials for patients and providers and general information and guidance for the New Jersey POLST Program.

There is a reason the “P” in POLST stands for Practitioner and not Physician. Prior to September of this year, the POLST forms must have been signed by the patient and the patient’s physician or APN.  Last month, the New Jersey Legislature passed a law adding PA’s to the list of practitioners who can co-sign a New Jersey POLST, the law immediately became effective on effective September 1, 2019.

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On Friday, April 12, 2019, New Jersey Governor Murphy signed the “Medical Aid in Dying for the Terminally Ill Act” into law.  This bill, which goes into effect as of August 1, 2019, makes it legal for physicians to write prescriptions for terminally ill patients for medications that can be self-administered to end the patient’s life.  Patients seeking such a prescription must be terminally ill with no more than six months left to live.  The patent must (i) submit a written request to his or her attending physician that is witnessed by two individuals (with certain specifications) at the time of the first oral request or anytime thereafter and (ii)  make two oral requests to his or her attending physician that must be at least 15 days apart.  The prescription cannot be written without very specific informed consent and no fewer than 48 hours after the attending physicians receipt of the written request.  Any patient making such a request must be a resident of the State of New Jersey.

No physician shall be subject to any criminal, civil or disciplinary authority for participation, or refusal to participate in such requests under this law.  For any physician who does elect to participate in such requests, there are specific documentation and reporting requirements that must be adopted.

If you intend to provide such services, be sure you have all of the proper policies, procedures and consent forms in place before any such prescriptions are provided.

We anticipate regulations to be drafted and adopted by each of the State Board of Medical Examiners, State Board of Pharmacy, State Board of Psychological Examiners and State Board of Social Work Examiners between now and August 1, 2019, which will provide more specific guidance to each Board’s licensees as to how to implement this monumental change.  We will issue updates as they become available.

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