Bill seeks to simplify health care advance planning, ease burden for patients and families

As COVID-19 continues to spotlight the importance of health care and end-of-life decision-making like never before, advance directive legislation moving forward at the Statehouse may make it easier for Hoosiers to navigate the process.

Senate Bill 204, a measure that would update and streamline Indiana law concerning health care advance directives, is the culmination of years of work by legislators as well as an alliance of numerous physicians, attorneys and advocacy groups. The Indiana Patient Preferences Coalition has sought to combine and clarify three related statutes that comprise Indiana’s current legal framework for advance directives, which are documents that allow individuals to express their treatment preferences in the event of a serious illness or life-threatening situation.

Advance directives also provide people with the opportunity to designate a representative to make decisions on their behalf if they are incapacitated and cannot articulate their wishes themselves. Although the work leading to Senate Bill 204 has been years in the making, the global pandemic has brought the need for clear advance directives into even sharper focus, according to David Mandelbaum, M.D., the chairman of the coalition.  

“We have witnessed heartbreaking scenarios week after week for the past year that are going to be difficult to forget – all due to the inadequacies of existing (advance directive) documents or by the lack of documents altogether, often related to the difficulty encountered by those who should be completing them,” said Mandelbaum, medical director of palliative care services for Franciscan Health in Indianapolis and Mooresville. “If this bill becomes law, it will establish a best-practice approach to the completion of advance directives in our state, making it easier, more efficient, and less confusing for all Hoosiers.”

Indiana’s current advance directive laws are outdated, Mandelbaum told members of the House Public Policy Committee during a March 24 hearing on Senate Bill 204. In his testimony supporting the legislation, he was speaking from his experiences in the field of palliative care, which is dedicated to maximizing quality of life for patients facing serious illness.

“While there have been significant advancements made in treatments available to critically ill patients, and while the methods for documenting one’s own treatment preferences and priorities have evolved, statutes related to these matters haven’t been meaningfully updated or revised in nearly 30 years,” Mandelbaum said.

Senate Bill 204, authored by Sen. Linda Rogers (R-Granger), passed the House committee 10-0 after earlier passing the Senate unanimously on a 46-0 vote. Among other provisions, the bill would remove vague and conflicting cross references in current statutes, create one agreed-upon mechanism for appointing a legal representative, and establish general standards for advance directives.

The legislation has a broad base of support statewide that includes the Indiana Catholic Conference (ICC), which collaborated with interested parties on a similar bill in the 2020 General Assembly.

“Respect for the dignity of life is the basis of Catholic social teaching,” said Angela Espada, executive director of the ICC, the public policy voice of the Catholic Church in Indiana. “Respecting the dignity of those who may not be able to care for themselves is crucial. We believe that Senate Bill 204 will eliminate some of the confusion that has existed and allow for the wishes of the individual to be fulfilled. This allows for the dignity of the gravely ill or vulnerable person to be maintained and respected.”

Ascension St. Vincent ethicist Elliott Bedford, Ph.D., who calls the legislation “a major advancement,” said that a simplified and standardized process for advance directives should encourage “essential conversations” regarding health care choices.

“From the Catholic faith perspective, this is a prudent and positive thing to do and a way of witnessing to our faith,” said Bedford, director of Ethics Integration for Ascension Indiana and a member of the Hospice and Palliative Care Initiative, a collaboration among the Archdiocese of Indianapolis, Ascension St. Vincent and Franciscan Health.

Bedford said he believes that the extreme challenges of COVID-19 have “opened up space” for many people to begin discussing health care planning with their families.

“COVID has certainly brought us face to face with our mortality, not only as individuals but as a society,” said Bedford, a member of Our Lady of Mount Carmel Parish in Carmel, Ind. “And that allows us to focus on nailing down simple questions: Who do you want to speak for you? What would your goals and values and highest priorities be? Our faith is the perfect context for these conversations – and our faith actually calls us to do this.”

Ideally, he said those discussions should also occur in places like a primary care provider’s office – not in the ICU, when it’s often too late.

Bedford recognizes that these are difficult topics, but he says that simply starting the conversation is a way of acknowledging what is a normal part of life. 

“Ultimately, we believe that this is not the end, and that we are called to life with God in heaven,” Bedford said. “Then this becomes a more contextualized conversation, and a natural part of how we express our faith. This is what you do as a Catholic.”

To follow priority legislation of the ICC, visit www.indianacc.org. This website includes access to I-CAN, the Indiana Catholic Action Network, which offers the Church’s position on key issues. Those who sign up for I-CAN receive alerts on legislation moving forward and ways to contact their elected representatives.