SENATE AMENDED
PRIOR PRINTER'S NOS. 75, 1797, 2028 PRINTER'S NO. 2943
No. 96 Session of 1999
INTRODUCED BY FLEAGLE, BARRAR, BELARDI, BROWNE, CORNELL,
FAIRCHILD, GEIST, HARHAI, HENNESSEY, HERMAN, JOSEPHS,
LAUGHLIN, NICKOL, PESCI, ROSS, RUBLEY, SATHER, SAYLOR,
SCHULER, SCRIMENTI, B. SMITH, STEVENSON, E. Z. TAYLOR, TIGUE,
TRAVAGLIO, VANCE, WILLIAMS, WRIGHT, MUNDY, HERSHEY, TRELLO,
SEYFERT, CAPPABIANCA, BENNINGHOFF, S. MILLER, SOLOBAY,
STEELMAN, CORRIGAN, L. I. COHEN AND SERAFINI,
JANUARY 20, 1999
SENATOR MOWERY, PUBLIC HEALTH AND WELFARE, IN SENATE, AS
AMENDED, FEBRUARY 8, 2000
AN ACT
1 Amending Title 20 (Decedents, Estates and Fiduciaries) of the <--
2 Pennsylvania Consolidated Statutes, further providing for
3 advance directives for emergency medical service health care.
4 AMENDING TITLE 20 (DECEDENTS, ESTATES AND FIDUCIARIES) OF THE <--
5 PENNSYLVANIA CONSOLIDATED STATUTES, FURTHER PROVIDING FOR
6 ADVANCE DIRECTIVES FOR HEALTH CARE DEFINITIONS AND EMERGENCY
7 MEDICAL SERVICES; AND PROVIDING FOR OUT-OF-HOSPITAL
8 NONRESUSCITATION.
9 The General Assembly of the Commonwealth of Pennsylvania
10 hereby enacts as follows:
11 Section 1. Sections 5403, 5407, 5410(b), 5411, 5413 and 5415 <--
12 of Title 20 of the Pennsylvania Consolidated Statutes are
13 amended to read:
14 § 5403. Definitions.
15 The following words and phrases when used in this chapter
16 shall have the meanings given to them in this section unless the
17 context clearly indicates otherwise:
1 "Attending physician." The physician who has primary
2 responsibility for the treatment and care of the declarant.
3 "Declarant." A person, including an emancipated minor, who
4 makes a declaration in accordance with this chapter.
5 "Declaration." A written document voluntarily executed by
6 the declarant in accordance with this chapter.
7 "Emergency medical service provider." A health care provider
8 recognized under the act of July 3, 1985 (P.L.164, No.45), known
9 as the Emergency Medical Services Act. For the purposes of this
10 act, the term shall include those individuals recognized under
11 42 Pa.C.S. § 8331.2 (relating to good Samaritan civil immunity
12 for use of automated external defibrillator).
13 "Emergency medical services do-not-resuscitate bracelet" or
14 "EMS-DNR bracelet." A bracelet in the standard format set forth
15 in section 5413 (relating to emergency medical services),
16 supplied by the Department of Health and issued by the attending
17 physician, which may be worn, at the declarant's option, to
18 notify emergency medical service providers of the presence of a
19 do-not-resuscitate order.
20 "Emergency medical services do-not-resuscitate card" or "EMS-
21 DNR card." A wallet-sized card in the standard format set forth
22 in section 5413 (relating to emergency medical services),
23 supplied by the Department of Health and issued by the attending
24 physician, which may be displayed, at the declarant's option, to
25 notify emergency medical service providers of the presence of a
26 do-not-resuscitate order.
27 "Emergency medical services do-not-resuscitate order" or
28 "EMS-DNR order." An order in the standard format set forth in
29 section 5413 (relating to emergency medical services), supplied
30 by the Department of Health and issued by the attending
19990H0096B2943 - 2 -
1 physician, directing emergency medical service providers to
2 withhold cardiopulmonary resuscitation (cardiac compression,
3 endotracheal intubation, artificial ventilation, defibrillation
4 and other related procedures) from the declarant in the event of
5 respiratory or cardiac arrest.
6 "Emergency medical services do-not-resuscitate patient" or
7 "EMS-DNR patient." A person who, pursuant to section 5413(b)
8 (relating to emergency medical services), possesses and in any
9 manner displays or causes to be displayed for EMS providers an
10 apparently valid EMS-DNR order, bracelet or card.
11 "Health care provider." A person who is licensed or
12 certified by the laws of this Commonwealth to administer health
13 care in the ordinary course of business or practice of a
14 profession. The term includes personnel recognized under the act
15 of July 3, 1985 (P.L.164, No.45), known as the Emergency Medical
16 Services Act. For purposes of this act, the term shall include
17 those individuals recognized under 42 Pa.C.S. § 8331.2 (relating
18 to good Samaritan civil immunity for use of automated external
19 defibrillator).
20 "Incompetent." The lack of sufficient capacity for a person
21 to make or communicate decisions concerning himself.
22 "Invasive airway technique." Any advanced airway technique,
23 including endotracheal intubation.
24 "Life-sustaining treatment." Any medical procedure or
25 intervention that, when administered to a qualified patient,
26 will serve only to prolong the process of dying or to maintain
27 the patient in a state of permanent unconsciousness. Life-
28 sustaining treatment shall include nutrition and hydration
29 administered by gastric tube or intravenously or any other
30 artificial or invasive means if the declaration of the qualified
19990H0096B2943 - 3 -
1 patient so specifically provides.
2 "Medical command physician." A licensed physician who is
3 authorized to give medical command under the act of July 3, 1985
4 (P.L.164, No.45), known as the Emergency Medical Services Act.
5 "Permanently unconscious." A medical condition that has been
6 diagnosed in accordance with currently accepted medical
7 standards and with reasonable medical certainty as total and
8 irreversible loss of consciousness and capacity for interaction
9 with the environment. The term includes, without limitation, a
10 persistent vegetative state or irreversible coma.
11 "Person." An individual, corporation, partnership,
12 association or Federal, State or local government or
13 governmental agency.
14 "Qualified patient." A person who has executed a declaration
15 and who has been determined to be in a terminal condition or to
16 be permanently unconscious or an EMS-DNR patient.
17 "Terminal condition." An incurable and irreversible medical
18 condition in an advanced state caused by injury, disease or
19 physical illness which will, in the opinion of the attending
20 physician, to a reasonable degree of medical certainty, result
21 in death regardless of the continued application of life-
22 sustaining treatment.
23 § 5407. Liability.
24 (a) General rule.--No physician, emergency medical service
25 provider or other health care provider who, consistent with this
26 chapter, causes or participates in the initiating, continuing,
27 withholding or withdrawal of life-sustaining treatment from an
28 EMS-DNR patient or a qualified patient who is incompetent shall,
29 as a result thereof, be subject to criminal or civil liability
30 or be found to have committed an act of unprofessional conduct
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1 if the attending physician, health care provider or EMS provider
2 has followed the declarant's wishes as expressed earlier by the
3 declarant in the form of a declaration and/or EMS-DNR order
4 executed pursuant to this chapter.
5 (b) Absence of declaration or EMS-DNR order, bracelet or
6 card.--The absence of a declaration or EMS-DNR order, bracelet
7 or card by a patient shall not give rise to any presumption as
8 to the intent of the patient to consent to or to refuse the
9 initiation, continuation or termination of life-sustaining
10 treatment.
11 § 5410. Effect on suicide and life insurance.
12 * * *
13 (b) Life insurance.--The making of or failure to make a
14 declaration or EMS-DNR order in accordance with this chapter
15 shall not affect in any manner the sale, procurement or issuance
16 of any policy of life insurance nor shall it be deemed to modify
17 the terms of an existing policy of life insurance. No policy of
18 life insurance shall be legally impaired or invalidated in any
19 manner by the withholding or withdrawal of life-sustaining
20 treatment from an insured patient, notwithstanding any term of
21 the policy to the contrary.
22 § 5411. Declaration optional.
23 No physician or other health care provider and no health care
24 service plan, health maintenance organization, insurer issuing
25 disability insurance, self-insured employee welfare benefit
26 plan, nonprofit hospital plan or Federal, State or local
27 government sponsored or operated program shall:
28 (1) require any person to execute a declaration or EMS-
29 DNR order as a condition for being insured for or receiving
30 health care services; or
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1 (2) charge any person a different rate or fee whether or
2 not the person executes or has executed a declaration.
3 § 5413. Emergency medical services.
4 [(a) Care given prior to declaration taking effect.--Nothing
5 in this chapter shall be construed to make the provisions of a
6 declaration apply to care given to a patient by emergency
7 medical services personnel prior to the declaration's becoming
8 operative under sections 5405 (relating to when declaration
9 becomes operative) and 5408 (relating to duty of physician to
10 confirm terminal condition).
11 (b) Care given after declaration takes effect.--The
12 provisions of a declaration shall apply to care given to a
13 patient by emergency medical services personnel after the
14 declaration becomes operative under sections 5405 and 5408 only
15 if:
16 (1) an original declaration, signed by the declarant or
17 other authorized person, is presented to the emergency
18 medical services personnel. The emergency medical services
19 personnel must immediately notify the medical command
20 physician of the presence of the declaration; or
21 (2) the medical command physician, based on prior
22 notification by the attending physician or other health care
23 provider that a valid and operative declaration exists,
24 directs the emergency medical service personnel according to
25 the provisions of the declaration.
26 (c) Uncertainty regarding validity of declaration.--
27 Emergency medical services personnel confronted with any
28 conflicting information regarding the patient's wishes for life-
29 sustaining treatment shall act according to the accepted
30 treatment protocols and standards appropriate to their level of
19990H0096B2943 - 6 -
1 certification.]
2 (a) Medical command instructions.--Notwithstanding the
3 absence of an EMS-DNR order, bracelet or card pursuant to this
4 section, EMS providers shall at all times comply with the
5 instructions of an authorized medical command physician to
6 withhold or discontinue resuscitation.
7 (b) EMS-DNR orders, bracelets and cards.--A declarant's
8 attending physician, upon the request of a declarant in a
9 terminal condition or his surrogate, if the surrogate is so
10 authorized, or upon making a determination pursuant to section
11 5405(2) (relating to when declaration becomes operative), shall,
12 if appropriate based on the declaration, issue to the declarant
13 an emergency medical services do-not-resuscitate order, and may
14 issue at the request of the declarant or his surrogate an EMS-
15 DNR bracelet and/or card supplied by the Department of Health.
16 The declarant may, at the declarant's option, wear the bracelet
17 and/or display the order or card to notify emergency medical
18 service providers of the declarant's do-not-resuscitate status.
19 (c) Revocation of EMS-DNR order.--The declarant may revoke
20 his EMS-DNR status at any time without regard to the declarant's
21 physical or mental condition and in any manner, including
22 verbally or by destroying or not displaying the order, bracelet
23 or card. Revocation of the declaration shall also serve to
24 revoke the EMS-DNR order, though emergency medical service
25 providers shall not be subject to civil or criminal liability or
26 administrative sanction for failure to verify the declaration
27 prior to complying with the EMS-DNR order.
28 (d) Effect of EMS-DNR order, bracelet or card.--Emergency
29 medical service providers are hereby authorized to and shall,
30 comply, subject to subsection (e), with an approved Department
19990H0096B2943 - 7 -
1 of Health-issued EMS-DNR order if made aware of such by
2 examining an EMS-DNR bracelet, card or the order itself. Such
3 providers shall have no duty to examine the underlying
4 declaration. "Compliance" for purposes of this subsection shall
5 mean the withholding of cardiopulmonary resuscitation (cardiac
6 compression, invasive airway techniques, artificial ventilation,
7 defibrillation and other related procedures) from the declarant
8 in the event of respiratory or cardiac arrest. "Compliance"
9 shall also mean the discontinuance and cessation of such
10 resuscitative measures in the event the emergency medical
11 service provider is presented with an EMS-DNR order, card and/or
12 bracelet after initiating such resuscitative measures. Emergency
13 medical service providers shall provide other medical
14 interventions necessary and appropriate to provide comfort and
15 alleviate pain, including intravenous fluids, medications,
16 oxygen and any other intervention appropriate to the level of
17 the certification of the provider, unless otherwise directed by
18 the declarant or the EMS provider's authorized medical command
19 physician.
20 (e) Unwillingness of emergency medical service provider to
21 comply.--Emergency medical services providers who cannot in good
22 conscience comply with an EMS-DNR order shall make a good faith
23 effort to proceed under section 5409 (relating to unwillingness
24 to comply; transfer of declarant) and, so long as such good
25 faith effort is made, shall not be subject to civil or criminal
26 liability or administrative sanction for failure to comply with
27 an EMS-DNR order. Emergency medical service providers unable to
28 comply with an EMS-DNR order under this subsection shall not be
29 subject to discipline, termination, demotion or other
30 retribution by their employer or the EMS organization with which
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1 they are affiliated solely for their actions under this
2 subsection.
3 (f) Uncertainty regarding validity or applicability of
4 order, bracelet or card.--Emergency medical service providers
5 who in good faith are uncertain about the validity or
6 applicability of an EMS-DNR order, bracelet or card shall render
7 care in accordance with their level of certification. Such
8 providers shall not be subject to civil or criminal liability or
9 administrative sanction for failure to comply with an EMS-DNR
10 order under this subsection.
11 (g) Format of EMS-DNR order.--The Department of Health
12 shall, with the advice of the Pennsylvania Emergency Health
13 Services Council and with the assistance of the regional
14 emergency medical services councils, make available within 180
15 days of the effective date of this subsection standard EMS-DNR
16 orders for issuance to declarants by attending physicians of
17 this Commonwealth. The form of the order shall contain, but not
18 be limited to, the following:
19 PENNSYLVANIA EMERGENCY MEDICAL SERVICES
20 DO-NOT-RESUSCITATE ORDER
21 Patient's full legal name:
22 I, the undersigned, state that I am the attending
23 physician of the patient named above. The above-named
24 patient has executed an advance directive for health care
25 and this EMS-DNR order and I have made the determination
26 that this patient is in a terminal condition and eligible
27 for an EMS-DNR order.
28 I direct any and all emergency medical service
29 personnel, commencing on the effective date of this
30 order, to withhold cardiopulmonary resuscitation (cardiac
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1 compression, invasive airway techniques, artificial
2 ventilation, defibrillation and other related procedures)
3 from the declarant in the event of the declarant's
4 respiratory or cardiac arrest. I further direct such
5 personnel to provide to the patient other medical
6 interventions, such as intravenous fluids, oxygen or
7 other therapies necessary to provide comfort care or to
8 alleviate pain, unless directed otherwise by the
9 declarant or the EMS provider's authorized medical
10 command physician.
11 Signature of attending physician:
12 Printed name of attending physician:
13 Dated:
14 Attending physician's emergency telephone number:
15 Signature of patient (if capable of making informed
16 decisions):
17 I, the undersigned, hereby direct that in the event
18 of my cardiac and/or respiratory arrest, efforts at
19 cardiopulmonary resuscitation not be initiated. I
20 understand that I may revoke these directions at any time
21 by giving verbal instructions to the emergency medical
22 service providers, by physical cancellation or
23 destruction of this form or my EMS-DNR bracelet or card,
24 or by simply not displaying this form or the EMS-DNR
25 bracelet or card for my EMS caregivers.
26 Signature of surrogate (if patient is incapable of
27 making informed decisions):
28 I, the undersigned, hereby certify that I am
29 authorized to execute this EMS-DNR order on the patient's
30 behalf by virtue of having been designated as the
19990H0096B2943 - 10 -
1 patient's surrogate and/or by virtue of my relationship
2 to the patient (specify relationship: _________________).
3 I hereby direct that in the event of the patient's
4 cardiac and/or respiratory arrest, efforts at
5 cardiopulmonary resuscitation not be initiated.
6 (h) Format of EMS-DNR bracelet.--The Department of Health
7 shall, with the advice of the Pennsylvania Emergency Health
8 Services Council and with the assistance of the regional
9 emergency medical services councils, make available within 180
10 days of the effective date of this subsection standard EMS-DNR
11 bracelets for issuance to declarants by attending physicians.
12 The bracelets shall be uniform in design and shall at a minimum
13 on the face clearly indicate EMS-DNR and the name of the patient
14 and attending physician, as well as the dated signature of the
15 attending physician.
16 (i) Format of EMS-DNR card.--The Department of Health shall,
17 with the advice of the Pennsylvania Emergency Health Services
18 Council and with the assistance of the regional emergency
19 medical services councils, make available within 180 days of the
20 effective date of this subsection standard EMS-DNR cards for
21 issuance to declarants by attending physicians. The cards shall
22 be wallet-sized and contain, but not be limited to, the
23 following:
24 PENNSYLVANIA EMERGENCY MEDICAL SERVICES
25 DO-NOT-RESUSCITATE CARD
26 Patient's full legal name:
27 Attending physician's name:
28 This patient has a valid emergency medical services
29 do-not-resuscitate order. EMS personnel are instructed
30 not to perform cardiopulmonary resuscitation (cardiac
19990H0096B2943 - 11 -
1 compression, endotracheal intubation, artificial
2 ventilation, defibrillation and other related procedures)
3 on this patient in the event of the patient's respiratory
4 or cardiac arrest. Do provide to the patient other
5 medical interventions, such as intravenous fluids, oxygen
6 or other therapies deemed necessary to provide comfort
7 care or to alleviate pain, unless directed otherwise by
8 the declarant or the EMS provider's authorized medical
9 command physician.
10 Attending physician's signature:
11 Date:
12 (j) Recognition of other states' EMS or out-of-hospital DNR
13 orders.--EMS or out-of-hospital DNR orders, bracelets or cards
14 valid in states other than this Commonwealth shall be recognized
15 in this Commonwealth to the extent that these orders, bracelets
16 or cards are consistent with the laws of this Commonwealth. EMS
17 providers shall act in accordance with the provisions of section
18 5413(e) (relating to emergency medical services) when
19 encountering a patient with an apparently valid EMS or out-of-
20 hospital DNR form, bracelet or card issued by another state. EMS
21 providers acting in good faith under this section shall be
22 entitled to the same immunities and protections that would
23 otherwise be applicable.
24 § 5415. Penalties.
25 Any person who willfully conceals, cancels, defaces,
26 obliterates or damages the declaration or EMS-DNR order,
27 bracelet or card of another without the consent of the declarant
28 commits a felony of the third degree. Any person who falsifies
29 or forges the declaration or EMS-DNR order, bracelet or card of
30 another, or willfully conceals or withholds personal knowledge
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1 of a revocation as provided in section 5406 (relating to
2 revocation) or 5413(c) (relating to emergency medical services),
3 with the intent to cause a withholding or withdrawal of life-
4 sustaining treatment contrary to the wishes of the declarant
5 and, because of such an act, directly causes life-sustaining
6 treatment to be withheld or withdrawn and death to be hastened
7 shall be subject to prosecution for criminal homicide as
8 provided in 18 Pa.C.S. Ch. 25 (relating to criminal homicide).
9 Any person who willfully, by undue influence, fraud or duress,
10 causes a person to execute a declaration or EMS-DNR order
11 pursuant to this chapter commits a felony of the third degree.
12 Section 2. The Department of Health shall, with the advice
13 of the Pennsylvania Emergency Health Services Council and with
14 the assistance of the regional emergency medical services
15 councils, develop and make available to health care providers
16 recognized under the act of July 3, 1985 (P.L.164, No.45), known
17 as the Emergency Medical Services Act, including those
18 individuals recognized under 42 Pa.C.S. § 8331.2, within 180
19 days of the effective date of this act educational materials
20 relating to the implementation of the provisions of this act.
21 The department shall also cause the requirements of this act to
22 be included as part of the curricula for health care providers
23 recognized under the Emergency Medical Services Act.
24 Section 3. The Department of Health may contract with any
25 public or private entity to facilitate all or part of its
26 responsibilities under 20 Pa.C.S. Ch. 54.
27 Section 4. The Department of Health, upon the conclusion of
28 at least one public hearing, shall publish interim regulations
29 in the Pennsylvania Bulletin within 120 days of the effective
30 date of this act. The interim regulations shall not be subject
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1 to the act of July 31, 1968 (P.L.769, No.240), referred to as
2 the Commonwealth Documents Law, or to the act of June 25, 1982
3 (P.L.633, No.181), known as the Regulatory Review Act. The
4 interim regulations shall be effective until final regulations
5 are promulgated by the department. Final regulations shall be
6 promulgated no later than 18 months following the effective date
7 of this act.
8 Section 5. This act shall take effect in 60 days.
9 SECTION 1. THE DEFINITION OF "DECLARANT" IN SECTION 5403 OF <--
10 TITLE 20 OF THE PENNSYLVANIA CONSOLIDATED STATUTES IS AMENDED TO
11 READ:
12 § 5403. DEFINITIONS.
13 THE FOLLOWING WORDS AND PHRASES WHEN USED IN THIS CHAPTER
14 SHALL HAVE THE MEANINGS GIVEN TO THEM IN THIS SECTION UNLESS THE
15 CONTEXT CLEARLY INDICATES OTHERWISE:
16 * * *
17 "DECLARANT." A PERSON WHO MAKES A DECLARATION IN ACCORDANCE
18 WITH THIS CHAPTER. THE TERM INCLUDES AN EMANCIPATED MINOR.
19 * * *
20 SECTION 2. SECTION 5413 OF TITLE 20 IS AMENDED TO READ:
21 § 5413. EMERGENCY MEDICAL SERVICES.
22 [(A) CARE GIVEN PRIOR TO DECLARATION TAKING EFFECT.--NOTHING
23 IN THIS CHAPTER SHALL BE CONSTRUED TO MAKE THE PROVISIONS OF A
24 DECLARATION APPLY TO CARE GIVEN TO A PATIENT BY EMERGENCY
25 MEDICAL SERVICES PERSONNEL PRIOR TO THE DECLARATION'S BECOMING
26 OPERATIVE UNDER SECTIONS 5405 (RELATING TO WHEN DECLARATION
27 BECOMES OPERATIVE) AND 5408 (RELATING TO DUTY OF PHYSICIAN TO
28 CONFIRM TERMINAL CONDITION).
29 (B) CARE GIVEN AFTER DECLARATION TAKES EFFECT.--THE
30 PROVISIONS OF A DECLARATION SHALL APPLY TO CARE GIVEN TO A
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1 PATIENT BY EMERGENCY MEDICAL SERVICES PERSONNEL AFTER THE
2 DECLARATION BECOMES OPERATIVE UNDER SECTIONS 5405 AND 5408 ONLY
3 IF:
4 (1) AN ORIGINAL DECLARATION, SIGNED BY THE DECLARANT OR
5 OTHER AUTHORIZED PERSON, IS PRESENTED TO THE EMERGENCY
6 MEDICAL SERVICES PERSONNEL. THE EMERGENCY MEDICAL SERVICES
7 PERSONNEL MUST IMMEDIATELY NOTIFY THE MEDICAL COMMAND
8 PHYSICIAN OF THE PRESENCE OF THE DECLARATION; OR
9 (2) THE MEDICAL COMMAND PHYSICIAN, BASED ON PRIOR
10 NOTIFICATION BY THE ATTENDING PHYSICIAN OR OTHER HEALTH CARE
11 PROVIDER THAT A VALID AND OPERATIVE DECLARATION EXISTS,
12 DIRECTS THE EMERGENCY MEDICAL SERVICE PERSONNEL ACCORDING TO
13 THE PROVISIONS OF THE DECLARATION.
14 (C) UNCERTAINTY REGARDING VALIDITY OF DECLARATION.--
15 EMERGENCY MEDICAL SERVICES PERSONNEL CONFRONTED WITH ANY
16 CONFLICTING INFORMATION REGARDING THE PATIENT'S WISHES FOR LIFE-
17 SUSTAINING TREATMENT SHALL ACT ACCORDING TO THE ACCEPTED
18 TREATMENT PROTOCOLS AND STANDARDS APPROPRIATE TO THEIR LEVEL OF
19 CERTIFICATION.]
20 (A) GENERAL RULE.--AN EMERGENCY MEDICAL SERVICES PROVIDER
21 SHALL, IN THE COURSE OF PROVIDING CARE TO A DECLARANT, AT ALL
22 TIMES COMPLY WITH THE INSTRUCTIONS OF AN AUTHORIZED MEDICAL
23 COMMAND PHYSICIAN TO WITHHOLD OR DISCONTINUE CARDIOPULMONARY
24 RESUSCITATION.
25 (B) APPLICABILITY.--THIS SECTION IS APPLICABLE ONLY IN THOSE
26 INSTANCES WHERE AN OUT-OF-HOSPITAL DNR ORDER IS NOT IN EFFECT
27 UNDER SECTION 5404-A(A) (RELATING TO ORDERS, BRACELETS AND
28 NECKLACES).
29 SECTION 3. TITLE 20 IS AMENDED BY ADDING A CHAPTER TO READ:
30 CHAPTER 54-A
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1 OUT-OF-HOSPITAL NONRESUSCITATION
2 SEC.
3 5401-A. SHORT TITLE OF CHAPTER.
4 5402-A. LEGISLATIVE FINDINGS AND INTENT.
5 5403-A. DEFINITIONS.
6 5404-A. ORDERS, BRACELETS AND NECKLACES.
7 5405-A. REVOCATION.
8 5406-A. LIABILITY.
9 5407-A. EFFECT ON SUICIDE AND LIFE INSURANCE.
10 5408-A. ORDER OPTIONAL.
11 5409-A. PRESERVATION OF EXISTING RIGHTS.
12 5410-A. EMERGENCY MEDICAL SERVICES.
13 5411-A. PREGNANCY.
14 5412-A. PENALTIES.
15 5413-A. SEVERABILITY.
16 § 5401-A. SHORT TITLE OF CHAPTER.
17 THIS CHAPTER SHALL BE KNOWN AND MAY BE CITED AS THE DO-NOT-
18 RESUSCITATE ACT.
19 § 5402-A. LEGISLATIVE FINDINGS AND INTENT.
20 THE GENERAL ASSEMBLY FINDS AND DECLARES AS FOLLOWS:
21 (1) ALTHOUGH CARDIOPULMONARY RESUSCITATION HAS SAVED THE
22 LIVES OF INDIVIDUALS ABOUT TO EXPERIENCE SUDDEN, UNEXPECTED
23 DEATH, PRESENT MEDICAL DATA INDICATES THAT CARDIOPULMONARY
24 RESUSCITATION RARELY LEADS TO PROLONGED SURVIVAL IN
25 INDIVIDUALS WITH TERMINAL ILLNESSES IN WHOM DEATH IS
26 EXPECTED.
27 (2) IN MANY CIRCUMSTANCES, THE PERFORMANCE OF
28 CARDIOPULMONARY RESUSCITATION MAY CAUSE INFLICTION OF
29 UNWANTED AND UNNECESSARY PAIN AND SUFFERING.
30 (3) EXISTING EMERGENCY MEDICAL SERVICES PROTOCOLS MAY
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1 REQUIRE EMERGENCY MEDICAL SERVICES PERSONNEL TO PROCEED TO
2 CARDIOPULMONARY RESUSCITATION WHEN AN INDIVIDUAL IS FOUND IN
3 A CARDIAC OR RESPIRATORY ARREST EVEN IF THE INDIVIDUAL HAS
4 COMPLETED A LIVING WILL OR ADVANCE DIRECTIVE INDICATING THAT
5 THE INDIVIDUAL DOES NOT WISH TO RECEIVE CARDIOPULMONARY
6 RESUSCITATION.
7 (4) THE ADMINISTRATION OF CARDIOPULMONARY RESUSCITATION
8 BY EMERGENCY MEDICAL SERVICES PERSONNEL TO AN INDIVIDUAL WITH
9 AN OUT-OF-HOSPITAL DO-NOT-RESUSCITATE ORDER OFFENDS THE
10 DIGNITY OF THE INDIVIDUAL AND CONFLICTS WITH STANDARDS OF
11 ACCEPTED MEDICAL PRACTICE.
12 (5) THIS CHAPTER PROVIDES CLEAR DIRECTION TO EMERGENCY
13 MEDICAL SERVICES PERSONNEL AND OTHER HEALTH CARE PROVIDERS IN
14 REGARD TO THE PERFORMANCE OF CARDIOPULMONARY RESUSCITATION.
15 (6) NOTHING IN THIS CHAPTER IS INTENDED TO CONDONE,
16 AUTHORIZE OR APPROVE MERCY KILLING, EUTHANASIA OR AIDED
17 SUICIDE OR TO PERMIT ANY AFFIRMATIVE OR DELIBERATE ACT OR
18 OMISSION TO END LIFE OTHER THAN AS DEFINED IN THIS CHAPTER.
19 § 5403-A. DEFINITIONS.
20 THE FOLLOWING WORDS AND PHRASES WHEN USED IN THIS CHAPTER
21 SHALL HAVE THE MEANINGS GIVEN TO THEM IN THIS SECTION UNLESS THE
22 CONTEXT CLEARLY INDICATES OTHERWISE:
23 "ATTENDING PHYSICIAN." THE PHYSICIAN WHO HAS PRIMARY
24 RESPONSIBILITY FOR THE TREATMENT AND CARE OF THE PATIENT.
25 "BRACELET." AN OUT-OF-HOSPITAL DO-NOT-RESUSCITATE BRACELET.
26 "CARDIOPULMONARY RESUSCITATION." CARDIAC COMPRESSION,
27 INVASIVE AIRWAY TECHNIQUES, ARTIFICIAL VENTILATION,
28 DEFIBRILLATION AND OTHER RELATED PROCEDURES.
29 "DECLARANT." AS DEFINED IN SECTION 5403 (RELATING TO
30 DEFINITIONS).
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1 "DECLARATION." AS DEFINED IN SECTION 5403 (RELATING TO
2 DEFINITIONS).
3 "DEPARTMENT." THE DEPARTMENT OF HEALTH OF THE COMMONWEALTH.
4 "DNR." DO NOT RESUSCITATE.
5 "EMERGENCY MEDICAL SERVICES PROVIDER." A HEALTH CARE
6 PROVIDER RECOGNIZED UNDER THE ACT OF JULY 3, 1985 (P.L.164,
7 NO.45), KNOWN AS THE EMERGENCY MEDICAL SERVICES ACT. THE TERM
8 INCLUDES THOSE INDIVIDUALS RECOGNIZED UNDER 42 PA.C.S. § 8331.2
9 (RELATING TO GOOD SAMARITAN CIVIL IMMUNITY FOR USE OF AUTOMATED
10 EXTERNAL DEFIBRILLATOR).
11 "EMS." EMERGENCY MEDICAL SERVICES.
12 "HEALTH CARE PROVIDER." A PERSON WHO IS LICENSED OR
13 CERTIFIED BY THE LAWS OF THIS COMMONWEALTH TO ADMINISTER HEALTH
14 CARE IN THE ORDINARY COURSE OF BUSINESS OR PRACTICE OF A
15 PROFESSION. THE TERM INCLUDES PERSONNEL RECOGNIZED UNDER THE ACT
16 OF JULY 3, 1985 (P.L.164, NO.45), KNOWN AS THE EMERGENCY MEDICAL
17 SERVICES ACT. THE TERM INCLUDES THOSE INDIVIDUALS RECOGNIZED
18 UNDER 42 PA.C.S. § 8331.2 (RELATING TO GOOD SAMARITAN CIVIL
19 IMMUNITY FOR USE OF AUTOMATED EXTERNAL DEFIBRILLATOR).
20 "INCOMPETENT." THE LACK OF SUFFICIENT CAPACITY FOR A PERSON
21 TO MAKE OR COMMUNICATE DECISIONS CONCERNING HIMSELF.
22 "INVASIVE AIRWAY TECHNIQUE." ANY ADVANCED AIRWAY TECHNIQUE,
23 INCLUDING ENDOTRACHEAL INTUBATION.
24 "LIFE-SUSTAINING TREATMENT." ANY MEDICAL PROCEDURE OR
25 INTERVENTION THAT, WHEN ADMINISTERED TO A PATIENT, WILL SERVE
26 ONLY TO PROLONG THE PROCESS OF DYING OR TO MAINTAIN THE PATIENT
27 IN A STATE OF PERMANENT UNCONSCIOUSNESS. LIFE-SUSTAINING
28 TREATMENT SHALL INCLUDE NUTRITION AND HYDRATION ADMINISTERED BY
29 GASTRIC TUBE OR INTRAVENOUSLY OR ANY OTHER ARTIFICIAL OR
30 INVASIVE MEANS IF THE ORDER OF THE PATIENT SO SPECIFICALLY
19990H0096B2943 - 18 -
1 PROVIDES.
2 "MEDICAL COMMAND PHYSICIAN." A LICENSED PHYSICIAN WHO IS
3 AUTHORIZED TO GIVE MEDICAL COMMAND UNDER THE ACT OF JULY 3, 1985
4 (P.L.164, NO.45), KNOWN AS THE EMERGENCY MEDICAL SERVICES ACT.
5 "NECKLACE." AN OUT-OF-HOSPITAL DO-NOT-RESUSCITATE NECKLACE.
6 "ORDER." AN OUT-OF-HOSPITAL DO-NOT-RESUSCITATE ORDER.
7 "OUT-OF-HOSPITAL DO-NOT-RESUSCITATE BRACELET." A BRACELET IN
8 THE STANDARD FORMAT SET FORTH IN SECTION 5404-A (RELATING TO
9 ORDERS, BRACELETS AND NECKLACES), SUPPLIED BY THE DEPARTMENT AND
10 ISSUED BY THE ATTENDING PHYSICIAN, WHICH MAY BE WORN, AT THE
11 PATIENT'S OPTION, TO NOTIFY EMERGENCY MEDICAL SERVICES PROVIDERS
12 OF THE PRESENCE OF AN ORDER.
13 "OUT-OF-HOSPITAL DO-NOT-RESUSCITATE NECKLACE." A NECKLACE IN
14 THE STANDARD FORMAT SET FORTH IN SECTION 5404-A (RELATING TO
15 ORDERS, BRACELETS AND NECKLACES), SUPPLIED BY THE DEPARTMENT AND
16 ISSUED BY THE ATTENDING PHYSICIAN, WHICH MAY BE WORN, AT THE
17 PATIENT'S OPTION, TO NOTIFY EMERGENCY MEDICAL SERVICES PROVIDERS
18 OF THE PRESENCE OF AN ORDER.
19 "OUT-OF-HOSPITAL DO-NOT-RESUSCITATE ORDER." AN ORDER IN THE
20 STANDARD FORMAT SET FORTH IN SECTION 5404-A (RELATING TO ORDERS,
21 BRACELETS AND NECKLACES), SUPPLIED BY THE DEPARTMENT AND ISSUED
22 BY THE ATTENDING PHYSICIAN, DIRECTING EMERGENCY MEDICAL SERVICES
23 PROVIDERS TO WITHHOLD CARDIOPULMONARY RESUSCITATION FROM THE
24 PATIENT IN THE EVENT OF RESPIRATORY OR CARDIAC ARREST.
25 "OUT-OF-HOSPITAL DO-NOT-RESUSCITATE PATIENT." ANY OF THE
26 FOLLOWING:
27 (1) AN INDIVIDUAL:
28 (I) WHO IS IN A TERMINAL CONDITION; AND
29 (II) WHO, PURSUANT TO SECTION 5404-A(A) (RELATING TO
30 ORDERS, BRACELETS AND NECKLACES), POSSESSES AND IN ANY
19990H0096B2943 - 19 -
1 MANNER DISPLAYS OR CAUSES TO BE DISPLAYED FOR EMERGENCY
2 MEDICAL SERVICES PROVIDERS AN APPARENTLY VALID ORDER,
3 BRACELET OR NECKLACE.
4 (2) A DECLARANT:
5 (I) WHOSE DECLARATION HAS BECOME OPERATIVE UNDER
6 SECTION 5405(2) (RELATING TO WHEN DECLARATION BECOMES
7 OPERATIVE); AND
8 (II) WHO, PURSUANT TO SECTION 5404-A(A), POSSESSES
9 AND IN ANY MANNER DISPLAYS OR CAUSES TO BE DISPLAYED FOR
10 EMERGENCY MEDICAL SERVICES PROVIDERS AN APPARENTLY VALID
11 ORDER, BRACELET OR NECKLACE.
12 "PATIENT." AN OUT-OF-HOSPITAL DO-NOT-RESUSCITATE PATIENT.
13 "PERMANENTLY UNCONSCIOUS." A MEDICAL CONDITION THAT HAS BEEN
14 DIAGNOSED IN ACCORDANCE WITH CURRENTLY ACCEPTED MEDICAL
15 STANDARDS AND WITH REASONABLE MEDICAL CERTAINTY AS TOTAL AND
16 IRREVERSIBLE LOSS OF CONSCIOUSNESS AND CAPACITY FOR INTERACTION
17 WITH THE ENVIRONMENT. THE TERM INCLUDES, WITHOUT LIMITATION, A
18 PERSISTENT VEGETATIVE STATE OR IRREVERSIBLE COMA.
19 "PERSON." AN INDIVIDUAL, CORPORATION, PARTNERSHIP,
20 ASSOCIATION OR FEDERAL, STATE OR LOCAL GOVERNMENT OR
21 GOVERNMENTAL AGENCY.
22 "TERMINAL CONDITION." AN INCURABLE AND IRREVERSIBLE MEDICAL
23 CONDITION IN AN ADVANCED STATE CAUSED BY INJURY, DISEASE OR
24 PHYSICAL ILLNESS WHICH WILL, IN THE OPINION OF THE ATTENDING
25 PHYSICIAN, TO A REASONABLE DEGREE OF MEDICAL CERTAINTY, RESULT
26 IN DEATH REGARDLESS OF THE CONTINUED APPLICATION OF LIFE-
27 SUSTAINING TREATMENT.
28 § 5404-A. ORDERS, BRACELETS AND NECKLACES.
29 (A) ISSUANCE.--AN ATTENDING PHYSICIAN, UPON THE REQUEST OF
30 AN INDIVIDUAL WHO IS AT LEAST 18 YEARS OF AGE, HAS GRADUATED
19990H0096B2943 - 20 -
1 FROM HIGH SCHOOL OR HAS MARRIED, OR THE INDIVIDUAL'S SURROGATE
2 IF THE SURROGATE IS SO AUTHORIZED, SHALL ISSUE TO THE INDIVIDUAL
3 AN ORDER, AND MAY ISSUE AT THE REQUEST OF THE PATIENT OR THE
4 PATIENT'S SURROGATE A BRACELET OR NECKLACE SUPPLIED BY THE
5 DEPARTMENT. THE PATIENT MAY, AT THE PATIENT'S OPTION, WEAR THE
6 BRACELET OR DISPLAY THE ORDER OR NECKLACE TO NOTIFY EMERGENCY
7 MEDICAL SERVICES PROVIDERS OF THE PATIENT'S DO-NOT-RESUSCITATE
8 STATUS.
9 (B) FORMAT OF ORDER.--THE DEPARTMENT SHALL, WITH THE ADVICE
10 OF THE PENNSYLVANIA EMERGENCY HEALTH SERVICES COUNCIL AND WITH
11 THE ASSISTANCE OF THE REGIONAL EMERGENCY MEDICAL SERVICES
12 COUNCILS, MAKE AVAILABLE WITHIN 180 DAYS OF THE EFFECTIVE DATE
13 OF THIS SUBSECTION STANDARD ORDERS FOR ISSUANCE TO PATIENTS BY
14 ATTENDING PHYSICIANS OF THIS COMMONWEALTH. THE FORM OF THE ORDER
15 SHALL CONTAIN, BUT NOT BE LIMITED TO, THE FOLLOWING:
16 PENNSYLVANIA OUT-OF-HOSPITAL
17 DO-NOT-RESUSCITATE ORDER
18 PATIENT'S FULL LEGAL NAME:
19 I, THE UNDERSIGNED, STATE THAT I AM THE ATTENDING
20 PHYSICIAN OF THE PATIENT NAMED ABOVE. THE ABOVE-NAMED
21 PATIENT HAS REQUESTED THIS ORDER AND I HAVE MADE THE
22 DETERMINATION THAT THIS PATIENT IS IN A TERMINAL
23 CONDITION AND ELIGIBLE FOR AN ORDER.
24 I DIRECT ANY AND ALL EMERGENCY MEDICAL SERVICES
25 PERSONNEL, COMMENCING ON THE EFFECTIVE DATE OF THIS
26 ORDER, TO WITHHOLD CARDIOPULMONARY RESUSCITATION (CARDIAC
27 COMPRESSION, INVASIVE AIRWAY TECHNIQUES, ARTIFICIAL
28 VENTILATION, DEFIBRILLATION AND OTHER RELATED PROCEDURES)
29 FROM THE PATIENT IN THE EVENT OF THE PATIENT'S
30 RESPIRATORY OR CARDIAC ARREST. I FURTHER DIRECT SUCH
19990H0096B2943 - 21 -
1 PERSONNEL TO PROVIDE TO THE PATIENT OTHER MEDICAL
2 INTERVENTIONS, SUCH AS INTRAVENOUS FLUIDS, OXYGEN OR
3 OTHER THERAPIES NECESSARY TO PROVIDE COMFORT CARE OR TO
4 ALLEVIATE PAIN, UNLESS DIRECTED OTHERWISE BY THE PATIENT
5 OR THE EMERGENCY MEDICAL SERVICES PROVIDER'S AUTHORIZED
6 MEDICAL COMMAND PHYSICIAN.
7 SIGNATURE OF ATTENDING PHYSICIAN:
8 PRINTED NAME OF ATTENDING PHYSICIAN:
9 DATED:
10 ATTENDING PHYSICIAN'S EMERGENCY TELEPHONE NUMBER:
11 SIGNATURE OF PATIENT (IF CAPABLE OF MAKING INFORMED
12 DECISIONS):
13 I, THE UNDERSIGNED, HEREBY DIRECT THAT IN THE EVENT
14 OF MY CARDIAC AND/OR RESPIRATORY ARREST, EFFORTS AT
15 CARDIOPULMONARY RESUSCITATION NOT BE INITIATED. I
16 UNDERSTAND THAT I MAY REVOKE THESE DIRECTIONS AT ANY TIME
17 BY GIVING VERBAL INSTRUCTIONS TO THE EMERGENCY MEDICAL
18 SERVICES PROVIDERS, BY PHYSICAL CANCELLATION OR
19 DESTRUCTION OF THIS FORM OR MY BRACELET OR NECKLACE, OR
20 BY SIMPLY NOT DISPLAYING THIS FORM OR THE BRACELET OR
21 NECKLACE FOR MY EMS CAREGIVERS.
22 SIGNATURE OF SURROGATE (IF PATIENT IS INCAPABLE OF
23 MAKING INFORMED DECISIONS):
24 I, THE UNDERSIGNED, HEREBY CERTIFY THAT I AM
25 AUTHORIZED TO EXECUTE THIS ORDER ON THE PATIENT'S BEHALF
26 BY VIRTUE OF HAVING BEEN DESIGNATED AS THE PATIENT'S
27 SURROGATE AND/OR BY VIRTUE OF MY RELATIONSHIP TO THE
28 PATIENT (SPECIFY RELATIONSHIP: _________________). I
29 HEREBY DIRECT THAT IN THE EVENT OF THE PATIENT'S CARDIAC
30 AND/OR RESPIRATORY ARREST, EFFORTS AT CARDIOPULMONARY
19990H0096B2943 - 22 -
1 RESUSCITATION NOT BE INITIATED.
2 (C) FORMAT OF BRACELET.--THE DEPARTMENT SHALL, WITH THE
3 ADVICE OF THE PENNSYLVANIA EMERGENCY HEALTH SERVICES COUNCIL AND
4 WITH THE ASSISTANCE OF THE REGIONAL EMERGENCY MEDICAL SERVICES
5 COUNCILS, MAKE AVAILABLE WITHIN 180 DAYS OF THE EFFECTIVE DATE
6 OF THIS SUBSECTION STANDARD BRACELETS FOR ISSUANCE TO PATIENTS
7 BY ATTENDING PHYSICIANS. THE BRACELETS SHALL BE UNIFORM IN
8 DESIGN AND SHALL, AT A MINIMUM, ON THE FACE CLEARLY INDICATE
9 OUT-OF-HOSPITAL DNR AND THE NAME OF THE PATIENT AND ATTENDING
10 PHYSICIAN, AS WELL AS THE DATED SIGNATURE OF THE ATTENDING
11 PHYSICIAN.
12 (D) FORMAT OF NECKLACE.--THE DEPARTMENT SHALL, WITH THE
13 ADVICE OF THE PENNSYLVANIA EMERGENCY HEALTH SERVICES COUNCIL AND
14 WITH THE ASSISTANCE OF THE REGIONAL EMERGENCY MEDICAL SERVICES
15 COUNCILS, MAKE AVAILABLE WITHIN 180 DAYS OF THE EFFECTIVE DATE
16 OF THIS SUBSECTION STANDARD NECKLACES FOR ISSUANCE TO PATIENTS
17 BY ATTENDING PHYSICIANS. THE NECKLACES SHALL BE UNIFORM IN
18 DESIGN AND SHALL, AT A MINIMUM, ON THE FACE CLEARLY INDICATE
19 OUT-OF-HOSPITAL DNR AND THE NAME OF THE PATIENT AND ATTENDING
20 PHYSICIAN, AS WELL AS THE DATED SIGNATURE OF THE ATTENDING
21 PHYSICIAN.
22 § 5405-A. REVOCATION.
23 (A) PATIENT.--IF A PATIENT HAS OBTAINED AN ORDER, ONLY THE
24 PATIENT MAY REVOKE THE PATIENT'S DNR STATUS.
25 (B) SURROGATE.--IF A SURROGATE HAS OBTAINED AN ORDER, THE
26 PATIENT OR THE SURROGATE MAY REVOKE THE PATIENT'S STATUS.
27 (C) MANNER.--REVOCATION UNDER THIS SECTION MAY BE DONE AT
28 ANY TIME WITHOUT REGARD TO THE PATIENT'S PHYSICAL OR MENTAL
29 CONDITION AND IN ANY MANNER, INCLUDING VERBALLY OR BY DESTROYING
30 OR NOT DISPLAYING THE ORDER, BRACELET OR NECKLACE.
19990H0096B2943 - 23 -
1 § 5406-A. LIABILITY.
2 (A) GENERAL RULE.--NO PHYSICIAN, EMERGENCY MEDICAL SERVICES
3 PROVIDER OR OTHER HEALTH CARE PROVIDER WHO, CONSISTENT WITH THIS
4 CHAPTER, CAUSES OR PARTICIPATES IN THE INITIATING, CONTINUING,
5 WITHHOLDING OR WITHDRAWAL OF LIFE-SUSTAINING TREATMENT OR
6 CARDIOPULMONARY RESUSCITATION FROM A PATIENT SHALL, AS A RESULT
7 OF SUCH ACTION, BE SUBJECT TO CRIMINAL OR CIVIL LIABILITY OR BE
8 FOUND TO HAVE COMMITTED AN ACT OF UNPROFESSIONAL CONDUCT IF THE
9 ATTENDING PHYSICIAN, HEALTH CARE PROVIDER OR EMERGENCY MEDICAL
10 SERVICES PROVIDER HAS FOLLOWED THE PATIENT'S WISHES AS EXPRESSED
11 EARLIER BY THE PATIENT IN THE FORM OF A DECLARATION OR ORDER
12 EXECUTED PURSUANT TO THIS CHAPTER.
13 (B) ABSENCE OF ORDER, BRACELET OR NECKLACE.--THE ABSENCE OF
14 AN ORDER, BRACELET OR NECKLACE BY A PATIENT SHALL NOT GIVE RISE
15 TO ANY PRESUMPTION AS TO THE INTENT OF THE PATIENT TO CONSENT TO
16 OR TO REFUSE THE INITIATION, CONTINUATION OR TERMINATION OF
17 LIFE-SUSTAINING TREATMENT.
18 § 5407-A. EFFECT ON SUICIDE AND LIFE INSURANCE.
19 (A) CRIMINAL EFFECT.--THE WITHHOLDING OR WITHDRAWAL OF LIFE-
20 SUSTAINING TREATMENT FROM A PATIENT IN ACCORDANCE WITH THE
21 PROVISIONS OF THIS CHAPTER SHALL NOT, FOR ANY PURPOSE,
22 CONSTITUTE SUICIDE OR HOMICIDE.
23 (B) LIFE INSURANCE.--THE MAKING OF OR FAILURE TO MAKE AN
24 ORDER IN ACCORDANCE WITH THIS CHAPTER SHALL NOT AFFECT IN ANY
25 MANNER THE SALE, PROCUREMENT OR ISSUANCE OF ANY POLICY OF LIFE
26 INSURANCE NOR SHALL IT BE DEEMED TO MODIFY THE TERMS OF AN
27 EXISTING POLICY OF LIFE INSURANCE. NO POLICY OF LIFE INSURANCE
28 SHALL BE LEGALLY IMPAIRED OR INVALIDATED IN ANY MANNER BY THE
29 WITHHOLDING OR WITHDRAWAL OF LIFE-SUSTAINING TREATMENT FROM AN
30 INSURED PATIENT, NOTWITHSTANDING ANY TERM OF THE POLICY TO THE
19990H0096B2943 - 24 -
1 CONTRARY.
2 § 5408-A. ORDER OPTIONAL.
3 NO PHYSICIAN OR OTHER HEALTH CARE PROVIDER AND NO HEALTH CARE
4 SERVICE PLAN, HEALTH MAINTENANCE ORGANIZATION, INSURER ISSUING
5 DISABILITY INSURANCE, SELF-INSURED EMPLOYEE WELFARE BENEFIT
6 PLAN, NONPROFIT HOSPITAL PLAN OR FEDERAL, STATE OR LOCAL
7 GOVERNMENT SPONSORED OR OPERATED PROGRAM MAY:
8 (1) REQUIRE ANY PERSON TO EXECUTE AN ORDER AS A
9 CONDITION FOR BEING INSURED FOR OR RECEIVING HEALTH CARE
10 SERVICES; OR
11 (2) CHARGE ANY PERSON A DIFFERENT RATE OR FEE WHETHER OR
12 NOT THE PERSON EXECUTES OR HAS EXECUTED AN ORDER.
13 § 5409-A. PRESERVATION OF EXISTING RIGHTS.
14 THE PROVISIONS OF THIS CHAPTER SHALL NOT IMPAIR OR SUPERSEDE
15 ANY EXISTING RIGHTS OR RESPONSIBILITIES NOT ADDRESSED IN THIS
16 CHAPTER.
17 § 5410-A. EMERGENCY MEDICAL SERVICES.
18 (A) MEDICAL COMMAND INSTRUCTIONS.--NOTWITHSTANDING THE
19 ABSENCE OF AN ORDER, BRACELET OR NECKLACE PURSUANT TO THIS
20 SECTION, EMERGENCY MEDICAL SERVICES PROVIDERS SHALL AT ALL TIMES
21 COMPLY WITH THE INSTRUCTIONS OF AN AUTHORIZED MEDICAL COMMAND
22 PHYSICIAN TO WITHHOLD OR DISCONTINUE RESUSCITATION.
23 (B) EFFECT OF ORDER, BRACELET OR NECKLACE.--
24 (1) EMERGENCY MEDICAL SERVICES PROVIDERS ARE AUTHORIZED
25 TO, AND SHALL, COMPLY WITH AN ORDER IF MADE AWARE OF THE
26 ORDER BY EXAMINING A BRACELET, A NECKLACE OR THE ORDER
27 ITSELF.
28 (2) EMERGENCY MEDICAL SERVICES PROVIDERS SHALL PROVIDE
29 OTHER MEDICAL INTERVENTIONS NECESSARY AND APPROPRIATE TO
30 PROVIDE COMFORT AND ALLEVIATE PAIN, INCLUDING INTRAVENOUS
19990H0096B2943 - 25 -
1 FLUIDS, MEDICATIONS, OXYGEN AND ANY OTHER INTERVENTION
2 APPROPRIATE TO THE LEVEL OF THE CERTIFICATION OF THE
3 PROVIDER, UNLESS OTHERWISE DIRECTED BY THE PATIENT OR THE
4 EMERGENCY MEDICAL SERVICES PROVIDER'S AUTHORIZED MEDICAL
5 COMMAND PHYSICIAN.
6 (3) AS USED IN THIS SUBSECTION, THE TERM "COMPLY" MEANS:
7 (I) TO WITHHOLD CARDIOPULMONARY RESUSCITATION FROM
8 THE PATIENT IN THE EVENT OF RESPIRATORY OR CARDIAC
9 ARREST; OR
10 (II) TO DISCONTINUE AND CEASE CARDIOPULMONARY
11 RESUSCITATION IN THE EVENT THE EMERGENCY MEDICAL SERVICES
12 PROVIDER IS PRESENTED WITH AN ORDER OR DISCOVERS A
13 NECKLACE OR BRACELET AFTER INITIATING CARDIOPULMONARY
14 RESUSCITATION.
15 (C) UNCERTAINTY REGARDING VALIDITY OR APPLICABILITY OF
16 ORDER, BRACELET OR NECKLACE.--
17 (1) EMERGENCY MEDICAL SERVICES PROVIDERS WHO IN GOOD
18 FAITH ARE UNCERTAIN ABOUT THE VALIDITY OR APPLICABILITY OF AN
19 ORDER, BRACELET OR NECKLACE SHALL RENDER CARE IN ACCORDANCE
20 WITH THEIR LEVEL OF CERTIFICATION.
21 (2) EMERGENCY MEDICAL SERVICES PROVIDERS WHO ACT UNDER
22 PARAGRAPH (1) SHALL NOT BE SUBJECT TO CIVIL OR CRIMINAL
23 LIABILITY OR ADMINISTRATIVE SANCTION FOR FAILURE TO COMPLY
24 WITH AN ORDER UNDER THIS SECTION.
25 (D) RECOGNITION OF OTHER STATES' ORDERS.--EMERGENCY MEDICAL
26 SERVICES OR OUT-OF-HOSPITAL DNR ORDERS, BRACELETS OR NECKLACES
27 VALID IN STATES OTHER THAN THIS COMMONWEALTH SHALL BE RECOGNIZED
28 IN THIS COMMONWEALTH TO THE EXTENT THAT THESE ORDERS, BRACELETS
29 OR NECKLACES ARE CONSISTENT WITH THE LAWS OF THIS COMMONWEALTH.
30 EMERGENCY MEDICAL SERVICES PROVIDERS SHALL ACT IN ACCORDANCE
19990H0096B2943 - 26 -
1 WITH THE PROVISIONS OF THIS SECTION WHEN ENCOUNTERING A PATIENT
2 WITH AN APPARENTLY VALID EMS OR OUT-OF-HOSPITAL DNR FORM,
3 BRACELET OR NECKLACE ISSUED BY ANOTHER STATE. EMERGENCY MEDICAL
4 SERVICES PROVIDERS ACTING IN GOOD FAITH UNDER THIS SECTION SHALL
5 BE ENTITLED TO THE SAME IMMUNITIES AND PROTECTIONS THAT WOULD
6 OTHERWISE BE APPLICABLE.
7 § 5411-A. PREGNANCY.
8 (A) GENERAL RULE.--NOTWITHSTANDING THE EXISTENCE OF AN ORDER
9 OR DIRECTION TO THE CONTRARY, LIFE-SUSTAINING TREATMENT,
10 CARDIOPULMONARY RESUSCITATION, NUTRITION AND HYDRATION MUST BE
11 PROVIDED TO A PREGNANT PATIENT UNLESS, TO A REASONABLE DEGREE OF
12 MEDICAL CERTAINTY AS CERTIFIED ON THE PATIENT'S MEDICAL RECORD
13 BY THE ATTENDING PHYSICIAN AND AN OBSTETRICIAN WHO HAS EXAMINED
14 THE PATIENT, LIFE-SUSTAINING TREATMENT, NUTRITION AND HYDRATION:
15 (1) WILL NOT MAINTAIN THE PREGNANT PATIENT IN SUCH A WAY
16 AS TO PERMIT THE CONTINUING DEVELOPMENT AND LIVE BIRTH OF THE
17 UNBORN CHILD;
18 (2) WILL BE PHYSICALLY HARMFUL TO THE PREGNANT PATIENT;
19 OR
20 (3) WOULD CAUSE PAIN TO THE PREGNANT PATIENT WHICH
21 CANNOT BE ALLEVIATED BY MEDICATION.
22 (B) PREGNANCY TEST.--NOTHING IN THIS SECTION SHALL REQUIRE A
23 PHYSICIAN TO PERFORM A PREGNANCY TEST UNLESS THE PHYSICIAN HAS
24 REASON TO BELIEVE THAT THE PATIENT MAY BE PREGNANT.
25 (C) PAYMENT OF EXPENSES BY COMMONWEALTH.--
26 (1) IN THE EVENT THAT TREATMENT, CARDIOPULMONARY
27 RESUSCITATION, NUTRITION OR HYDRATION ARE PROVIDED TO A
28 PREGNANT PATIENT, NOTWITHSTANDING THE EXISTENCE OF AN ORDER
29 OR DIRECTION TO THE CONTRARY, THE COMMONWEALTH SHALL PAY ALL
30 USUAL, CUSTOMARY AND REASONABLE EXPENSES DIRECTLY AND
19990H0096B2943 - 27 -
1 INDIRECTLY INCURRED BY THE PREGNANT PATIENT TO WHOM SUCH
2 TREATMENT, NUTRITION AND HYDRATION ARE PROVIDED.
3 (2) THE COMMONWEALTH SHALL HAVE THE RIGHT OF SUBROGATION
4 AGAINST ALL MONEYS PAID BY ANY THIRD-PARTY HEALTH INSURER ON
5 BEHALF OF THE PREGNANT PATIENT.
6 (3) THE EXPENDITURES INCURRED ON BEHALF OF THE PREGNANT
7 PATIENT SHALL CONSTITUTE A GRANT AND NO LIEN SHALL BE PLACED
8 UPON THE PROPERTY OF THE PREGNANT PATIENT, HER ESTATE OR HER
9 HEIRS.
10 § 5412-A. PENALTIES.
11 ANY PERSON WHO INTENTIONALLY CONCEALS, CANCELS, DEFACES,
12 OBLITERATES OR DAMAGES THE ORDER, BRACELET OR NECKLACE OF
13 ANOTHER WITHOUT THE CONSENT OF THE PATIENT COMMITS A FELONY OF
14 THE THIRD DEGREE. ANY PERSON WHO FALSIFIES OR FORGES THE ORDER,
15 BRACELET OR NECKLACE OF ANOTHER, OR CONCEALS OR WITHHOLDS
16 PERSONAL KNOWLEDGE OF A REVOCATION AS PROVIDED IN SECTION 5405-A
17 (RELATING TO REVOCATION), WITH THE INTENT TO CAUSE A WITHHOLDING
18 OR WITHDRAWAL OF LIFE-SUSTAINING TREATMENT CONTRARY TO THE
19 WISHES OF THE PATIENT AND, BECAUSE OF SUCH AN ACT, DIRECTLY
20 CAUSES LIFE-SUSTAINING TREATMENT TO BE WITHHELD OR WITHDRAWN AND
21 DEATH TO BE HASTENED SHALL BE SUBJECT TO PROSECUTION FOR
22 CRIMINAL HOMICIDE AS PROVIDED IN 18 PA.C.S. CH. 25 (RELATING TO
23 CRIMINAL HOMICIDE). ANY PERSON WHO INTENTIONALLY, BY UNDUE
24 INFLUENCE, FRAUD OR DURESS, CAUSES A PERSON TO EXECUTE AN ORDER
25 PURSUANT TO THIS CHAPTER COMMITS A FELONY OF THE THIRD DEGREE.
26 § 5413-A. SEVERABILITY.
27 THE PROVISIONS OF THIS CHAPTER ARE SEVERABLE, AND, IF ANY
28 WORD, PHRASE, CLAUSE, SENTENCE, SECTION OR PROVISION OF THIS
29 CHAPTER IS FOR ANY REASON HELD TO BE UNCONSTITUTIONAL, THE
30 DECISION OF THE COURT SHALL NOT AFFECT OR IMPAIR ANY OF THE
19990H0096B2943 - 28 -
1 REMAINING PROVISIONS OF THIS CHAPTER. IT IS HEREBY DECLARED AS
2 THE LEGISLATIVE INTENT THAT THIS CHAPTER WOULD HAVE BEEN ADOPTED
3 HAD SUCH UNCONSTITUTIONAL WORD, PHRASE, CLAUSE, SENTENCE,
4 SECTION OR PROVISION THEREOF NOT BEEN INCLUDED HEREIN.
5 SECTION 4. THE DEPARTMENT OF HEALTH SHALL, WITH THE ADVICE
6 OF THE PENNSYLVANIA EMERGENCY HEALTH SERVICES COUNCIL AND WITH
7 THE ASSISTANCE OF THE REGIONAL EMERGENCY MEDICAL SERVICES
8 COUNCILS, DEVELOP AND MAKE AVAILABLE TO HEALTH CARE PROVIDERS
9 RECOGNIZED UNDER THE ACT OF JULY 3, 1985 (P.L.164, NO.45), KNOWN
10 AS THE EMERGENCY MEDICAL SERVICES ACT, INCLUDING THOSE
11 INDIVIDUALS RECOGNIZED UNDER 42 PA.C.S. § 8331.2, WITHIN 180
12 DAYS OF THE EFFECTIVE DATE OF THIS ACT, EDUCATIONAL MATERIALS
13 RELATING TO THE IMPLEMENTATION OF THE PROVISIONS OF THIS ACT.
14 THE DEPARTMENT SHALL ALSO CAUSE THE REQUIREMENTS OF THIS ACT TO
15 BE INCLUDED AS PART OF THE CURRICULA FOR HEALTH CARE PROVIDERS
16 RECOGNIZED UNDER THE EMERGENCY MEDICAL SERVICES ACT.
17 SECTION 5. THE DEPARTMENT OF HEALTH MAY CONTRACT WITH ANY
18 PUBLIC OR PRIVATE ENTITY TO FACILITATE ALL OR PART OF ITS
19 RESPONSIBILITIES UNDER 20 PA.C.S. CH. 54 OR 54-A.
20 SECTION 6. THE DEPARTMENT OF HEALTH, UPON THE CONCLUSION OF
21 AT LEAST ONE PUBLIC HEARING, SHALL PUBLISH INTERIM REGULATIONS
22 IN THE PENNSYLVANIA BULLETIN WITHIN 120 DAYS OF THE EFFECTIVE
23 DATE OF THIS ACT. THE INTERIM REGULATIONS SHALL NOT BE SUBJECT
24 TO THE ACT OF JULY 31, 1968 (P.L.769, NO.240), REFERRED TO AS
25 THE COMMONWEALTH DOCUMENTS LAW, OR TO THE ACT OF JUNE 25, 1982
26 (P.L.633, NO.181), KNOWN AS THE REGULATORY REVIEW ACT. THE
27 INTERIM REGULATIONS SHALL BE EFFECTIVE UNTIL FINAL REGULATIONS
28 ARE PROMULGATED BY THE DEPARTMENT. FINAL REGULATIONS SHALL BE
29 PROMULGATED NO LATER THAN 18 MONTHS FOLLOWING THE EFFECTIVE DATE
30 OF THIS ACT.
19990H0096B2943 - 29 -
1 SECTION 7. THIS ACT SHALL TAKE EFFECT IN 60 DAYS.
L21L20JRW/19990H0096B2943 - 30 -