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House rejects expansion of who may sign advance health-care directives
Summary
The House voted 54-12 to reject first substitute S.B. 117, which would have allowed physician assistants and psychologists to sign and implement certain "life with dignity" health-care orders; sponsors said the change reflected years of study while opponents warned the decision is too consequential to broaden.
The Utah House on Feb. 11 defeated first substitute S.B. 117, Advanced Healthcare Directive Act amendments, after an often-emotional floor debate about who should be authorized to sign and carry out end-of-life orders.
Representative Janice Mascaro, the House sponsor, told colleagues the bill followed about three years of study and would add additional clinicians — including physician assistants — to the list of professionals authorized to sign the medical orders that implement a "life with dignity" directive. "This bill authorizes them to sign the orders needed to carry out the patient's wishes about their end of life care," Mascaro said, arguing that physician assistants and other clinicians frequently provide hands-on care and are well positioned to ensure patients' instructions are followed.
Opponents argued the change was too broad for decisions that can be irreversible. Representative Bigelow said, "These kinds of decisions are so profound ... I am not going to support this bill" unless authority is kept narrowly defined for physicians. Representative Hutchings said physician assistants can and should advise clinicians but warned against giving them final authority: "When it comes down to making critical life decisions ... we need the most qualified, most capable, most confident, best trained people making that decision."
Other speakers raised concerns about psychologists being granted the same authority and about variable clinical settings. Supporters countered that advanced practice clinicians already play central roles in hospitals and long-term care settings and that the measure preserves physician oversight where appropriate. Representative Allen recounted a personal family experience and said physician assistants were the clinicians most familiar with day-to-day care.
After discussion and a short summation by the sponsor, the House opened and closed the vote. The roll count showed 12 yes votes and 54 no votes; the bill failed and will be returned to the Senate for filing.
The immediate effect is procedural: the proposed statutory change to permit additional categories of clinicians to sign and implement health-care directives did not pass the House. Sponsors said the issue arose from multi-year work by the Commission on Aging and related committees; opponents said the proposal warrants further study and narrower drafting before any future enactment.
