PRIOR PRINTER'S NOS. 2734, 3998 PRINTER'S NO. 4143
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
AS AMENDED ON THIRD CONSIDERATION, HOUSE OF REPRESENTATIVES, NOVEMBER 17, 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 and making an appropriation. 5 The General Assembly of the Commonwealth of Pennsylvania 6 hereby enacts as follows: 7 Section 1. Sections 5403, 5407, 5410(b), 5411, 5413 and 5415 8 of Title 20 of the Pennsylvania Consolidated Statutes are 9 amended to read: 10 § 5403. Definitions. 11 The following words and phrases when used in this chapter 12 shall have the meanings given to them in this section unless the 13 context clearly indicates otherwise: 14 "Attending physician." The physician who has primary 15 responsibility for the treatment and care of the declarant. 16 "Declarant." A person who makes a declaration in accordance 17 with this chapter.
1 "Declaration." A written document voluntarily executed by 2 the declarant in accordance with this chapter. 3 "Emergency medical service provider." A health care provider 4 recognized under the act of July 3, 1985 (P.L.164, No.45), known 5 as the Emergency Medical Services Act. 6 "Emergency medical services do-not-resuscitate bracelet" or 7 "EMS-DNR bracelet." A bracelet in the standard format set forth 8 in section 5413 (relating to emergency medical services), 9 supplied by the Department of Health and issued by the attending 10 physician, which may be worn, at the declarant's option, to 11 notify emergency medical service providers of the presence of a 12 do-not-resuscitate order. 13 "Emergency medical services do-not-resuscitate card" or "EMS- 14 DNR card." A wallet-sized card in the standard format set forth 15 in section 5413 (relating to emergency medical services), 16 supplied by the Department of Health and issued by the attending 17 physician, which may be displayed, at the declarant's option, to 18 notify emergency medical service providers of the presence of a 19 do-not-resuscitate order. 20 "Emergency medical services do-not-resuscitate order" or 21 "EMS-DNR order." An order in the standard format set forth in 22 section 5413 (relating to emergency medical services), supplied 23 by the Department of Health and issued by the attending 24 physician, directing emergency medical service providers to 25 withhold cardiopulmonary resuscitation (cardiac compression, 26 endotracheal intubation, artificial ventilation, defibrillation 27 and other related procedures) from the declarant in the event of 28 respiratory or cardiac arrest. 29 "Health care provider." A person who is licensed or 30 certified by the laws of this Commonwealth to administer health 19980H2085B4143 - 2 -
1 care in the ordinary course of business or practice of a 2 profession. The term includes personnel recognized under the act 3 of July 3, 1985 (P.L.164, No.45), known as the Emergency Medical 4 Services Act. 5 "Incompetent." The lack of sufficient capacity for a person 6 to make or communicate decisions concerning himself. 7 "INVASIVE AIRWAY TECHNIQUE." ANY ADVANCED AIRWAY TECHNIQUE, <-- 8 INCLUDING ENDOTRACHEAL AND ESOPHAGEAL INTUBATION. 9 "Life-sustaining treatment." Any medical procedure or 10 intervention that, when administered to a qualified patient, 11 will serve only to prolong the process of dying or to maintain 12 the patient in a state of permanent unconsciousness. Life- 13 sustaining treatment shall include nutrition and hydration 14 administered by gastric tube or intravenously or any other 15 artificial or invasive means if the declaration of the qualified 16 patient so specifically provides. 17 ["Medical command physician." A licensed physician who is 18 authorized to give medical command under the act of July 3, 1985 19 (P.L.164, No.45), known as the Emergency Medical Services Act.] 20 "Permanently unconscious." A medical condition that has been 21 diagnosed in accordance with currently accepted medical 22 standards and with reasonable medical certainty as total and 23 irreversible loss of consciousness and capacity for interaction 24 with the environment. The term includes, without limitation, a 25 persistent vegetative state or irreversible coma. 26 "Person." An individual, corporation, partnership, 27 association or Federal, State or local government or 28 governmental agency. 29 "Qualified patient." A person who has executed a declaration 30 and who has been determined to be in a terminal condition or to 19980H2085B4143 - 3 -
1 be permanently unconscious. 2 "Terminal condition." An incurable and irreversible medical 3 condition in an advanced state caused by injury, disease or 4 physical illness which will, in the opinion of the attending 5 physician, to a reasonable degree of medical certainty, result 6 in death regardless of the continued application of life- 7 sustaining treatment. 8 § 5407. Liability. 9 (a) General rule.--No physician, emergency medical service 10 provider or other health care provider who, consistent with this 11 chapter, causes or participates in the initiating, continuing, 12 withholding or withdrawal of life-sustaining treatment from a 13 qualified patient who is incompetent shall, as a result thereof, 14 be subject to criminal or civil liability or be found to have 15 committed an act of unprofessional conduct if the attending 16 physician has followed the declarant's wishes as expressed 17 earlier by the declarant in the form of a declaration and/or 18 EMS-DNR order executed pursuant to this chapter. 19 (b) Absence of declaration or EMS-DNR order, bracelet or 20 card.--The absence of a declaration or EMS-DNR order, bracelet 21 or card by a patient shall not give rise to any presumption as 22 to the intent of the patient to consent to or to refuse the 23 initiation, continuation or termination of life-sustaining 24 treatment. 25 § 5410. Effect on suicide and life insurance. 26 * * * 27 (b) Life insurance.--The making of or failure to make a 28 declaration or EMS-DNR order in accordance with this chapter 29 shall not affect in any manner the sale, procurement or issuance 30 of any policy of life insurance nor shall it be deemed to modify 19980H2085B4143 - 4 -
1 the terms of an existing policy of life insurance. No policy of 2 life insurance shall be legally impaired or invalidated in any 3 manner by the withholding or withdrawal of life-sustaining 4 treatment from an insured patient, notwithstanding any term of 5 the policy to the contrary. 6 § 5411. Declaration optional. 7 No physician or other health care provider and no health care 8 service plan, health maintenance organization, insurer issuing 9 disability insurance, self-insured employee welfare benefit 10 plan, nonprofit hospital plan or Federal, State or local 11 government sponsored or operated program shall: 12 (1) require any person to execute a declaration or EMS- 13 DNR order as a condition for being insured for or receiving 14 health care services; or 15 (2) charge any person a different rate or fee whether or 16 not the person executes or has executed a declaration. 17 § 5413. Emergency medical services. 18 (a) Care given prior to declaration taking effect.--Nothing 19 in this chapter shall be construed to make the provisions of a 20 declaration apply to care given to a patient by emergency 21 medical services personnel prior to the declaration's becoming 22 operative under sections 5405 (relating to when declaration 23 becomes operative) and 5408 (relating to duty of physician to 24 confirm terminal condition). 25 [(b) Care given after declaration takes effect.--The 26 provisions of a declaration shall apply to care given to a 27 patient by emergency medical services personnel after the 28 declaration becomes operative under sections 5405 and 5408 only 29 if: 30 (1) an original declaration, signed by the declarant or 19980H2085B4143 - 5 -
1 other authorized person, is presented to the emergency 2 medical services personnel. The emergency medical services 3 personnel must immediately notify the medical command 4 physician of the presence of the declaration; or 5 (2) the medical command physician, based on prior 6 notification by the attending physician or other health care 7 provider that a valid and operative declaration exists, 8 directs the emergency medical service personnel according to 9 the provisions of the declaration. 10 (c) Uncertainty regarding validity of declaration.-- 11 Emergency medical services personnel confronted with any 12 conflicting information regarding the patient's wishes for life- 13 sustaining treatment shall act according to the accepted 14 treatment protocols and standards appropriate to their level of 15 certification.] 16 (b) EMS-DNR orders, bracelets and cards.--The attending 17 physician who makes the determination pursuant to section 18 5405(2) (relating to when declaration becomes operative) shall, 19 if appropriate based on the declaration, issue to the declarant 20 an emergency medical services do-not-resuscitate order, and may 21 issue at the request of the declarant or his surrogate an EMS- 22 DNR bracelet and/or card supplied by the Department of Health. 23 The declarant may, at the declarant's option, wear the bracelet 24 and/or display the order or card to notify emergency medical 25 service providers of the declarant's do-not-resuscitate status. 26 (c) Revocation of EMS-DNR order.--The declarant or the 27 declarant's surrogate may revoke the declarant's EMS-DNR status 28 at any time without regard to the declarant's physical or mental 29 condition and in any manner, including verbally or by destroying 30 or not displaying the order, bracelet or card. Revocation of the 19980H2085B4143 - 6 -
1 declaration shall also serve to revoke the EMS-DNR order, though 2 emergency medical service providers shall not be subject to 3 civil or criminal liability or administrative sanction for 4 failure to verify the declaration prior to complying with the 5 EMS-DNR order. 6 (d) Effect of EMS-DNR order, bracelet or card.--Emergency 7 medical service providers are hereby authorized to and shall 8 comply, subject to subsection (e), with an approved Department 9 of Health-issued EMS-DNR order if made aware of such by 10 examining an EMS-DNR bracelet, card or the order itself. Such 11 providers shall have no duty to examine the underlying 12 declaration. "Compliance" for purposes of this subsection shall 13 mean the withholding of cardiopulmonary resuscitation (cardiac 14 compression, invasive airway techniques, artificial ventilation, 15 defibrillation and other related procedures) from the declarant 16 in the event of respiratory or cardiac arrest. "Compliance" 17 shall also mean the discontinuance and cessation of such 18 resuscitative measures in the event the emergency medical 19 service provider is presented with an EMS-DNR order, card and/or 20 bracelet after initiating such resuscitative measures. Emergency 21 medical service providers shall provide other medical 22 interventions necessary and appropriate to provide comfort and 23 alleviate pain, including intravenous fluids, medications, 24 oxygen and any other intervention appropriate to the level of 25 the certification of the provider, unless otherwise directed by 26 the declarant or the declarant's surrogate. 27 (e) Unwillingness of emergency medical service provider to 28 comply.--Emergency medical services providers who cannot in good 29 conscience comply with an EMS-DNR order shall make a good faith 30 effort to proceed under section 5409 (relating to unwillingness 19980H2085B4143 - 7 -
1 to comply; transfer of declarant) and, so long as such good 2 faith effort is made, shall not be subject to civil or criminal 3 liability or administrative sanction for failure to comply with 4 an EMS-DNR order. Emergency medical service providers unable to 5 comply with an EMS-DNR order under this subsection shall not be 6 subject to discipline, termination, demotion or other 7 retribution by their employer or the EMS organization with which 8 they are affiliated solely for their actions under this 9 subsection. 10 (f) Uncertainty regarding validity of order, bracelet or 11 card.--Emergency medical service providers who in good faith are 12 uncertain about the validity of an EMS-DNR order, bracelet or 13 card shall render care in accordance with their level of 14 certification. Such providers shall not be subject to civil or 15 criminal liability or administrative sanction for failure to 16 comply with an EMS-DNR order under this subsection. 17 (g) Format of EMS-DNR order.--The Department of Health 18 shall, with the advice of the Pennsylvania Emergency Health 19 Services Council and with the assistance of the regional 20 emergency medical services councils, make available within 180 21 days of the effective date of this subsection standard EMS-DNR 22 orders for issuance to declarants by attending physicians of 23 this Commonwealth. The form of the order shall contain, but not 24 be limited to, the following: 25 PENNSYLVANIA EMERGENCY MEDICAL SERVICES 26 DO-NOT-RESUSCITATE ORDER 27 Patient's full legal name: 28 I, the undersigned, state that I am the attending 29 physician of the patient named above. The above-named 30 patient has executed an advance directive for health care 19980H2085B4143 - 8 -
1 and I have made the determination that this patient is 2 incompetent and in a terminal condition or in a state of 3 permanent unconsciousness and that their declaration is 4 now operative. 5 I direct any and all emergency medical service 6 personnel, commencing on the effective date of this 7 order, to withhold cardiopulmonary resuscitation (cardiac 8 compression, invasive airway techniques, artificial 9 ventilation, defibrillation and other related procedures) 10 from the declarant in the event of the declarant's 11 respiratory or cardiac arrest. I further direct such 12 personnel to provide to the patient other medical 13 interventions, such as intravenous fluids, oxygen or 14 other therapies necessary to provide comfort care or to 15 alleviate pain, unless directed otherwise by the 16 declarant or the declarant's lawful surrogate. 17 Signature of attending physician: 18 Printed name of attending physician: 19 Dated: 20 Attending physician's emergency telephone number: 21 Signature of patient (if capable of making informed 22 decisions): 23 I, the undersigned, hereby direct that in the event 24 of my cardiac and/or respiratory arrest, efforts at 25 cardiopulmonary resuscitation not be initiated. I 26 understand that I may revoke these directions at any time 27 by giving verbal instructions to the emergency medical 28 service providers, by physical cancellation or 29 destruction of this form or my EMS-DNR bracelet or card, 30 or by simply not displaying this form or the EMS-DNR 19980H2085B4143 - 9 -
1 bracelet or card for my EMS caregivers. 2 Signature of surrogate (if patient is incapable of 3 making informed decisions): 4 I, the undersigned, hereby certify that I am 5 authorized to provide consent on the patient's behalf by 6 virtue of having been designated as the patient's 7 surrogate and/or by virtue of my relationship to the 8 patient (specify relationship: _________________). I 9 hereby direct that in the event of the patient's cardiac 10 and/or respiratory arrest, efforts at cardiopulmonary 11 resuscitation not be initiated. I understand that I may 12 revoke these directions at any time by giving verbal 13 instructions to the emergency medical service providers, 14 by physical cancellation or destruction of this form 15 and/or the patient's EMS-DNR bracelet or card, or by 16 simply not displaying this form or the EMS-DNR bracelet 17 or card for the patient's EMS caregivers. 18 (h) Format of EMS-DNR bracelet.--The Department of Health 19 shall, with the advice of the Pennsylvania Emergency Health 20 Services Council and with the assistance of the regional 21 emergency medical services councils, make available within 180 22 days of the effective date of this subsection standard EMS-DNR 23 bracelets for issuance to declarants by attending physicians. 24 The bracelets shall be uniform in design and shall at a minimum 25 on the face clearly indicate EMS-DNR and the name of the patient 26 and attending physician. 27 (i) Format of EMS-DNR card.--The Department of Health shall, 28 with the advice of the Pennsylvania Emergency Health Services 29 Council and with the assistance of the regional emergency 30 medical services councils, make available within 180 days of the 19980H2085B4143 - 10 -
1 effective date of this subsection standard EMS-DNR cards for 2 issuance to declarants by attending physicians. The cards shall 3 be wallet-sized and contain, but not be limited to, the 4 following: 5 PENNSYLVANIA EMERGENCY MEDICAL SERVICES 6 DO-NOT-RESUSCITATE CARD 7 Patient's full legal name: 8 Attending physician's name: 9 This patient has an operative advance directive and 10 emergency medical services do-not-resuscitate order. EMS 11 personnel are instructed not to perform cardiopulmonary 12 resuscitation (cardiac compression, endotracheal 13 intubation, artificial ventilation, defibrillation and 14 other related procedures) on this patient in the event of 15 the patient's respiratory or cardiac arrest. Do provide 16 to the patient other medical interventions, such as 17 intravenous fluids, oxygen or other therapies deemed 18 necessary to provide comfort care or to alleviate pain, 19 unless directed otherwise by the declarant or the 20 declarant's lawful surrogate. 21 § 5415. Penalties. 22 Any person who willfully conceals, cancels, defaces, 23 obliterates or damages the declaration or EMS-DNR order, 24 bracelet or card of another without the consent of the declarant 25 commits a felony of the third degree. Any person who falsifies 26 or forges the declaration or EMS-DNR order, bracelet or card of 27 another, or willfully conceals or withholds personal knowledge 28 of a revocation as provided in section 5406 (relating to 29 revocation) or 5413(c) (relating to emergency medical services), 30 with the intent to cause a withholding or withdrawal of life- 19980H2085B4143 - 11 -
1 sustaining treatment contrary to the wishes of the declarant
2 and, because of such an act, directly causes life-sustaining
3 treatment to be withheld or withdrawn and death to be hastened
4 shall be subject to prosecution for criminal homicide as
5 provided in 18 Pa.C.S. Ch. 25 (relating to criminal homicide).
6 Any person who willfully, by undue influence, fraud or duress,
7 causes a person to execute a declaration or EMS-DNR order
8 pursuant to this chapter commits a felony of the third degree.
9 Section 2. The Department of Health shall, with the advice
10 of the Pennsylvania Emergency Health Services Council and with
11 the assistance of the regional emergency medical services
12 councils, develop and make available to health care providers
13 recognized under the act of July 3, 1985 (P.L.164, No.45), known
14 as the Emergency Medical Services Act, within 180 days of the
15 effective date of this act educational materials relating to the
16 implementation of the provisions of this act. The department
17 shall also cause the requirements of this act to be included as
18 part of the curricula for health care providers recognized under
19 the Emergency Medical Services Act.
20 Section 3. The sum of $50,000, or as much thereof as may be
21 necessary, is hereby appropriated to the Department of Health
22 for the fiscal year July 1, 1998, to June 30, 1999, to carry out
23 the provisions of this act.
24 Section 4. This act shall take effect in 60 days.
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