Wisconsin bill lets advance directives be ignored

Legislative approval of a Wisconsin "conscience clause" bill opposed by the state medical association actually could turn out to strengthen the organization's efforts to promote advance directives for end-of-life care.

"The bill raised awareness of advance directives and it's caused some proactive measures among some folks," said Wisconsin Medical Society Vice President of Government Relations Mark Grapentine. "Our involvement raised an issue that no one expected to get that much attention."

While the WMS is encouraging doctors to discuss advance directives with patients, the conscience clause bill would allow health care workers to ignore advance directives without referring the patient to a physician who would honor requests for limited end-of-life treatment, Grapentine said.

The bill took a year to be approved. Gov. Jim Doyle, however, is expected to veto it.

Grapentine said some improvements had been made to the bill, including a requirement that doctors make a "good faith attempt" to transfer a patient to a doctor who would abide by the advance directive, but he said the bill was still flawed. WMS concerns were outlined in a letter from society President Paul Wertsch, MD, that was hand-delivered to Doyle.

"Still remaining is the possible situation of an incapacitated patient who lacks an advance directive having a physician refuse to follow a family's wishes regarding end-of-life care, while also refusing to transfer the patient to another physician," Dr. Wertsch wrote. "While this physician would not be 'abandoning' a patient -- indeed, that physician would still oversee care maintaining the patient's life -- there is debate as to whether that physician might be causing the patient undue harm."

State health care workers already can refuse to participate in abortions or sterilizations, but the new bill also would let them opt out of withholding nutrition or hydration, assisted suicide and procedures involving material obtained from embryos.