PRIOR PRINTER'S NO. 693 PRINTER'S NO. 1943
No. 628 Session of 2005
INTRODUCED BY GREENLEAF, LEMMOND, ORIE, O'PAKE, COSTA, ERICKSON,
BRIGHTBILL, MADIGAN, WENGER, RAFFERTY, RHOADES, BOSCOLA,
PILEGGI, ROBBINS AND PICCOLA, APRIL 13, 2005
SENATOR WENGER, APPROPRIATIONS, RE-REPORTED AS AMENDED,
JUNE 26, 2006
AN ACT
1 Amending Titles 18 (Crimes and Offenses) and 20 (Decedents,
2 Estates and Fiduciaries) of the Pennsylvania Consolidated
3 Statutes, providing for the offenses of neglect of care-
4 dependent person and for living wills and health care powers
5 of attorney; further providing for implementation of out-of-
6 hospital nonresuscitation; making conforming amendments; and
7 making related repeals. REPEALING PROVISIONS OF 20 PA.C.S. <--
8 CHS. 54 AND 54A.
9 The General Assembly of the Commonwealth of Pennsylvania
10 hereby enacts as follows:
11 Section 1. Section 2713(e) of Title 18 of the Pennsylvania
12 Consolidated Statutes is amended to read:
13 § 2713. Neglect of care-dependent person.
14 * * *
15 (e) Treatment in conformance with care-dependent person's
16 right to accept or refuse services.--A caretaker or any other
17 individual or facility may offer an affirmative defense to
18 charges filed pursuant to this section if the caretaker,
19 individual or facility can demonstrate through a preponderance
20 of the evidence that the alleged violations result directly
1 from:
2 (1) the caretaker's, individual's or facility's lawful
3 compliance with a care-dependent person's [advance directive
4 for health care] living will as provided in 20 Pa.C.S. Ch. 54
5 (relating to [advance directive for] health care);
6 (2) the caretaker's, individual's or facility's lawful
7 compliance with the care-dependent person's written, signed
8 and witnessed instructions, [composed] executed when the
9 care-dependent person is competent as to the treatment he
10 wishes to receive;
11 (3) the caretaker's, individual's or facility's lawful
12 compliance with the direction of the care-dependent person's <--
13 [attorney-in-fact] agent acting pursuant to a lawful durable
14 power of attorney; [or] PERSON'S: <--
15 (I) [ATTORNEY-IN-FACT] AGENT ACTING PURSUANT TO A
16 LAWFUL DURABLE POWER OF ATTORNEY UNDER 20 PA.C.S. CH. 56
17 (RELATING TO POWERS OF ATTORNEY), WITHIN THE SCOPE OF
18 THAT POWER; OR
19 (II) HEALTH CARE AGENT ACTING PURSUANT TO A HEALTH
20 CARE POWER OF ATTORNEY UNDER 20 PA.C.S. CH. 54 SUBCH. C
21 (RELATING TO HEALTH CARE AGENTS AND REPRESENTATIVES),
22 WITHIN THE SCOPE OF THAT POWER;
23 (4) the caretaker's, individual's or facility's lawful
24 compliance with a "Do Not Resuscitate" order written and
25 signed by the care-dependent person's attending physician[.];
26 or
27 (5) the caretaker's, individual's or facility's lawful <--
28 compliance with the direction of the care-dependent person's
29 health care agent acting pursuant to a lawful health care
30 power of attorney.
20050S0628B1943 - 2 -
1 (5) THE CARETAKER'S, INDIVIDUAL'S OR FACILITY'S LAWFUL <--
2 COMPLIANCE WITH THE DIRECTION OF THE CARE-DEPENDENT PERSON'S
3 HEALTH CARE REPRESENTATIVE UNDER 20 PA.C.S. § 5461 (RELATING
4 TO DECISIONS BY HEALTH CARE REPRESENTATIVE), PROVIDED THE
5 CARE-DEPENDENT PERSON HAS AN END-STAGE MEDICAL CONDITION OR
6 IS PERMANENTLY UNCONSCIOUS AS THESE TERMS ARE DEFINED IN 20
7 PA.C.S. § 5422 (RELATING TO DEFINITIONS) AS DIAGNOSED AND
8 DOCUMENTED IN THE PERSON'S MEDICAL RECORD BY THE PERSON'S
9 ATTENDING PHYSICIAN.
10 * * *
11 Section 2. Section 711(22) of Title 20 is amended to read:
12 § 711. Mandatory exercise of jurisdiction through orphans'
13 court division in general.
14 Except as provided in section 712 (relating to nonmandatory
15 exercise of jurisdiction through the orphans' court division)
16 and section 713 (relating to special provisions for Philadelphia
17 County), the jurisdiction of the court of common pleas over the
18 following shall be exercised through its orphans' court
19 division:
20 * * *
21 (22) Agents.--All matters pertaining to the exercise of
22 powers by agents acting under powers of attorney as provided
23 in Subchapter C of Chapter 54 (relating to health care agents
24 and representatives) or in Chapter 56 (relating to powers of
25 attorney).
26 Section 3. Chapter 54 of Title 20 is repealed. <--
27 SECTION 3. CHAPTER 54 OF TITLE 20 IS AMENDED TO READ: <--
28 [CHAPTER 54
29 ADVANCE DIRECTIVE FOR HEALTH CARE
20050S0628B1943 - 3 -
1 SEC.
2 5401. SHORT TITLE OF CHAPTER.
3 5402. LEGISLATIVE FINDINGS AND INTENT.
4 5403. DEFINITIONS.
5 5404. DECLARATION.
6 5405. WHEN DECLARATION BECOMES OPERATIVE.
7 5406. REVOCATION.
8 5407. LIABILITY.
9 5408. DUTY OF PHYSICIAN TO CONFIRM TERMINAL CONDITION.
10 5409. UNWILLINGNESS TO COMPLY; TRANSFER OF DECLARANT.
11 5410. EFFECT ON SUICIDE AND LIFE INSURANCE.
12 5411. DECLARATION OPTIONAL.
13 5412. PRESERVATION OF EXISTING RIGHTS.
14 5413. EMERGENCY MEDICAL SERVICES.
15 5414. PREGNANCY.
16 5415. PENALTIES.
17 5416. SEVERABILITY.
18 § 5401. SHORT TITLE OF CHAPTER.
19 THIS CHAPTER SHALL BE KNOWN AND MAY BE CITED AS THE ADVANCE
20 DIRECTIVE FOR HEALTH CARE ACT.
21 § 5402. LEGISLATIVE FINDINGS AND INTENT.
22 (A) FINDINGS.--THE GENERAL ASSEMBLY FINDS THAT ALL COMPETENT
23 ADULTS HAVE A QUALIFIED RIGHT TO CONTROL DECISIONS RELATING TO
24 THEIR OWN MEDICAL CARE. THIS RIGHT IS SUBJECT TO CERTAIN
25 INTERESTS OF SOCIETY, SUCH AS THE MAINTENANCE OF ETHICAL
26 STANDARDS IN THE MEDICAL PROFESSION AND THE PRESERVATION AND
27 PROTECTION OF HUMAN LIFE. MODERN MEDICAL TECHNOLOGICAL
28 PROCEDURES MAKE POSSIBLE THE PROLONGATION OF HUMAN LIFE BEYOND
29 NATURAL LIMITS. THE APPLICATION OF SOME PROCEDURES TO AN
30 INDIVIDUAL SUFFERING A DIFFICULT AND UNCOMFORTABLE PROCESS OF
20050S0628B1943 - 4 -
1 DYING MAY CAUSE LOSS OF PATIENT DIGNITY AND SECURE ONLY
2 CONTINUATION OF A PRECARIOUS AND BURDENSOME PROLONGATION OF
3 LIFE.
4 (B) INTENT.--NOTHING IN THIS CHAPTER IS INTENDED TO CONDONE,
5 AUTHORIZE OR APPROVE MERCY KILLING, EUTHANASIA OR AIDED SUICIDE
6 OR TO PERMIT ANY AFFIRMATIVE OR DELIBERATE ACT OR OMISSION TO
7 END LIFE OTHER THAN AS DEFINED IN THIS CHAPTER. FURTHERMORE,
8 THIS CHAPTER SHALL CREATE NO PRESUMPTION CONCERNING THE INTENT
9 OF ANY PERSON WHO HAS NOT EXECUTED A DECLARATION TO CONSENT TO
10 THE USE OR WITHHOLDING OF LIFE-SUSTAINING PROCEDURES IN THE
11 EVENT OF A TERMINAL CONDITION OR A STATE OF PERMANENT
12 UNCONSCIOUSNESS.
13 § 5403. DEFINITIONS.
14 THE FOLLOWING WORDS AND PHRASES WHEN USED IN THIS CHAPTER
15 SHALL HAVE THE MEANINGS GIVEN TO THEM IN THIS SECTION UNLESS THE
16 CONTEXT CLEARLY INDICATES OTHERWISE:
17 "ATTENDING PHYSICIAN." THE PHYSICIAN WHO HAS PRIMARY
18 RESPONSIBILITY FOR THE TREATMENT AND CARE OF THE DECLARANT.
19 "DECLARANT." A PERSON WHO MAKES A DECLARATION IN ACCORDANCE
20 WITH THIS CHAPTER. THE TERM INCLUDES AN EMANCIPATED MINOR.
21 "DECLARATION." A WRITTEN DOCUMENT VOLUNTARILY EXECUTED BY
22 THE DECLARANT IN ACCORDANCE WITH THIS CHAPTER.
23 "HEALTH CARE PROVIDER." A PERSON WHO IS LICENSED OR
24 CERTIFIED BY THE LAWS OF THIS COMMONWEALTH TO ADMINISTER HEALTH
25 CARE IN THE ORDINARY COURSE OF BUSINESS OR PRACTICE OF A
26 PROFESSION. THE TERM INCLUDES PERSONNEL RECOGNIZED UNDER THE ACT
27 OF JULY 3, 1985 (P.L.164, NO.45), KNOWN AS THE EMERGENCY MEDICAL
28 SERVICES ACT.
29 "INCOMPETENT." THE LACK OF SUFFICIENT CAPACITY FOR A PERSON
30 TO MAKE OR COMMUNICATE DECISIONS CONCERNING HIMSELF.
20050S0628B1943 - 5 -
1 "LIFE-SUSTAINING TREATMENT." ANY MEDICAL PROCEDURE OR
2 INTERVENTION THAT, WHEN ADMINISTERED TO A QUALIFIED PATIENT,
3 WILL SERVE ONLY TO PROLONG THE PROCESS OF DYING OR TO MAINTAIN
4 THE PATIENT IN A STATE OF PERMANENT UNCONSCIOUSNESS. LIFE-
5 SUSTAINING TREATMENT SHALL INCLUDE NUTRITION AND HYDRATION
6 ADMINISTERED BY GASTRIC TUBE OR INTRAVENOUSLY OR ANY OTHER
7 ARTIFICIAL OR INVASIVE MEANS IF THE DECLARATION OF THE QUALIFIED
8 PATIENT SO SPECIFICALLY PROVIDES.
9 "MEDICAL COMMAND PHYSICIAN." A LICENSED PHYSICIAN WHO IS
10 AUTHORIZED TO GIVE MEDICAL COMMAND UNDER THE ACT OF JULY 3, 1985
11 (P.L.164, NO.45), KNOWN AS THE EMERGENCY MEDICAL SERVICES ACT.
12 "PERMANENTLY UNCONSCIOUS." A MEDICAL CONDITION THAT HAS BEEN
13 DIAGNOSED IN ACCORDANCE WITH CURRENTLY ACCEPTED MEDICAL
14 STANDARDS AND WITH REASONABLE MEDICAL CERTAINTY AS TOTAL AND
15 IRREVERSIBLE LOSS OF CONSCIOUSNESS AND CAPACITY FOR INTERACTION
16 WITH THE ENVIRONMENT. THE TERM INCLUDES, WITHOUT LIMITATION, A
17 PERSISTENT VEGETATIVE STATE OR IRREVERSIBLE COMA.
18 "PERSON." AN INDIVIDUAL, CORPORATION, PARTNERSHIP,
19 ASSOCIATION OR FEDERAL, STATE OR LOCAL GOVERNMENT OR
20 GOVERNMENTAL AGENCY.
21 "QUALIFIED PATIENT." A PERSON WHO HAS EXECUTED A DECLARATION
22 AND WHO HAS BEEN DETERMINED TO BE IN A TERMINAL CONDITION OR TO
23 BE PERMANENTLY UNCONSCIOUS.
24 "TERMINAL CONDITION." AN INCURABLE AND IRREVERSIBLE MEDICAL
25 CONDITION IN AN ADVANCED STATE CAUSED BY INJURY, DISEASE OR
26 PHYSICAL ILLNESS WHICH WILL, IN THE OPINION OF THE ATTENDING
27 PHYSICIAN, TO A REASONABLE DEGREE OF MEDICAL CERTAINTY, RESULT
28 IN DEATH REGARDLESS OF THE CONTINUED APPLICATION OF LIFE-
29 SUSTAINING TREATMENT.
30 § 5404. DECLARATION.
20050S0628B1943 - 6 -
1 (A) EXECUTION.--AN INDIVIDUAL OF SOUND MIND WHO IS 18 YEARS
2 OF AGE OR OLDER OR WHO HAS GRADUATED FROM HIGH SCHOOL OR HAS
3 MARRIED MAY EXECUTE AT ANY TIME A DECLARATION GOVERNING THE
4 INITIATION, CONTINUATION, WITHHOLDING OR WITHDRAWAL OF LIFE-
5 SUSTAINING TREATMENT. THE DECLARATION MUST BE SIGNED BY THE
6 DECLARANT, OR BY ANOTHER ON BEHALF OF AND AT THE DIRECTION OF
7 THE DECLARANT, AND MUST BE WITNESSED BY TWO INDIVIDUALS EACH OF
8 WHOM IS 18 YEARS OF AGE OR OLDER. A WITNESS SHALL NOT BE THE
9 PERSON WHO SIGNED THE DECLARATION ON BEHALF OF AND AT THE
10 DIRECTION OF THE DECLARANT.
11 (B) FORM.--A DECLARATION MAY BUT NEED NOT BE IN THE
12 FOLLOWING FORM AND MAY INCLUDE OTHER SPECIFIC DIRECTIONS,
13 INCLUDING, BUT NOT LIMITED TO, DESIGNATION OF ANOTHER PERSON TO
14 MAKE THE TREATMENT DECISION FOR THE DECLARANT IF THE DECLARANT
15 IS INCOMPETENT AND IS DETERMINED TO BE IN A TERMINAL CONDITION
16 OR TO BE PERMANENTLY UNCONSCIOUS.
17 DECLARATION
18 I, , BEING OF SOUND MIND, WILLFULLY AND
19 VOLUNTARILY MAKE THIS DECLARATION TO BE FOLLOWED IF I BECOME
20 INCOMPETENT. THIS DECLARATION REFLECTS MY FIRM AND SETTLED
21 COMMITMENT TO REFUSE LIFE-SUSTAINING TREATMENT UNDER THE
22 CIRCUMSTANCES INDICATED BELOW.
23 I DIRECT MY ATTENDING PHYSICIAN TO WITHHOLD OR WITHDRAW
24 LIFE-SUSTAINING TREATMENT THAT SERVES ONLY TO PROLONG THE
25 PROCESS OF MY DYING, IF I SHOULD BE IN A TERMINAL CONDITION
26 OR IN A STATE OF PERMANENT UNCONSCIOUSNESS.
27 I DIRECT THAT TREATMENT BE LIMITED TO MEASURES TO KEEP ME
28 COMFORTABLE AND TO RELIEVE PAIN, INCLUDING ANY PAIN THAT
29 MIGHT OCCUR BY WITHHOLDING OR WITHDRAWING LIFE-SUSTAINING
30 TREATMENT.
20050S0628B1943 - 7 -
1 IN ADDITION, IF I AM IN THE CONDITION DESCRIBED ABOVE, I
2 FEEL ESPECIALLY STRONG ABOUT THE FOLLOWING FORMS OF
3 TREATMENT:
4 I ( ) DO ( ) DO NOT WANT CARDIAC RESUSCITATION.
5 I ( ) DO ( ) DO NOT WANT MECHANICAL RESPIRATION.
6 I ( ) DO ( ) DO NOT WANT TUBE FEEDING OR ANY OTHER
7 ARTIFICIAL OR INVASIVE FORM OF NUTRITION (FOOD) OR HYDRATION
8 (WATER).
9 I ( ) DO ( ) DO NOT WANT BLOOD OR BLOOD PRODUCTS.
10 I ( ) DO ( ) DO NOT WANT ANY FORM OF SURGERY OR INVASIVE
11 DIAGNOSTIC TESTS.
12 I ( ) DO ( ) DO NOT WANT KIDNEY DIALYSIS.
13 I ( ) DO ( ) DO NOT WANT ANTIBIOTICS.
14 I REALIZE THAT IF I DO NOT SPECIFICALLY INDICATE MY
15 PREFERENCE REGARDING ANY OF THE FORMS OF TREATMENT LISTED
16 ABOVE, I MAY RECEIVE THAT FORM OF TREATMENT.
17 OTHER INSTRUCTIONS:
18 I ( ) DO ( ) DO NOT WANT TO DESIGNATE ANOTHER PERSON AS
19 MY SURROGATE TO MAKE MEDICAL TREATMENT DECISIONS FOR ME IF I
20 SHOULD BE INCOMPETENT AND IN A TERMINAL CONDITION OR IN A
21 STATE OF PERMANENT UNCONSCIOUSNESS. NAME AND ADDRESS OF
22 SURROGATE (IF APPLICABLE):
23 NAME AND ADDRESS OF SUBSTITUTE SURROGATE (IF SURROGATE
24 DESIGNATED ABOVE IS UNABLE TO SERVE):
25 I ( ) DO ( ) DO NOT WANT TO MAKE AN ANATOMICAL GIFT OF
26 ALL OR PART OF MY BODY, SUBJECT TO THE FOLLOWING LIMITATIONS,
27 IF ANY:
28 I MADE THIS DECLARATION ON THE DAY OF (MONTH,
29 YEAR).
30 DECLARANT'S SIGNATURE:
20050S0628B1943 - 8 -
1 DECLARANT'S ADDRESS:
2 THE DECLARANT OR THE PERSON ON BEHALF OF AND AT THE
3 DIRECTION OF THE DECLARANT KNOWINGLY AND VOLUNTARILY SIGNED
4 THIS WRITING BY SIGNATURE OR MARK IN MY PRESENCE.
5 WITNESS'S SIGNATURE:
6 WITNESS'S ADDRESS:
7 WITNESS'S SIGNATURE:
8 WITNESS'S ADDRESS:
9 (C) INVALIDITY OF SPECIFIC DIRECTION.--SHOULD ANY SPECIFIC
10 DIRECTION IN THE DECLARATION BE HELD TO BE INVALID, THE
11 INVALIDITY SHALL NOT OFFSET OTHER DIRECTIONS OF THE DECLARATION
12 WHICH CAN BE EFFECTED WITHOUT THE INVALID DIRECTION.
13 (D) MEDICAL RECORD.--A PHYSICIAN OR OTHER HEALTH CARE
14 PROVIDER WHO IS FURNISHED A COPY OF THE DECLARATION SHALL MAKE
15 IT A PART OF THE DECLARANT'S MEDICAL RECORD AND, IF UNWILLING TO
16 COMPLY WITH THE DECLARATION, PROMPTLY SO ADVISE THE DECLARANT.
17 § 5405. WHEN DECLARATION BECOMES OPERATIVE.
18 A DECLARATION BECOMES OPERATIVE WHEN:
19 (1) A COPY IS PROVIDED TO THE ATTENDING PHYSICIAN; AND
20 (2) THE DECLARANT IS DETERMINED BY THE ATTENDING
21 PHYSICIAN TO BE INCOMPETENT AND IN A TERMINAL CONDITION OR IN
22 A STATE OF PERMANENT UNCONSCIOUSNESS.
23 WHEN THE DECLARATION BECOMES OPERATIVE, THE ATTENDING PHYSICIAN
24 AND OTHER HEALTH CARE PROVIDERS SHALL ACT IN ACCORDANCE WITH ITS
25 PROVISIONS OR COMPLY WITH THE TRANSFER PROVISIONS OF SECTION
26 5409 (RELATING TO UNWILLINGNESS TO COMPLY; TRANSFER OF
27 DECLARANT).
28 § 5406. REVOCATION.
29 (A) GENERAL RULE.--A DECLARATION MAY BE REVOKED AT ANY TIME
30 AND IN ANY MANNER BY THE DECLARANT WITHOUT REGARD TO THE
20050S0628B1943 - 9 -
1 DECLARANT'S MENTAL OR PHYSICAL CONDITION. A REVOCATION IS
2 EFFECTIVE UPON COMMUNICATION TO THE ATTENDING PHYSICIAN OR OTHER
3 HEALTH CARE PROVIDER BY THE DECLARANT OR A WITNESS TO THE
4 REVOCATION.
5 (B) MEDICAL RECORD.--THE ATTENDING PHYSICIAN OR OTHER HEALTH
6 CARE PROVIDER SHALL MAKE THE REVOCATION A PART OF THE
7 DECLARANT'S MEDICAL RECORD.
8 § 5407. LIABILITY.
9 (A) GENERAL RULE.--NO PHYSICIAN OR OTHER HEALTH CARE
10 PROVIDER WHO, CONSISTENT WITH THIS CHAPTER, CAUSES OR
11 PARTICIPATES IN THE INITIATING, CONTINUING, WITHHOLDING OR
12 WITHDRAWAL OF LIFE-SUSTAINING TREATMENT FROM A QUALIFIED PATIENT
13 WHO IS INCOMPETENT SHALL, AS A RESULT THEREOF, BE SUBJECT TO
14 CRIMINAL OR CIVIL LIABILITY OR BE FOUND TO HAVE COMMITTED AN ACT
15 OF UNPROFESSIONAL CONDUCT IF THE ATTENDING PHYSICIAN HAS
16 FOLLOWED THE DECLARANT'S WISHES AS EXPRESSED EARLIER BY THE
17 DECLARANT IN THE FORM OF A DECLARATION EXECUTED PURSUANT TO THIS
18 CHAPTER.
19 (B) ABSENCE OF DECLARATION.--THE ABSENCE OF A DECLARATION BY
20 A PATIENT SHALL NOT GIVE RISE TO ANY PRESUMPTION AS TO THE
21 INTENT OF THE PATIENT TO CONSENT TO OR TO REFUSE THE INITIATION,
22 CONTINUATION OR TERMINATION OF LIFE-SUSTAINING TREATMENT.
23 § 5408. DUTY OF PHYSICIAN TO CONFIRM TERMINAL CONDITION.
24 FOR PURPOSES OF SECTION 5405 (RELATING TO WHEN DECLARATION
25 BECOMES OPERATIVE), AN ATTENDING PHYSICIAN SHALL, WITHOUT DELAY
26 AFTER THE DIAGNOSIS THAT THE DECLARANT IS IN A TERMINAL
27 CONDITION OR IN A STATE OF PERMANENT UNCONSCIOUSNESS, CERTIFY IN
28 WRITING THAT THE DECLARANT IS IN A TERMINAL CONDITION OR IN A
29 STATE OF PERMANENT UNCONSCIOUSNESS AND ARRANGE FOR THE PHYSICAL
30 EXAMINATION AND CONFIRMATION OF THE TERMINAL CONDITION OR STATE
20050S0628B1943 - 10 -
1 OF PERMANENT UNCONSCIOUSNESS OF THE DECLARANT BY A SECOND
2 PHYSICIAN.
3 § 5409. UNWILLINGNESS TO COMPLY; TRANSFER OF DECLARANT.
4 (A) ATTENDING PHYSICIAN OR HEALTH CARE PROVIDER.--IF AN
5 ATTENDING PHYSICIAN OR OTHER HEALTH CARE PROVIDER CANNOT IN GOOD
6 CONSCIENCE COMPLY WITH A DECLARATION OR IF THE POLICIES OF THE
7 HEALTH CARE PROVIDER PRECLUDE COMPLIANCE WITH A DECLARATION, THE
8 ATTENDING PHYSICIAN OR HEALTH CARE PROVIDER SHALL SO INFORM THE
9 DECLARANT, OR, IF THE DECLARANT IS INCOMPETENT, SHALL SO INFORM
10 THE DECLARANT'S SURROGATE, OR, IF A SURROGATE IS NOT NAMED IN
11 THE DECLARATION, SHALL SO INFORM THE FAMILY, GUARDIAN OR OTHER
12 REPRESENTATIVE OF THE DECLARANT. THE ATTENDING PHYSICIAN OR
13 HEALTH CARE PROVIDER SHALL MAKE EVERY REASONABLE EFFORT TO
14 ASSIST IN THE TRANSFER OF THE DECLARANT TO ANOTHER PHYSICIAN OR
15 HEALTH CARE PROVIDER WHO WILL COMPLY WITH THE DECLARATION.
16 (B) EMPLOYEE OR STAFF MEMBER OF HEALTH CARE PROVIDER.--AN
17 EMPLOYEE OR STAFF MEMBER OF A HEALTH CARE PROVIDER SHALL NOT BE
18 REQUIRED TO PARTICIPATE IN THE WITHHOLDING OR WITHDRAWAL OF
19 LIFE-SUSTAINING TREATMENT. IT SHALL BE UNLAWFUL FOR AN EMPLOYER
20 TO DISCHARGE OR IN ANY OTHER MANNER TO DISCRIMINATE AGAINST AN
21 EMPLOYEE OR STAFF MEMBER WHO INFORMS THE EMPLOYER THAT HE DOES
22 NOT WISH TO PARTICIPATE IN THE WITHHOLDING OR WITHDRAWAL OF
23 LIFE-SUSTAINING TREATMENT. THE EMPLOYER MAY REQUIRE THE EMPLOYEE
24 OR STAFF MEMBER TO EXPRESS HIS WISHES IN WRITING.
25 (C) LIABILITY.--IF TRANSFER UNDER SUBSECTION (A) IS NOT
26 POSSIBLE, THE PROVISION OF LIFE-SUSTAINING TREATMENT TO A
27 DECLARANT SHALL NOT SUBJECT A HEALTH CARE PROVIDER TO CRIMINAL
28 OR CIVIL LIABILITY OR ADMINISTRATIVE SANCTION FOR FAILURE TO
29 CARRY OUT THE PROVISIONS OF A DECLARATION.
30 § 5410. EFFECT ON SUICIDE AND LIFE INSURANCE.
20050S0628B1943 - 11 -
1 (A) CRIMINAL EFFECT.--THE WITHHOLDING OR WITHDRAWAL OF LIFE-
2 SUSTAINING TREATMENT FROM A QUALIFIED PATIENT IN ACCORDANCE WITH
3 THE PROVISIONS OF THIS CHAPTER SHALL NOT, FOR ANY PURPOSE,
4 CONSTITUTE SUICIDE OR HOMICIDE.
5 (B) LIFE INSURANCE.--THE MAKING OF OR FAILURE TO MAKE A
6 DECLARATION IN ACCORDANCE WITH THIS CHAPTER SHALL NOT AFFECT IN
7 ANY MANNER THE SALE, PROCUREMENT OR ISSUANCE OF ANY POLICY OF
8 LIFE INSURANCE NOR SHALL IT BE DEEMED TO MODIFY THE TERMS OF AN
9 EXISTING POLICY OF LIFE INSURANCE. NO POLICY OF LIFE INSURANCE
10 SHALL BE LEGALLY IMPAIRED OR INVALIDATED IN ANY MANNER BY THE
11 WITHHOLDING OR WITHDRAWAL OF LIFE-SUSTAINING TREATMENT FROM AN
12 INSURED PATIENT, NOTWITHSTANDING ANY TERM OF THE POLICY TO THE
13 CONTRARY.
14 § 5411. DECLARATION OPTIONAL.
15 NO PHYSICIAN OR OTHER HEALTH CARE PROVIDER AND NO HEALTH CARE
16 SERVICE PLAN, HEALTH MAINTENANCE ORGANIZATION, INSURER ISSUING
17 DISABILITY INSURANCE, SELF-INSURED EMPLOYEE WELFARE BENEFIT
18 PLAN, NONPROFIT HOSPITAL PLAN OR FEDERAL, STATE OR LOCAL
19 GOVERNMENT SPONSORED OR OPERATED PROGRAM SHALL:
20 (1) REQUIRE ANY PERSON TO EXECUTE A DECLARATION AS A
21 CONDITION FOR BEING INSURED FOR OR RECEIVING HEALTH CARE
22 SERVICES; OR
23 (2) CHARGE ANY PERSON A DIFFERENT RATE OR FEE WHETHER OR
24 NOT THE PERSON EXECUTES OR HAS EXECUTED A DECLARATION.
25 § 5412. PRESERVATION OF EXISTING RIGHTS.
26 THE PROVISIONS OF THIS CHAPTER SHALL NOT IMPAIR OR SUPERSEDE
27 ANY EXISTING RIGHTS OR RESPONSIBILITIES NOT ADDRESSED IN THIS
28 CHAPTER.
29 § 5413. EMERGENCY MEDICAL SERVICES.
30 (A) GENERAL RULE.--AN EMERGENCY MEDICAL SERVICES PROVIDER
20050S0628B1943 - 12 -
1 SHALL, IN THE COURSE OF PROVIDING CARE TO A DECLARANT, AT ALL
2 TIMES COMPLY WITH THE INSTRUCTIONS OF AN AUTHORIZED MEDICAL
3 COMMAND PHYSICIAN TO WITHHOLD OR DISCONTINUE CARDIOPULMONARY
4 RESUSCITATION FOR A DECLARANT WHOSE ADVANCE DIRECTIVE HAS BECOME
5 OPERATIVE UNDER SECTION 5405 (RELATING TO WHEN DECLARATION
6 BECOMES OPERATIVE).
7 (B) APPLICABILITY.--THIS SECTION IS APPLICABLE ONLY IN THOSE
8 INSTANCES WHERE AN OUT-OF-HOSPITAL DNR ORDER IS NOT IN EFFECT
9 UNDER SECTION 54A04(A) (RELATING TO ORDERS, BRACELETS AND
10 NECKLACES).
11 § 5414. PREGNANCY.
12 (A) GENERAL RULE.--NOTWITHSTANDING THE EXISTENCE OF A
13 DECLARATION OR DIRECTION TO THE CONTRARY, LIFE-SUSTAINING
14 TREATMENT, NUTRITION AND HYDRATION MUST BE PROVIDED TO A
15 PREGNANT WOMAN WHO IS INCOMPETENT AND HAS A TERMINAL CONDITION
16 OR WHO IS PERMANENTLY UNCONSCIOUS UNLESS, TO A REASONABLE DEGREE
17 OF MEDICAL CERTAINTY AS CERTIFIED ON THE PATIENT'S MEDICAL
18 RECORD BY THE ATTENDING PHYSICIAN AND AN OBSTETRICIAN WHO HAS
19 EXAMINED THE PATIENT, LIFE-SUSTAINING TREATMENT, NUTRITION AND
20 HYDRATION:
21 (1) WILL NOT MAINTAIN THE PREGNANT WOMAN IN SUCH A WAY
22 AS TO PERMIT THE CONTINUING DEVELOPMENT AND LIVE BIRTH OF THE
23 UNBORN CHILD;
24 (2) WILL BE PHYSICALLY HARMFUL TO THE PREGNANT WOMAN; OR
25 (3) WOULD CAUSE PAIN TO THE PREGNANT WOMAN WHICH CANNOT
26 BE ALLEVIATED BY MEDICATION.
27 (B) PREGNANCY TEST.--NOTHING IN THIS SECTION SHALL REQUIRE A
28 PHYSICIAN TO PERFORM A PREGNANCY TEST UNLESS THE PHYSICIAN HAS
29 REASON TO BELIEVE THAT THE WOMAN MAY BE PREGNANT.
30 (C) PAYMENT OF EXPENSES BY COMMONWEALTH.--
20050S0628B1943 - 13 -
1 (1) IN THE EVENT THAT TREATMENT, NUTRITION AND HYDRATION
2 ARE PROVIDED TO A PREGNANT WOMAN WHO IS INCOMPETENT AND HAS A
3 TERMINAL CONDITION OR WHO IS PERMANENTLY UNCONSCIOUS,
4 NOTWITHSTANDING THE EXISTENCE OF A DECLARATION OR DIRECTION
5 TO THE CONTRARY, THE COMMONWEALTH SHALL PAY ALL USUAL,
6 CUSTOMARY AND REASONABLE EXPENSES DIRECTLY AND INDIRECTLY
7 INCURRED BY THE PREGNANT WOMAN TO WHOM SUCH TREATMENT,
8 NUTRITION AND HYDRATION ARE PROVIDED.
9 (2) THE COMMONWEALTH SHALL HAVE THE RIGHT OF SUBROGATION
10 AGAINST ALL MONEYS PAID BY ANY THIRD-PARTY HEALTH INSURER ON
11 BEHALF OF THE PREGNANT WOMAN.
12 (3) THE EXPENDITURES INCURRED ON BEHALF OF THE PREGNANT
13 WOMAN SHALL CONSTITUTE A GRANT AND NO LIEN SHALL BE PLACED
14 UPON THE PROPERTY OF THE PREGNANT WOMAN, HER ESTATE OR HER
15 HEIRS.
16 § 5415. PENALTIES.
17 ANY PERSON WHO WILLFULLY CONCEALS, CANCELS, DEFACES,
18 OBLITERATES OR DAMAGES THE DECLARATION OF ANOTHER WITHOUT THE
19 CONSENT OF THE DECLARANT COMMITS A FELONY OF THE THIRD DEGREE.
20 ANY PERSON WHO FALSIFIES OR FORGES THE DECLARATION OF ANOTHER,
21 OR WILLFULLY CONCEALS OR WITHHOLDS PERSONAL KNOWLEDGE OF A
22 REVOCATION AS PROVIDED IN SECTION 5406 (RELATING TO REVOCATION),
23 WITH THE INTENT TO CAUSE A WITHHOLDING OR WITHDRAWAL OF LIFE-
24 SUSTAINING TREATMENT CONTRARY TO THE WISHES OF THE DECLARANT
25 AND, BECAUSE OF SUCH AN ACT, DIRECTLY CAUSES LIFE-SUSTAINING
26 TREATMENT TO BE WITHHELD OR WITHDRAWN AND DEATH TO BE HASTENED
27 SHALL BE SUBJECT TO PROSECUTION FOR CRIMINAL HOMICIDE AS
28 PROVIDED IN 18 PA.C.S. CH. 25 (RELATING TO CRIMINAL HOMICIDE).
29 ANY PERSON WHO WILLFULLY, BY UNDUE INFLUENCE, FRAUD OR DURESS,
30 CAUSES A PERSON TO EXECUTE A DECLARATION PURSUANT TO THIS
20050S0628B1943 - 14 -
1 CHAPTER COMMITS A FELONY OF THE THIRD DEGREE.
2 § 5416. SEVERABILITY.
3 THE PROVISIONS OF THIS CHAPTER ARE SEVERABLE, AND, IF ANY
4 WORD, PHRASE, CLAUSE, SENTENCE, SECTION OR PROVISION OF THE
5 CHAPTER IS FOR ANY REASON HELD TO BE UNCONSTITUTIONAL, THE
6 DECISION OF THE COURT SHALL NOT AFFECT OR IMPAIR ANY OF THE
7 REMAINING PROVISIONS OF THIS CHAPTER. IT IS HEREBY DECLARED AS
8 THE LEGISLATIVE INTENT THAT THIS CHAPTER WOULD HAVE BEEN ADOPTED
9 HAD SUCH UNCONSTITUTIONAL WORD, PHRASE, CLAUSE, SENTENCE,
10 SECTION OR PROVISION THEREOF NOT BEEN INCLUDED HEREIN.]
11 Section 4. Title 20 is amended by adding a chapter to read:
12 CHAPTER 54
13 HEALTH CARE
14 Subchapter
15 A. General Provisions
16 B. Living Wills
17 C. Health Care Agents and Representatives
18 D. Combined Form
19 E. Out-of-Hospital Nonresuscitation
20 SUBCHAPTER A
21 GENERAL PROVISIONS
22 Sec.
23 5421. Applicability.
24 5422. Definitions.
25 5423. Legislative findings and intent.
26 5424. Compliance.
27 5425. Conflicting advance health care directives.
28 5426. Death not suicide or homicide.
29 5427. Life insurance.
30 5428. Health care instruments optional.
20050S0628B1943 - 15 -
1 5429. Pregnancy.
2 5430. Effect of divorce.
3 5431. Liability.
4 5432. Criminal penalties.
5 5433. Forms.
6 § 5421. Applicability.
7 (a) General rule.--This chapter applies to advance health
8 care directives and out-of-hospital nonresuscitation orders.
9 (b) Preservation of existing rights.--The provisions of this
10 chapter shall not impair or supersede any existing rights or
11 responsibilities not addressed in this chapter.
12 § 5422. 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 "Advance health care directive." A health care power of
17 attorney, living will or a written combination of a health care
18 power of attorney and living will.
19 "Attending physician." The physician who has primary
20 responsibility for the health care of a principal or patient.
21 "Bracelet." An out-of-hospital DNR bracelet.
22 "Cardiopulmonary resuscitation." Any of the following
23 procedures:
24 (1) Cardiac compression.
25 (2) Invasive airway technique.
26 (3) Artificial ventilation.
27 (4) Defibrillation.
28 (5) Any other procedure related to those set forth in
29 paragraphs (1) through (4).
30 "COMPETENT." A CONDITION IN WHICH AN INDIVIDUAL, WHEN <--
20050S0628B1943 - 16 -
1 PROVIDED APPROPRIATE MEDICAL INFORMATION, COMMUNICATION SUPPORTS
2 AND TECHNICAL ASSISTANCE, IS DOCUMENTED BY A HEALTH CARE
3 PROVIDER TO BE:
4 (1) ABLE TO UNDERSTAND THE POTENTIAL MATERIAL BENEFITS,
5 RISKS AND ALTERNATIVES INVOLVED IN A SPECIFIC PROPOSED HEALTH
6 CARE DECISION.
7 (2) ABLE TO MAKE THAT HEALTH CARE DECISION ON HIS OWN
8 BEHALF.
9 (3) ABLE TO COMMUNICATE THAT HEALTH CARE DECISION TO ANY
10 OTHER PERSON.
11 THIS TERM IS INTENDED TO PERMIT INDIVIDUALS TO BE FOUND
12 COMPETENT TO MAKE SOME HEALTH CARE DECISIONS, BUT INCOMPETENT TO
13 MAKE OTHERS.
14 "DNR." Do not resuscitate.
15 "END-STAGE MEDICAL CONDITION." AN INCURABLE AND IRREVERSIBLE <--
16 MEDICAL CONDITION IN AN ADVANCED STATE CAUSED BY INJURY, DISEASE
17 OR PHYSICAL ILLNESS THAT WILL, IN THE OPINION OF THE ATTENDING
18 PHYSICIAN TO A REASONABLE DEGREE OF MEDICAL CERTAINTY, RESULT IN
19 DEATH REGARDLESS OF THE CONTINUED APPLICATION OF LIFE-SUSTAINING
20 TREATMENT.
21 "Health care." Any care, treatment, service or procedure to
22 maintain, diagnose, treat or provide for physical or mental
23 health, custodial or personal care, including any medication
24 program, therapeutical and surgical procedure and life-
25 sustaining treatment.
26 "Health care agent." An individual designated by a principal
27 in an advance health care directive.
28 "Health care decision." A decision regarding an individual's
29 health care, including, but not limited to, the following:
30 (1) Selection and discharge of a health care provider.
20050S0628B1943 - 17 -
1 (2) Approval or disapproval of a diagnostic test,
2 surgical procedure or program of medication.
3 (3) Directions to initiate, continue, withhold or
4 withdraw all forms of life-sustaining treatment, including
5 instructions not to resuscitate.
6 "Health care power of attorney." A writing made by a
7 principal designating an individual to make health care
8 decisions for the principal.
9 "Health care provider." A person who is licensed, certified
10 or otherwise authorized by the laws of this Commonwealth to
11 administer or provide health care in the ordinary course of
12 business or practice of a profession. The term includes
13 personnel recognized under the act of July 3, 1985 (P.L.164,
14 No.45), known as the Emergency Medical Services Act.
15 "Health care representative." An individual authorized under
16 section 5461 (relating to decisions by health care
17 representative) to make health care decisions for a principal.
18 "Incompetent." Unable to understand the significant <--
19 benefits, risks and alternatives to proposed health care and to
20 make and communicate a health care decision.
21 "INCOMPETENT." A CONDITION IN WHICH AN INDIVIDUAL DESPITE <--
22 BEING PROVIDED APPROPRIATE MEDICAL INFORMATION, COMMUNICATION
23 SUPPORTS AND TECHNICAL ASSISTANCE, IS DOCUMENTED BY A HEALTH
24 CARE PROVIDER TO BE:
25 (1) UNABLE TO UNDERSTAND THE POTENTIAL MATERIAL
26 BENEFITS, RISKS AND ALTERNATIVES INVOLVED IN A SPECIFIC
27 PROPOSED HEALTH CARE DECISION;
28 (2) UNABLE TO MAKE THAT HEALTH CARE DECISION ON HIS OWN
29 BEHALF; OR
30 (3) UNABLE TO COMMUNICATE THAT HEALTH CARE DECISION TO
20050S0628B1943 - 18 -
1 ANY OTHER PERSON.
2 THE TERM IS INTENDED TO PERMIT INDIVIDUALS TO BE FOUND
3 INCOMPETENT TO MAKE SOME HEALTH CARE DECISIONS, BUT COMPETENT TO
4 MAKE OTHERS.
5 "Invasive airway technique." Any advanced airway technique,
6 including endotracheal intubation.
7 "Life-sustaining treatment." Any medical procedure or
8 intervention that, when administered to a patient or principal
9 who has been determined to be in a terminal condition or WHO HAS <--
10 AN END-STAGE MEDICAL CONDITION OR IS permanently unconscious,
11 will serve only to prolong the process of dying or maintain the
12 individual in a state of permanent unconsciousness. The term
13 includes nutrition and hydration administered by gastric tube or
14 intravenously or any other artificial or invasive means if the
15 advance health care directive or order so specifically provides.
16 "Living will." A writing made in accordance with this
17 chapter that expresses a principal's wishes and instructions for
18 health care and health care directions when the principal is
19 determined to be incompetent and in a terminal condition or in a <--
20 state of permanent unconsciousness. HAS AN END-STAGE MEDICAL <--
21 CONDITION OR IS PERMANENTLY UNCONSCIOUS.
22 "Medical command physician." A licensed physician who is
23 authorized to give medical command under the act of July 3, 1985
24 (P.L.164, No.45), known as the Emergency Medical Services Act.
25 "Necklace." An out-of-hospital do-not-resuscitate necklace.
26 "Order." An out-of-hospital do-not-resuscitate order.
27 "Patient." An out-of-hospital do-not-resuscitate patient.
28 "Permanently unconscious." A medical condition that has been
29 diagnosed in accordance with currently accepted medical
30 standards and with reasonable medical certainty as total and
20050S0628B1943 - 19 -
1 irreversible loss of consciousness and capacity for interaction
2 with the environment. The term includes, without limitation, an
3 irreversible vegetative state or irreversible coma.
4 "Person." Any individual, corporation, partnership,
5 association or other similar entity, or any Federal, State or
6 local government or governmental agency.
7 "Principal." An individual who executes an advance health
8 care directive, designates an individual to act or disqualifies
9 an individual from acting as a health care representative or an
10 individual for whom a health care representative acts in
11 accordance with this chapter.
12 "Reasonably available." Readily able to be contacted without
13 undue effort and willing and able to act in a timely manner
14 considering the urgency of the individual's health care needs.
15 "Terminal condition." An incurable and irreversible medical <--
16 condition in an advanced state caused by injury, disease or
17 physical illness that will, in the opinion of the attending
18 physician to a reasonable degree of medical certainty, result in
19 death regardless of the continued application of life-sustaining
20 treatment.
21 § 5423. Legislative findings and intent.
22 (a) Intent.--This chapter provides a statutory means for
23 competent adults to control their health care through
24 instructions written in advance or by health care agents or
25 health care representatives and requested orders. Nothing in
26 this chapter is intended to:
27 (1) condone, authorize or approve mercy killing,
28 euthanasia or aided suicide; or
29 (2) permit any affirmative or deliberate act or omission
30 to end life other than as defined in this chapter.
20050S0628B1943 - 20 -
1 (b) Presumption not created.--This chapter does not create
2 any presumption regarding the intent of an individual who has
3 not executed an advance health care directive to consent to the
4 use or withholding of life-sustaining treatment in the event of
5 a terminal condition or state of permanent unconsciousness. AN <--
6 END-STAGE MEDICAL CONDITION OR IN THE EVENT THE INDIVIDUAL IS
7 PERMANENTLY UNCONSCIOUS.
8 (c) Findings in general.--The General Assembly finds that <--
9 individuals have a qualified right to make decisions relating to
10 their own health care. This right is subject to certain THAT: <--
11 (1) INDIVIDUALS HAVE A QUALIFIED RIGHT TO MAKE DECISIONS
12 RELATING TO THEIR OWN HEALTH CARE.
13 (2) THIS RIGHT IS SUBJECT TO CERTAIN interests of
14 society, such as the maintenance of ethical standards in the
15 medical profession and the preservation and protection of <--
16 human life. Modern medical technological PROTECTION OF HUMAN <--
17 LIFE.
18 (3) MODERN MEDICAL TECHNOLOGICAL procedures make
19 possible the prolongation of human life beyond natural <--
20 limits. The application of some procedures to an NATURAL <--
21 LIMITS.
22 (4) THE APPLICATION OF SOME PROCEDURES TO AN individual
23 suffering a difficult and uncomfortable process of dying may
24 cause loss of dignity and secure only continuation of a
25 precarious and burdensome prolongation of life.
26 (5) IT IS IN THE BEST INTEREST OF INDIVIDUALS UNDER THE <--
27 CARE OF HEALTH CARE PROVIDERS IF HEALTH CARE PROVIDERS
28 INITIATE DISCUSSIONS WITH THEM REGARDING LIVING WILLS AND
29 HEALTH CARE POWERS OF ATTORNEY DURING INITIAL CONSULTATIONS,
30 ANNUAL EXAMINATIONS, AT DIAGNOSIS OF A CHRONIC ILLNESS OR
20050S0628B1943 - 21 -
1 WHEN AN INDIVIDUAL UNDER THEIR CARE TRANSFERS FROM ONE HEALTH
2 CARE SETTING TO ANOTHER, SO THAT THE INDIVIDUALS UNDER THEIR
3 CARE MAY MAKE KNOWN THEIR WISHES TO RECEIVE, CONTINUE,
4 DISCONTINUE OR REFUSE MEDICAL TREATMENT IN THE EVENT THAT
5 THEY ARE DIAGNOSED WITH AN END-STAGE MEDICAL CONDITION OR
6 BECOME PERMANENTLY UNCONSCIOUS.
7 (6) HEALTH CARE PROVIDERS SHOULD INITIATE SUCH
8 DISCUSSIONS, INCLUDING DISCUSSION OF OUT-OF-HOSPITAL DO-NOT-
9 RESUSCITATE ORDERS, WITH INDIVIDUALS UNDER THEIR CARE AT THE
10 TIME OF DIAGNOSIS OF AN END-STAGE MEDICAL CONDITION AND
11 SHOULD DOCUMENT SUCH DISCUSSION IN THE INDIVIDUAL'S MEDICAL
12 RECORD.
13 § 5424. Compliance.
14 (a) Notification by attending physician or health care
15 provider.--If an attending physician or other health care
16 provider cannot in good conscience comply with a living will or
17 health care decision of a health care agent or health care
18 representative or if the policies of a health care provider
19 preclude compliance with a living will or health care decision
20 of a health care agent or health care representative, the
21 attending physician or health care provider shall so inform the
22 following:
23 (1) The principal, if the principal is competent.
24 (2) The family, guardian or other representative of the
25 principal, if the principal is incompetent and a health care
26 agent is not named in the advance health care directive.
27 (3) The health care agent of the principal.
28 (4) The health care representative.
29 (b) Transfer.--The attending physician or health care
30 provider under subsection (a) shall make every reasonable effort
20050S0628B1943 - 22 -
1 to assist in the transfer of the principal to another physician
2 or health care provider who will comply with the living will or
3 health care decision of the health care agent or health care
4 representative.
5 (c) Employee or staff member of health care provider.--
6 (1) An employee or a staff member of a health care
7 provider may not be required to participate in the
8 withholding or withdrawal of life-sustaining treatment.
9 (2) A health care provider that is an employer may not
10 discharge or in any other manner discriminate against its
11 employee or staff member who informs the employer of a wish <--
12 AS A RESULT OF INFORMING THE EMPLOYER OF THE EMPLOYEE'S <--
13 CHOICE not to participate in the withholding or withdrawal of
14 life-sustaining treatment.
15 (3) A health care provider that is an employer may
16 require its employee or staff member to express in writing
17 the wishes or unwillingness of the employee or staff member
18 as set forth in this subsection.
19 (d) Liability.--If transfer under subsection (b) is
20 impossible, the provision of life-sustaining treatment to a
21 principal may not subject an attending physician or a health
22 care provider to criminal or civil liability or administrative
23 sanction for failure to carry out either the provisions of a
24 living will or a health care decision of a health care agent or
25 health care representative.
26 § 5425. Conflicting advance health care directives.
27 If a provision of an advance health care directive conflicts
28 with a provision of another advance health care directive, the
29 provision of the instrument latest in date of execution shall
30 prevail to the extent of the conflict unless the instruments
20050S0628B1943 - 23 -
1 expressly provide otherwise.
2 § 5426. Death not suicide or homicide.
3 The withholding or withdrawal of life-sustaining treatment
4 from a principal or patient resulting in death, in accordance
5 with the provisions of this chapter, shall not, for any purpose,
6 constitute suicide or homicide.
7 § 5427. Life insurance.
8 The making of or failure to make an advance health care
9 directive, to request an order or to designate or disqualify a
10 health care representative in accordance with this chapter shall
11 not affect in any manner the sale, procurement or issuance of a
12 policy of life insurance nor shall it be deemed to modify the
13 terms of an existing policy of life insurance. No policy of life
14 insurance shall be legally impaired or invalidated in any manner
15 by the withholding or withdrawal of life-sustaining treatment
16 from an insured individual, notwithstanding a term of the policy
17 to the contrary.
18 § 5428. Health care instruments optional.
19 A health care provider, a health care service plan, a health
20 maintenance organization, an insurer issuing disability
21 insurance, a self-insured employee welfare benefit plan, a
22 nonprofit hospital plan and a Federal, State or local government
23 sponsored or operated program may not:
24 (1) Require an individual to execute an advance health
25 care directive or order or to designate or disqualify a
26 health care representative as a condition for being insured
27 for or receiving health care services.
28 (2) Charge an individual a different rate or fee whether
29 or not the individual executes or has executed an advance
30 health care directive or order or designated or disqualified
20050S0628B1943 - 24 -
1 a health care representative.
2 § 5429. Pregnancy.
3 (a) Living wills and health care decisions.--Notwithstanding
4 the existence of a living will, a health care decision by a
5 health care representative or health care agent or any other
6 direction to the contrary, life-sustaining treatment, nutrition
7 and hydration shall be provided to a pregnant woman who is
8 incompetent and has a terminal condition AN END-STAGE MEDICAL <--
9 CONDITION or who is permanently unconscious unless, to a
10 reasonable degree of medical certainty as certified on the
11 pregnant woman's medical record by the pregnant woman's
12 attending physician and an obstetrician who has examined the
13 pregnant woman, life-sustaining treatment, nutrition and
14 hydration:
15 (1) will not maintain the pregnant woman 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 woman; or
19 (3) will cause pain to the pregnant woman that cannot be
20 alleviated by medication.
21 (b) Rule for orders.--Notwithstanding the existence of an
22 order or direction to the contrary, life-sustaining treatment,
23 cardiopulmonary resuscitation, nutrition and hydration shall be
24 provided to a pregnant patient unless, to a reasonable degree of
25 medical certainty as certified on the pregnant patient's medical
26 record by the attending physician and an obstetrician who has
27 examined the pregnant patient, life-sustaining treatment,
28 nutrition and hydration:
29 (1) will not maintain the pregnant patient in such a way
30 as to permit the continuing development and live birth of the
20050S0628B1943 - 25 -
1 unborn child;
2 (2) will be physically harmful to the pregnant patient;
3 or
4 (3) would cause pain to the pregnant patient that cannot
5 be alleviated by medication.
6 (c) Pregnancy test.--Nothing in this chapter shall require a
7 physician to perform a pregnancy test unless the physician has
8 reason to believe that the woman may be pregnant.
9 (d) Payment of expenses by Commonwealth.--
10 (1) In the event that treatment, cardiopulmonary
11 resuscitation, nutrition and hydration are provided to a
12 pregnant woman, notwithstanding the existence of a living
13 will, health care decision by a health care representative or
14 health care agent, order or direction to the contrary, the
15 Commonwealth shall pay all usual, customary and reasonable
16 expenses directly, indirectly and actually incurred by the
17 pregnant woman to whom such treatment, cardiopulmonary
18 resuscitation, nutrition and hydration are provided.
19 (2) The Commonwealth shall have the right of subrogation
20 against all moneys paid by any third-party health insurer on
21 behalf of the pregnant woman.
22 (3) The expenditures incurred on behalf of the pregnant
23 woman constitute a grant, and a lien may not be placed upon
24 the property of the pregnant woman, her estate or her heirs.
25 § 5430. Effect of divorce.
26 (a) General rule.--If the spouse of a principal is
27 designated as the principal's health care agent and thereafter
28 either spouse files an action in divorce, the designation of the
29 spouse as health care agent shall be revoked as of the time the
30 action is filed unless it clearly appears from the advance
20050S0628B1943 - 26 -
1 health care directive that the designation was intended to
2 continue to be effective notwithstanding the filing of an action
3 in divorce by either spouse.
4 (b) Construction.--A revocation under this section shall not
5 be construed to invalidate an advance health care directive
6 unless its terms expressly direct otherwise.
7 § 5431. Liability.
8 (a) General rule.--A health care provider or another person
9 that acts in good faith and consistent with this chapter may not
10 be subject to criminal or civil liability, discipline for
11 unprofessional conduct or administrative sanctions and may not
12 be found to have committed an act of unprofessional conduct as a
13 result of any of the following:
14 (1) Causing or participating in the initiating,
15 continuing, withholding or withdrawal of life-sustaining
16 treatment or cardiopulmonary resuscitation from a patient or
17 principal, if the patient's or principal's health care
18 provider has followed the patient's or principal's wishes as
19 expressed in a living will, order or revocation made under
20 this chapter.
21 (2) Complying with a direction or decision of an
22 individual who the health care provider believes in good
23 faith has authority to act as a principal's health care agent
24 or health care representative so long as the direction or
25 decision is not clearly contrary to the terms of the health
26 care power of attorney.
27 (3) Refusing to comply with a direction or decision of
28 an individual based on a good faith belief that the
29 individual lacks authority to act as a principal's health
30 care agent OR HEALTH CARE REPRESENTATIVE. <--
20050S0628B1943 - 27 -
1 (4) Complying with a health care power of attorney under
2 the assumption that it was valid when made and the person
3 reasonably believes that it has not been amended or revoked.
4 (5) Disclosing health care information to another person
5 based upon a good faith belief that the disclosure is
6 authorized, permitted or required by this chapter.
7 (6) REFUSING TO COMPLY WITH A DIRECTION OR DECISION OF <--
8 AN INDIVIDUAL BASED ON A GOOD FAITH BELIEF THAT COMPLIANCE
9 WITH THE DIRECTION OR DECISION WOULD BE UNETHICAL OR, TO A
10 REASONABLE DEGREE OF MEDICAL CERTAINTY, WOULD RESULT IN
11 MEDICAL CARE HAVING NO MEDICAL BASIS IN ADDRESSING ANY
12 MEDICAL NEED OR CONDITION OF THE PATIENT.
13 (b) Same effect as if dealing with principal.--Any health
14 care provider and other person acting under subsection (a) is
15 protected and released to the same extent as if dealing directly
16 with a competent principal.
17 (c) Health care agent.--No health care agent acting
18 according to the terms of a health care power of attorney shall
19 be subject to civil or criminal liability for acting in good
20 faith for a principal or failing in good faith to act for a
21 principal.
22 (d) Health care representative.--No health care
23 representative who in good faith acts or fails in good faith to
24 act for the principal shall be subject to civil or criminal
25 liability for the action or failure to act.
26 § 5432. Criminal penalties.
27 (a) Criminal homicide.--A person shall be subject to
28 prosecution for criminal homicide as provided in 18 Pa.C.S. Ch.
29 25 (relating to criminal homicide), if the person intends to
30 cause the withholding or withdrawal of life-sustaining treatment
20050S0628B1943 - 28 -
1 contrary to the wishes of the principal or patient and, because
2 of that action, directly causes life-sustaining treatment to be
3 withheld or withdrawn and death to be hastened and:
4 (1) falsifies or forges the advance health care
5 directive, order, bracelet or necklace of that principal or
6 patient; or
7 (2) willfully conceals or withholds personal knowledge
8 of a revocation of an advance health care directive or DNR
9 status.
10 (b) Interference with health care directive.--A person
11 commits a felony of the third degree if that person willfully:
12 (1) conceals, cancels, alters, defaces, obliterates or
13 damages an advance health care directive, order, bracelet or
14 necklace without the consent of the principal or patient;
15 (2) causes a person to execute an advance health care
16 directive or order or wear a bracelet or necklace by undue
17 influence, fraud or duress; or
18 (3) falsifies or forges an advance health care
19 directive, order, bracelet or necklace or any amendment or
20 revocation thereof, the result of which is a direct change in
21 the health care provided to the principal or patient.
22 § 5433. Forms.
23 (a) Substance of forms.--
24 (1) An advance health care directive may be in the form
25 provided under Subchapter D (relating to combined form) or in
26 any other written form that contains the information required
27 under Subchapters B (relating to living wills) and C
28 (relating to health care agents and representatives).
29 (2) A commonwealth agency that licenses health care
30 providers or regulates health care may not prescribe a
20050S0628B1943 - 29 -
1 mandatory form of an advance health care directive.
2 (b) Combining forms.--A living will and health care power of
3 attorney may be combined into one document.
4 SUBCHAPTER B
5 LIVING WILLS
6 Sec.
7 5441. Short title of subchapter.
8 5442. Execution.
9 5443. When living will operative.
10 5444. Revocation.
11 5445. Emergency medical services.
12 5446. Validity.
13 5447. Form.
14 § 5441. Short title of subchapter.
15 This subchapter shall be known and may be cited as the Living
16 Will Act.
17 § 5442. Execution.
18 (a) Who may make.--An individual of sound mind may make a
19 living will governing the initiation, continuation, withholding
20 or withdrawal of life-sustaining treatment if the individual:
21 (1) is 18 years of age or older;
22 (2) has graduated from high school; or <--
23 (3) has married; OR <--
24 (4) IS AN EMANICPATED MINOR.
25 (b) Requirements.--A living will shall be:
26 (1) dated and signed by the principal by signature or
27 mark or by another individual on behalf of and at the
28 direction of the principal if the principal is unable to
29 sign, but specifically directs another individual to sign the
30 living will; and
20050S0628B1943 - 30 -
1 (2) witnessed by two individuals, each of whom is 18
2 years of age or older.
3 (c) Witnesses.--
4 (1) An individual who signs a living will on behalf of
5 and at the direction of a principal may not witness the
6 living will.
7 (2) A health care provider and its agent may not sign a
8 living will on behalf of and at the direction of a principal
9 if the health care provider or agent provides health care
10 services to the principal.
11 § 5443. When living will operative.
12 (a) When operative.--A living will becomes operative when:
13 (1) a copy is provided to the attending physician; and
14 (2) the principal is determined by the attending
15 physician to be incompetent and in a terminal condition or in <--
16 a state of permanent unconsciousness. TO HAVE AN END-STAGE <--
17 MEDICAL CONDITION OR TO BE PERMANENTLY UNCONSCIOUS, IF THE
18 LIVING WILL PROVIDES THAT IT WILL BECOME OPERATIVE UNDER SUCH
19 CIRCUMSTANCES.
20 (b) Compliance.--When a living will becomes operative, the
21 attending physician and other health care providers shall act in
22 accordance with its provisions or comply with the transfer
23 provisions of section 5424 (relating to compliance).
24 (c) Invalidity of specific direction.--If a specific
25 direction in a living will is held to be invalid, the invalidity
26 does not negate other directions in the living will that can be
27 effected without the invalid direction.
28 (d) Medical record.--Any health care provider to whom a copy
29 of a living will is furnished shall make it a part of the
30 medical record of the principal and, if unwilling to comply with
20050S0628B1943 - 31 -
1 the living will, promptly so advise the principal, OR THE <--
2 PRINCIPAL'S HEALTH CARE AGENT OR REPRESENTATIVE.
3 (e) Duration.--Unless a living will states a time of
4 termination, it is valid until revoked by the principal,
5 notwithstanding the lapse of time since its execution.
6 (f) Absence of living will.--If an individual does not make
7 a living will, a presumption does not arise regarding the intent
8 of the individual to consent to or to refuse the initiation,
9 continuation, withholding or withdrawal of life-sustaining
10 treatment.
11 (g) Duty of physician to certify terminal condition END- <--
12 STAGE MEDICAL CONDITION.--Without delay after a diagnosis that
13 the principal is in a terminal condition or in a state of <--
14 permanent unconsciousness, HAS AN END-STAGE MEDICAL CONDITION OR <--
15 IS PERMANENTLY UNCONSCIOUS, the attending physician shall
16 certify in writing that the principal is in a terminal condition <--
17 or in a state of permanent unconsciousness. PRINCIPAL HAS AN <--
18 END-STAGE MEDICAL CONDITION OR IS PERMANENTLY UNCONSCIOUS.
19 § 5444. Revocation.
20 (a) When living will may be revoked.--A living will may be
21 revoked at any time and in any manner by the principal
22 regardless of the mental or physical condition of the principal.
23 (b) Effect of revocation.--A revocation is effective upon
24 communication to the attending physician or other health care
25 provider by the principal or a witness to the revocation.
26 (c) Medical record.--The attending physician or other health
27 care provider shall make the revocation part of the medical
28 record of the principal.
29 § 5445. Emergency medical services.
30 (a) General rule.--An emergency medical services provider
20050S0628B1943 - 32 -
1 shall, in the course of providing care to a principal, at all
2 times comply with the instructions of an authorized medical
3 command physician to withhold or discontinue cardiopulmonary
4 resuscitation for a principal whose living will has become
5 operative under section 5443(a) (relating to when living will
6 operative).
7 (b) Applicability.--This section is applicable only in those
8 instances where an out-of-hospital DNR order is not in effect
9 under section 5474 5484 (relating to orders, bracelets and <--
10 necklaces).
11 § 5446. Validity.
12 (a) Living will executed prior to effective date of
13 subchapter.--This subchapter does not limit the validity of a
14 living will executed prior to the effective date of this
15 subchapter.
16 (b) Living will executed in another state or jurisdiction.--
17 A living will executed in another state or jurisdiction and in
18 conformity with the laws of that state or jurisdiction shall be
19 considered valid in this Commonwealth, except to the extent that
20 the living will executed in another state or jurisdiction would
21 allow a principal to direct procedures inconsistent with the
22 laws of this Commonwealth.
23 § 5447. Form.
24 A living will may be in any written form expressing the
25 wishes of a principal regarding the initiation, continuation,
26 withholding or withdrawal of life-sustaining treatment and may
27 include other specific directions, including, but not limited
28 to, designation of a health care agent to make health care
29 decisions for the principal if the principal is DETERMINED TO BE <--
30 incompetent and determined to be either in a terminal condition <--
20050S0628B1943 - 33 -
1 or permanently TO HAVE AN END-STAGE MEDICAL CONDITION OR IS <--
2 PERMANENTLY unconscious. An example of a living will appears in
3 the combined form set forth in Subchapter D (relating to
4 combined form).
5 SUBCHAPTER C
6 HEALTH CARE AGENTS AND REPRESENTATIVES
7 Sec.
8 5451. Short title of subchapter.
9 5452. Execution.
10 5453. Requirements and options.
11 5454. When health care power of attorney operative.
12 5455. Appointment of health care agents.
13 5456. Authority of health care agent.
14 5457. Countermand.
15 5458. Amendment.
16 5459. Revocation.
17 5460. Relation of health care agent to court-appointed
18 guardian and other agents.
19 5461. Decisions by health care representative.
20 5462. Duties of attending physician and health care provider.
21 5463. Effect on other State law.
22 5464. Validity.
23 5465. Form.
24 § 5451. Short title of subchapter.
25 This subchapter shall be known and may be cited as the Health
26 Care Agents and Representatives Act.
27 § 5452. Execution.
28 (a) Who may make.--An individual of sound mind may make a
29 health care power of attorney if the individual:
30 (1) is 18 years of age or older;
20050S0628B1943 - 34 -
1 (2) has graduated from high school; or <--
2 (3) has married; OR <--
3 (4) IS AN EMANCIPATED MINOR.
4 (b) Requirements.--A health care power of attorney must be:
5 (1) dated and signed by the principal by signature or
6 mark or by another individual on behalf of and at the
7 direction of the principal if the principal is unable to
8 sign, but specifically directs another individual to sign the
9 health care power of attorney; and
10 (2) witnessed by two individuals, each of whom is 18
11 years of age or older.
12 (c) Witnesses.--
13 (1) An individual who signs a health care power of
14 attorney on behalf of and at the direction of a principal may
15 not witness the health care power of attorney.
16 (2) A health care provider and its agent may not sign a
17 health care power of attorney on behalf of and at the
18 direction of a principal if the health care provider or agent
19 provides health care services to the principal.
20 § 5453. Requirements and options.
21 (a) General rule.--A health care power of attorney shall:
22 (1) Identify the principal and appoint the health care
23 agent.
24 (2) Declare that the principal authorizes the health
25 care agent to make health care decisions on behalf of the
26 principal.
27 (b) Optional provisions.--A health care power of attorney
28 may, but need not:
29 (1) Describe any limitations that the principal imposes
30 upon the authority of the health care agent.
20050S0628B1943 - 35 -
1 (2) Indicate the intent of the principal regarding the
2 initiation, continuation, withholding or withdrawal of life-
3 sustaining treatment.
4 (3) Indicate whether the principal wants tube feeding or
5 any other artificial or invasive form of nutrition or
6 hydration.
7 (4) Disqualify an individual from acting as a health
8 care representative, prohibit the appointment of a health
9 care representative or provide for an order of priority of
10 appointment of a health care representative pursuant to
11 section 5461(d) (relating to decisions by health care
12 representative).
13 (5) Nominate a guardian of the person of the principal
14 as provided in section 5460 (relating to relation of health
15 care agent to court-appointed guardian and other agents).
16 (6) Contain other provisions as the principal may
17 specify regarding the implementation of health care decisions
18 and related actions by the health care agent or health care
19 representative.
20 (7) Request that the health care agent or health care
21 representative exercise his sole and absolute discretion to
22 consult the principal's relative, cleric or physician should
23 the health care agent or health care representative be
24 uncertain of the principal's wishes or best interests.
25 § 5454. When health care power of attorney operative.
26 (a) When operative.--Unless otherwise specified in the
27 health care power of attorney, a health care power of attorney
28 becomes operative when:
29 (1) a copy is provided to the attending physician; and
30 (2) the attending physician determines that the
20050S0628B1943 - 36 -
1 principal is unable to make or communicate health care <--
2 decisions. IS INCOMPETENT. <--
3 (b) When inoperative.--Unless otherwise specified in the
4 health care power of attorney, a health care power of attorney
5 becomes inoperative during such time as, in the determination of
6 the attending physician, the principal has the ability to make <--
7 and communicate health care decisions. IS COMPETENT. <--
8 (c) Invalidity of specific direction.--If a specific
9 direction in the health care power of attorney is held to be
10 invalid, the invalidity does not negate other directions in the
11 health care power of attorney that can be effected without the
12 invalid direction.
13 (d) Duration.--Unless the health care power of attorney
14 states a time of termination, it is valid until revoked by the
15 principal or the principal's guardian of the person,
16 notwithstanding the lapse of time since its execution.
17 (e) Court approval unnecessary.--A health care decision made
18 by a health care agent for a principal is effective without
19 court approval.
20 § 5455. Appointment of health care agents.
21 (a) Multiple and successor health care agents.--A principal
22 may appoint the following in a health care power of attorney:
23 (1) More than one health care agent who shall act
24 jointly unless the health care power of attorney expressly
25 provides otherwise.
26 (2) One or more successor agents who shall serve in the
27 order named in the health care power of attorney, unless the
28 principal expressly directs to the contrary.
29 (b) Who may not be appointed health care agent.--Unless
30 related to the principal by blood, marriage or adoption, a
20050S0628B1943 - 37 -
1 health care agent of the principal may not be any of the
2 following:
3 (1) The principal's attending physician or other health
4 care provider.
5 (2) An owner, operator or employee of a health care
6 provider in which the principal is receiving care.
7 § 5456. Authority of health care agent.
8 (a) Extent of authority.--Except as expressly provided
9 otherwise in a health care power of attorney and subject to
10 subsection (b) and section 5460 (relating to relation of health
11 care agent to court-appointed guardian and other agents), a
12 health care agent shall have the authority to make any health
13 care decision and to exercise any right and power regarding the
14 principal's care, custody and health care treatment that the
15 principal could have made and exercised. The health care agent's
16 authority may extend beyond the principal's death to make
17 anatomical gifts, dispose of the remains and consent to
18 autopsies.
19 (b) Life-sustaining treatment decisions.--A life-sustaining
20 treatment decision made by a health care agent is subject to
21 this section and sections 5429 (relating to pregnancy), 5454
22 (relating to when health care power of attorney operative) and
23 5462(a) (relating to duties of attending physician and health
24 care provider).
25 (c) Health care decisions.--After consultation with health <--
26 care providers and after consideration of the prognosis and
27 acceptable medical alternatives regarding diagnosis, treatments
28 and side effects, the health care agent shall make health care
29 decisions in accordance with the health care agent's
30 understanding and interpretation of the instructions given by
20050S0628B1943 - 38 -
1 the principal at a time when the principal had the capacity to
2 make and communicate health care decisions. Instructions include
3 an advance health care directive made by the principal and any
4 clear written or verbal directions that cover the situation
5 presented. In the absence of instructions, the health care agent
6 shall make health care decisions conforming with the health care
7 agent's assessment of the principal's preferences and values,
8 including religious and moral beliefs. If the health care agent
9 does not know enough about the principal's instructions,
10 preferences and values to decide accordingly, the health care
11 agent shall act in accordance with the health care agent's
12 assessment of the principal's best interests.
13 (C) HEALTH CARE DECISIONS.-- <--
14 (1) THE HEALTH CARE AGENT SHALL GATHER INFORMATION ON
15 THE PRINCIPAL'S PROGNOSIS AND ACCEPTABLE MEDICAL ALTERNATIVES
16 REGARDING DIAGNOSIS, TREATMENTS AND SUPPORTIVE CARE. THIS
17 INFORMATION SHALL INCLUDE THE BENEFITS, RISKS AND POTENTIAL
18 SIDE EFFECTS OF EACH ALTERNATIVE. THE INFORMATION SHALL
19 DISTINGUISH BETWEEN CURATIVE ALTERNATIVES, PALLIATIVE
20 ALTERNATIVES AND ALTERNATIVES WHICH WILL MERELY SERVE TO
21 PROLONG THE PROCESS OF DYING. THE INFORMATION SHALL ALSO
22 DISTINGUISH BETWEEN THE PRINCIPAL'S END-STAGE MEDICAL
23 CONDITION AND ANY OTHER CONCURRENT DISEASE, ILLNESS OR
24 PHYSICAL, MENTAL, COGNITIVE OR INTELLECTUAL CONDITION THAT
25 PREDATED THE PRINCIPAL'S END-STATE MEDICAL CONDITION.
26 (2) AFTER CONSULTATION WITH HEALTH CARE PROVIDERS AND
27 AFTER CONSIDERATION OF THE PROGNOSIS AND ACCEPTABLE MEDICAL
28 ALTERNATIVES REGARDING DIAGNOSIS, TREATMENTS AND SIDE
29 EFFECTS, THE HEALTH CARE AGENT SHALL MAKE HEALTH CARE
30 DECISIONS IN ACCORDANCE WITH THE HEALTH CARE AGENT'S
20050S0628B1943 - 39 -
1 UNDERSTANDING AND INTERPRETATION OF THE INSTRUCTIONS GIVEN BY
2 THE PRINCIPAL AT A TIME WHEN THE PRINCIPAL HAD THE CAPACITY
3 TO MAKE AND COMMUNICATE HEALTH CARE DECISIONS. INSTRUCTIONS
4 INCLUDE AN ADVANCE HEALTH CARE DIRECTIVE MADE BY THE
5 PRINCIPAL AND ANY CLEAR WRITTEN OR VERBAL DIRECTIONS THAT
6 COVER THE SITUATION PRESENTED.
7 (3) (I) IN THE ABSENCE OF INSTRUCTION, THE HEALTH CARE
8 AGENT SHALL MAKE HEALTH CARE DECISIONS CONFORMING WITH
9 THE HEALTH CARE AGENT'S ASSESSMENT OF THE PRINCIPAL'S
10 PREFERENCES AND VALUES, INCLUDING RELIGIOUS AND MORAL
11 BELIEFS.
12 (II) IF THE HEALTH CARE AGENT DOES NOT KNOW ENOUGH
13 ABOUT THE PRINCIPAL'S INSTRUCTIONS, PREFERENCES AND
14 VALUES TO DECIDE ACCORDINGLY, THE HEALTH CARE AGENT SHALL
15 ACT IN ACCORDANCE WITH THE HEALTH CARE AGENT'S ASSESSMENT
16 OF THE PRINCIPAL'S BEST INTERESTS.
17 (4) THE HEALTH CARE PROVIDER SHALL DOCUMENT THE
18 INFORMATION PROVIDED IN THE PRINCIPAL'S MEDICAL RECORD.
19 (d) Health care information.--
20 (1) Unless specifically provided otherwise in a health
21 care power of attorney, a health care agent has the same
22 rights and limitations as the principal to request, examine,
23 copy and consent or refuse to consent to the disclosure of
24 medical or other health care information.
25 (2) Disclosure of medical or other health care
26 information to a health care agent does not constitute a
27 waiver of any evidentiary privilege or of a right to assert
28 confidentiality. A health care provider that discloses such
29 information to a health care agent in good faith shall not be
30 liable for the disclosure. A health care agent may not
20050S0628B1943 - 40 -
1 disclose health care information regarding the principal
2 except as is reasonably necessary to perform the agent's
3 obligations to the principal or as otherwise required by law.
4 § 5457. Countermand.
5 (a) Competent principal.--A principal of sound mind may
6 countermand any health care decision made by the principal's
7 health care agent at any time and in any manner by personally
8 informing the attending physician or health care provider.
9 (b) Incompetent principal.--Regardless of the principal's
10 mental or physical capacity, a principal may countermand a
11 health care decision made by the principal's health care agent
12 that would withhold or withdraw life-sustaining treatment at any
13 time and in any manner by personally informing the attending
14 physician.
15 (c) Attending physician.--The attending physician or health
16 care provider shall make reasonable efforts to promptly inform
17 the health care agent of a countermand under this section.
18 (d) Health care agent.--A countermand exercised under this
19 section shall not affect the authority of a health care agent to
20 make other health care decisions in accordance with the health
21 care power of attorney.
22 § 5458. Amendment.
23 While of sound mind, a principal may amend a health care
24 power of attorney by a writing executed in accordance with the
25 provisions of section 5452 (relating to execution). An amendment
26 may include the revocation in part of the health care power of
27 attorney or the designation of new or additional health care
28 agents.
29 § 5459. Revocation.
30 (a) When health care power of attorney may be revoked.--
20050S0628B1943 - 41 -
1 While of sound mind, a principal may revoke a health care power
2 of attorney by a writing executed in accordance with the
3 provisions of section 5452 (relating to execution) or by
4 personally informing the attending physician, health care
5 provider or health care agent that the health care power of
6 attorney is revoked.
7 (b) Reliance on health care power of attorney.--A health
8 care provider may rely on the effectiveness of a health care
9 power of attorney unless notified of its revocation.
10 (c) Subsequent action by agent.--A health care agent,
11 knowing of the revocation of the health care power of attorney,
12 may not make or attempt to make health care decisions for the
13 principal.
14 § 5460. Relation of health care agent to court-appointed
15 guardian and other agents.
16 (a) Accountability of health care agent.--If a principal who
17 has executed a health care power of attorney is later
18 adjudicated an incapacitated person and a guardian of the person
19 to make health care decisions is appointed by a court, the
20 health care agent is accountable to the guardian as well as to
21 the principal. The guardian shall have the same power to revoke
22 or amend the appointment of a health care agent that the
23 principal would have if the principal were not incapacitated but
24 may not revoke or amend other instructions in an advance health
25 directive absent judicial authorization.
26 (b) Nomination of guardian of person.--In a health care
27 power of attorney, a principal may nominate a guardian of the
28 person for the principal for consideration by a court if
29 incapacity proceedings for the principal's person are thereafter
30 commenced. If a court determines that the appointment of a
20050S0628B1943 - 42 -
1 guardian is necessary, the court shall appoint A GUARDIAN in <--
2 accordance with the principal's most recent nomination except
3 for good cause or disqualification.
4 (c) Reasonable expenses.--In fulfilling the health care
5 needs for a principal, a health care agent may incur reasonable
6 expenses, including the purchase of health care insurance, to
7 the extent the expenses are not otherwise covered by insurance
8 or other similar benefits. Payment for the expenses or
9 reimbursement to the health care agent for the expenses from the
10 principal's funds shall be made by either of the following:
11 (1) A guardian of the estate of the principal.
12 (2) An agent acting on behalf of the principal under a
13 power of attorney if the agent has the power to disburse the
14 funds of the principal.
15 § 5461. Decisions by health care representative.
16 (a) General rule.--A health care representative may make a
17 health care decision for an individual whose attending physician
18 has determined that the individual lacks the ability to make or <--
19 communicate health care decisions IS INCOMPETENT if: <--
20 (1) the individual is at least 18 years of age, has
21 graduated from high school or, has married OR IS AN <--
22 EMANCIPATED MINOR;
23 (2) (i) the individual does not have a health care
24 power of attorney; or
25 (ii) the individual's health care agent is not
26 reasonably available or has indicated an unwillingness to
27 act and no alternate health care agent is reasonably
28 available; and
29 (3) a guardian of the person to make health care
30 decisions has not been appointed for the individual.
20050S0628B1943 - 43 -
1 (b) Exception.--This section shall not apply to decisions <--
2 regarding treatment, care, goods or services that a caretaker is
3 obligated to provide to a care-dependent person pursuant to 18
4 Pa.C.S. § 2713 (relating to neglect of care-dependent person).
5 (B) LIMITATION.--THIS SECTION APPLIES TO DECISIONS REGARDING <--
6 TREATMENT, CARE, GOODS OR SERVICES THAT A CARETAKER IS OBLIGATED
7 TO PROVIDE TO A CARE-DEPENDENT PERSON WHO HAS AN END-STAGE
8 MEDICAL CONDITION OR IS PERMANENTLY UNCONSCIOUS AS PERMITTED
9 UNDER 18 PA.C.S. § 2713(E)(5) (RELATING TO NEGLECT OF CARE-
10 DEPENDENT PERSON).
11 (c) Extent of authority of health care representative.--The
12 authority of a health care representative shall be the same as
13 provided for a health care agent in section 5456 (relating to
14 authority of health care agent) and 5460(c) (relating to
15 relation of health care agent to court-appointed guardian and
16 other agents).
17 (d) Who may act as health care representative.--
18 (1) An individual of sound mind may, by a signed writing
19 or by personally informing the attending physician or the
20 health care provider, designate one or more individuals to
21 act as health care representative. In the absence of a
22 designation or if no designee is reasonably available any
23 member of the following classes, in descending order of
24 priority, who is reasonably available, may act as health care
25 representative:
26 (i) The spouse unless an action for divorce is
27 pending AND THE ADULT CHILDREN OF THE PRINCIPAL ARE NOT <--
28 THE CHILDREN OF THE SPOUSE.
29 (ii) An adult child.
30 (iii) A parent.
20050S0628B1943 - 44 -
1 (iv) An adult brother or sister.
2 (v) An adult grandchild.
3 (vi) An adult who has exhibited special care and <--
4 concern for the principal and who is familiar with the
5 principal's personal values. KNOWLEDGE OF THE PRINCIPAL'S <--
6 PREFERENCES AND VALUES, INCLUDING, BUT NOT LIMITED TO,
7 RELIGIOUS AND MORAL BELIEFS, TO ASSESS HOW THE PRINCIPAL
8 WOULD MAKE HEALTH CARE DECISIONS.
9 (2) An individual may by signed writing, including a
10 health care power of attorney, provide for a different order
11 of priority.
12 (3) An individual with a higher priority who is willing
13 to act as a health care representative may assume the
14 authority to act notwithstanding the fact that another
15 individual has previously assumed that authority.
16 (e) Disqualification.--An individual of sound mind may
17 disqualify one or more individuals from acting as health care
18 representative in the same manner as specified under subsection
19 (d) for the designation of a health care representative. An
20 individual may also disqualify one or more individuals from
21 acting as health care representative by a health care power of
22 attorney. Upon the petition of any member of the classes set
23 forth in subsection (d), the court may disqualify for cause
24 shown an individual otherwise eligible to serve as a health care
25 representative.
26 (f) Limitation on designation of health care
27 representative.--Unless related by blood, marriage or adoption,
28 a health care representative may not be the principal's
29 attending physician or other health care provider, nor an owner,
30 operator or employee of a health care provider in which the
20050S0628B1943 - 45 -
1 principal receives care.
2 (g) Decision of health care representative.--
3 (1) If more than one member of a class assumes authority
4 to act as a health care representative, the members do not
5 agree on a health care decision and the attending physician
6 or health care provider is so informed, the attending
7 physician or health care provider may rely on the decision of
8 a majority of the members of that class who have communicated
9 their views to the attending physician or health care
10 provider.
11 (2) If the members of the class of health care
12 representatives are evenly divided concerning the health care
13 decision and the attending physician or health care provider
14 is so informed, an individual having a lower priority may not
15 act as a health care representative. So long as the class
16 remains evenly divided, no decision shall be deemed made
17 until such time as the parties resolve their disagreement.
18 Notwithstanding such disagreement, nothing in this subsection
19 shall be construed to preclude the administration of health
20 care treatment in accordance with accepted standards of
21 medical practice.
22 (h) Duty of health care representative.--Immediately <--
23 PROMPTLY upon assuming authority to act, a health care <--
24 representative shall communicate the assumption of authority to
25 the members of the principal's family specified in subsection
26 (d) who can be readily contacted.
27 (i) Countermand of health care decision.--
28 (1) A principal of sound mind may countermand any health
29 care decision made by the principal's health care
30 representative at any time and in any manner by personally
20050S0628B1943 - 46 -
1 informing the attending physician or health care provider.
2 (2) Regardless of the principal's mental or physical
3 capacity, a principal may countermand a health care decision
4 made by the principal's health care representative that would
5 withhold or withdraw life-sustaining treatment at any time
6 and in any manner by personally informing the attending
7 physician.
8 (3) The attending physician or health care provider
9 shall make reasonable efforts to promptly inform the health
10 care representative of a countermand exercised under this
11 section.
12 (4) A countermand exercised under this section shall not
13 affect the authority of the health care representative to
14 make other health care decisions.
15 (j) Court approval unnecessary.--A health care decision made
16 by a health care representative for a principal shall be
17 effective without court approval.
18 (k) Written declaration of health care representative.--An
19 attending physician or health care provider may require a person
20 claiming the right to act as health care representative for a
21 principal to provide a written declaration made under penalty of
22 perjury stating facts and circumstances reasonably sufficient to
23 establish the claimed authority.
24 § 5462. Duties of attending physician and health care provider.
25 (a) Duty to certify terminal condition END-STAGE MEDICAL <--
26 CONDITION.--Without delay after a diagnosis that a principal is <--
27 in a terminal condition or in a state of permanent
28 unconsciousness HAS AN END-STAGE MEDICAL CONDITION OR IS <--
29 PERMANENTLY UNCONSCIOUS, the attending physician shall certify
30 in writing that the principal is in a terminal condition or in a <--
20050S0628B1943 - 47 -
1 state of permanent unconsciousness. HAS AN END-STAGE MEDICAL <--
2 CONDITION OR IS PERMANENTLY UNCONSCIOUS.
3 (b) Communication of health care decision.--Whenever
4 possible before implementing a health care decision made by a
5 health care representative or health care agent, an attending
6 physician or health care provider shall promptly communicate to
7 the principal the decision and the identity of the person making
8 the decision.
9 (c) Compliance with decisions of health care agent and
10 health care representative.--
11 (1) Subject to any limitation specified in the health <--
12 care power of attorney, an attending physician or health care
13 provider shall comply with a health care decision made by a
14 health care agent or health care representative to the same
15 extent as if the decision had been made by the principal.
16 Health care necessary to preserve life shall be provided to
17 an individual who is neither in a terminal condition nor
18 permanently unconscious except if the individual is competent
19 and objects to such care or a health care agent objects on
20 behalf of the principal.
21 (1) HEALTH CARE NECESSARY TO PRESERVE LIFE SHALL BE <--
22 PROVIDED TO AN INDIVIDUAL WHO HAS NEITHER AN END-STAGE
23 MEDICAL CONDITION NOR IS PERMANENTLY UNCONSCIOUS, EXCEPT IF
24 THE INDIVIDUAL IS COMPETENT AND OBJECTS TO SUCH CARE OR A
25 HEALTH CARE AGENT OBJECTS ON BEHALF OF THE PRINCIPAL IF
26 AUTHORIZED TO DO SO BY THE HEALTH CARE POWER OF ATTORNEY OR
27 LIVING WILL. IN EVERY OTHER CASE, SUBJECT TO ANY LIMITATION
28 SPECIFIED IN THE HEALTH CARE POWER OF ATTORNEY, AN ATTENDING
29 PHYSICIAN OR HEALTH CARE PROVIDER SHALL COMPLY WITH A HEALTH
30 CARE DECISION MADE BY A HEALTH CARE AGENT OR HEALTH CARE
20050S0628B1943 - 48 -
1 REPRESENTATIVE TO THE SAME EXTENT AS IF THE DECISION HAD BEEN
2 MADE BY THE PRINCIPAL.
3 (2) In all circumstances, this subsection shall be
4 construed so as to be consistent with the Americans with
5 Disabilities Act of 1990 (Public Law 101-336, 104 Stat. 327).
6 (d) Medical record.--
7 (1) An attending physician or health care provider who
8 is given a health care power of attorney shall arrange for
9 the health care power of attorney or a copy to be placed in
10 the medical record of the principal.
11 (2) An attending physician or health care provider to
12 whom an amendment or revocation of a health care power of
13 attorney is communicated shall promptly enter the information
14 in the medical record of the principal and maintain a copy if
15 one is furnished.
16 (e) Record of determination.--An attending physician who
17 determines that a principal is unable or has regained the <--
18 ability to make and communicate health care decisions
19 INCOMPETENT OR HAS BECOME COMPETENT or makes a determination <--
20 that affects the authority of a health care agent shall enter
21 the determination in the medical record of the principal and, if
22 possible, promptly inform the principal and any health care
23 agent of the determination.
24 § 5463. Effect on other State law.
25 (a) Mental health.--This subchapter does not affect the
26 requirements of other laws of this Commonwealth regarding
27 consent to observation, diagnosis, treatment or hospitalization
28 for a mental illness.
29 (b) Prohibited care.--This subchapter does not authorize a
30 health care agent OR HEALTH CARE REPRESENTATIVE to consent to <--
20050S0628B1943 - 49 -
1 any health care prohibited by the laws of this Commonwealth.
2 (c) Consent.--This subchapter does not affect the laws of
3 this Commonwealth regarding any of the following:
4 (1) The standard of care of a health care provider
5 required in the administration of health care.
6 (2) When consent is required for health care.
7 (3) Informed consent for health care.
8 (4) Consent to health care in an emergency.
9 (d) Preservation of religious rights.--This subchapter does
10 not prevent a health care agent or health care representative
11 from consenting to health care administered in good faith
12 pursuant to religious beliefs of the principal or from
13 withholding consent to health care that is contrary to religious
14 beliefs of the principal.
15 (e) Rights of individuals.--This subchapter does not affect
16 the right of an individual to make health care decisions.
17 (f) Disclosure.--The disclosure requirements of section
18 5456(d) (relating to authority of health care agent) supersede
19 any provision in any other State statute or regulation that
20 requires the principal to consent to disclosure or which
21 otherwise conflicts with section 5456(d), including, but not
22 limited to, the following:
23 (1) Section 8 of the act of April 14, 1972 (P.L.221,
24 No.63), known as the Pennsylvania Drug and Alcohol Abuse
25 Control Act.
26 (2) Section 111 of the act of July 9, 1976 (P.L.817,
27 No.143), known as the Mental Health Procedures Act.
28 (3) Section 15 of the act of October 5, 1978 (P.L.1109,
29 No.261), known as the Osteopathic Medical Practice Act.
30 (4) Section 41 of the act of December 20, 1985 (P.L.457,
20050S0628B1943 - 50 -
1 No.112), known as the Medical Practice Act of 1985.
2 (5) Section 7 of the act of November 29, 1990 (P.L.585,
3 No.148), known as the Confidentiality of HIV-Related
4 Information Act.
5 § 5464. Validity.
6 This subchapter does not limit the validity of a health care <--
7 power of attorney executed prior to the effective date of this
8 subchapter. A health care power of attorney executed in another
9 state or jurisdiction and in conformity with the laws of that
10 state or jurisdiction shall be considered valid in this
11 Commonwealth, except to the extent that the health care power of
12 attorney executed in another state or jurisdiction would allow a
13 health care agent to make a health care decision inconsistent
14 with the laws of this Commonwealth.
15 § 5465. Form.
16 A health care power of attorney may be in any written form
17 identifying the principal, appointing a health care agent and
18 declaring that the principal authorizes the health care agent to
19 make health care decisions on behalf of the principal. An
20 example of a health care power of attorney appears in the
21 combined form set forth in Subchapter D (relating to combined
22 form).
23 SUBCHAPTER D
24 COMBINED FORM
25 Sec.
26 5471. Example.
27 § 5471. Example.
28 The following is an example of a document that combines a
29 living will and health care power of attorney:
30 DURABLE HEALTH CARE POWER OF ATTORNEY
20050S0628B1943 - 51 -
1 AND HEALTH CARE TREATMENT INSTRUCTIONS
2 (LIVING WILL)
3 PART I
4 INTRODUCTORY REMARKS ON
5 HEALTH CARE DECISION MAKING
6 You have the right to decide the type of health care you
7 want.
8 Should you become unable to make or communicate decisions
9 about medical care, your wishes for medical treatment are
10 most likely to be followed if you express those wishes in
11 advance by:
12 (1) naming an agent to decide treatment for you; and
13 (2) giving health care treatment instructions to
14 your agent or health care provider.
15 An advance health care directive is a written set of
16 instructions expressing your wishes for medical treatment. It
17 may contain a health care power of attorney, where you name a
18 person called an "agent" A "HEALTH CARE AGENT" to decide <--
19 treatment for you, and a living will, where you tell your
20 agent and health care providers YOUR CHOICES REGARDING THE <--
21 INITIATION, CONTINUATION, WITHHOLDING OR WITHDRAWAL OF LIFE-
22 SUSTAINING TREATMENT to limit health care treatments if you
23 are terminally ill or HAVE AN END-STAGE MEDICAL CONDITION, <--
24 HAVE AN ADVANCED PROGRESSIVE CONDITION THAT CAUSES YOU TO
25 BECOME IRREVERSIBLY INCOMPETENT AND COMPLETELY PHYSICALLY
26 DEPENDENT (END-STAGE CONDITION) OR ARE permanently
27 unconscious.
28 You may limit your agent's involvement in deciding your
29 medical treatment so that your agent will speak for you only
30 when you are unable to speak for yourself. A LIVING WILL <--
20050S0628B1943 - 52 -
1 CANNOT BE FOLLOWED UNLESS YOUR ATTENDING PHYSICIAN DETERMINES
2 THAT YOU LACK THE ABILITY TO MAKE AND COMMUNICATE HEALTH CARE
3 DECISIONS FOR YOURSELF. A HEALTH CARE POWER OF ATTORNEY WILL
4 GO INTO EFFECT IN ACCORDANCE WITH THE TERMS AND CONDITIONS
5 YOU EXPRESSLY PROVIDE IN THAT HEALTH CARE POWER OF ATTORNEY.
6 You, and not your agent, remain responsible for the cost of
7 your medical care.
8 If you do not write down your wishes about your health
9 care in advance, and if later you become unable to make or
10 communicate these decisions, those wishes may not be honored
11 because they may remain unknown to others.
12 A health care provider who refuses to honor your wishes
13 about health care must tell you of its refusal and help to
14 transfer you to a health care provider who will honor your
15 wishes.
16 You should give a copy of your advance health care
17 directive (A LIVING WILL, HEALTH CARE POWER OF ATTORNEY OR A <--
18 DOCUMENT CONTAINING BOTH) to your agent, your physician <--
19 PHYSICIANS, FAMILY MEMBERS and others whom you expect would <--
20 likely attend to your needs if you become unable to make or
21 communicate decisions about medical care. If your health care
22 wishes change, tell your physician and write a new advance
23 health care directive to replace your old one.
24 You may wish to consult with knowledgeable, trusted
25 individuals such as family members, your physician or clergy
26 when considering an expression of your values and health care
27 wishes. You are free to create your own advance health care
28 directive to convey your wishes regarding medical treatment.
29 The following form is an example of an advance health care
30 directive that combines a health care power of attorney with
20050S0628B1943 - 53 -
1 a living will.
2 NOTES ABOUT THE USE OF THIS FORM
3 If you decide to use this form or create your own advance
4 health care directive, you should consult with your physician
5 and your attorney to make sure that your wishes are clearly
6 expressed and comply with the law.
7 If you decide to use this form but disagree with any of
8 its statements, you may cross out those statements.
9 You may add comments to this form or your own form to
10 help your physician or agent decide your medical care.
11 This form is designed to give your agent broad powers to
12 make health care decisions for you whenever you cannot make
13 them for yourself. It is also designed to express a desire to
14 limit OR AUTHORIZE care if you suffer from a terminal <--
15 condition HAVE AN END-STAGE MEDICAL CONDITION or are <--
16 permanently unconscious. If you do not desire to give your
17 agent broad powers, or you do not wish to limit your care if
18 you are terminally ill or HAVE AN END-STAGE MEDICAL CONDITION <--
19 OR ARE permanently unconscious, you may wish to use a
20 different form or create your own. YOU SHOULD ALSO USE A
21 DIFFERENT FORM IF YOU WISH TO EXPRESS YOUR PREFERENCES IN
22 MORE DETAIL THAN THIS FORM ALLOWS. In these situations, it is
23 particularly important that you consult with your attorney
24 and physician to make sure that your wishes are clearly
25 expressed.
26 This form allows you to tell your agent your goals if you
27 suffer from a terminal illness HAVE AN END-STAGE MEDICAL <--
28 CONDITION or other extreme and irreversible medical
29 condition, such as advanced Alzheimer's disease. Do you want
30 medical care applied aggressively in these situations or
20050S0628B1943 - 54 -
1 would you consider such aggressive medical care burdensome
2 and undesirable?
3 You may choose whether you want your agent to be bound by
4 your instructions or whether you want your agent to be able
5 to decide at the time what course of treatment the agent
6 thinks most fully reflects your wishes and values.
7 IF YOU ARE A WOMAN AND DIAGNOSED AS BEING PREGNANT AT THE <--
8 TIME A HEALTH CARE DECISION WOULD OTHERWISE BE MADE PURSUANT
9 TO THIS FORM, THE LAWS OF THIS COMMONWEALTH PROHIBIT
10 IMPLEMENTATION OF THAT DECISION IF IT DIRECTS THAT LIFE-
11 SUSTAINING TREATMENT, NUTRITION AND HYDRATION BE WITHHELD OR
12 WITHDRAWN FROM YOU, UNLESS YOUR ATTENDING PHYSICIAN AND AN
13 OBSTETRICIAN WHO HAVE EXAMINED YOU CERTIFY IN YOUR MEDICAL
14 RECORD THAT THE LIFE-SUSTAINING TREATMENT:
15 (1) WILL NOT MAINTAIN YOU IN SUCH A WAY AS TO PERMIT THE
16 CONTINUING DEVELOPMENT AND LIVE BIRTH OF THE UNBORN CHILD;
17 (2) WILL BE PHYSICALLY HARMFUL TO YOU; OR
18 (3) WILL CAUSE PAIN TO YOU THAT CANNOT BE ALLEVIATED BY
19 MEDICATION.
20 A PHYSICIAN IS NOT REQUIRED TO PERFORM A PREGNANCY TEST ON YOU
21 UNLESS THE PHYSICIAN HAS REASON TO BELIEVE THAT YOU MAY BE
22 PREGNANT.
23 Pennsylvania law protects your agent and health care
24 providers from any legal liability for following in good
25 faith your wishes as expressed in the form or by your agent's
26 direction. It does not otherwise change professional
27 standards or excuse negligence in the way your wishes are
28 carried out. If you have any questions about the law, consult
29 an attorney for guidance.
30 This form and explanation is not intended to take the
20050S0628B1943 - 55 -
1 place of specific legal or medical advice for which you
2 should rely upon your own attorney and physician.
3 PART II
4 DURABLE HEALTH CARE POWER OF ATTORNEY
5 I,........................, of....................
6 County, Pennsylvania, appoint the person named below to be my
7 HEALTH CARE agent to make health and personal care decisions <--
8 for me.
9 Effective immediately and continuously until my death or
10 revocation by a writing signed by me or someone authorized to
11 make health care treatment decisions for me, I authorize all
12 health care providers or other covered entities to disclose
13 to my agent, upon my agent's request, any information, oral
14 or written, regarding my physical or mental health,
15 including, but not limited to, medical and hospital records
16 and what is otherwise private, privileged, protected or
17 personal health information, such as health information as
18 defined and described in the Health Insurance Portability and
19 Accountability Act of 1996 (Public Law 104-191, 110 Stat.
20 2024), the regulations promulgated thereunder and any other
21 State or local laws and rules. Information disclosed by a
22 health care provider or other covered entity may be
23 redisclosed and may no longer be subject to the privacy rules
24 provided by 45 C.F.R. Pt. 164.
25 The remainder of this document will take effect when and
26 only when I lack sufficient capacity THE ABILITY to make or <--
27 communicate a choice regarding a health or personal care
28 decision as verified by my attending physician. My agent may
29 not delegate the authority to make decisions.
30 MY AGENT HAS ALL OF THE FOLLOWING POWERS SUBJECT TO THE
20050S0628B1943 - 56 -
1 HEALTH CARE TREATMENT INSTRUCTIONS THAT FOLLOW IN PART III
2 (CROSS OUT ANY POWERS YOU DO NOT WANT TO GIVE YOUR AGENT):
3 1. To authorize, withhold or withdraw medical care and
4 surgical procedures.
5 2. To authorize, withhold or withdraw nutrition (food)
6 or hydration (water) medically supplied by tube through my
7 nose, stomach, intestines or veins.
8 3. To authorize my admission to or discharge from a
9 medical, nursing, residential or similar facility and to make
10 agreements for my care and health insurance for my care,
11 including hospice and/or palliative care.
12 4. To hire and fire medical, social service and other
13 support personnel responsible for my care.
14 5. To take any legal action necessary to do what I have
15 directed.
16 6. To request that a physician responsible for my care
17 issue a do-not-resuscitate (DNR) order, including an out-of-
18 hospital DNR order, and sign any required documents and
19 consents.
20 APPOINTMENT OF AGENT
21 I appoint the following agent:
22 Agent:...............................................
23 (Name and relationship)
24 Address:.............................................
25 .....................................................
26 Telephone Number: Home............. Work............
27 YOU ARE NOT REQUIRED TO APPOINT AN AGENT. IF YOU DO NOT WISH
28 TO APPOINT AN AGENT, WRITE "NONE" IN THE ABOVE SPACE. IF YOU
29 DO NOT NAME AN AGENT, HEALTH CARE PROVIDERS WILL ASK YOUR
30 FAMILY OR AN ADULT WHO HAS EXHIBITED SPECIAL CARE AND CONCERN <--
20050S0628B1943 - 57 -
1 FOR YOU FOR HELP IN DETERMINING YOUR WISHES FOR TREATMENT.
2 NOTE THAT YOU MAY NOT APPOINT YOUR DOCTOR OR OTHER HEALTH
3 CARE PROVIDER AS YOUR AGENT UNLESS RELATED TO YOU BY BLOOD,
4 MARRIAGE OR ADOPTION.
5 If my agent is not readily available or if my agent is my
6 spouse and an action for divorce is filed by either of us
7 after the date of this document, I appoint the person or
8 persons named below in the order named. (It is helpful, but
9 not required, to name alternative agents.)
10 First Alternative Agent:.............................
11 (Name and relationship)
12 Address:.............................................
13 .....................................................
14 Telephone Number: Home............. Work............
15 Second Alternative Agent:............................
16 (Name and relationship)
17 Address:.............................................
18 .....................................................
19 Telephone Number: Home............. Work............
20 GUIDANCE FOR AGENT (OPTIONAL)
21 GOALS
22 If I suffer from a terminal illness HAVE AN END-STAGE <--
23 MEDICAL CONDITION or other extreme irreversible medical
24 condition, my goals in making medical decisions are as
25 follows (insert your personal priorities such as comfort,
26 care, preservation of mental function, etc.):......... ......
27 .............................................................
28 .............................................................
29 .............................................................
30 SEVERE BRAIN DAMAGE OR BRAIN DISEASE
20050S0628B1943 - 58 -
1 If I should suffer from severe and irreversible brain
2 damage or brain disease with no realistic hope of significant
3 recovery, I would consider such a condition intolerable and
4 the application of aggressive medical care to be burdensome.
5 I therefore request that my agent respond to any intervening
6 (other and separate) life-threatening conditions in the same
7 manner as directed for a terminal condition AN END-STAGE <--
8 MEDICAL CONDITION or state of permanent unconsciousness as I
9 have indicated below.
10 Initials..............I agree
11 Initials..............I disagree
12 PART III
13 HEALTH CARE TREATMENT INSTRUCTIONS IN THE EVENT
14 OF TERMINAL CONDITION <--
15 END-STAGE MEDICAL CONDITION <--
16 OR PERMANENT UNCONSCIOUSNESS
17 (LIVING WILL)
18 The following health care treatment instructions exercise
19 my right to make decisions concerning my health care. These
20 instructions are intended to provide clear and convincing
21 evidence of my wishes to be followed when I lack the capacity
22 to make or communicate my treatment decisions:
23 IF I SUFFER FROM A TERMINAL CONDITION OR A STATE OF <--
24 PERMANENT IF I HAVE AN END-STAGE MEDICAL CONDITION OR AM <--
25 PERMANENTLY UNCONSCIOUS SUCH AS AN IRREVERSIBLE COMA OR AN
26 IRREVERSIBLE VEGETATIVE STATE AND THERE IS NO REALISTIC HOPE
27 OF SIGNIFICANT RECOVERY, ALL OF THE FOLLOWING APPLY (CROSS
28 OUT ANY TREATMENT INSTRUCTIONS WITH WHICH YOU DO NOT AGREE):
29 1. I direct that I be given health care treatment to
30 relieve pain or provide comfort even if such treatment might
20050S0628B1943 - 59 -
1 shorten my life, suppress my appetite or my breathing, or be
2 habit forming.
3 2. I direct that all life prolonging procedures be
4 withheld or withdrawn.
5 3. I specifically do not want any of the following as
6 life prolonging procedures: (If you wish to receive any of
7 these treatments, write "I do want" after the treatment)
8 heart-lung resuscitation (CPR).......................
9 mechanical ventilator (breathing machine)............
10 dialysis (kidney machine)............................
11 surgery..............................................
12 chemotherapy.........................................
13 radiation treatment .................................
14 antibiotics..........................................
15 Please indicate whether you want nutrition (food) or
16 hydration (water) medically supplied by a tube into your
17 nose, stomach, intestine or veins if you suffer from a <--
18 terminal condition or a state of permanent HAVE AN END-STAGE <--
19 MEDICAL CONDITION OR ARE PERMANENTLY unconscious and there is
20 no realistic hope of significant recovery. (Initial only one
21 statement.)
22 TUBE FEEDINGS
23 ........I want tube feedings to be given
24 OR
25 NO TUBE FEEDINGS
26 ........I do not want tube feedings to be given.
27 AGENT'S USE OF INSTRUCTIONS (INITIAL ONE OPTION ONLY).
28 ........My agent must follow these instructions.
29 OR
30 ........These instructions are only guidance.
20050S0628B1943 - 60 -
1 My agent shall have final say and may override
2 any of my instructions. (Indicate any
3 exceptions)......................................
4 .................................................
5 If I did not appoint an agent, these instructions shall
6 be followed.
7 LEGAL PROTECTION
8 Pennsylvania law protects my agent and health care
9 providers from any legal liability for their good faith
10 actions in following my wishes as expressed in this form or
11 in complying with my agent's direction. On behalf of myself,
12 my executors and heirs, I further hold my agents and my
13 health care providers harmless and indemnify them against any
14 claim for their good faith actions in recognizing my agent's
15 authority or in following my treatment instructions.
16 ORGAN DONATION (INITIAL ONE OPTION ONLY.)
17 ........I consent to donate my organs and tissues at the
18 time of my death for the purpose of transplant,
19 medical study or education. (Insert any
20 limitations you desire on donation of specific
21 organs or tissues or uses for donation of organs
22 and tissues.)....................................
23 .................................................
24 OR
25 ........I do not consent to donate my organs or tissues
26 at the time of my death.
27 SIGNATURE
28 Having carefully read this document, I have signed it
29 this.......day of............., 20..., revoking all previous
30 health care powers of attorney and medical treatment
20050S0628B1943 - 61 -
1 instructions.
2 .............................................................
3 (SIGN FULL NAME HERE FOR HEALTH CARE POWER OF ATTORNEY AND
4 HEALTH CARE TREATMENT INSTRUCTIONS)
5 WITNESS:.......................
6 WITNESS:.......................
7 Two witnesses at least 18 years of age are required by
8 Pennsylvania law and should witness your signature in each
9 other's presence. A person who signs this document on behalf
10 of and at the direction of a principal may not be a witness.
11 (It is preferable if the witnesses are not your heirs, nor
12 your creditors, nor employed by any of your health care
13 providers.)
14 NOTARIZATION (OPTIONAL)
15 (Notarization of document is not required by Pennsylvania
16 law, but if the document is both witnessed and notarized, it
17 is more likely to be honored by the laws of some other
18 states.)
19 On this..........day of .............., 20...., before me
20 personally appeared the aforesaid declarant, to me known to
21 be the person described in and who executed the foregoing
22 instrument and acknowledged that he/she executed the same as
23 his/her free act and deed.
24 IN WITNESS WHEREOF, I have hereunto set my hand and
25 affixed my official seal in the County of............., State
26 of.............. the day and year first above written.
27 ............................... ........................
28 Notary Public My commission expires
29 SUBCHAPTER E
30 OUT-OF-HOSPITAL NONRESUSCITATION
20050S0628B1943 - 62 -
1 Sec.
2 5481. Short title of subchapter.
3 5482. Legislative findings and intent.
4 5483. Definitions.
5 5484. Orders, bracelets and necklaces.
6 5485. Revocation.
7 5486. Absence of order, bracelet or necklace.
8 5487. Emergency medical services.
9 5488. Advisory committee.
10 § 5481. Short title of subchapter.
11 This subchapter shall be known and may be cited as the Out-
12 of-Hospital Nonresuscitation Act.
13 § 5482. Legislative findings and intent.
14 The General Assembly finds and declares as follows:
15 (1) Although cardiopulmonary resuscitation has saved the
16 lives of individuals about to experience sudden, unexpected
17 death, present medical data indicates that cardiopulmonary
18 resuscitation rarely leads to prolonged survival in
19 individuals with terminal illnesses in whom death is
20 expected.
21 (2) In many circumstances, the performance of
22 cardiopulmonary resuscitation may inflict unwanted and
23 unnecessary pain and suffering.
24 (3) Existing emergency medical services protocols may
25 require emergency medical services personnel to proceed to
26 cardiopulmonary resuscitation when an individual is found in
27 a cardiac or respiratory arrest even if the individual has
28 completed an advance health care directive indicating that
29 the individual does not wish to receive cardiopulmonary
30 resuscitation.
20050S0628B1943 - 63 -
1 (4) The administration of cardiopulmonary resuscitation
2 by emergency medical services personnel to an individual with
3 an out-of-hospital do-not-resuscitate order offends the
4 dignity of the individual and conflicts with standards of
5 accepted medical practice.
6 (5) This subchapter provides clear direction to
7 emergency medical services personnel and other health care
8 providers in regard to the performance of cardiopulmonary
9 resuscitation.
10 § 5483. Definitions.
11 The following words and phrases when used in this subchapter
12 shall have the meanings given to them in this section unless the
13 context clearly indicates otherwise:
14 "Department." The Department of Health of the Commonwealth.
15 "Emergency medical services provider." A health care
16 provider recognized under the act of July 3, 1985 (P.L.164,
17 No.45), known as the Emergency Medical Services Act. The term
18 includes those individuals recognized under 42 Pa.C.S. § 8331.2
19 (relating to good Samaritan civil immunity for use of automated
20 external defibrillator).
21 "EMS." Emergency medical services.
22 "Health care provider." A person who is licensed, certified
23 or otherwise authorized by the laws of this Commonwealth to
24 administer or provide health care in the ordinary course of
25 business or practice of a profession. The term includes
26 personnel recognized under the act of July 3, 1985 (P.L.164,
27 No.45), known as the Emergency Medical Services Act, and those
28 individuals recognized under 42 Pa.C.S. § 8331.2 (relating to
29 good Samaritan civil immunity for use of automated external
30 defibrillator).
20050S0628B1943 - 64 -
1 "Out-of-hospital do-not-resuscitate bracelet." A bracelet in
2 the standard format set forth in section 5484 (relating to
3 orders, bracelets and necklaces), supplied by the department and
4 issued by the attending physician, which may be worn at the
5 patient's option to notify emergency medical services providers
6 of the presence of an order.
7 "Out-of-hospital do-not-resuscitate necklace." A necklace in
8 the standard format set forth in section 5484 (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 order." An order in the
14 standard format set forth in section 5484 (relating to orders,
15 bracelets and necklaces), supplied by the department and issued
16 by the attending physician, directing emergency medical services
17 providers to withhold cardiopulmonary resuscitation from the
18 patient in the event of respiratory or cardiac arrest.
19 "Out-of-hospital do-not-resuscitate patient." Any of the <--
20 following:
21 (1) An individual:
22 (i) who is in a terminal condition; and
23 (ii) who, pursuant to section 5484(a) (relating to
24 AN INDIVIDUAL WHO: <--
25 (1) HAS AN END-STAGE MEDICAL CONDITION OR IS PERMANENTLY
26 UNCONSCIOUS.
27 (2) PURSUANT TO SECTION 5484(A) (RELATING TO orders,
28 bracelets and necklaces), possesses and in any manner
29 displays or causes to be displayed for emergency medical
30 services providers an apparently valid order, bracelet or
20050S0628B1943 - 65 -
1 necklace.
2 (2) A principal: <--
3 (i) whose living will has become operative under
4 section 5443(a) (relating to when living will operative)
5 if the living will:
6 (A) provides that no cardiopulmonary
7 resuscitation shall be provided in the event of the
8 patient's cardiac or respiratory arrest if principal
9 becomes permanently unconscious;
10 (B) designates a surrogate to make that decision
11 under those circumstances; and
12 (ii) who, pursuant to section 5484(a) (relating to
13 orders, bracelets and necklaces) possesses and in any
14 manner displays or causes to be displayed for emergency
15 medical services providers an apparently valid order,
16 bracelet or necklace.
17 "Surrogate." A health care agent or a health care
18 representative.
19 § 5484. Orders, bracelets and necklaces.
20 (a) Issuance.--An attending physician, upon the request of a
21 patient who is at least 18 years of age, has graduated from high
22 school, has married or is an emancipated minor, or the patient's
23 surrogate if the surrogate is so authorized, shall issue to the
24 patient an order and may issue at the request of the patient or
25 the patient's surrogate a bracelet or necklace supplied by the
26 department. The patient may, at the patient's option, wear the
27 bracelet or display the order or necklace to notify emergency
28 medical services providers of the patient's DNR status.
29 (b) Format of order.--The department shall, with the advice
30 of the Pennsylvania Emergency Health Services Council and with
20050S0628B1943 - 66 -
1 the assistance of the regional emergency medical services
2 councils, make available standard orders for issuance to
3 patients by attending physicians of this Commonwealth. The form
4 of the order shall contain, but not be limited to, the
5 following:
6 PENNSYLVANIA OUT-OF-HOSPITAL
7 DO-NOT-RESUSCITATE ORDER
8 Patient's full legal name:
9 I, the undersigned, state that I am the attending
10 physician of the patient named above. The above-named
11 patient or the patient's surrogate has requested this
12 order, and I have made the determination that the patient
13 is eligible for an order and satisfies one of the
14 following:
15 .......... is in a terminal condition. ..........HAS <--
16 AN END-STAGE MEDICAL CONDITION.
17 .......... is permanently unconscious and has a
18 living will directing that no cardiopulmonary
19 resuscitation be provided to the patient in the event of
20 the patient's cardiac or respiratory arrest.
21 .......... is permanently unconscious and has a <--
22 living will authorizing ....... to request an out-of-
23 hospital do-not-resuscitate order for the patient.
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
20050S0628B1943 - 67 -
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 AND THAT <--
16 THEY MAY BE WITHDRAWN IF INITIATED. I understand that I
17 may revoke these directions at any time by giving verbal
18 instructions to the emergency medical services providers,
19 by physical cancellation or destruction of this form or
20 my bracelet or necklace or by simply not displaying this
21 form or the bracelet or necklace for my EMS caregivers.
22 Signature of surrogate (if patient is incapable of <--
23 making informed decisions):
24 SIGNATURE OF PATIENT (IF CAPABLE OF MAKING INFORMED <--
25 DECISIONS):
26 I, the undersigned, hereby certify that I am
27 authorized to execute this order on the patient's behalf
28 by virtue of having been designated as the patient's
29 surrogate and/or by virtue of my relationship to the
30 patient (specify relationship: .................). I
20050S0628B1943 - 68 -
1 hereby direct that in the event of the patient's cardiac
2 and/or respiratory arrest efforts at cardiopulmonary
3 resuscitation not be initiated AND BE WITHDRAWN IF <--
4 INITIATED.
5 SIGNATURE OF SURROGATE (IF PATIENT IS INCAPABLE OF MAKING
6 INFORMED DECISIONS):
7 (c) Format of bracelet.--The department shall, with the
8 advice of the Pennsylvania Emergency Health Services Council and
9 with the assistance of the regional emergency medical services
10 councils, make available standard bracelets for issuance to
11 patients by attending physicians. The bracelets shall be uniform
12 in design and shall, at a minimum, on the face clearly indicate
13 OUT-OF-HOSPITAL DNR and the name of the patient and attending
14 physician as well as the dated signature of the attending
15 physician.
16 (d) Format of necklace.--The department shall, with the
17 advice of the Pennsylvania Emergency Health Services Council and
18 with the assistance of the regional emergency medical services
19 councils, make available standard necklaces for issuance to
20 patients by attending physicians. The necklaces shall be uniform
21 in design and shall, at a minimum, on the face clearly indicate
22 OUT-OF-HOSPITAL DNR and the name of the patient and attending
23 physician as well as the dated signature of the attending
24 physician.
25 § 5485. Revocation.
26 (a) Patient.--If a patient has obtained an order, only the
27 patient may revoke the patient's DNR status.
28 (b) Surrogate.--If a surrogate has obtained an order, the
29 patient or the surrogate may revoke the A patient's status. <--
30 (c) Manner.--Revocation under this section may be done at
20050S0628B1943 - 69 -
1 any time without regard to the patient's physical or mental
2 condition and in any manner, including verbally or by destroying
3 or not displaying the order, bracelet or necklace.
4 § 5486. Absence of order, bracelet or necklace.
5 If an order has not been issued by an attending physician, a
6 presumption does not arise as to the intent of the patient <--
7 INDIVIDUAL to consent to or to refuse the initiation, <--
8 continuation or termination of life-sustaining treatment.
9 § 5487. Emergency medical services.
10 (a) Medical command instructions.--Notwithstanding the
11 absence of an order, bracelet or necklace pursuant to this
12 section, emergency medical services providers shall at all times
13 comply with the instructions of an authorized medical command
14 physician to withhold or discontinue resuscitation.
15 (b) Effect of order, bracelet or necklace.--
16 (1) Emergency medical services providers are authorized
17 to and shall comply with an order if made aware of the order
18 by examining a bracelet, a necklace or the order itself.
19 (2) Emergency medical services providers shall provide
20 other medical interventions necessary and appropriate to
21 provide comfort and alleviate pain, including intravenous
22 fluids, medications, oxygen and any other intervention
23 appropriate to the level of the certification of the
24 provider, unless otherwise directed by the patient or the
25 emergency medical services provider's authorized medical
26 command physician.
27 (3) As used in this subsection, the term "comply" means:
28 (i) to withhold cardiopulmonary resuscitation from
29 the patient in the event of respiratory or cardiac
30 arrest; or
20050S0628B1943 - 70 -
1 (ii) to discontinue and cease cardiopulmonary
2 resuscitation in the event the emergency medical services
3 provider is presented with an order or discovers a
4 necklace or bracelet after initiating cardiopulmonary
5 resuscitation.
6 (c) Uncertainty regarding validity or applicability of
7 order, bracelet or necklace.--
8 (1) Emergency medical services providers who in good
9 faith are uncertain about the validity or applicability of an
10 order, bracelet or necklace shall render care in accordance
11 with their level of certification.
12 (2) Emergency medical services providers who act under
13 paragraph (1) shall not be subject to civil or criminal
14 liability or administrative sanction for failure to comply
15 with an order under this section.
16 (d) Recognition of other states' orders.--Emergency medical
17 services or out-of-hospital DNR orders, bracelets or necklaces
18 valid in states other than this Commonwealth shall be recognized
19 in this Commonwealth to the extent that these orders, bracelets
20 or necklaces AND THE CRITERIA FOR THEIR ISSUANCES are consistent <--
21 with the laws of this Commonwealth. Emergency medical services
22 providers shall act in accordance with the provisions of this
23 section when encountering a patient with an apparently valid EMS
24 or out-of-hospital DNR form, bracelet or necklace issued by
25 another state. Emergency medical services providers acting in
26 good faith under this section shall be entitled to the same
27 immunities and protections that would otherwise be applicable.
28 § 5488. Advisory committee.
29 (a) Establishment.--Within 60 days of the effective date of
30 this section, the department shall establish a committee to
20050S0628B1943 - 71 -
1 advise it on regulating the mandatory use of ASSIST IT IN <--
2 DETERMINING THE ADVISABILITY OF USING a standardized form
3 containing orders by qualified physicians that detail the scope
4 of medical treatment for patients' life-sustaining wishes. By <--
5 regulation, the department may require that this form accompany
6 patients who are transferred from one regulated facility to
7 another and may allow attending physicians to amend, continue or
8 void the issuing physician's order or orders contained in the
9 form to assure its conformity with the wishes of the patient or
10 decisions of the health care agent or health care
11 representative.
12 (b) Membership.--The committee shall include representatives
13 from the Pennsylvania Medical Society, THE HOSPITAL AND HEALTH <--
14 SYSTEM ASSOCIATION OF PENNSYLVANIA, the Joint State Government
15 Commission's Advisory Committee on Decedents' Estates Laws and
16 the Pennsylvania Bar Association, THE DEPARTMENT OF AGING AND <--
17 THE DEPARTMENT OF PUBLIC WELFARE and other interested persons at
18 the department's discretion.
19 (C) SCOPE OF REVIEW.--THE COMMITTEE'S REVIEW SHALL INCLUDE, <--
20 BUT NOT BE LIMITED TO, EXAMINATION OF THE FOLLOWING:
21 (1) THE NEED TO ADOPT THIS TYPE OF STANDARDIZED FORM IN
22 VIEW OF THE EXISTING USE OF DO-NOT-RESUSCITATE ORDERS.
23 (2) THE USE AND EVALUATION OF USE OF SUCH FORMS IN OTHER
24 STATES.
25 (3) THE POTENTIAL FOR LOSS OF NUANCE OR INADVERTENT
26 ALTERATION OF A DECLARANT'S WISHES AS SET FORTH IN AN ADVANCE
27 DIRECTIVE WHEN TRANSLATING SUCH WISHES TO A STANDARDIZED
28 FORM.
29 (4) THE ADVANTAGES AND DISADVANTAGES OF HAVING A
30 STANDING MEDICAL ORDER ON A STANDARDIZED FORM THAT ELIMINATES
20050S0628B1943 - 72 -
1 THE NEED FOR A PHYSICIAN TO CONSULT WITH A PATIENT OR
2 SURROGATE OR A NURSE TO CONSULT WITH A PHYSICIAN ON MATTERS
3 THAT DO NOT REQUIRE IMMEDIATE ACTION.
4 (5) ANY OTHER MATTERS DETERMINED BY THE DEPARTMENT TO BE
5 RELEVANT TO ITS DETERMINATION.
6 Section 5. Chapter 54A of Title 20 is repealed. <--
7 SECTION 5. CHAPTER 54A OF TITLE 20 IS AMENDED TO READ: <--
8 [CHAPTER 54A. OUT-OF-HOSPITAL NONRESUSCITATION
9 § 54A01. SHORT TITLE OF CHAPTER.
10 THIS CHAPTER SHALL BE KNOWN AND MAY BE CITED AS THE DO-NOT-
11 RESUSCITATE ACT.
12 § 54A02. LEGISLATIVE FINDINGS AND INTENT.
13 THE GENERAL ASSEMBLY FINDS AND DECLARES AS FOLLOWS:
14 (1) ALTHOUGH CARDIOPULMONARY RESUSCITATION HAS SAVED THE
15 LIVES OF INDIVIDUALS ABOUT TO EXPERIENCE SUDDEN, UNEXPECTED
16 DEATH, PRESENT MEDICAL DATA INDICATES THAT CARDIOPULMONARY
17 RESUSCITATION RARELY LEADS TO PROLONGED SURVIVAL IN
18 INDIVIDUALS WITH TERMINAL ILLNESSES IN WHOM DEATH IS
19 EXPECTED.
20 (2) IN MANY CIRCUMSTANCES, THE PERFORMANCE OF
21 CARDIOPULMONARY RESUSCITATION MAY CAUSE INFLICTION OF
22 UNWANTED AND UNNECESSARY PAIN AND SUFFERING.
23 (3) EXISTING EMERGENCY MEDICAL SERVICES PROTOCOLS MAY
24 REQUIRE EMERGENCY MEDICAL SERVICES PERSONNEL TO PROCEED TO
25 CARDIOPULMONARY RESUSCITATION WHEN AN INDIVIDUAL IS FOUND IN
26 A CARDIAC OR RESPIRATORY ARREST EVEN IF THE INDIVIDUAL HAS
27 COMPLETED A LIVING WILL OR ADVANCE DIRECTIVE INDICATING THAT
28 THE INDIVIDUAL DOES NOT WISH TO RECEIVE CARDIOPULMONARY
29 RESUSCITATION.
30 (4) THE ADMINISTRATION OF CARDIOPULMONARY RESUSCITATION
20050S0628B1943 - 73 -
1 BY EMERGENCY MEDICAL SERVICES PERSONNEL TO AN INDIVIDUAL WITH
2 AN OUT-OF-HOSPITAL DO-NOT-RESUSCITATE ORDER OFFENDS THE
3 DIGNITY OF THE INDIVIDUAL AND CONFLICTS WITH STANDARDS OF
4 ACCEPTED MEDICAL PRACTICE.
5 (5) THIS CHAPTER PROVIDES CLEAR DIRECTION TO EMERGENCY
6 MEDICAL SERVICES PERSONNEL AND OTHER HEALTH CARE PROVIDERS IN
7 REGARD TO THE PERFORMANCE OF CARDIOPULMONARY RESUSCITATION.
8 (6) NOTHING IN THIS CHAPTER IS INTENDED TO CONDONE,
9 AUTHORIZE OR APPROVE MERCY KILLING, EUTHANASIA OR AIDED
10 SUICIDE OR TO PERMIT ANY AFFIRMATIVE OR DELIBERATE ACT OR
11 OMISSION TO END LIFE OTHER THAN AS DEFINED IN THIS CHAPTER.
12 § 54A03. 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 "ATTENDING PHYSICIAN." THE PHYSICIAN WHO HAS PRIMARY
17 RESPONSIBILITY FOR THE TREATMENT AND CARE OF THE PATIENT.
18 "BRACELET." AN OUT-OF-HOSPITAL DO-NOT-RESUSCITATE BRACELET.
19 "CARDIOPULMONARY RESUSCITATION." CARDIAC COMPRESSION,
20 INVASIVE AIRWAY TECHNIQUES, ARTIFICIAL VENTILATION,
21 DEFIBRILLATION AND OTHER RELATED PROCEDURES.
22 "DECLARANT." AS DEFINED IN SECTION 5403 (RELATING TO
23 DEFINITIONS).
24 "DECLARATION." AS DEFINED IN SECTION 5403 (RELATING TO
25 DEFINITIONS).
26 "DEPARTMENT." THE DEPARTMENT OF HEALTH OF THE COMMONWEALTH.
27 "DNR." DO NOT RESUSCITATE.
28 "EMERGENCY MEDICAL SERVICES PROVIDER." A HEALTH CARE
29 PROVIDER RECOGNIZED UNDER THE ACT OF JULY 3, 1985 (P.L.164,
30 NO.45), KNOWN AS THE EMERGENCY MEDICAL SERVICES ACT. THE TERM
20050S0628B1943 - 74 -
1 INCLUDES THOSE INDIVIDUALS RECOGNIZED UNDER 42 PA.C.S. § 8331.2
2 (RELATING TO GOOD SAMARITAN CIVIL IMMUNITY FOR USE OF AUTOMATED
3 EXTERNAL DEFIBRILLATOR).
4 "EMS." EMERGENCY MEDICAL SERVICES.
5 "HEALTH CARE PROVIDER." A PERSON WHO IS LICENSED OR
6 CERTIFIED BY THE LAWS OF THIS COMMONWEALTH TO ADMINISTER HEALTH
7 CARE IN THE ORDINARY COURSE OF BUSINESS OR PRACTICE OF A
8 PROFESSION. THE TERM INCLUDES PERSONNEL RECOGNIZED UNDER THE ACT
9 OF JULY 3, 1985 (P.L.164, NO.45), KNOWN AS THE EMERGENCY MEDICAL
10 SERVICES ACT. THE TERM INCLUDES THOSE INDIVIDUALS RECOGNIZED
11 UNDER 42 PA.C.S. § 8331.2 (RELATING TO GOOD SAMARITAN CIVIL
12 IMMUNITY FOR USE OF AUTOMATED EXTERNAL DEFIBRILLATOR).
13 "INCOMPETENT." THE LACK OF SUFFICIENT CAPACITY FOR A PERSON
14 TO MAKE OR COMMUNICATE DECISIONS CONCERNING HIMSELF.
15 "INVASIVE AIRWAY TECHNIQUE." ANY ADVANCED AIRWAY TECHNIQUE,
16 INCLUDING ENDOTRACHEAL INTUBATION.
17 "LIFE-SUSTAINING TREATMENT." ANY MEDICAL PROCEDURE OR
18 INTERVENTION THAT, WHEN ADMINISTERED TO A PATIENT, WILL SERVE
19 ONLY TO PROLONG THE PROCESS OF DYING OR TO MAINTAIN THE PATIENT
20 IN A STATE OF PERMANENT UNCONSCIOUSNESS. "LIFE-SUSTAINING
21 TREATMENT" SHALL INCLUDE NUTRITION AND HYDRATION ADMINISTERED BY
22 GASTRIC TUBE OR INTRAVENOUSLY OR ANY OTHER ARTIFICIAL OR
23 INVASIVE MEANS IF THE ORDER OF THE PATIENT SO SPECIFICALLY
24 PROVIDES.
25 "MEDICAL COMMAND PHYSICIAN." A LICENSED PHYSICIAN WHO IS
26 AUTHORIZED TO GIVE MEDICAL COMMAND UNDER THE ACT OF JULY 3, 1985
27 (P.L.164, NO.45), KNOWN AS THE EMERGENCY MEDICAL SERVICES ACT.
28 "NECKLACE." AN OUT-OF-HOSPITAL DO-NOT-RESUSCITATE NECKLACE.
29 "ORDER." AN OUT-OF-HOSPITAL DO-NOT-RESUSCITATE ORDER.
30 "OUT-OF-HOSPITAL DO-NOT-RESUSCITATE BRACELET." A BRACELET IN
20050S0628B1943 - 75 -
1 THE STANDARD FORMAT SET FORTH IN SECTION 54A04 (RELATING TO
2 ORDERS, BRACELETS AND NECKLACES), SUPPLIED BY THE DEPARTMENT AND
3 ISSUED BY THE ATTENDING PHYSICIAN, WHICH MAY BE WORN AT THE
4 PATIENT'S OPTION TO NOTIFY EMERGENCY MEDICAL SERVICES PROVIDERS
5 OF THE PRESENCE OF AN ORDER.
6 "OUT-OF-HOSPITAL DO-NOT-RESUSCITATE NECKLACE." A NECKLACE IN
7 THE STANDARD FORMAT SET FORTH IN SECTION 54A04 (RELATING TO
8 ORDERS, BRACELETS AND NECKLACES), SUPPLIED BY THE DEPARTMENT AND
9 ISSUED BY THE ATTENDING PHYSICIAN, WHICH MAY BE WORN AT THE
10 PATIENT'S OPTION TO NOTIFY EMERGENCY MEDICAL SERVICES PROVIDERS
11 OF THE PRESENCE OF AN ORDER.
12 "OUT-OF-HOSPITAL DO-NOT-RESUSCITATE ORDER." AN ORDER IN THE
13 STANDARD FORMAT SET FORTH IN SECTION 54A04 (RELATING TO ORDERS,
14 BRACELETS AND NECKLACES), SUPPLIED BY THE DEPARTMENT AND ISSUED
15 BY THE ATTENDING PHYSICIAN, DIRECTING EMERGENCY MEDICAL SERVICES
16 PROVIDERS TO WITHHOLD CARDIOPULMONARY RESUSCITATION FROM THE
17 PATIENT IN THE EVENT OF RESPIRATORY OR CARDIAC ARREST.
18 "OUT-OF-HOSPITAL DO-NOT-RESUSCITATE PATIENT." ANY OF THE
19 FOLLOWING:
20 (1) AN INDIVIDUAL:
21 (I) WHO IS IN A TERMINAL CONDITION; AND
22 (II) WHO, PURSUANT TO SECTION 54A04(A) (RELATING TO
23 ORDERS, BRACELETS AND NECKLACES), POSSESSES AND IN ANY
24 MANNER DISPLAYS OR CAUSES TO BE DISPLAYED FOR EMERGENCY
25 MEDICAL SERVICES PROVIDERS AN APPARENTLY VALID ORDER,
26 BRACELET OR NECKLACE.
27 (2) A DECLARANT:
28 (I) WHOSE DECLARATION HAS BECOME OPERATIVE UNDER
29 SECTION 5405(2) (RELATING TO WHEN DECLARATION BECOMES
30 OPERATIVE); AND
20050S0628B1943 - 76 -
1 (II) WHO, PURSUANT TO SECTION 54A04(A), POSSESSES
2 AND IN ANY MANNER DISPLAYS OR CAUSES TO BE DISPLAYED FOR
3 EMERGENCY MEDICAL SERVICES PROVIDERS AN APPARENTLY VALID
4 ORDER, BRACELET OR NECKLACE.
5 "PATIENT." AN OUT-OF-HOSPITAL DO-NOT-RESUSCITATE PATIENT.
6 "PERMANENTLY UNCONSCIOUS." A MEDICAL CONDITION THAT HAS BEEN
7 DIAGNOSED IN ACCORDANCE WITH CURRENTLY ACCEPTED MEDICAL
8 STANDARDS AND WITH REASONABLE MEDICAL CERTAINTY AS TOTAL AND
9 IRREVERSIBLE LOSS OF CONSCIOUSNESS AND CAPACITY FOR INTERACTION
10 WITH THE ENVIRONMENT. THE TERM INCLUDES, WITHOUT LIMITATION, A
11 PERSISTENT VEGETATIVE STATE OR IRREVERSIBLE COMA.
12 "PERSON." AN INDIVIDUAL, CORPORATION, PARTNERSHIP,
13 ASSOCIATION OR FEDERAL, STATE OR LOCAL GOVERNMENT OR
14 GOVERNMENTAL AGENCY.
15 "TERMINAL CONDITION." AN INCURABLE AND IRREVERSIBLE MEDICAL
16 CONDITION IN AN ADVANCED STATE CAUSED BY INJURY, DISEASE OR
17 PHYSICAL ILLNESS WHICH WILL, IN THE OPINION OF THE ATTENDING
18 PHYSICIAN, TO A REASONABLE DEGREE OF MEDICAL CERTAINTY RESULT IN
19 DEATH REGARDLESS OF THE CONTINUED APPLICATION OF LIFE-SUSTAINING
20 TREATMENT.
21 § 54A04. ORDERS, BRACELETS AND NECKLACES.
22 (A) ISSUANCE.--AN ATTENDING PHYSICIAN, UPON THE REQUEST OF A
23 PATIENT WHO IS AT LEAST 18 YEARS OF AGE, HAS GRADUATED FROM HIGH
24 SCHOOL OR HAS MARRIED, OR THE PATIENT'S SURROGATE IF THE
25 SURROGATE IS SO AUTHORIZED, SHALL ISSUE TO THE PATIENT AN ORDER
26 AND MAY ISSUE AT THE REQUEST OF THE PATIENT OR THE PATIENT'S
27 SURROGATE A BRACELET OR NECKLACE SUPPLIED BY THE DEPARTMENT. THE
28 PATIENT MAY, AT THE PATIENT'S OPTION, WEAR THE BRACELET OR
29 DISPLAY THE ORDER OR NECKLACE TO NOTIFY EMERGENCY MEDICAL
30 SERVICES PROVIDERS OF THE PATIENT'S DO-NOT-RESUSCITATE STATUS.
20050S0628B1943 - 77 -
1 (B) FORMAT OF ORDER.--THE DEPARTMENT SHALL, WITH THE ADVICE
2 OF THE PENNSYLVANIA EMERGENCY HEALTH SERVICES COUNCIL AND WITH
3 THE ASSISTANCE OF THE REGIONAL EMERGENCY MEDICAL SERVICES
4 COUNCILS, MAKE AVAILABLE WITHIN 180 DAYS OF THE EFFECTIVE DATE
5 OF THIS SUBSECTION STANDARD ORDERS FOR ISSUANCE TO PATIENTS BY
6 ATTENDING PHYSICIANS OF THIS COMMONWEALTH. THE FORM OF THE ORDER
7 SHALL CONTAIN, BUT NOT BE LIMITED TO, THE FOLLOWING:
8 PENNSYLVANIA OUT-OF-HOSPITAL
9 DO-NOT-RESUSCITATE ORDER
10 PATIENT'S FULL LEGAL NAME:
11 I, THE UNDERSIGNED, STATE THAT I AM THE ATTENDING
12 PHYSICIAN OF THE PATIENT NAMED ABOVE. THE ABOVE-NAMED
13 PATIENT HAS REQUESTED THIS ORDER, AND I HAVE MADE THE
14 DETERMINATION THAT THIS PATIENT IS IN A TERMINAL
15 CONDITION AND ELIGIBLE FOR AN ORDER.
16 I DIRECT ANY AND ALL EMERGENCY MEDICAL SERVICES
17 PERSONNEL, COMMENCING ON THE EFFECTIVE DATE OF THIS
18 ORDER, TO WITHHOLD CARDIOPULMONARY RESUSCITATION (CARDIAC
19 COMPRESSION, INVASIVE AIRWAY TECHNIQUES, ARTIFICIAL
20 VENTILATION, DEFIBRILLATION AND OTHER RELATED PROCEDURES)
21 FROM THE PATIENT IN THE EVENT OF THE PATIENT'S
22 RESPIRATORY OR CARDIAC ARREST. I FURTHER DIRECT SUCH
23 PERSONNEL TO PROVIDE TO THE PATIENT OTHER MEDICAL
24 INTERVENTIONS, SUCH AS INTRAVENOUS FLUIDS, OXYGEN OR
25 OTHER THERAPIES NECESSARY TO PROVIDE COMFORT CARE OR TO
26 ALLEVIATE PAIN, UNLESS DIRECTED OTHERWISE BY THE PATIENT
27 OR THE EMERGENCY MEDICAL SERVICES PROVIDER'S AUTHORIZED
28 MEDICAL COMMAND PHYSICIAN.
29 SIGNATURE OF ATTENDING PHYSICIAN:
30 PRINTED NAME OF ATTENDING PHYSICIAN:
20050S0628B1943 - 78 -
1 DATED:
2 ATTENDING PHYSICIAN'S EMERGENCY TELEPHONE NUMBER:
3 SIGNATURE OF PATIENT (IF CAPABLE OF MAKING INFORMED
4 DECISIONS):
5 I, THE UNDERSIGNED, HEREBY DIRECT THAT IN THE EVENT
6 OF MY CARDIAC AND/OR RESPIRATORY ARREST EFFORTS AT
7 CARDIOPULMONARY RESUSCITATION NOT BE INITIATED. I
8 UNDERSTAND THAT I MAY REVOKE THESE DIRECTIONS AT ANY TIME
9 BY GIVING VERBAL INSTRUCTIONS TO THE EMERGENCY MEDICAL
10 SERVICES PROVIDERS, BY PHYSICAL CANCELLATION OR
11 DESTRUCTION OF THIS FORM OR MY BRACELET OR NECKLACE OR BY
12 SIMPLY NOT DISPLAYING THIS FORM OR THE BRACELET OR
13 NECKLACE FOR MY EMS CAREGIVERS.
14 SIGNATURE OF SURROGATE (IF PATIENT IS INCAPABLE OF
15 MAKING INFORMED DECISIONS):
16 I, THE UNDERSIGNED, HEREBY CERTIFY THAT I AM
17 AUTHORIZED TO EXECUTE THIS ORDER ON THE PATIENT'S BEHALF
18 BY VIRTUE OF HAVING BEEN DESIGNATED AS THE PATIENT'S
19 SURROGATE AND/OR BY VIRTUE OF MY RELATIONSHIP TO THE
20 PATIENT (SPECIFY RELATIONSHIP: _________________). I
21 HEREBY DIRECT THAT IN THE EVENT OF THE PATIENT'S CARDIAC
22 AND/OR RESPIRATORY ARREST EFFORTS AT CARDIOPULMONARY
23 RESUSCITATION NOT BE INITIATED.
24 (C) FORMAT OF BRACELET.--THE DEPARTMENT SHALL, WITH THE
25 ADVICE OF THE PENNSYLVANIA EMERGENCY HEALTH SERVICES COUNCIL AND
26 WITH THE ASSISTANCE OF THE REGIONAL EMERGENCY MEDICAL SERVICES
27 COUNCILS, MAKE AVAILABLE WITHIN 180 DAYS OF THE EFFECTIVE DATE
28 OF THIS SUBSECTION STANDARD BRACELETS FOR ISSUANCE TO PATIENTS
29 BY ATTENDING PHYSICIANS. THE BRACELETS SHALL BE UNIFORM IN
30 DESIGN AND SHALL, AT A MINIMUM, ON THE FACE CLEARLY INDICATE
20050S0628B1943 - 79 -
1 OUT-OF-HOSPITAL DNR AND THE NAME OF THE PATIENT AND ATTENDING
2 PHYSICIAN AS WELL AS THE DATED SIGNATURE OF THE ATTENDING
3 PHYSICIAN.
4 (D) FORMAT OF NECKLACE.--THE DEPARTMENT SHALL, WITH THE
5 ADVICE OF THE PENNSYLVANIA EMERGENCY HEALTH SERVICES COUNCIL AND
6 WITH THE ASSISTANCE OF THE REGIONAL EMERGENCY MEDICAL SERVICES
7 COUNCILS, MAKE AVAILABLE WITHIN 180 DAYS OF THE EFFECTIVE DATE
8 OF THIS SUBSECTION STANDARD NECKLACES FOR ISSUANCE TO PATIENTS
9 BY ATTENDING PHYSICIANS. THE NECKLACES SHALL BE UNIFORM IN
10 DESIGN AND SHALL, AT A MINIMUM, ON THE FACE CLEARLY INDICATE
11 OUT-OF-HOSPITAL DNR AND THE NAME OF THE PATIENT AND ATTENDING
12 PHYSICIAN AS WELL AS THE DATED SIGNATURE OF THE ATTENDING
13 PHYSICIAN.
14 § 54A05. REVOCATION.
15 (A) PATIENT.--IF A PATIENT HAS OBTAINED AN ORDER, ONLY THE
16 PATIENT MAY REVOKE THE PATIENT'S DNR STATUS.
17 (B) SURROGATE.--IF A SURROGATE HAS OBTAINED AN ORDER, THE
18 PATIENT OR THE SURROGATE MAY REVOKE THE PATIENT'S STATUS.
19 (C) MANNER.--REVOCATION UNDER THIS SECTION MAY BE DONE AT
20 ANY TIME WITHOUT REGARD TO THE PATIENT'S PHYSICAL OR MENTAL
21 CONDITION AND IN ANY MANNER, INCLUDING VERBALLY OR BY DESTROYING
22 OR NOT DISPLAYING THE ORDER, BRACELET OR NECKLACE.
23 § 54A06. LIABILITY.
24 (A) GENERAL RULE.--NO PHYSICIAN, EMERGENCY MEDICAL SERVICES
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 OR
28 CARDIOPULMONARY RESUSCITATION FROM A PATIENT SHALL, AS A RESULT
29 OF SUCH ACTION, BE SUBJECT TO CRIMINAL OR CIVIL LIABILITY OR BE
30 FOUND TO HAVE COMMITTED AN ACT OF UNPROFESSIONAL CONDUCT IF THE
20050S0628B1943 - 80 -
1 ATTENDING PHYSICIAN, HEALTH CARE PROVIDER OR EMERGENCY MEDICAL
2 SERVICES PROVIDER HAS FOLLOWED THE PATIENT'S EXPRESSED WISHES IN
3 THE FORM OF A DECLARATION, ORDER OR REVOCATION EXECUTED PURSUANT
4 TO THIS CHAPTER.
5 (B) ABSENCE OF ORDER, BRACELET OR NECKLACE.--THE ABSENCE OF
6 AN ORDER, BRACELET OR NECKLACE BY A PATIENT SHALL NOT GIVE RISE
7 TO ANY PRESUMPTION AS TO THE INTENT OF THE PATIENT TO CONSENT TO
8 OR TO REFUSE THE INITIATION, CONTINUATION OR TERMINATION OF
9 LIFE-SUSTAINING TREATMENT.
10 § 54A07. EFFECT ON SUICIDE AND LIFE INSURANCE.
11 (A) CRIMINAL EFFECT.--THE WITHHOLDING OR WITHDRAWAL OF LIFE-
12 SUSTAINING TREATMENT FROM A PATIENT IN ACCORDANCE WITH THE
13 PROVISIONS OF THIS CHAPTER SHALL NOT, FOR ANY PURPOSE,
14 CONSTITUTE SUICIDE OR HOMICIDE.
15 (B) LIFE INSURANCE.--THE MAKING OF OR FAILURE TO MAKE AN
16 ORDER IN ACCORDANCE WITH THIS CHAPTER SHALL NOT AFFECT IN ANY
17 MANNER THE SALE, PROCUREMENT OR ISSUANCE OF ANY POLICY OF LIFE
18 INSURANCE NOR SHALL IT BE DEEMED TO MODIFY THE TERMS OF AN
19 EXISTING POLICY OF LIFE INSURANCE. NO POLICY OF LIFE INSURANCE
20 SHALL BE LEGALLY IMPAIRED OR INVALIDATED IN ANY MANNER BY THE
21 WITHHOLDING OR WITHDRAWAL OF LIFE-SUSTAINING TREATMENT FROM AN
22 INSURED PATIENT, NOTWITHSTANDING ANY TERM OF THE POLICY TO THE
23 CONTRARY.
24 § 54A08. ORDER OPTIONAL.
25 NO PHYSICIAN OR OTHER HEALTH CARE PROVIDER AND NO HEALTH CARE
26 SERVICE PLAN, HEALTH MAINTENANCE ORGANIZATION, INSURER ISSUING
27 DISABILITY INSURANCE, SELF-INSURED EMPLOYEE WELFARE BENEFIT
28 PLAN, NONPROFIT HOSPITAL PLAN OR FEDERAL, STATE OR LOCAL
29 GOVERNMENT-SPONSORED OR -OPERATED PROGRAM MAY:
30 (1) REQUIRE ANY PERSON TO EXECUTE AN ORDER AS A
20050S0628B1943 - 81 -
1 CONDITION FOR BEING INSURED FOR OR RECEIVING HEALTH CARE
2 SERVICES; OR
3 (2) CHARGE ANY PERSON A DIFFERENT RATE OR FEE WHETHER OR
4 NOT THE PERSON EXECUTES OR HAS EXECUTED AN ORDER.
5 § 54A09. PRESERVATION OF EXISTING RIGHTS.
6 THE PROVISIONS OF THIS CHAPTER SHALL NOT IMPAIR OR SUPERSEDE
7 ANY EXISTING RIGHTS OR RESPONSIBILITIES NOT ADDRESSED IN THIS
8 CHAPTER.
9 § 54A10. EMERGENCY MEDICAL SERVICES.
10 (A) MEDICAL COMMAND INSTRUCTIONS.--NOTWITHSTANDING THE
11 ABSENCE OF AN ORDER, BRACELET OR NECKLACE PURSUANT TO THIS
12 SECTION, EMERGENCY MEDICAL SERVICES PROVIDERS SHALL AT ALL TIMES
13 COMPLY WITH THE INSTRUCTIONS OF AN AUTHORIZED MEDICAL COMMAND
14 PHYSICIAN TO WITHHOLD OR DISCONTINUE RESUSCITATION.
15 (B) EFFECT OF ORDER, BRACELET OR NECKLACE.--
16 (1) EMERGENCY MEDICAL SERVICES PROVIDERS ARE AUTHORIZED
17 TO AND SHALL COMPLY WITH AN ORDER IF MADE AWARE OF THE ORDER
18 BY EXAMINING A BRACELET, A NECKLACE OR THE ORDER ITSELF.
19 (2) EMERGENCY MEDICAL SERVICES PROVIDERS SHALL PROVIDE
20 OTHER MEDICAL INTERVENTIONS NECESSARY AND APPROPRIATE TO
21 PROVIDE COMFORT AND ALLEVIATE PAIN, INCLUDING INTRAVENOUS
22 FLUIDS, MEDICATIONS, OXYGEN AND ANY OTHER INTERVENTION
23 APPROPRIATE TO THE LEVEL OF THE CERTIFICATION OF THE
24 PROVIDER, UNLESS OTHERWISE DIRECTED BY THE PATIENT OR THE
25 EMERGENCY MEDICAL SERVICES PROVIDER'S AUTHORIZED MEDICAL
26 COMMAND PHYSICIAN.
27 (3) AS USED IN THIS SUBSECTION, THE TERM "COMPLY" MEANS:
28 (I) TO WITHHOLD CARDIOPULMONARY RESUSCITATION FROM
29 THE PATIENT IN THE EVENT OF RESPIRATORY OR CARDIAC
30 ARREST; OR
20050S0628B1943 - 82 -
1 (II) TO DISCONTINUE AND CEASE CARDIOPULMONARY
2 RESUSCITATION IN THE EVENT THE EMERGENCY MEDICAL SERVICES
3 PROVIDER IS PRESENTED WITH AN ORDER OR DISCOVERS A
4 NECKLACE OR BRACELET AFTER INITIATING CARDIOPULMONARY
5 RESUSCITATION.
6 (C) UNCERTAINTY REGARDING VALIDITY OR APPLICABILITY OF
7 ORDER, BRACELET OR NECKLACE.--
8 (1) EMERGENCY MEDICAL SERVICES PROVIDERS WHO IN GOOD
9 FAITH ARE UNCERTAIN ABOUT THE VALIDITY OR APPLICABILITY OF AN
10 ORDER, BRACELET OR NECKLACE SHALL RENDER CARE IN ACCORDANCE
11 WITH THEIR LEVEL OF CERTIFICATION.
12 (2) EMERGENCY MEDICAL SERVICES PROVIDERS WHO ACT UNDER
13 PARAGRAPH (1) SHALL NOT BE SUBJECT TO CIVIL OR CRIMINAL
14 LIABILITY OR ADMINISTRATIVE SANCTION FOR FAILURE TO COMPLY
15 WITH AN ORDER UNDER THIS SECTION.
16 (D) RECOGNITION OF OTHER STATES' ORDERS.--EMERGENCY MEDICAL
17 SERVICES OR OUT-OF-HOSPITAL DNR ORDERS, BRACELETS OR NECKLACES
18 VALID IN STATES OTHER THAN THIS COMMONWEALTH SHALL BE RECOGNIZED
19 IN THIS COMMONWEALTH TO THE EXTENT THAT THESE ORDERS, BRACELETS
20 OR NECKLACES ARE CONSISTENT WITH THE LAWS OF THIS COMMONWEALTH.
21 EMERGENCY MEDICAL SERVICES PROVIDERS SHALL ACT IN ACCORDANCE
22 WITH THE PROVISIONS OF THIS SECTION WHEN ENCOUNTERING A PATIENT
23 WITH AN APPARENTLY VALID EMS OR OUT-OF-HOSPITAL DNR FORM,
24 BRACELET OR NECKLACE ISSUED BY ANOTHER STATE. EMERGENCY MEDICAL
25 SERVICES PROVIDERS ACTING IN GOOD FAITH UNDER THIS SECTION SHALL
26 BE ENTITLED TO THE SAME IMMUNITIES AND PROTECTIONS THAT WOULD
27 OTHERWISE BE APPLICABLE.
28 § 54A11. PREGNANCY.
29 (A) GENERAL RULE.--NOTWITHSTANDING THE EXISTENCE OF AN ORDER
30 OR DIRECTION TO THE CONTRARY, LIFE-SUSTAINING TREATMENT,
20050S0628B1943 - 83 -
1 CARDIOPULMONARY RESUSCITATION, NUTRITION AND HYDRATION MUST BE
2 PROVIDED TO A PREGNANT PATIENT UNLESS, TO A REASONABLE DEGREE OF
3 MEDICAL CERTAINTY AS CERTIFIED ON THE PATIENT'S MEDICAL RECORD
4 BY THE ATTENDING PHYSICIAN AND AN OBSTETRICIAN WHO HAS EXAMINED
5 THE PATIENT, LIFE-SUSTAINING TREATMENT, NUTRITION AND HYDRATION:
6 (1) WILL NOT MAINTAIN THE PREGNANT PATIENT IN SUCH A WAY
7 AS TO PERMIT THE CONTINUING DEVELOPMENT AND LIVE BIRTH OF THE
8 UNBORN CHILD;
9 (2) WILL BE PHYSICALLY HARMFUL TO THE PREGNANT PATIENT;
10 OR
11 (3) WOULD CAUSE PAIN TO THE PREGNANT PATIENT WHICH
12 CANNOT BE ALLEVIATED BY MEDICATION.
13 (B) PREGNANCY TEST.--NOTHING IN THIS SECTION SHALL REQUIRE A
14 PHYSICIAN TO PERFORM A PREGNANCY TEST UNLESS THE PHYSICIAN HAS
15 REASON TO BELIEVE THAT THE PATIENT MAY BE PREGNANT.
16 (C) PAYMENT OF EXPENSES BY COMMONWEALTH.--
17 (1) IN THE EVENT THAT TREATMENT, CARDIOPULMONARY
18 RESUSCITATION, NUTRITION OR HYDRATION ARE PROVIDED TO A
19 PREGNANT PATIENT, NOTWITHSTANDING THE EXISTENCE OF AN ORDER
20 OR DIRECTION TO THE CONTRARY, THE COMMONWEALTH SHALL PAY ALL
21 USUAL, CUSTOMARY AND REASONABLE EXPENSES DIRECTLY AND
22 INDIRECTLY INCURRED BY THE PREGNANT PATIENT TO WHOM SUCH
23 TREATMENT, NUTRITION AND HYDRATION ARE PROVIDED.
24 (2) THE COMMONWEALTH SHALL HAVE THE RIGHT OF SUBROGATION
25 AGAINST ALL MONEYS PAID BY ANY THIRD-PARTY HEALTH INSURER ON
26 BEHALF OF THE PREGNANT PATIENT.
27 (3) THE EXPENDITURES INCURRED ON BEHALF OF THE PREGNANT
28 PATIENT SHALL CONSTITUTE A GRANT, AND NO LIEN SHALL BE PLACED
29 UPON THE PROPERTY OF THE PREGNANT PATIENT, HER ESTATE OR HER
30 HEIRS.
20050S0628B1943 - 84 -
1 § 54A12. PENALTIES.
2 ANY PERSON WHO INTENTIONALLY CONCEALS, CANCELS, DEFACES,
3 OBLITERATES OR DAMAGES THE ORDER, BRACELET OR NECKLACE OF
4 ANOTHER WITHOUT THE CONSENT OF THE PATIENT COMMITS A FELONY OF
5 THE THIRD DEGREE. ANY PERSON WHO FALSIFIES OR FORGES THE ORDER,
6 BRACELET OR NECKLACE OF ANOTHER, OR CONCEALS OR WITHHOLDS
7 PERSONAL KNOWLEDGE OF A REVOCATION AS PROVIDED IN SECTION 54A05
8 (RELATING TO REVOCATION), WITH THE INTENT TO CAUSE A WITHHOLDING
9 OR WITHDRAWAL OF LIFE-SUSTAINING TREATMENT CONTRARY TO THE
10 WISHES OF THE PATIENT AND, BECAUSE OF SUCH AN ACT, DIRECTLY
11 CAUSES LIFE-SUSTAINING TREATMENT TO BE WITHHELD OR WITHDRAWN AND
12 DEATH TO BE HASTENED SHALL BE SUBJECT TO PROSECUTION FOR
13 CRIMINAL HOMICIDE AS PROVIDED IN 18 PA.C.S. CH. 25 (RELATING TO
14 CRIMINAL HOMICIDE). ANY PERSON WHO INTENTIONALLY, BY UNDUE
15 INFLUENCE, FRAUD OR DURESS, CAUSES A PERSON TO EXECUTE AN ORDER
16 PURSUANT TO THIS CHAPTER COMMITS A FELONY OF THE THIRD DEGREE.
17 § 54A13. SEVERABILITY.
18 THE PROVISIONS OF THIS CHAPTER ARE SEVERABLE, AND IF ANY
19 WORD, PHRASE, CLAUSE, SENTENCE, SECTION OR PROVISION OF THIS
20 CHAPTER IS FOR ANY REASON HELD TO BE UNCONSTITUTIONAL, THE
21 DECISION OF THE COURT SHALL NOT AFFECT OR IMPAIR ANY OF THE
22 REMAINING PROVISIONS OF THIS CHAPTER. IT IS HEREBY DECLARED AS
23 THE LEGISLATIVE INTENT THAT THIS CHAPTER WOULD HAVE BEEN ADOPTED
24 HAD SUCH UNCONSTITUTIONAL WORD, PHRASE, CLAUSE, SENTENCE,
25 SECTION OR PROVISION THEREOF NOT BEEN INCLUDED HEREIN.]
26 SECTION 6. THE DEPARTMENT OF HEALTH SHALL ADOPT REGULATIONS,
27 AS NECESSARY, TO FACILITATE IMPLEMENTATION OF 20 PA.C.S. CH. 54
28 SUBCH. E. REGULATIONS ADOPTED UNDER FORMER 20 PA.C.S. CH. 54A
29 SHALL REMAIN EFFECTIVE UNLESS THEY ARE INCONSISTENT WITH 20
30 PA.C.S. CH. 54 OR UNTIL THEY ARE SUPERSEDED BY REGULATIONS
20050S0628B1943 - 85 -
1 PROMULGATED UNDER THIS ACT.
2 Section 6 7. The repeal of the form of the declaration in 20 <--
3 Pa.C.S. § 5424(b) 5404(B) shall not affect the validity of any <--
4 declaration executed, pursuant to that form, before, on or after
5 the effective date of this act SECTION. <--
6 Section 7 8. Nothing in this act is intended to affect or <--
7 supersede the holdings of In re Fiori, 543 Pa. 592, 673 A.2d 905
8 (1996).
9 Section 8 9. Section 6 of the act of June 19, 2002 (P.L.409, <--
10 No.59), entitled "An act amending Title 20 (Decedents, Estates
11 and Fiduciaries) of the Pennsylvania Consolidated Statutes,
12 further providing for advance directives for health care, for
13 definitions and for emergency medical services; and providing
14 for out-of-hospital nonresuscitation," is repealed.
15 Section 9 10. This act shall take effect as follows: <--
16 (1) The following provisions shall take effect
17 immediately:
18 (i) Sections 2, 6 and 7 7 AND 8 of this act. <--
19 (ii) This section.
20 (2) The remainder of this act shall take effect in 60
21 days.
D6L20DMS/20050S0628B1943 - 86 -