PRINTER'S NO. 1481
No. 1283 Session of 1991
INTRODUCED BY JOSEPHS, HAGARTY, ITKIN, LEE, ROEBUCK, VEON,
RITTER, PICCOLA, HARLEY, STEELMAN AND STURLA, MAY 6, 1991
REFERRED TO COMMITTEE ON HEALTH AND WELFARE, MAY 6, 1991
AN ACT
1 Establishing a procedure whereby a person may execute in advance
2 a written declaration indicating to a physician the person's
3 desire for a physician to initiate, continue, withhold or
4 withdraw certain life-sustaining medical treatment in the
5 event the person is incompetent and is determined to be in a
6 terminal condition or to be permanently unconscious; and
7 providing penalties.
8 TABLE OF CONTENTS
9 Section 1. Short title.
10 Section 2. Legislative findings; intent.
11 Section 3. Definitions.
12 Section 4. Declaration.
13 Section 5. When declaration becomes operative.
14 Section 6. Revocation.
15 Section 7. Liability.
16 Section 8. Duty of physician to confirm terminal condition.
17 Section 9. Transfer of declarant.
18 Section 10. Effect on suicide and life insurance; declaration
19 optional.
20 Section 11. Preservation of existing rights; power of
1 attorney.
2 Section 12. Penalties.
3 Section 13. Effective date.
4 The General Assembly of the Commonwealth of Pennsylvania
5 hereby enacts as follows:
6 Section 1. Short title.
7 This act shall be known and may be cited as the Advance
8 Directive for Health Care Act.
9 Section 2. Legislative findings; intent.
10 (a) Findings.--The General Assembly finds that all competent
11 adults have a qualified right to control decisions relating to
12 their own medical care. This right is subject to certain
13 interests of society, such as the maintenance of ethical
14 standards in the medical profession and the preservation and
15 protection of human life. Modern medical technological
16 procedures make possible the prolongation of human life beyond
17 natural limits. The application of some procedures to an
18 individual suffering a difficult and uncomfortable process of
19 dying may cause loss of patient dignity and secure only
20 continuation of a precarious and burdensome prolongation of
21 life.
22 (b) Intent.--Nothing in this act is intended to condone,
23 authorize or approve mercy killing, or to permit any affirmative
24 or deliberate act or omission to end life other than as defined
25 in this act. Furthermore, this act shall create no presumption
26 concerning the intent of any person who has not executed a
27 declaration to consent to the use or withholding of life-
28 sustaining procedures in the event of a terminal condition or a
29 state of permanent unconsciousness.
30 Section 3. Definitions.
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1 The following words and phrases when used in this act shall
2 have the meanings given to them in this section unless the
3 context clearly indicates otherwise:
4 "Attending physician." The physician who has primary
5 responsibility for the treatment and care of the declarant.
6 "Declarant." A person who makes a declaration in accordance
7 with this act.
8 "Declaration." A written document, voluntarily executed by
9 the declarant in accordance with this act.
10 "Health care provider." A person who is licensed by the laws
11 of this Commonwealth to administer health care in the ordinary
12 course of business or practice of a profession.
13 "Incompetent." The lack of sufficient capacity for a person
14 to make or communicate decisions concerning himself.
15 "Life-sustaining treatment." Any medical procedure or
16 intervention that, when administered to a qualified patient,
17 will serve only to prolong the process of dying or to maintain
18 the patient in a state of permanent unconsciousness. Life-
19 sustaining treatment shall include nutrition and hydration
20 administered by gastric tube or intravenously or any other
21 artificial or invasive means if the declaration of the qualified
22 patient so specifically provides.
23 "Permanently unconscious." A medical condition that has been
24 diagnosed in accordance with currently accepted medical
25 standards and with reasonable medical certainty as total and
26 irreversible loss of consciousness and capacity for interaction
27 with the environment. The term includes without limitation a
28 persistent vegetative state or irreversible coma.
29 "Person." An individual, corporation, partnership,
30 association, or Federal, State or local government or
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1 governmental agency.
2 "Qualified patient." A person who has executed a declaration
3 and who has been determined to be in a terminal condition or to
4 be permanently unconscious.
5 "Terminal condition." An incurable and irreversible medical
6 condition caused by injury, disease or physical illness which
7 will, in the opinion of the attending physician, to a reasonable
8 degree of medical certainty, result in death regardless of the
9 continued application of life-sustaining treatment.
10 Section 4. Declaration.
11 (a) Execution.--An individual of sound mind who is 18 years
12 of age or older or who is otherwise authorized to give medical
13 consent on his behalf pursuant to the act of February 13, 1970
14 (P.L.19, No.10), entitled "An act enabling certain minors to
15 consent to medical, dental and health services, declaring
16 consent unnecessary under certain circumstances," may execute at
17 any time a declaration governing the initiation, continuation,
18 withholding or withdrawal of life-sustaining treatment. The
19 declaration must be signed by the declarant, or by another on
20 behalf of and at the direction of the declarant, and must be
21 witnessed by two individuals each of whom is 18 years of age or
22 older. A witness shall not be the person who signed the
23 declaration on behalf of and at the direction of the declarant.
24 (b) Form.--A declaration may but need not be in the
25 following form and may include other specific directions
26 including, but not limited to, designation of another person to
27 make the treatment decision for the declarant if the declarant
28 is incompetent and is determined to be in a terminal condition
29 or to be permanently unconscious.
30 DECLARATION
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1 I, , being of sound mind, willfully and
2 voluntarily make this declaration to be followed if I become
3 incompetent. This declaration reflects my firm and settled
4 commitment to refuse life-sustaining treatment under the
5 circumstances indicated below.
6 I direct my attending physician to withhold or withdraw
7 life-sustaining treatment that serves only to prolong the
8 process of my dying, if I should be in a terminal condition
9 or in a state of permanent unconsciousness.
10 I direct that treatment be limited to measures to keep me
11 comfortable and to relieve pain, including any pain that
12 might occur by withholding or withdrawing life-sustaining
13 treatment.
14 In addition, if I am in the condition described above, I
15 feel especially strongly about the following forms of
16 treatment:
17 I ( ) do ( ) do not want cardiac resuscitation.
18 I ( ) do ( ) do not want mechanical respiration.
19 I ( ) do ( ) do not want tube feeding or any other
20 artificial or invasive form of nutrition (food) or hydration
21 (water).
22 I ( ) do ( ) do not want blood or blood products.
23 I ( ) do ( ) do not want any form of surgery or invasive
24 diagnostic tests.
25 I ( ) do ( ) do not want kidney dialysis.
26 I ( ) do ( ) do not want antibiotics.
27 I realize that if I do not specifically indicate my
28 preference regarding any of the forms of treatment listed
29 above, I may receive that form of treatment.
30 I ( ) wish ( ) do not wish to change these instructions
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1 in the following ways if pregnant.
2 Other instructions:
3 I ( ) do ( ) do not want to designate another person as
4 my surrogate to make medical treatment decisions for me if I
5 should be incompetent and in a terminal condition or in a
6 state of permanent unconsciousness. Name and address of
7 surrogate (if applicable):
8 Name and address of substitute surrogate (if surrogate
9 designated above is unable to serve):
10 I made this declaration on the day of
11 (month, year).
12 Declarant's signature:
13 Declarant's address:
14 The declarant or the person on behalf of and at the
15 direction of the declarant knowingly and voluntarily signed
16 this writing by signature or mark in my presence.
17 Witness's signature:
18 Witness's address:
19 Witness's signature:
20 Witness's address:
21 (c) Invalidity of specific direction.--Should any specific
22 direction in the declaration be held to be invalid, the
23 invalidity shall not offset other directions of the declaration
24 which can be effected without the invalid direction.
25 (d) Medical record.--A physician or other health care
26 provider who is furnished a copy of the declaration shall make
27 it a part of the declarant's medical record and, if unwilling to
28 comply with the declaration, promptly so advise the declarant.
29 Section 5. When declaration becomes operative.
30 A declaration becomes operative when:
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1 (1) a copy is provided to the attending physician; and
2 (2) the declarant is determined by the attending
3 physician to be incompetent and in a terminal condition or in
4 a state of permanent unconsciousness.
5 When the declaration becomes operative, the attending physician
6 and other health care providers shall act in accordance with its
7 provisions or comply with the transfer provisions of section 9.
8 Section 6. Revocation.
9 (a) General rule.--A declaration may be revoked at any time
10 and in any manner by the declarant, without regard to the
11 declarant's mental or physical condition. A revocation is
12 effective upon communication to the attending physician or other
13 health care provider by the declarant or a witness to the
14 revocation.
15 (b) Medical record.--The attending physician or other health
16 care provider shall make the revocation a part of the
17 declarant's medical record.
18 Section 7. Liability.
19 (a) General rule.--No physician or other health care
20 provider who, consistent with this act, causes or participates
21 in the initiating, continuing, withholding or withdrawal of
22 life-sustaining treatment from a qualified patient who is
23 incompetent shall, as a result thereof, be subject to criminal
24 or civil liability, or be found to have committed an act of
25 unprofessional conduct, if the attending physician has followed
26 the declarant's wishes as expressed earlier by the declarant in
27 the form of a declaration executed pursuant to this act.
28 (b) Absence of declaration.--The absence of a declaration by
29 a patient shall not give rise to any presumption as to the
30 intent of the patient to consent to or to refuse the initiation,
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1 continuation or termination of life-sustaining treatment.
2 Section 8. Duty of physician to confirm terminal condition.
3 For purposes of section 5, an attending physician shall,
4 without delay after the diagnosis that the declarant is in a
5 terminal condition or in a state of permanent unconsciousness,
6 certify in writing that the declarant is in a terminal condition
7 or in a state of permanent unconsciousness and arrange for the
8 physical examination and confirmation of the terminal condition
9 or state of permanent unconsciousness of the declarant by a
10 second physician.
11 Section 9. Transfer of declarant.
12 An attending physician or other health care provider who is
13 unwilling to comply with this act shall, as promptly as
14 practical, take all reasonable steps to transfer care of the
15 declarant to another physician or health care provider.
16 Section 10. Effect on suicide and life insurance; declaration
17 optional.
18 (a) Criminal effect.--The withholding or withdrawal of life-
19 sustaining treatment from a qualified patient in accordance with
20 the provisions of this act shall not, for any purpose,
21 constitute suicide or homicide.
22 (b) Life insurance.--The making of, or failure to make, a
23 declaration in accordance with this act shall not affect in any
24 manner the sale, procurement or issuance of any policy of life
25 insurance, nor shall it be deemed to modify the terms of an
26 existing policy of life insurance. No policy of life insurance
27 shall be legally impaired or invalidated in any manner by the
28 withholding or withdrawal of life-sustaining treatment from an
29 insured patient, notwithstanding any term of the policy to the
30 contrary.
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1 (c) Declaration optional.--No physician or other health care
2 provider, and no health care service plan, health maintenance
3 organization, insurer issuing disability insurance, self-insured
4 employee welfare benefit plan, nonprofit hospital plan or
5 Federal, State or local government-sponsored or operated program
6 shall:
7 (1) require any person to execute a declaration as a
8 condition for being insured for, or receiving, health care
9 services; or
10 (2) charge any person a different rate or fee whether or
11 not the person executes or has executed a declaration.
12 Section 11. Preservation of existing rights; power of attorney.
13 (a) Legal rights not impaired.--The provisions of this act
14 are cumulative with existing law regarding the right of an
15 individual to consent or refuse to consent to life-sustaining
16 treatment and shall not impair or supersede any existing rights
17 or responsibilities which a health care provider, a patient,
18 including a minor or incompetent patient, or the family of a
19 patient may have in regard to the withholding or withdrawal of
20 life-sustaining treatment under the laws of this Commonwealth.
21 (b) Power of attorney.--Nothing in this act shall limit a
22 power of attorney executed under 20 Pa.C.S. Ch. 56 (relating to
23 powers of attorney).
24 Section 12. Penalties.
25 Any person who willfully conceals, cancels, defaces,
26 obliterates or damages the declaration of another without the
27 consent of the declarant commits a felony of the third degree.
28 Any person who falsifies or forges the declaration of another,
29 or willfully conceals or withholds personal knowledge of a
30 revocation as provided in section 6, with the intent to cause a
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1 withholding or withdrawal of life-sustaining treatment contrary
2 to the wishes of the declarant and, because of such an act,
3 directly causes life-sustaining treatment to be withheld or
4 withdrawn and death to be hastened, shall be subject to
5 prosecution for criminal homicide as provided in 18 Pa.C.S. Ch.
6 25 (relating to criminal homicide). Any person who willfully, by
7 undue influence, fraud or duress, causes a person to execute a
8 declaration pursuant to this act commits a felony of the third
9 degree.
10 Section 13. Effective date.
11 This act shall take effect immediately.
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