PRINTER'S NO. 2734
No. 2085 Session of 1998
INTRODUCED BY FLEAGLE, WAUGH, VANCE, TANGRETTI, GEIST, HERSHEY,
MUNDY, MILLER, LAUGHLIN, DEMPSEY, EGOLF, COY, M. COHEN,
BELFANTI, STEELMAN, McGILL, PESCI, SATHER, TRELLO, ROSS,
SAYLOR AND WILT, JANUARY 12, 1998
REFERRED TO COMMITTEE ON JUDICIARY, JANUARY 12, 1998
AN ACT
1 Amending Title 20 (Decedents, Estates and Fiduciaries) of the
2 Pennsylvania Consolidated Statutes, further providing for
3 advance directives for emergency medical service health care.
4 The General Assembly of the Commonwealth of Pennsylvania
5 hereby enacts as follows:
6 Section 1. Sections 5403, 5407, 5410(b), 5411, 5413 and 5415
7 of Title 20 of the Pennsylvania Consolidated Statutes are
8 amended to read:
9 § 5403. Definitions.
10 The following words and phrases when used in this chapter
11 shall have the meanings given to them in this section unless the
12 context clearly indicates otherwise:
13 "Attending physician." The physician who has primary
14 responsibility for the treatment and care of the declarant.
15 "Declarant." A person who makes a declaration in accordance
16 with this chapter.
17 "Declaration." A written document voluntarily executed by
1 the declarant in accordance with this chapter.
2 "Emergency medical service provider." A health care provider
3 recognized under the act of July 3, 1985 (P.L.164, No.45), known
4 as the Emergency Medical Services Act.
5 "Emergency medical services do-not-resuscitate bracelet" or
6 "EMS-DNR bracelet." A bracelet in the standard format set forth
7 in section 5413 (relating to emergency medical services),
8 supplied by the Department of Health and issued by the attending
9 physician, which may be worn, at the declarant's option, to
10 notify emergency medical service providers of the presence of a
11 do-not-resuscitate order.
12 "Emergency medical services do-not-resuscitate card" or "EMS-
13 DNR card." A wallet-sized card in the standard format set forth
14 in section 5413 (relating to emergency medical services),
15 supplied by the Department of Health and issued by the attending
16 physician, which may be displayed, at the declarant's option, to
17 notify emergency medical service providers of the presence of a
18 do-not-resuscitate order.
19 "Emergency medical services do-not-resuscitate order" or
20 "EMS-DNR order." An order in the standard format set forth in
21 section 5413 (relating to emergency medical services), supplied
22 by the Department of Health and issued by the attending
23 physician, directing emergency medical service providers to
24 withhold cardiopulmonary resuscitation (cardiac compression,
25 endotracheal intubation, artificial ventilation, defibrillation
26 and other related procedures) from the declarant in the event of
27 respiratory or cardiac arrest.
28 "Health care provider." A person who is licensed or
29 certified by the laws of this Commonwealth to administer health
30 care in the ordinary course of business or practice of a
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1 profession. The term includes personnel recognized under the act
2 of July 3, 1985 (P.L.164, No.45), known as the Emergency Medical
3 Services Act.
4 "Incompetent." The lack of sufficient capacity for a person
5 to make or communicate decisions concerning himself.
6 "Life-sustaining treatment." Any medical procedure or
7 intervention that, when administered to a qualified patient,
8 will serve only to prolong the process of dying or to maintain
9 the patient in a state of permanent unconsciousness. Life-
10 sustaining treatment shall include nutrition and hydration
11 administered by gastric tube or intravenously or any other
12 artificial or invasive means if the declaration of the qualified
13 patient so specifically provides.
14 ["Medical command physician." A licensed physician who is
15 authorized to give medical command under the act of July 3, 1985
16 (P.L.164, No.45), known as the Emergency Medical Services Act.]
17 "Permanently unconscious." A medical condition that has been
18 diagnosed in accordance with currently accepted medical
19 standards and with reasonable medical certainty as total and
20 irreversible loss of consciousness and capacity for interaction
21 with the environment. The term includes, without limitation, a
22 persistent vegetative state or irreversible coma.
23 "Person." An individual, corporation, partnership,
24 association or Federal, State or local government or
25 governmental agency.
26 "Qualified patient." A person who has executed a declaration
27 and who has been determined to be in a terminal condition or to
28 be permanently unconscious.
29 "Terminal condition." An incurable and irreversible medical
30 condition in an advanced state caused by injury, disease or
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1 physical illness which will, in the opinion of the attending
2 physician, to a reasonable degree of medical certainty, result
3 in death regardless of the continued application of life-
4 sustaining treatment.
5 § 5407. Liability.
6 (a) General rule.--No physician, emergency medical service
7 provider or other health care provider who, consistent with this
8 chapter, causes or participates in the initiating, continuing,
9 withholding or withdrawal of life-sustaining treatment from a
10 qualified patient who is incompetent shall, as a result thereof,
11 be subject to criminal or civil liability or be found to have
12 committed an act of unprofessional conduct if the attending
13 physician has followed the declarant's wishes as expressed
14 earlier by the declarant in the form of a declaration and/or
15 EMS-DNR order executed pursuant to this chapter.
16 (b) Absence of declaration or EMS-DNR order, bracelet or
17 card.--The absence of a declaration or EMS-DNR order, bracelet
18 or card by a patient shall not give rise to any presumption as
19 to the intent of the patient to consent to or to refuse the
20 initiation, continuation or termination of life-sustaining
21 treatment.
22 § 5410. Effect on suicide and life insurance.
23 * * *
24 (b) Life insurance.--The making of or failure to make a
25 declaration or EMS-DNR order in accordance with this chapter
26 shall not affect in any manner the sale, procurement or issuance
27 of any policy of life insurance nor shall it be deemed to modify
28 the terms of an existing policy of life insurance. No policy of
29 life insurance shall be legally impaired or invalidated in any
30 manner by the withholding or withdrawal of life-sustaining
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1 treatment from an insured patient, notwithstanding any term of
2 the policy to the contrary.
3 § 5411. Declaration optional.
4 No physician or other health care provider and no health care
5 service plan, health maintenance organization, insurer issuing
6 disability insurance, self-insured employee welfare benefit
7 plan, nonprofit hospital plan or Federal, State or local
8 government sponsored or operated program shall:
9 (1) require any person to execute a declaration or EMS-
10 DNR order as a condition for being insured for or receiving
11 health care services; or
12 (2) charge any person a different rate or fee whether or
13 not the person executes or has executed a declaration.
14 § 5413. Emergency medical services.
15 (a) Care given prior to declaration taking effect.--Nothing
16 in this chapter shall be construed to make the provisions of a
17 declaration apply to care given to a patient by emergency
18 medical services personnel prior to the declaration's becoming
19 operative under sections 5405 (relating to when declaration
20 becomes operative) and 5408 (relating to duty of physician to
21 confirm terminal condition).
22 [(b) Care given after declaration takes effect.--The
23 provisions of a declaration shall apply to care given to a
24 patient by emergency medical services personnel after the
25 declaration becomes operative under sections 5405 and 5408 only
26 if:
27 (1) an original declaration, signed by the declarant or
28 other authorized person, is presented to the emergency
29 medical services personnel. The emergency medical services
30 personnel must immediately notify the medical command
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1 physician of the presence of the declaration; or
2 (2) the medical command physician, based on prior
3 notification by the attending physician or other health care
4 provider that a valid and operative declaration exists,
5 directs the emergency medical service personnel according to
6 the provisions of the declaration.
7 (c) Uncertainty regarding validity of declaration.--
8 Emergency medical services personnel confronted with any
9 conflicting information regarding the patient's wishes for life-
10 sustaining treatment shall act according to the accepted
11 treatment protocols and standards appropriate to their level of
12 certification.]
13 (b) EMS-DNR orders, bracelets and cards.--The attending
14 physician who makes the determination pursuant to section
15 5405(2) (relating to when declaration becomes operative) shall,
16 if appropriate based on the declaration, issue to the declarant
17 an emergency medical services do-not-resuscitate order, and may
18 issue at the request of the declarant or his surrogate an EMS-
19 DNR bracelet and/or card supplied by the Department of Health.
20 The declarant may, at the declarant's option, wear the bracelet
21 and/or display the order or card to notify emergency medical
22 service providers of the declarant's do-not-resuscitate status.
23 (c) Revocation of EMS-DNR order.--The declarant or the
24 declarant's surrogate may revoke the declarant's EMS-DNR status
25 at any time without regard to the declarant's physical or mental
26 condition and in any manner, including verbally or by destroying
27 or not displaying the order, bracelet or card. Revocation of the
28 declaration shall also serve to revoke the EMS-DNR order, though
29 emergency medical service providers shall not be subject to
30 civil or criminal liability or administrative sanction for
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1 failure to verify the declaration prior to complying with the
2 EMS-DNR order.
3 (d) Effect of EMS-DNR order, bracelet or card.--Emergency
4 medical service providers are hereby authorized to and shall
5 comply, subject to subsection (e), with an approved Department
6 of Health-issued EMS-DNR order if made aware of such by
7 examining an EMS-DNR bracelet, card or the order itself. Such
8 providers shall have no duty to examine the underlying
9 declaration. "Compliance" for purposes of this subsection shall
10 mean the withholding of cardiopulmonary resuscitation (cardiac
11 compression, endotracheal intubation, artificial ventilation,
12 defibrillation and other related procedures) from the declarant
13 in the event of respiratory or cardiac arrest. "Compliance"
14 shall also mean the discontinuance and cessation of such
15 resuscitative measures in the event the emergency medical
16 service provider is presented with an EMS-DNR order, card and/or
17 bracelet after initiating such resusciative measures. Emergency
18 medical service providers shall provide other medical
19 interventions necessary and appropriate to provide comfort and
20 alleviate pain, including intravenous fluids, medications and
21 oxygen, unless otherwise directed by the declarant or the
22 declarant's surrogate.
23 (e) Unwillingness of emergency medical service provider to
24 comply.--Emergency medical services providers who cannot in good
25 conscience comply with an EMS-DNR order shall make a good faith
26 effort to proceed under section 5409 (relating to unwillingness
27 to comply; transfer of declarant) and, so long as such good
28 faith effort is made, shall not be subject to civil or criminal
29 liability or administrative sanction for failure to comply with
30 an EMS-DNR order. Emergency medical service providers unable to
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1 comply with an EMS-DNR order under this subsection shall not be
2 subject to discipline, termination, demotion or other
3 retribution by their employer or the EMS organization with which
4 they are affiliated solely for their actions under this
5 subsection.
6 (f) Uncertainty regarding validity of order, bracelet or
7 card.--Emergency medical service providers who in good faith are
8 uncertain about the validity of an EMS-DNR order, bracelet or
9 card shall render care in accordance with their level of
10 certification. Such providers shall not be subject to civil or
11 criminal liability or administrative sanction for failure to
12 comply with an EMS-DNR order under this subsection.
13 (g) Format of EMS-DNR order.--The Department of Health
14 shall, with the advice of the Pennsylvania Emergency Health
15 Services Council and with the assistance of the regional
16 emergency medical services councils, make available within 180
17 days of the effective date of this subsection standard EMS-DNR
18 orders for issuance to declarants by attending physicians of
19 this Commonwealth. The form of the order shall contain, but not
20 be limited to, the following:
21 PENNSYLVANIA EMERGENCY MEDICAL SERVICES
22 DO-NOT-RESUSCITATE ORDER
23 Patient's full legal name:
24 I, the undersigned, state that I am the attending
25 physician of the patient named above. The above-named
26 patient has executed an advance directive for health care
27 and I have made the determination that this patient is in
28 a terminal condition or in a state of permanent
29 unconsciousness and that their declaration is now
30 operative.
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1 I direct any and all emergency medical service
2 personnel, commencing on the effective date of this
3 order, to withhold cardiopulmonary resuscitation (cardiac
4 compression, endotracheal intubation, artificial
5 ventilation, defibrillation and other related procedures)
6 from the declarant in the event of the declarant's
7 respiratory or cardiac arrest. I further direct such
8 personnel to provide to the patient other medical
9 interventions, such as intravenous fluids, oxygen or
10 other therapies necessary to provide comfort care or to
11 alleviate pain, unless directed otherwise by the
12 declarant or the declarant's lawful surrogate.
13 Signature of attending physician:
14 Printed name of attending physician:
15 Dated:
16 Attending physician's emergency telephone number:
17 Signature of patient (if capable of making informed
18 decisions):
19 I, the undersigned, hereby direct that in the event
20 of my cardiac and/or respiratory arrest, efforts at
21 cardiopulmonary resuscitation not be initiated. I
22 understand that I may revoke these directions at any time
23 by giving verbal instructions to the emergency medical
24 service providers, by physical cancellation or
25 destruction of this form or my EMS-DNR bracelet or card,
26 or by simply not displaying this form or the EMS-DNR
27 bracelet or card for my EMS caregivers.
28 Signature of surrogate (if patient is incapable of
29 making informed decisions):
30 I, the undersigned, hereby certify that I am
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1 authorized to provide consent on the patient's behalf by
2 virtue of having been designated as the patient's
3 surrogate and/or by virtue of my relationship to the
4 patient (specify relationship: _________________). I
5 hereby direct that in the event of the patient's cardiac
6 and/or respiratory arrest, efforts at cardiopulmonary
7 resuscitation not be initiated. I understand that I may
8 revoke these directions at any time by giving verbal
9 instructions to the emergency medical service providers,
10 by physical cancellation or destruction of this form
11 and/or the patient's EMS-DNR bracelet or card, or by
12 simply not displaying this form or the EMS-DNR bracelet
13 or card for the patient's EMS caregivers.
14 (h) Format of EMS-DNR bracelet.--The Department of Health
15 shall, with the advice of the Pennsylvania Emergency Health
16 Services Council and with the assistance of the regional
17 emergency medical services councils, make available within 180
18 days of the effective date of this subsection standard EMS-DNR
19 bracelets for issuance to declarants by attending physicians.
20 The bracelets shall be uniform in design and shall on the face
21 clearly indicate EMS-DNR and the name of the patient and
22 attending physician.
23 (i) Format of EMS-DNR card.--The Department of Health shall,
24 with the advice of the Pennsylvania Emergency Health Services
25 Council and with the assistance of the regional emergency
26 medical services councils, make available within 180 days of the
27 effective date of this subsection standard EMS-DNR cards for
28 issuance to declarants by attending physicians. The cards shall
29 be wallet-sized and contain the following:
30 PENNSYLVANIA EMERGENCY MEDICAL SERVICES
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1 DO-NOT-RESUSCITATE CARD
2 Patient's full legal name:
3 Attending physician's name:
4 This patient has an operative advance directive and
5 emergency medical services do-not-resuscitate order. EMS
6 personnel are instructed not to perform cardiopulmonary
7 resuscitation (cardiac compression, endotracheal
8 intubation, artificial ventilation, defibrillation and
9 other related procedures) on this patient in the event of
10 the patient's respiratory or cardiac arrest. Do provide
11 to the patient other medical interventions, such as
12 intravenous fluids, oxygen or other therapies deemed
13 necessary to provide comfort care or to alleviate pain,
14 unless directed otherwise by the declarant or the
15 declarant's lawful surrogate.
16 § 5415. Penalties.
17 Any person who willfully conceals, cancels, defaces,
18 obliterates or damages the declaration or EMS-DNR order,
19 bracelet or card of another without the consent of the declarant
20 commits a felony of the third degree. Any person who falsifies
21 or forges the declaration or EMS-DNR order, bracelet or card of
22 another, or willfully conceals or withholds personal knowledge
23 of a revocation as provided in section 5406 (relating to
24 revocation) or 5413(c) (relating to emergency medical services),
25 with the intent to cause a withholding or withdrawal of life-
26 sustaining treatment contrary to the wishes of the declarant
27 and, because of such an act, directly causes life-sustaining
28 treatment to be withheld or withdrawn and death to be hastened
29 shall be subject to prosecution for criminal homicide as
30 provided in 18 Pa.C.S. Ch. 25 (relating to criminal homicide).
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1 Any person who willfully, by undue influence, fraud or duress,
2 causes a person to execute a declaration or EMS-DNR order
3 pursuant to this chapter commits a felony of the third degree.
4 Section 2. This act shall take effect in 60 days.
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