PRIOR PRINTER'S NO. 689 PRINTER'S NO. 2533
No. 646 Session of 1989
INTRODUCED BY WILT, SHUMAKER, LEMMOND, PORTERFIELD, HESS,
SHAFFER, AFFLERBACH, MADIGAN, FISHER, ROCKS AND MELLOW,
MARCH 6, 1989
SENATOR PETERSON, PUBLIC HEALTH AND WELFARE, AS AMENDED,
OCTOBER 1, 1990
AN ACT
1 Facilitating medical treatment decisionmaking by establishing a <--
2 procedure whereby a person may execute in advance a written
3 declaration indicating to a physician the person's desire for
4 a physician to initiate, continue, withhold or withdraw
5 certain medical treatment in the event the person suffers a
6 terminal illness or injury and is incompetent; requiring in
7 certain cases the provision of nutrition and hydration; and
8 providing penalties.
9 TABLE OF CONTENTS
10 Section 1. Short title.
11 Section 2. Legislative purpose.
12 Section 3. Definitions.
13 Section 4. Declaration.
14 Section 5. Revocation.
15 Section 6. Time limitation.
16 Section 7. Liability.
17 Section 8. Duty of physician to confirm terminal condition.
18 Section 9. Failure to comply.
19 Section 10. Effect on suicide and life insurance; declaration
1 optional.
2 Section 11. Euthanasia and aided-suicide prohibited.
3 Section 12. Preservation of existing rights; required
4 treatment; power of attorney.
5 Section 13. Requirement to provide nutrition and hydration.
6 Section 14. Penalties.
7 Section 15. Effective date.
8 ESTABLISHING A PROCEDURE WHEREBY A PERSON MAY EXECUTE IN ADVANCE <--
9 A WRITTEN DECLARATION INDICATING TO A PHYSICIAN THE PERSON'S
10 DESIRE FOR A PHYSICIAN TO INITIATE, CONTINUE, WITHHOLD OR
11 WITHDRAW CERTAIN LIFE-SUSTAINING MEDICAL TREATMENT IN THE
12 EVENT THE PERSON IS INCOMPETENT AND IS DETERMINED TO BE IN A
13 TERMINAL CONDITION OR TO BE PERMANENTLY UNCONSCIOUS; AND
14 PROVIDING PENALTIES.
15 TABLE OF CONTENTS
16 SECTION 1. SHORT TITLE.
17 SECTION 2. LEGISLATIVE FINDINGS; INTENT.
18 SECTION 3. DEFINITIONS.
19 SECTION 4. DECLARATION.
20 SECTION 5. WHEN DECLARATION BECOMES OPERATIVE.
21 SECTION 6. REVOCATION.
22 SECTION 7. LIABILITY.
23 SECTION 8. DUTY OF PHYSICIAN TO CONFIRM TERMINAL CONDITION.
24 SECTION 9. TRANSFER OF DECLARANT.
25 SECTION 10. EFFECT ON SUICIDE AND LIFE INSURANCE; DECLARATION
26 OPTIONAL.
27 SECTION 11. PRESERVATION OF EXISTING RIGHTS; POWER OF
28 ATTORNEY.
29 SECTION 12. PENALTIES.
30 SECTION 13. EFFECTIVE DATE.
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1 The General Assembly of the Commonwealth of Pennsylvania
2 hereby enacts as follows:
3 Section 1. Short title. <--
4 This act shall be known and may be cited as the Medical
5 Treatment Decision Act.
6 Section 2. Legislative purpose.
7 The General Assembly finds that all competent adults have a
8 qualified right to control decisions relating to their own
9 medical care. This right is subject to certain interests of
10 society, such as the maintenance of ethical standards in the
11 medical profession and the preservation and protection of human
12 life, including the prevention of homicide, euthanasia and
13 suicide or aided-suicide. The General Assembly further finds
14 that, in some instances, the use of certain medical procedures
15 for an incompetent person in a terminal condition may provide
16 nothing necessary or beneficial to the person or may of itself
17 impose an unwarranted burden on the person. To insure that the
18 rights and intentions of a person in a terminal condition may be
19 respected, even after that person is no longer able to
20 participate actively in decisions concerning treatment, and to
21 encourage communication between such a person and his family and
22 physician, the General Assembly hereby declares its recognition
23 of the right of a competent adult to make a written declaration
24 respecting the initiation, continuation, withholding or
25 withdrawing of certain medical treatments in the event that such
26 person becomes incompetent and is diagnosed as suffering from a
27 terminal condition. The General Assembly further finds that
28 while certain medical treatments can be withdrawn or withheld,
29 it is a person's right to seek the institution or continuation
30 of reasonable medical treatment which sustains life and that
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1 undertreatment of the terminally ill is not acceptable whether
2 prompted by economic considerations or assumptions that some
3 lives are not worth sustaining.
4 Section 3. Definitions.
5 The following words and phrases when used in this act shall
6 have the meanings given to them in this section unless the
7 context clearly indicates otherwise:
8 "Adult." Any person 18 years of age or older.
9 "Attending physician." The physician who has primary
10 responsibility for the treatment and care of the patient.
11 "Declaration." A written document, voluntarily executed by
12 the declarant in accordance with this act.
13 "Euthanasia." The intentional causing of the death of a
14 person, whether by act or omission, in order to relieve such
15 person of suffering or other persons or entities of
16 psychological, financial, social or other burdens. The term
17 shall not include the withholding or withdrawal of medical
18 treatment as the term "medical treatment" is defined in this act
19 and, as to a "patient" as defined in this act, shall not include
20 the withholding or withdrawal of medical treatment done in
21 accordance with this act.
22 "Incompetent." The lack of sufficient capacity for a person
23 to make or communicate decisions concerning himself.
24 "Life-support system." Any mechanical or electronic device,
25 except one used for providing nutrition or hydration, utilized
26 in order to replace, assist or supplement the function of any
27 human vital organ or combination of organs.
28 "Medical treatment." The use of surgery, treatment,
29 medication and the utilization of mechanical or electronic
30 devices to sustain the life of a patient. The term shall not
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1 include any procedure, treatment, intervention or service to
2 provide nutrition or hydration to a patient unless the nutrition
3 or hydration could not be physically assimilated by the patient
4 or would be physically harmful or unreasonably painful to the
5 patient. The term shall also not include such medication or
6 medical procedures as are necessary to provide comfort and care
7 and to alleviate pain.
8 "Patient." A person who has been diagnosed and certified in
9 writing to be afflicted with a terminal condition by two
10 physicians, one of whom shall be the attending physician and
11 both of whom shall have personally examined the patient.
12 "Terminal condition." An incurable and irreversible medical
13 condition caused by injury, disease or physical illness which
14 will, in the opinion of the attending physician, to a reasonable
15 degree of medical certainty, result in death regardless of the
16 continued application of medical treatment, including life-
17 support systems. The term shall not include senility, affliction
18 with Alzheimer's disease, any form of mental retardation or
19 mental illness, or chronic mental or physical impairment,
20 including comatose conditions, which alone will not result in
21 death.
22 Section 4. Declaration.
23 (a) Execution.--Any competent adult may, at any time,
24 execute a declaration directing the initiating, continuing,
25 withholding or withdrawal of medical treatment in the event the
26 person should have a terminal condition and be incompetent. The
27 declaration shall be signed and dated by the declarant, or by
28 another person in the declarant's presence at the declarant's
29 express direction, in the presence of two witnesses. All
30 signatures must be notarized for the declaration to be
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1 effective. A witness must be at least 18 years of age. A witness
2 shall not be:
3 (1) Related to the declarant by blood or marriage.
4 (2) Entitled to any portion of the estate of the
5 declarant under the intestate succession laws of this
6 Commonwealth, then existing, or under any will of the
7 declarant, then existing.
8 (3) A person who has a claim against any portion of the
9 estate of the declarant.
10 (4) The attending physician, an employee of the
11 attending physician or an employee of a health facility in
12 which the declarant is a patient.
13 (5) Directly or indirectly financially responsible for
14 the medical care of the declarant or be an officer, agent or
15 employee of any government agency, any insurance company or
16 other organization financially responsible, in whole or in
17 part, for medical care of the declarant.
18 (6) The person who signed the declaration on behalf and
19 at the direction of the declarant.
20 (b) Notification.--It is the responsibility of the declarant
21 to notify the attending physician of the existence of the
22 declaration. The attending physician, when presented with the
23 declaration, shall make the declaration, or a copy thereof, a
24 part of the medical records of the declarant.
25 (c) Form.--The declaration may be in the following form and
26 may include other specific directions, including, but not
27 limited to, a designation of another person to make the
28 treatment decision for the declarant should the declarant be
29 diagnosed as suffering from a terminal condition and be
30 incompetent or otherwise mentally or physically incapable of
19890S0646B2533 - 6 -
1 communication. Should any specific direction be held to be
2 invalid, the invalidity shall not affect other directions of the
3 declaration which can be given effect without the invalid
4 direction.
5 DECLARATION
6 Declaration made this ____ day of ______________
7 (month, year). I, ________________________, being of
8 sound mind, willfully and voluntarily make known my
9 desire that my dying shall not be artificially prolonged
10 under the circumstances set forth below, and do hereby
11 declare:
12 (1) If at any time I should have an incurable
13 condition caused by injury, disease or illness certified
14 to be a terminal condition by two physicians who have
15 personally examined me, one of whom shall be my attending
16 physician, and the physicians have determined that my
17 death will occur whether or not medical treatment,
18 including life-support systems, are utilized and where
19 the application of medical treatment, including life-
20 support systems, would serve only to artificially prolong
21 the dying process, I direct that such treatment be
22 withheld or withdrawn, and that I be permitted to die
23 naturally with only the administration of medication or
24 the performance of any medical procedure deemed necessary
25 to alleviate pain.
26 (2) In the absence of my ability to give directions
27 regarding the use of such medical treatment, it is my
28 intention that this declaration shall be honored by my
29 family and physician as the final expression of my wish
30 to refuse medical treatment and accept the consequences
19890S0646B2533 - 7 -
1 from such refusal.
2 (3) I understand the full import of this declaration
3 and I am emotionally and mentally competent to make this
4 declaration.
5 Signed________________________
6 City, County and State of Residence _____________________
7 Jurat
8 (d) Limitations on declaration.--
9 (1) The declaration may include directions, including,
10 but not limited to, a designation of another person to
11 participate in the making of the treatment decision for the
12 declarant should the declarant be diagnosed as suffering from
13 a terminal condition and be incompetent or otherwise mentally
14 incapable of communication. However, a designee may not
15 participate in the treatment decision unless the patient does
16 not then have and will not regain, to a reasonable degree of
17 medical certainty, the capacity to make decisions for
18 himself.
19 (2) Notwithstanding the form or the specific directions
20 of a declaration, medical treatment must be provided to a
21 pregnant patient with a terminal condition unless, to a
22 reasonable degree of medical certainty, as certified on the
23 patient's medical chart by the attending physician and an
24 obstetrician who has examined the patient, such medical
25 treatment will not maintain the patient in such a way as to
26 permit the continuing development and live birth of the
27 unborn child or will be physically harmful or unreasonably
28 painful to the patient or prolong severe pain which cannot be
29 alleviated by medication.
30 (3) Should any specific direction in the declaration be
19890S0646B2533 - 8 -
1 held to be invalid, the invalidity shall not offset other
2 directions of the declaration which can be effected without
3 the invalid direction.
4 (e) Witnessing of a declaration.--The witnesses to a
5 declaration must sign a statement at the time the declaration is
6 executed which statement must be attached to the declaration and
7 be in substantially the following form:
8 I believe the declarant to be of sound mind. I did
9 not sign the declarant's signature above for or at the
10 direction of the declarant. I am at least 18 years of age
11 and am not related to the declarant by blood or marriage,
12 have no claim against any portion of the estate of the
13 declarant, am not entitled to any portion of the estate
14 of the declarant according to the laws of intestate
15 succession of Pennsylvania or under any will of the
16 declarant or codicil thereto, nor am I directly or
17 indirectly financially responsible for declarant's
18 medical care. I am not the declarant's attending
19 physician, an employee of the attending physician or an
20 employee of the health facility in which the declarant is
21 a patient.
22 Witness__________________
23 Witness__________________
24 Jurat
25 (f) Right to have medical treatment initiated or
26 continued.--Nothing in this section shall be construed to
27 prohibit a person from executing a declaration pursuant to this
28 section which directs the initiation or continuation of medical
29 treatment in the event the person should have a terminal
30 condition.
19890S0646B2533 - 9 -
1 Section 5. Revocation.
2 (a) Methods.--A declaration may be revoked at any time by
3 the declarant, without regard to his mental state or competency,
4 by any of the following methods:
5 (1) By being canceled, defaced, obliterated, burnt, torn
6 or otherwise destroyed by the declarant or by some person in
7 his presence and by his direction. Revocation of a
8 declaration shall become effective only upon:
9 (A) taking such an action; and
10 (B) upon communication of revocation to the
11 attending physician by the declarant or by a person
12 acting on behalf of the declarant.
13 (2) By a written revocation of the declarant expressing
14 his intent to revoke, signed and dated by the declarant. The
15 revocation shall become effective only upon communication of
16 the revocation to the attending physician by the declarant or
17 by a person acting on behalf of the declarant. The attending
18 physician shall record in the medical record of the patient
19 the time and date when he received notification of the
20 written revocation.
21 (3) By an oral expression by the declarant of his intent
22 to revoke the declaration. The revocation shall become
23 effective only upon communication of the revocation to the
24 attending physician by the declarant or by a person acting on
25 behalf of the declarant. The attending physician shall record
26 in the medical record of the patient the time, date and place
27 of the revocation and the time, date and place, if different,
28 of when he received notification of the revocation.
29 (b) Effect upon criminal or civil liability.--There shall be
30 no criminal or civil liability on the part of any person for
19890S0646B2533 - 10 -
1 failure to act upon a revocation made pursuant to this section
2 unless that person has actual knowledge of the revocation.
3 Section 6. Time limitation.
4 A declaration executed in accordance with this act shall be
5 effective for five years from the date of execution, provided
6 that, if the declarant becomes incompetent within five years
7 after the execution of the declaration and remains incompetent
8 at the time of the determination of a terminal condition as
9 provided by section 8, the declaration shall continue in effect.
10 Upon the expiration of the declaration, a new declaration must
11 be executed should the declarant wish to make a written
12 declaration pursuant to this act. However, if the declaration
13 has expired and the physician proceeds under section 7(a)(2),
14 there shall be a presumption in favor of the expired declaration
15 as the express wish of the patient concerning medical treatment.
16 Section 7. Liability.
17 (a) General rule.--No physician, licensed health care
18 professional, health care provider, health care facility or
19 employee thereof who, in good faith and pursuant to reasonable
20 medical standards and otherwise consistent with this act, causes
21 or participates in the initiating, continuing, withholding or
22 withdrawal of medical treatment, including life-support systems,
23 from a patient who is incompetent shall, as a result thereof, be
24 subject to criminal or civil liability, or be found to have
25 committed an act of unprofessional conduct if:
26 (1) the attending physician has followed the patient's
27 wishes as expressed earlier by the patient in the form of a
28 declaration executed pursuant to this act; or
29 (2) in a situation where there appears to exist no
30 declaration executed pursuant to this act, the physician has
19890S0646B2533 - 11 -
1 obtained the written informed consent of any of the following
2 individuals who shall be guided by the express or implied
3 wishes of the patient concerning medical treatment, these
4 persons to be consulted in the following order of priority:
5 (i) the guardian of the person of the patient if one
6 has been appointed;
7 (ii) the spouse of the patient;
8 (iii) the adult child of the patient or, if the
9 patient has more than one adult child, by a majority of
10 the adult children who are reasonably available for
11 consultation;
12 (iv) a parent of the patient; or
13 (v) the nearest living relative of the patient.
14 (b) Express consent.--The written informed consent of the
15 first of the individuals listed in subsection (a)(2) willing to
16 consult and competent to render the consent shall constitute the
17 written informed consent required by subsection (a)(1).
18 (c) Absence of declaration.--The absence of a declaration by
19 a patient shall not give rise to any presumption as to the
20 intent of the patient to consent to or to refuse the initiation,
21 continuation or termination of medical treatment.
22 Section 8. Duty of physician to confirm terminal condition.
23 (a) Procedure after diagnosis of terminal condition.--An
24 attending physician shall, without delay after the diagnosis of
25 a terminal condition of a person, certify, in writing, the
26 terminal condition of the patient and arrange for the physical
27 examination and diagnosis of the patient's condition by a second
28 physician.
29 (b) Informing patient of terminal condition.--Once written
30 certification and confirmation of the terminal condition of a
19890S0646B2533 - 12 -
1 declarant is made, a person who made a declaration must be
2 advised by the attending physician of his terminal condition.
3 The current wishes of the person shall, at all times, supersede
4 the effect of the declaration. If the person is diagnosed as
5 incompetent, the declarant shall become a patient as defined in
6 this act only upon written certification and confirmation of a
7 terminal condition by the attending physician and the second
8 physician.
9 Section 9. Failure to comply.
10 (a) Unprofessional conduct.--An attending physician shall be
11 deemed to have refused to comply with this act and be considered
12 to have committed an act of unprofessional conduct if:
13 (1) the physician fails to consider and act upon the
14 declaration of a patient or the treatment consent of a person
15 designated to participate in the treatment decision by the
16 declarant in the declaration to the extent that the
17 declaration or decision is consistent with this act and is
18 pursuant to reasonable medical standards; or
19 (2) as to a patient without a declaration executed
20 pursuant to this act, the physician fails to act consistent
21 with the terms of this act and reasonable medical standards.
22 (b) Transfer to another physician.--Notwithstanding the
23 provisions of subsection (a), an attending physician shall not
24 be considered to have committed an act of unprofessional conduct
25 if:
26 (1) the physician advises or attempts to advise the
27 designee of the patient named in his validly executed
28 declaration (but if there is no such declaration and
29 designee, then the first available person in the order of
30 priority set forth in section 7(a)(2)) of the physician's
19890S0646B2533 - 13 -
1 unwillingness to act; and
2 (2) the physician further advises or attempts to advise
3 him that the patient may be transferred to the care of
4 another physician chosen by the patient's representative with
5 arrangements for such transfer being the responsibility of
6 the patient's representative.
7 (c) Declaration or direction must be consistent with medical
8 standards.--Nothing in this act shall obligate a physician,
9 health care provider or health care facility to follow a
10 patient's declaration or the directions of the patient's
11 designee, if such declaration or direction would be contrary to
12 reasonable medical standards.
13 Section 10. Effect on suicide and life insurance; declaration
14 optional.
15 (a) Suicide.--The withholding or withdrawal of medical
16 treatment from a patient in accordance with the provisions of
17 this act shall not, for any purpose, constitute a suicide or
18 causing or aiding a suicide.
19 (b) Life insurance.--The making of, or failure to make, a
20 declaration in accordance with this act shall not affect in any
21 manner the sale, procurement or issuance of any policy of life
22 insurance, nor shall it be deemed to modify the terms of an
23 existing policy of life insurance. No policy of life insurance
24 shall be legally impaired or invalidated in any manner by the
25 withholding or withdrawal of medical treatment from an insured
26 patient, notwithstanding any term of the policy to the contrary.
27 (c) Declaration optional.--No physician, health care
28 facility or other health care provider, and no health care
29 service plan, health maintenance organization, insurer issuing
30 disability insurance, self-insured employee welfare benefit
19890S0646B2533 - 14 -
1 plan, nonprofit hospital plan or State, local, county or Federal
2 Government-sponsored or operated program:
3 (1) shall require any person to execute a declaration as
4 a condition for being insured for, or receiving, health care
5 services; or
6 (2) shall charge any person a different rate or fee
7 whether or not the person executes or has executed a
8 declaration.
9 Section 11. Euthanasia and aided-suicide prohibited.
10 Nothing in this act shall be construed to condone, authorize
11 or approve euthanasia or aided-suicide, or to permit any
12 affirmative or deliberate act or omission to end life other than
13 to permit the natural process of dying as provided in this act.
14 Section 12. Preservation of existing rights; required
15 treatment; power of attorney.
16 (a) Legal rights not impaired.--The provisions of this act
17 are cumulative with existing law regarding the right of an
18 individual to consent or refuse to consent to medical treatment
19 and shall not impair or supersede any existing rights or
20 responsibilities which a health care provider, a patient,
21 including a minor or incompetent patient, or the family of a
22 patient may have in regard to the withholding or withdrawal of
23 medical treatment under the laws of this Commonwealth.
24 (b) Necessary medical care.--Any section of this act which
25 requires that certain treatment, or nutrition or hydration, or
26 both, be provided establishes a course of necessary medical
27 care.
28 (c) Pregnant patients.--Whether or not a patient had made a
29 declaration pursuant to this act, medical treatment must be
30 provided to a pregnant patient with a terminal condition unless,
19890S0646B2533 - 15 -
1 to a reasonable degree of medical certainty, as certified on the
2 patient's medical chart by the attending physician and an
3 obstetrician who has examined the patient, such medical
4 treatment will not maintain the patient in such a way as to
5 permit the continuing development and live birth of the unborn
6 child or will be physically harmful or unreasonably painful to
7 the patient or prolong severe pain which cannot be alleviated by
8 medication.
9 (d) Power of attorney.--A power of attorney executed
10 pursuant to 20 Pa.C.S. Ch. 56 (relating to powers of attorney)
11 shall, as to the treatment for a patient with a terminal
12 condition, have no greater effect than a declaration executed
13 pursuant to this act notwithstanding any specific grant of power
14 by a patient regarding medical care, nursing care or medical and
15 surgical procedures.
16 Section 13. Requirement to provide nutrition and hydration.
17 Nothing in this act shall relieve a person, whether or not he
18 has a terminal condition, of the right and obligation to
19 receive, or the physician, health care provider or health care
20 facility of the obligation to provide, nutrition and hydration
21 except that as to a patient with a terminal condition such
22 nutrition and hydration may be withheld if it could not be
23 physically assimilated by the patient or would be physically
24 harmful or unreasonably painful to the patient. Further, nothing
25 in this act shall relieve the physician, health care provider or
26 health care facility of the obligation to provide other measures
27 deemed necessary to provide comfort to a person or to alleviate
28 his pain regardless of whether a person has a terminal
29 condition.
30 Section 14. Penalties.
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1 Any person who willfully conceals, cancels, defaces,
2 obliterates or damages the declaration of another without the
3 consent of the declarant commits a felony of the third degree.
4 Any person who falsifies or forges the declaration of another,
5 or willfully conceals or withholds personal knowledge of a
6 revocation as provided in section 5, with the intent to cause a
7 withholding or withdrawal of medical treatment contrary to the
8 wishes of the declarant and, because of such an act, directly
9 causes medical treatment to be withheld or withdrawn and death
10 to be hastened, shall be subject to prosecution for criminal
11 homicide as provided in 18 Pa.C.S. Ch. 25 (relating to criminal
12 homicide). Any person who willfully, by undue influence, fraud
13 or duress, causes a person to execute a declaration pursuant to
14 this act commits a felony of the third degree.
15 Section 15. Effective date.
16 This act shall take effect immediately.
17 SECTION 1. SHORT TITLE. <--
18 THIS ACT SHALL BE KNOWN AND MAY BE CITED AS THE ADVANCE
19 DIRECTIVE FOR HEALTH CARE ACT.
20 SECTION 2. LEGISLATIVE FINDINGS; INTENT.
21 (A) FINDINGS.--THE GENERAL ASSEMBLY FINDS THAT ALL COMPETENT
22 ADULTS HAVE A QUALIFIED RIGHT TO CONTROL DECISIONS RELATING TO
23 THEIR OWN MEDICAL CARE. THIS RIGHT IS SUBJECT TO CERTAIN
24 INTERESTS OF SOCIETY, SUCH AS THE MAINTENANCE OF ETHICAL
25 STANDARDS IN THE MEDICAL PROFESSION AND THE PRESERVATION AND
26 PROTECTION OF HUMAN LIFE. MODERN MEDICAL TECHNOLOGICAL
27 PROCEDURES MAKE POSSIBLE THE PROLONGATION OF HUMAN LIFE BEYOND
28 NATURAL LIMITS. THE APPLICATION OF SOME PROCEDURES TO AN
29 INDIVIDUAL SUFFERING A DIFFICULT AND UNCOMFORTABLE PROCESS OF
30 DYING MAY CAUSE LOSS OF PATIENT DIGNITY AND SECURE ONLY
19890S0646B2533 - 17 -
1 CONTINUATION OF A PRECARIOUS AND BURDENSOME PROLONGATION OF
2 LIFE.
3 (B) INTENT.--NOTHING IN THIS ACT IS INTENDED TO CONDONE,
4 AUTHORIZE OR APPROVE MERCY KILLING, OR TO PERMIT ANY AFFIRMATIVE
5 OR DELIBERATE ACT OR OMISSION TO END LIFE OTHER THAN AS DEFINED
6 IN THIS ACT. FURTHERMORE, THIS ACT SHALL CREATE NO PRESUMPTION
7 CONCERNING THE INTENT OF ANY PERSON WHO HAS NOT EXECUTED A
8 DECLARATION TO CONSENT TO THE USE OR WITHHOLDING OF LIFE-
9 SUSTAINING PROCEDURES IN THE EVENT OF A TERMINAL CONDITION OR A
10 STATE OF PERMANENT UNCONSCIOUSNESS.
11 SECTION 3. DEFINITIONS.
12 THE FOLLOWING WORDS AND PHRASES WHEN USED IN THIS ACT SHALL
13 HAVE THE MEANINGS GIVEN TO THEM IN THIS SECTION UNLESS THE
14 CONTEXT CLEARLY INDICATES OTHERWISE:
15 "ATTENDING PHYSICIAN." THE PHYSICIAN WHO HAS PRIMARY
16 RESPONSIBILITY FOR THE TREATMENT AND CARE OF THE DECLARANT.
17 "DECLARANT." A PERSON WHO MAKES A DECLARATION IN ACCORDANCE
18 WITH THIS ACT.
19 "DECLARATION." A WRITTEN DOCUMENT, VOLUNTARILY EXECUTED BY
20 THE DECLARANT IN ACCORDANCE WITH THIS ACT.
21 "HEALTH CARE PROVIDER." A PERSON WHO IS LICENSED BY THE LAWS
22 OF THIS COMMONWEALTH TO ADMINISTER HEALTH CARE IN THE ORDINARY
23 COURSE OF BUSINESS OR PRACTICE OF A PROFESSION.
24 "INCOMPETENT." THE LACK OF SUFFICIENT CAPACITY FOR A PERSON
25 TO MAKE OR COMMUNICATE DECISIONS CONCERNING HIMSELF.
26 "LIFE-SUSTAINING TREATMENT." ANY MEDICAL PROCEDURE OR
27 INTERVENTION THAT, WHEN ADMINISTERED TO A QUALIFIED PATIENT,
28 WILL SERVE ONLY TO PROLONG THE PROCESS OF DYING OR TO MAINTAIN
29 THE PATIENT IN A STATE OF PERMANENT UNCONSCIOUSNESS. LIFE-
30 SUSTAINING TREATMENT SHALL INCLUDE NUTRITION AND HYDRATION
19890S0646B2533 - 18 -
1 ADMINISTERED BY GASTRIC TUBE OR INTRAVENOUSLY OR ANY OTHER
2 ARTIFICIAL OR INVASIVE MEANS IF THE DECLARATION OF THE QUALIFIED
3 PATIENT SO SPECIFICALLY PROVIDES.
4 "PERMANENTLY UNCONSCIOUS." A MEDICAL CONDITION THAT HAS BEEN
5 DIAGNOSED IN ACCORDANCE WITH CURRENTLY ACCEPTED MEDICAL
6 STANDARDS AND WITH REASONABLE MEDICAL CERTAINTY AS TOTAL AND
7 IRREVERSIBLE LOSS OF CONSCIOUSNESS AND CAPACITY FOR INTERACTION
8 WITH THE ENVIRONMENT. THE TERM INCLUDES WITHOUT LIMITATION A
9 PERSISTENT VEGETATIVE STATE OR IRREVERSIBLE COMA.
10 "PERSON." AN INDIVIDUAL, CORPORATION, PARTNERSHIP,
11 ASSOCIATION, OR FEDERAL, STATE OR LOCAL GOVERNMENT OR
12 GOVERNMENTAL AGENCY.
13 "QUALIFIED PATIENT." A PERSON WHO HAS EXECUTED A DECLARATION
14 AND WHO HAS BEEN DETERMINED TO BE IN A TERMINAL CONDITION OR TO
15 BE PERMANENTLY UNCONSCIOUS.
16 "TERMINAL CONDITION." AN INCURABLE AND IRREVERSIBLE MEDICAL
17 CONDITION CAUSED BY INJURY, DISEASE OR PHYSICAL ILLNESS WHICH
18 WILL, IN THE OPINION OF THE ATTENDING PHYSICIAN, TO A REASONABLE
19 DEGREE OF MEDICAL CERTAINTY, RESULT IN DEATH REGARDLESS OF THE
20 CONTINUED APPLICATION OF LIFE-SUSTAINING TREATMENT.
21 SECTION 4. DECLARATION.
22 (A) EXECUTION.--AN INDIVIDUAL OF SOUND MIND WHO IS 18 YEARS
23 OF AGE OR OLDER OR WHO IS OTHERWISE AUTHORIZED TO GIVE MEDICAL
24 CONSENT ON HIS BEHALF PURSUANT TO THE ACT OF FEBRUARY 13, 1970
25 (P.L.19, NO.10), ENTITLED "AN ACT ENABLING CERTAIN MINORS TO
26 CONSENT TO MEDICAL, DENTAL AND HEALTH SERVICES, DECLARING
27 CONSENT UNNECESSARY UNDER CERTAIN CIRCUMSTANCES," MAY EXECUTE AT
28 ANY TIME A DECLARATION GOVERNING THE INITIATION, CONTINUATION,
29 WITHHOLDING OR WITHDRAWAL OF LIFE-SUSTAINING TREATMENT. THE
30 DECLARATION MUST BE SIGNED BY THE DECLARANT, OR BY ANOTHER ON
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1 BEHALF OF AND AT THE DIRECTION OF THE DECLARANT, AND MUST BE
2 WITNESSED BY TWO INDIVIDUALS EACH OF WHOM IS 18 YEARS OF AGE OR
3 OLDER. A WITNESS SHALL NOT BE THE PERSON WHO SIGNED THE
4 DECLARATION ON BEHALF OF AND AT THE DIRECTION OF THE DECLARANT.
5 (B) FORM.--A DECLARATION MAY BUT NEED NOT BE IN THE
6 FOLLOWING FORM AND MAY INCLUDE OTHER SPECIFIC DIRECTIONS
7 INCLUDING, BUT NOT LIMITED TO, DESIGNATION OF ANOTHER PERSON TO
8 MAKE THE TREATMENT DECISION FOR THE DECLARANT IF THE DECLARANT
9 IS INCOMPETENT AND IS DETERMINED TO BE IN A TERMINAL CONDITION
10 OR TO BE PERMANENTLY UNCONSCIOUS.
11 DECLARATION
12 I, , BEING OF SOUND MIND, WILLFULLY AND
13 VOLUNTARILY MAKE THIS DECLARATION TO BE FOLLOWED IF I BECOME
14 INCOMPETENT. THIS DECLARATION REFLECTS MY FIRM AND SETTLED
15 COMMITMENT TO REFUSE LIFE-SUSTAINING TREATMENT UNDER THE
16 CIRCUMSTANCES INDICATED BELOW.
17 I DIRECT MY ATTENDING PHYSICIAN TO WITHHOLD OR WITHDRAW
18 LIFE-SUSTAINING TREATMENT THAT SERVES ONLY TO PROLONG THE
19 PROCESS OF MY DYING, IF I SHOULD BE IN A TERMINAL CONDITION
20 OR IN A STATE OF PERMANENT UNCONSCIOUSNESS.
21 I DIRECT THAT TREATMENT BE LIMITED TO MEASURES TO KEEP ME
22 COMFORTABLE AND TO RELIEVE PAIN, INCLUDING ANY PAIN THAT
23 MIGHT OCCUR BY WITHHOLDING OR WITHDRAWING LIFE-SUSTAINING
24 TREATMENT.
25 IN ADDITION, IF I AM IN THE CONDITION DESCRIBED ABOVE, I
26 FEEL ESPECIALLY STRONGLY ABOUT THE FOLLOWING FORMS OF
27 TREATMENT:
28 I ( ) DO ( ) DO NOT WANT CARDIAC RESUSCITATION.
29 I ( ) DO ( ) DO NOT WANT MECHANICAL RESPIRATION.
30 I ( ) DO ( ) DO NOT WANT TUBE FEEDING OR ANY OTHER
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1 ARTIFICIAL OR INVASIVE FORM OF NUTRITION (FOOD) OR HYDRATION
2 (WATER).
3 I ( ) DO ( ) DO NOT WANT BLOOD OR BLOOD PRODUCTS.
4 I ( ) DO ( ) DO NOT WANT ANY FORM OF SURGERY OR INVASIVE
5 DIAGNOSTIC TESTS.
6 I ( ) DO ( ) DO NOT WANT KIDNEY DIALYSIS.
7 I ( ) DO ( ) DO NOT WANT ANTIBIOTICS.
8 I REALIZE THAT IF I DO NOT SPECIFICALLY INDICATE MY
9 PREFERENCE REGARDING ANY OF THE FORMS OF TREATMENT LISTED
10 ABOVE, I MAY RECEIVE THAT FORM OF TREATMENT.
11 OTHER INSTRUCTIONS:
12 I ( ) DO ( ) DO NOT WANT TO DESIGNATE ANOTHER PERSON AS
13 MY SURROGATE TO MAKE MEDICAL TREATMENT DECISIONS FOR ME IF I
14 SHOULD BE INCOMPETENT AND IN A TERMINAL CONDITION OR IN A
15 STATE OF PERMANENT UNCONSCIOUSNESS. NAME AND ADDRESS OF
16 SURROGATE (IF APPLICABLE):
17 NAME AND ADDRESS OF SUBSTITUTE SURROGATE (IF SURROGATE
18 DESIGNATED ABOVE IS UNABLE TO SERVE):
19 I MADE THIS DECLARATION ON THE DAY OF
20 (MONTH, YEAR).
21 DECLARANT'S SIGNATURE:
22 DECLARANT'S ADDRESS:
23 THE DECLARANT OR THE PERSON ON BEHALF OF AND AT THE
24 DIRECTION OF THE DECLARANT KNOWINGLY AND VOLUNTARILY SIGNED
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1 THIS WRITING BY SIGNATURE OR MARK IN MY PRESENCE.
2 WITNESS'S SIGNATURE:
3 WITNESS'S ADDRESS:
4 WITNESS'S SIGNATURE:
5 WITNESS'S ADDRESS:
6 (C) INVALIDITY OF SPECIFIC DIRECTION.--SHOULD ANY SPECIFIC
7 DIRECTION IN THE DECLARATION BE HELD TO BE INVALID, THE
8 INVALIDITY SHALL NOT OFFSET OTHER DIRECTIONS OF THE DECLARATION
9 WHICH CAN BE EFFECTED WITHOUT THE INVALID DIRECTION.
10 (D) MEDICAL RECORD.--A PHYSICIAN OR OTHER HEALTH CARE
11 PROVIDER WHO IS FURNISHED A COPY OF THE DECLARATION SHALL MAKE
12 IT A PART OF THE DECLARANT'S MEDICAL RECORD AND, IF UNWILLING TO
13 COMPLY WITH THE DECLARATION, PROMPTLY SO ADVISE THE DECLARANT.
14 SECTION 5. WHEN DECLARATION BECOMES OPERATIVE.
15 A DECLARATION BECOMES OPERATIVE WHEN:
16 (1) A COPY IS PROVIDED TO THE ATTENDING PHYSICIAN; AND
17 (2) THE DECLARANT IS DETERMINED BY THE ATTENDING
18 PHYSICIAN TO BE INCOMPETENT AND IN A TERMINAL CONDITION OR IN
19 A STATE OF PERMANENT UNCONSCIOUSNESS.
20 WHEN THE DECLARATION BECOMES OPERATIVE, THE ATTENDING PHYSICIAN
21 AND OTHER HEALTH CARE PROVIDERS SHALL ACT IN ACCORDANCE WITH ITS
22 PROVISIONS OR COMPLY WITH THE TRANSFER PROVISIONS OF SECTION 9.
23 SECTION 6. REVOCATION.
24 (A) GENERAL RULE.--A DECLARATION MAY BE REVOKED AT ANY TIME
25 AND IN ANY MANNER BY THE DECLARANT, WITHOUT REGARD TO THE
26 DECLARANT'S MENTAL OR PHYSICAL CONDITION. A REVOCATION IS
27 EFFECTIVE UPON COMMUNICATION TO THE ATTENDING PHYSICIAN OR OTHER
28 HEALTH CARE PROVIDER BY THE DECLARANT OR A WITNESS TO THE
29 REVOCATION.
30 (B) MEDICAL RECORD.--THE ATTENDING PHYSICIAN OR OTHER HEALTH
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1 CARE PROVIDER SHALL MAKE THE REVOCATION A PART OF THE
2 DECLARANT'S MEDICAL RECORD.
3 SECTION 7. LIABILITY.
4 (A) GENERAL RULE.--NO PHYSICIAN OR OTHER HEALTH CARE
5 PROVIDER WHO, CONSISTENT WITH THIS ACT, CAUSES OR PARTICIPATES
6 IN THE INITIATING, CONTINUING, WITHHOLDING OR WITHDRAWAL OF
7 LIFE-SUSTAINING TREATMENT FROM A QUALIFIED PATIENT WHO IS
8 INCOMPETENT SHALL, AS A RESULT THEREOF, BE SUBJECT TO CRIMINAL
9 OR CIVIL LIABILITY, OR BE FOUND TO HAVE COMMITTED AN ACT OF
10 UNPROFESSIONAL CONDUCT, IF THE ATTENDING PHYSICIAN HAS FOLLOWED
11 THE DECLARANT'S WISHES AS EXPRESSED EARLIER BY THE DECLARANT IN
12 THE FORM OF A DECLARATION EXECUTED PURSUANT TO THIS ACT.
13 (B) ABSENCE OF DECLARATION.--THE ABSENCE OF A DECLARATION BY
14 A PATIENT SHALL NOT GIVE RISE TO ANY PRESUMPTION AS TO THE
15 INTENT OF THE PATIENT TO CONSENT TO OR TO REFUSE THE INITIATION,
16 CONTINUATION OR TERMINATION OF LIFE-SUSTAINING TREATMENT.
17 SECTION 8. DUTY OF PHYSICIAN TO CONFIRM TERMINAL CONDITION.
18 FOR PURPOSES OF SECTION 5, AN ATTENDING PHYSICIAN SHALL,
19 WITHOUT DELAY AFTER THE DIAGNOSIS THAT THE DECLARANT IS IN A
20 TERMINAL CONDITION OR IN A STATE OF PERMANENT UNCONSCIOUSNESS,
21 CERTIFY IN WRITING THAT THE DECLARANT IS IN A TERMINAL CONDITION
22 OR IN A STATE OF PERMANENT UNCONSCIOUSNESS AND ARRANGE FOR THE
23 PHYSICAL EXAMINATION AND CONFIRMATION OF THE TERMINAL CONDITION
24 OR STATE OF PERMANENT UNCONSCIOUSNESS OF THE DECLARANT BY A
25 SECOND PHYSICIAN.
26 SECTION 9. TRANSFER OF DECLARANT.
27 AN ATTENDING PHYSICIAN OR OTHER HEALTH CARE PROVIDER WHO IS
28 UNWILLING TO COMPLY WITH THIS ACT SHALL, AS PROMPTLY AS
29 PRACTICAL, TAKE ALL REASONABLE STEPS TO TRANSFER CARE OF THE
30 DECLARANT TO ANOTHER PHYSICIAN OR HEALTH CARE PROVIDER.
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1 SECTION 10. EFFECT ON SUICIDE AND LIFE INSURANCE; DECLARATION
2 OPTIONAL.
3 (A) CRIMINAL EFFECT.--THE WITHHOLDING OR WITHDRAWAL OF LIFE-
4 SUSTAINING TREATMENT FROM A QUALIFIED PATIENT IN ACCORDANCE WITH
5 THE PROVISIONS OF THIS ACT SHALL NOT, FOR ANY PURPOSE,
6 CONSTITUTE SUICIDE OR HOMICIDE.
7 (B) LIFE INSURANCE.--THE MAKING OF, OR FAILURE TO MAKE, A
8 DECLARATION IN ACCORDANCE WITH THIS ACT SHALL NOT AFFECT IN ANY
9 MANNER THE SALE, PROCUREMENT OR ISSUANCE OF ANY POLICY OF LIFE
10 INSURANCE, NOR SHALL IT BE DEEMED TO MODIFY THE TERMS OF AN
11 EXISTING POLICY OF LIFE INSURANCE. NO POLICY OF LIFE INSURANCE
12 SHALL BE LEGALLY IMPAIRED OR INVALIDATED IN ANY MANNER BY THE
13 WITHHOLDING OR WITHDRAWAL OF LIFE-SUSTAINING TREATMENT FROM AN
14 INSURED PATIENT, NOTWITHSTANDING ANY TERM OF THE POLICY TO THE
15 CONTRARY.
16 (C) DECLARATION OPTIONAL.--NO PHYSICIAN OR OTHER HEALTH CARE
17 PROVIDER, AND NO HEALTH CARE SERVICE PLAN, HEALTH MAINTENANCE
18 ORGANIZATION, INSURER ISSUING DISABILITY INSURANCE, SELF-INSURED
19 EMPLOYEE WELFARE BENEFIT PLAN, NONPROFIT HOSPITAL PLAN OR
20 FEDERAL, STATE OR LOCAL GOVERNMENT-SPONSORED OR OPERATED PROGRAM
21 SHALL:
22 (1) REQUIRE ANY PERSON TO EXECUTE A DECLARATION AS A
23 CONDITION FOR BEING INSURED FOR, OR RECEIVING, HEALTH CARE
24 SERVICES; OR
25 (2) CHARGE ANY PERSON A DIFFERENT RATE OR FEE WHETHER OR
26 NOT THE PERSON EXECUTES OR HAS EXECUTED A DECLARATION.
27 SECTION 11. PRESERVATION OF EXISTING RIGHTS; POWER OF ATTORNEY.
28 (A) LEGAL RIGHTS NOT IMPAIRED.--THE PROVISIONS OF THIS ACT
29 ARE CUMULATIVE WITH EXISTING LAW REGARDING THE RIGHT OF AN
30 INDIVIDUAL TO CONSENT OR REFUSE TO CONSENT TO LIFE-SUSTAINING
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1 TREATMENT AND SHALL NOT IMPAIR OR SUPERSEDE ANY EXISTING RIGHTS
2 OR RESPONSIBILITIES WHICH A HEALTH CARE PROVIDER, A PATIENT,
3 INCLUDING A MINOR OR INCOMPETENT PATIENT, OR THE FAMILY OF A
4 PATIENT MAY HAVE IN REGARD TO THE WITHHOLDING OR WITHDRAWAL OF
5 LIFE-SUSTAINING TREATMENT UNDER THE LAWS OF THIS COMMONWEALTH.
6 (B) POWER OF ATTORNEY.--NOTHING IN THIS ACT SHALL LIMIT A
7 POWER OF ATTORNEY EXECUTED UNDER 20 PA.C.S. CH. 56 (RELATING TO
8 POWERS OF ATTORNEY).
9 SECTION 12. PENALTIES.
10 ANY PERSON WHO WILLFULLY CONCEALS, CANCELS, DEFACES,
11 OBLITERATES OR DAMAGES THE DECLARATION OF ANOTHER WITHOUT THE
12 CONSENT OF THE DECLARANT COMMITS A FELONY OF THE THIRD DEGREE.
13 ANY PERSON WHO FALSIFIES OR FORGES THE DECLARATION OF ANOTHER,
14 OR WILLFULLY CONCEALS OR WITHHOLDS PERSONAL KNOWLEDGE OF A
15 REVOCATION AS PROVIDED IN SECTION 6, WITH THE INTENT TO CAUSE A
16 WITHHOLDING OR WITHDRAWAL OF LIFE-SUSTAINING TREATMENT CONTRARY
17 TO THE WISHES OF THE DECLARANT AND, BECAUSE OF SUCH AN ACT,
18 DIRECTLY CAUSES LIFE-SUSTAINING TREATMENT TO BE WITHHELD OR
19 WITHDRAWN AND DEATH TO BE HASTENED, SHALL BE SUBJECT TO
20 PROSECUTION FOR CRIMINAL HOMICIDE AS PROVIDED IN 18 PA.C.S. CH.
21 25 (RELATING TO CRIMINAL HOMICIDE). ANY PERSON WHO WILLFULLY, BY
22 UNDUE INFLUENCE, FRAUD OR DURESS, CAUSES A PERSON TO EXECUTE A
23 DECLARATION PURSUANT TO THIS ACT COMMITS A FELONY OF THE THIRD
24 DEGREE.
25 SECTION 13. EFFECTIVE DATE.
26 THIS ACT SHALL TAKE EFFECT IMMEDIATELY.
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