City, State and Zip Code:
Witness' signature:
Number and Street:
City, State and Zip Code:
NOTE: One witness shall not be a relative by blood, marriage
or adoption of the person signing this request, shall not be
entitled to any portion of the person's estate upon death and
shall not own, operate or be employed at a health care facility
where the person is a patient or resident. If the patient is an
inpatient at a health care facility, one of the witnesses shall
be an individual designated by the facility.
§ 54B23. Penalties for mishandling instrument.
(a) Intent to hasten death.--A person who without
authorization of the patient willfully alters, forges, conceals
or destroys an instrument, the reinstatement or revocation of an
instrument or any other evidence or document reflecting the
patient's desires and interests with the intent and effect of
causing a withholding or withdrawal of life-sustaining
procedures or of artificially administered nutrition and
hydration which hastens the death of the patient commits a
felony of the first degree.
(b) Intent to affect health care decision.--Except as
provided in subsection (a), a person without authorization of
the patient who willfully alters, forges, conceals or destroys
an instrument, the reinstatement or revocation of an instrument,
or any other evidence or document reflecting the patient's
desires and interests with the intent or effect of affecting a
health care decision commits a misdemeanor of the first degree.
Section 2. This act shall take effect in 60 days.
20170SB0238PN0220 - 18 -
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