PRIOR PRINTER'S NO. 2739 PRINTER'S NO. 4166
No. 2036 Session of 2003
INTRODUCED BY KENNEY, KOTIK, PAYNE, BEBKO-JONES, BELFANTI,
BENNINGHOFF, BUNT, CORRIGAN, COY, CURRY, DeWEESE, D. EVANS,
FLEAGLE, GEIST, HARHAI, HARHART, HERMAN, HESS, JAMES, KELLER,
KIRKLAND, LEACH, MACKERETH, MAITLAND, McGEEHAN, McGILL,
MUNDY, MYERS, NICKOL, O'NEILL, PALLONE, REICHLEY, ROSS,
SANTONI, SATHER, SEMMEL, SOLOBAY, STURLA, J. TAYLOR, THOMAS,
TIGUE, TRUE, VANCE, WALKO, WATSON, WEBER, YOUNGBLOOD,
GOODMAN, GANNON, E. Z. TAYLOR, BROWNE, OLIVER, RUBLEY,
DeLUCA, JOSEPHS, HORSEY, SAINATO, WILT, WASHINGTON, BISHOP
AND GERGLEY, OCTOBER 8, 2003
AS REPORTED FROM COMMITTEE ON HEALTH AND HUMAN SERVICES, HOUSE
OF REPRESENTATIVES, AS AMENDED, JUNE 23, 2004
AN ACT
1 Amending Title 20 (Decedents, Estates and Fiduciaries) of the
2 Pennsylvania Consolidated Statutes, providing for mental
3 health care declarations and powers of attorney.
4 The General Assembly of the Commonwealth of Pennsylvania
5 hereby enacts as follows:
6 Section 1. Title 20 of the Pennsylvania Consolidated
7 Statutes is amended by adding a chapter to read:
8 CHAPTER 58 <--
9 MENTAL HEALTH CARE
10 Subchapter
11 A. General Provisions
12 B. Mental Health Care Declarations
13 C. Mental Health Care Powers of Attorney
14 SUBCHAPTER A
1 GENERAL PROVISIONS
2 Sec.
3 5801. Applicability.
4 5802. Definitions.
5 5803. Legislative findings and intent.
6 5804. Compliance.
7 5805. Liability.
8 5806. Penalties.
9 5807. Rights and responsibilities.
10 5808. Combining mental health care instruments.
11 § 5801. Applicability.
12 (a) General rule.--This chapter applies to mental health
13 care declarations and mental health care powers of attorney.
14 (b) Preservation of existing rights.--The provisions of this
15 chapter shall not be construed to impair or supersede any
16 existing rights or responsibilities not addressed in this
17 chapter.
18 § 5802. Definitions.
19 The following words and phrases when used in this chapter
20 shall have the meanings given to them in this section unless the
21 context clearly indicates otherwise:
22 "Attending physician." A physician who has primary
23 responsibility for the treatment and care of the declarant or
24 principal.
25 "Declarant." An individual who makes a declaration in
26 accordance with this chapter.
27 "Declaration." A writing made in accordance with this
28 chapter that expresses a declarant's wishes and instructions for
29 mental health care and mental health care directions and which
30 may contain other specific directions.
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1 "Mental health care." Any care, treatment, service or
2 procedure to maintain, diagnose, treat or provide for mental
3 health, including any medication program and therapeutical
4 treatment.
5 "Mental health care agent." An individual designated by a
6 principal in a mental health care power of attorney.
7 "Mental health care power of attorney." A writing made by a
8 principal designating an individual to make mental health care
9 decisions for the principal.
10 "Mental health care provider." A person who is licensed,
11 certified or otherwise authorized by the laws of this
12 Commonwealth to administer or provide mental health care in the
13 ordinary course of business or practice of a profession.
14 "Mental health treatment professional." A person trained and
15 licensed in psychiatry, social work, psychology or nursing who
16 has a graduate degree and clinical experience.
17 "Principal." An individual who makes a mental health care
18 power of attorney in accordance with this chapter.
19 § 5803. Legislative findings and intent.
20 (a) Intent.--This chapter provides a means for competent
21 adults to control their mental health care either directly
22 through instructions written in advance or indirectly through a
23 mental health care agent.
24 (b) Presumption not created.--This chapter shall not be
25 construed to create any presumption regarding the intent of an
26 individual who has not executed a declaration or mental health
27 care power of attorney to consent to the use or withholding of
28 treatment.
29 (c) Findings in general.--The General Assembly finds that
30 all capable adults have a qualified right to control decisions
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1 relating to their own mental health care.
2 § 5804. Compliance.
3 (a) Duty to comply.--
4 (1) An attending physician and mental health care
5 provider shall comply with mental health declarations and
6 powers of attorney.
7 (2) If an attending physician or other mental health
8 care provider cannot in good conscience comply with a
9 declaration or mental health care decision of a mental health
10 care agent or if the policies of a mental health care
11 provider preclude compliance with a declaration or mental
12 health care decision of a mental health care agent,
13 immediately upon receipt of the declaration or power of
14 attorney, and as soon as any possibility of noncompliance
15 becomes apparent, the attending physician or mental health
16 care provider shall so inform the following:
17 (i) The declarant, if the declarant is competent.
18 (ii) The substitute named in the declaration, if the
19 declarant is incompetent.
20 (iii) The guardian or other legal representative of
21 the declarant, if the declarant is incompetent and a
22 substitute is not named in the declaration.
23 (iv) The mental health care agent of the principal.
24 (b) Transfer.--An attending physician or mental health care
25 provider under subsection (a)(1) shall make every reasonable
26 effort to assist in the transfer of the declarant or principal
27 to another physician or mental health care provider who will
28 comply with the declaration or mental health care decision of
29 the mental health care agent.
30 § 5805. Liability.
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1 (a) General rule.--A person who is a physician, another
2 mental health care provider or another person who acts in good
3 faith and consistent with this chapter may not be subject to
4 criminal or civil liability, discipline for unprofessional
5 conduct or administrative sanctions and may not be found to have
6 committed an act of unprofessional conduct by the State Board of
7 Medicine or the State Board of Osteopathic Medicine as a result
8 of any of the following:
9 (1) Complying with a direction or decision of an
10 individual who the person believes in good faith has
11 authority to act as a principal's mental health care agent so
12 long as the direction or decision is not clearly contrary to
13 the terms of the mental health care power of attorney.
14 (2) Refusing to comply with a direction or decision of
15 an individual based on a good faith belief that the
16 individual lacks authority to act as a principal's mental
17 health care agent.
18 (3) Complying with a mental health care power of
19 attorney under the assumption that it was valid when made and
20 has not been amended or revoked.
21 (4) Disclosing mental health care information to another
22 person based upon a good faith belief that the disclosure is
23 authorized, permitted or required by this chapter.
24 (b) Same effect as if dealing with principal.--Any attending
25 physician, mental health care provider and other person who acts
26 under subsection (a) shall be protected and released to the same
27 extent as if dealing directly with a competent principal.
28 (c) Good faith of mental health care agent.--A mental health
29 care agent who acts according to the terms of a mental health
30 care power of attorney may not be subject to civil or criminal
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1 liability for acting in good faith for a principal or failing in
2 good faith to act for a principal.
3 § 5806. Penalties.
4 (a) Offense defined.--A person commits a felony of the third
5 degree by willfully:
6 (1) Concealing, canceling, altering, defacing,
7 obliterating or damaging a declaration without the consent of
8 the declarant.
9 (2) Concealing, canceling, altering, defacing,
10 obliterating or damaging a mental health care power of
11 attorney or any amendment or revocation thereof without the
12 consent of the principal.
13 (3) Causing a person to execute a declaration or power
14 of attorney under this chapter by undue influence, fraud or
15 duress.
16 (4) Falsifying or forging a mental health care power of
17 attorney or declaration or any amendment or revocation
18 thereof, the result of which is a direct change in the mental
19 health care provided to the principal.
20 (b) Removal and liability.--An agent who willfully fails to
21 comply with a power of attorney may be removed and sued for
22 actual damages.
23 § 5807. Rights and responsibilities.
24 (a) Declarants and principals.--Persons who execute a
25 declaration or a power of attorney shall have the following
26 rights and responsibilities:
27 (1) Persons are presumed capable of making mental health
28 decisions unless they are adjudicated incapacitated,
29 involuntarily committed or found to be incapable of making
30 mental health decisions after examination by a psychiatrist
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1 and one of the following: another psychiatrist, psychologist,
2 family physician, attending physician or mental health
3 treatment professional. Whenever possible, at least one of
4 the decision makers shall be a treating professional of the
5 declarant or principal.
6 (2) Persons shall be required to notify their mental
7 health care provider of the existence of any declaration or
8 power of attorney.
9 (3) Periodically review their declarations or powers of
10 attorney.
11 (4) Give notice of amendment and revocation to
12 providers, agents and guardians, if any.
13 (b) Providers.--Mental health treatment providers shall have
14 the following rights and responsibilities:
15 (1) Inquire as to the existence of declarations or
16 powers of attorney for persons in their care.
17 (2) Inform persons who are being discharged from
18 treatment about the availability of mental health
19 declarations and powers of attorney as part of discharge
20 planning.
21 (3) Not discriminate against persons based on whether
22 they have or on the contents of mental health declarations or
23 powers of attorney.
24 (4) Not require declarations or powers of attorney as
25 conditions of treatment.
26 § 5808. Combining mental health care instruments.
27 (a) General rule.--A declaration and mental health care
28 power of attorney may be combined into one mental health care
29 document.
30 (b) Form.--A combined declaration and mental health care
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1 power of attorney may be in the following form or any other
2 written form which contains the information required under
3 Subchapters B (relating to mental health care declarations) and
4 C (relating to mental health care powers of attorney):
5 Combined Mental Health Care Declaration
6 and Power of Attorney Form
7 Part I. Introduction.
8 I, , being of sound mind, willfully and
9 voluntarily make this declaration and power of attorney
10 regarding my mental health care.
11 I understand that mental health care includes any care,
12 treatment, service or procedure to maintain, diagnose, treat
13 or provide for mental health, including any medication
14 program and therapeutic treatment. Mental health care does
15 not include electroconvulsive therapy, laboratory trials or
16 research, or commitment to a mental health facility unless
17 specifically provided for in this document. Mental health
18 care does not include psychosurgery or termination of
19 parental rights.
20 I understand that my incapacity will be determined by
21 examination by a psychiatrist and one of the following:
22 another psychiatrist, psychologist, family physician,
23 attending physician or mental health treatment professional.
24 Whenever possible, one of the decision makers will be one of
25 my treating professionals.
26 Part II. Mental Health Care Declaration.
27 A. When this declaration becomes effective.
28 This declaration becomes effective at the following
29 designated time:
30 ( ) When I am deemed incapable of making mental health care
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1 decisions.
2 ( ) When the following condition is met:
3 (List condition)
4 B. Treatment preferences.
5 1. Choice of treatment facility.
6 ( ) In the event that I require commitment to a psychiatric
7 treatment facility, I would prefer to be admitted to the
8 following facility:
9 (Insert name and address of facility)
10 ( ) In the event that I require commitment to a psychiatric
11 treatment facility, I do not wish to be committed to the
12 following facility:
13 (Insert name and address of facility)
14 I understand that my physician may have to place me in a
15 facility that is not my preference.
16 2. Preferences regarding medications for psychiatric
17 treatment.
18 ( ) I do not consent to the use of any medications.
19 ( ) I consent to the medications that my treating physician
20 recommends with the following exception or limitation:
21 (List medication and reason for exception or limitation)
22 The exception or limitation applies to generic, brand name
23 and trade name equivalents.
24 ( ) I have designated an agent under the power of attorney
25 portion of this document to make decisions related to
26 medication.
27 3. Preferences regarding electroconvulsive therapy
28 (ECT).
29 ( ) I do not consent to the administration of
30 electroconvulsive therapy.
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1 ( ) I consent to the administration of electroconvulsive
2 therapy.
3 ( ) I have designated an agent under the power of attorney
4 portion of this document to make decisions related to
5 electroconvulsive therapy.
6 4. Preferences for experimental studies or drug trials.
7 ( ) I do not consent to participation in experimental
8 studies.
9 ( ) I consent to participation in experimental studies if my
10 treating physician believes that the potential benefits to me
11 outweigh the possible risks to me.
12 ( ) I have designated an agent under the power of attorney
13 portion of this document to make decisions related to
14 experimental studies.
15 ( ) I do not consent to participation in any drug trials.
16 ( ) I consent to participation in drug trials if my treating
17 physician believes that the potential benefits to me outweigh
18 the possible risks to me.
19 ( ) I have designated an agent under the power of attorney
20 portion of this document to make decisions related to drug
21 trials.
22 5. Additional instructions or information.
23 Examples of other instructions or information that may be
24 included:
25 Activities that help or worsen symptoms.
26 Type of intervention preferred in the event of a
27 crisis.
28 Mental and physical health history.
29 Dietary requirements.
30 Religious preferences.
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1 Temporary custody of children.
2 Family notification.
3 Visitors that you do or do not want to have.
4 Limitations on the release or disclosure of
5 mental health records.
6 Instructions related to preferences if you are
7 pregnant.
8 Other matters of importance.
9 C. Revocation.
10 This declaration may be revoked in whole or in part in the
11 following manner:
12 ( ) At any time, either orally or in writing, as long as I
13 have not been found to be incapable of making mental health
14 decisions.
15 My revocation will be effective upon communication to my
16 attending physician or other mental health care provider,
17 either by me or a witness to my revocation. If I choose to
18 revoke a particular instruction contained in this declaration
19 in the manner specified, I understand that the other
20 instructions contained in this declaration will remain
21 effective until:
22 (1) I revoke this declaration in its entirety;
23 (2) I make a new combined mental health care declaration
24 and power of attorney; or
25 (3) until the date I have specified as the termination
26 date.
27 ( ) This declaration will remain effective until the time
28 specified for termination.
29 D. Termination.
30 I understand that I may specify a date upon which this
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1 declaration will automatically terminate.
2 ( ) This declaration will automatically terminate upon the
3 date specified, unless I am deemed incapable of making mental
4 health care decisions at the time that this declaration would
5 expire.
6 (Specify date)
7 ( ) This declaration will continue until I revoke it in its
8 entirety or I make a new mental health care declaration or
9 mental health care power of attorney.
10 E. Preference as to a court-appointed guardian.
11 I understand that I may nominate a guardian of my person for
12 consideration by the court if incapacity proceedings are
13 commenced under 20 Pa.C.S. § 5511. I understand that the
14 court will appoint a guardian in accordance with my most
15 recent nomination except for good cause or disqualification.
16 In the event a court decides to appoint a guardian, I desire
17 the following person to be appointed:
18 (Insert name, address, telephone number of the designated
19 person)
20 ( ) The appointment of a guardian of my person will not give
21 the guardian the power to revoke, suspend or terminate this
22 declaration.
23 ( ) Upon appointment of a guardian, I authorize the guardian
24 to revoke, suspend or terminate this declaration.
25 Part III. Mental Health Care Power of Attorney.
26 I, , being of sound mind, authorize my
27 designated health care agent to make certain decisions on my
28 behalf regarding my mental health care. If I have not
29 expressed a choice in this document or in the accompanying
30 declaration, I authorize my agent to make the decision that
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1 my agent determines is the decision I would make if I were
2 competent to do so.
3 A. Designation of agent.
4 I hereby designate and appoint the following person as my
5 agent to make mental health care decisions for me as
6 authorized in this document. This authorization applies only
7 to mental health decisions that are not addressed in the
8 accompanying signed declaration.
9 (Insert name of designated person)
10 Signed:
11 (My name, address, telephone number)
12 (Witnesses signatures)
13 (Insert names, addresses, telephone numbers of witnesses)
14 Agent's acceptance:
15 I hereby accept designation as mental health care agent for
16 (Insert name of declarant)
17 Agent's signature:
18 (Insert name, address, telephone number of designated person)
19 B. Designation of alternative agent.
20 In the event that my first agent is unavailable or unable to
21 serve as my mental health care agent, I hereby designate and
22 appoint the following individual as my alternative mental
23 health care agent to make mental health care decisions for me
24 as authorized in this document:
25 (Insert name of designated person)
26 Signed:
27 (My name, address, telephone number)
28 (Witnesses signatures)
29 (Insert names, addresses, telephone numbers of witnesses)
30 Alternative agent's acceptance:
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1 I hereby accept designation as alternative mental health care
2 agent for (Insert name of declarant)
3 Alternative agent's signature:
4 (Insert name, address, telephone number of alternative agent)
5 C. When this power of attorney become effective.
6 This power of attorney will become effective at the following
7 designated time:
8 ( ) When I am deemed incapable of making mental health care
9 decisions.
10 ( ) When the following condition is met:
11 (List condition)
12 D. Authority granted to my mental health care agent.
13 I hereby grant to my agent full power and authority to make
14 mental health care decisions for me consistent with the
15 instructions and limitations set forth in this document. If I
16 have not expressed a choice in this power of attorney, or in
17 the accompanying declaration, I authorize my agent to make
18 the decision that my agent determines is the decision I would
19 make if I were competent to do so.
20 (1) Voluntary commitment.
21 My agent ( ) does ( ) does not have the power to consent to
22 having me admitted to a psychiatric treatment facility.
23 (2) Preferences regarding medications for psychiatric
24 treatment.
25 ( ) My agent is not authorized to consent to the use of any
26 medications.
27 ( ) My agent is authorized to consent to the use of any
28 medications after consultation with my treating psychiatrist
29 and any other persons my agent considers appropriate.
30 (3) Preferences regarding electroconvulsive therapy
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1 (ECT).
2 ( ) My agent is not authorized to consent to the
3 administration of electroconvulsive therapy.
4 ( ) My agent is authorized to consent to the administration
5 of electroconvulsive therapy.
6 (4) Preferences for experimental studies or drug trials.
7 ( ) My agent is not authorized to consent to my participation
8 in experimental studies.
9 ( ) My agent is authorized to consent to my participation in
10 experimental studies if, after consultation with my treating
11 physician and any other individuals my agent deems
12 appropriate, my agent believes that the potential benefits to
13 me outweigh the possible risks to me.
14 ( ) My agent is not authorized to consent to my participation
15 in drug trials.
16 ( ) My agent is authorized to consent to my participation in
17 drug trials if, after consultation with my treating physician
18 and any other individuals my agent deems appropriate, my
19 agent believes that the potential benefits to me outweigh the
20 possible risks to me.
21 E. Revocation.
22 This power of attorney may be revoked in whole or in part in
23 the following manner:
24 ( ) At any time, either orally or in writing, as long as I
25 have not been found to be incapable of making mental health
26 decisions.
27 My revocation will be effective upon communication to my
28 attending physician or other mental health care provider,
29 either by me or a witness to my revocation. If I choose to
30 revoke a particular instruction contained in this power of
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1 attorney in the manner specified, I understand that the other
2 instructions contained in this power of attorney will remain
3 effective until:
4 (1) I revoke this power of attorney in its entirety;
5 (2) I make a new combined mental health care declaration
6 and power of attorney; or
7 (3) until the date that I have specified as the
8 termination date.
9 ( ) This power of attorney will remain effective until the
10 time specified for termination.
11 F. Termination.
12 I also understand that I may specify a date upon which this
13 power of attorney will automatically terminate.
14 ( ) This power of attorney will automatically terminate upon
15 the date specified unless I am deemed incapable of making
16 mental health care decisions at the time that the power of
17 attorney would expire.
18 (Specify date)
19 ( ) This power of attorney will continue until I revoke it in
20 its entirety or until I make a new combined mental health
21 care declaration and power of attorney.
22 I am making this combined mental health care declaration and
23 power of attorney on the (insert day) day of (insert month),
24 (insert year).
25 My signature:
26 (My name, address, telephone number)
27 Witnesses signatures:
28 (Names, addresses, telephone numbers of witnesses).
29 If the principal making this combined mental health care
30 declaration and power of attorney is unable to sign this
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1 document, another individual may sign on behalf of and at the
2 direction of the principal.
3 Signature of person signing on my behalf:
4 Signature
5 (Name, address, telephone number)
6 SUBCHAPTER B
7 MENTAL HEALTH CARE DECLARATIONS
8 Sec.
9 5821. Short title of subchapter.
10 5822. Execution.
11 5823. Form.
12 5824. Operation.
13 5825. Revocation.
14 5826. Amendment.
15 § 5821. Short title of subchapter.
16 This subchapter shall be known and may be cited as the
17 Advance Directive for Mental Health Care Act.
18 § 5822. Execution.
19 (a) Who may make.--An individual who is at least 18 years of
20 age and has not been deemed incapacitated pursuant to section
21 5511 (relating to petition and hearing; independent evaluation)
22 or severely mentally disabled pursuant to section 301 of the act
23 of July 9, 1976 (P.L.817, No.143), known as the Mental Health
24 Procedures Act, may make a declaration governing the initiation,
25 continuation, withholding or withdrawal of mental health
26 treatment.
27 (b) Requirements.--A declaration must be:
28 (1) Dated and signed by the declarant by signature or
29 mark or by another individual on behalf of and at the
30 direction of the declarant.
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1 (2) Witnessed by two individuals, each of whom must be
2 at least 18 years of age.
3 (c) Witnesses.--
4 (1) An individual who signs a declaration on behalf of
5 and at the direction of a declarant may not witness the
6 declaration.
7 (2) A mental health care provider and its agent may not
8 sign a declaration on behalf of and at the direction of a
9 declarant if the mental health care provider or agent
10 provides mental health care services to the declarant.
11 § 5823. Form.
12 A declaration may be in the following form or any other
13 written form that expresses the wishes of a declarant regarding
14 the initiation, continuation or refusal of mental health
15 treatment and may include other specific directions, including,
16 but not limited to, designation of another individual to make
17 mental health treatment decisions for the declarant if the
18 declarant is incapable of making mental health decisions:
19 Mental Health Care Declaration.
20 I, , being of sound mind, willfully and
21 voluntarily make this declaration regarding my mental health
22 care.
23 I understand that mental health care includes any care,
24 treatment, service or procedure to maintain, diagnose, treat
25 or provide for mental health, including any medication
26 program and therapeutic treatment. Mental health care does
27 not include electroconvulsive therapy, laboratory trials or
28 research, or commitment to a mental health facility unless
29 specifically provided for in this document. Mental health
30 care does not include psychosurgery or termination of
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1 parental rights.
2 I understand that my incapacity will be determined by
3 examination by a psychiatrist and one of the following:
4 another psychiatrist, psychologist, family physician,
5 attending physician or mental health treatment professional.
6 Whenever possible, one of the decision makers will be one of
7 my treating professionals.
8 A. When this declaration becomes effective.
9 This declaration becomes effective at the following
10 designated time:
11 ( ) When I am deemed incapable of making mental health care
12 decisions.
13 ( ) When the following condition is met:
14 (List condition)
15 B. Treatment preferences.
16 1. Choice of treatment facility.
17 ( ) In the event that I require commitment to a psychiatric
18 treatment facility, I would prefer to be admitted to the
19 following facility:
20 (Insert name and address of facility)
21 ( ) In the event that I require commitment to a psychiatric
22 treatment facility, I do not wish to be committed to the
23 following facility:
24 (Insert name and address of facility)
25 I understand that my physician may have to place me in a
26 facility that is not my preference.
27 2. Preferences regarding medications for psychiatric
28 treatment.
29 ( ) I do not consent to the use of any medications.
30 ( ) I consent to the medications that my treating physician
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1 recommends with the following exception or limitation:
2 (List medication and reason for exception or limitation)
3 This exception or limitation applies to generic, brand name
4 and trade name equivalents.
5 3. Preferences regarding electroconvulsive therapy
6 (ETC).
7 ( ) I do not consent to the administration of
8 electroconvulsive therapy.
9 ( ) I consent to the administration of electroconvulsive
10 therapy.
11 4. Preferences for experimental studies or drug trials.
12 ( ) I do not consent to participation in experimental
13 studies.
14 ( ) I consent to participation in experimental studies if my
15 treating physician believes that the potential benefits to me
16 outweigh the possible risks to me.
17 ( ) I do not consent to participation in any drug trials.
18 ( ) I consent to participation in drug trials if my treating
19 physician believes that the potential benefits to me outweigh
20 the possible risks to me.
21 5. Additional instructions or information:
22 Examples of other instructions or information that may be
23 included:
24 Activities that help or worsen symptoms.
25 Type of intervention preferred in the event of a
26 crisis.
27 Mental and physical health history.
28 Dietary requirements.
29 Religious preferences.
30 Temporary custody of children.
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1 Family notification.
2 Visitors that you do or do not want to have.
3 Limitations on the release or disclosure of mental
4 health records.
5 Instructions related to preferences if you are
6 pregnant.
7 Other matters of importance.
8 C. Revocation.
9 This declaration may be revoked in whole or in part in the
10 following manner:
11 ( ) At any time, either orally or in writing, as long as I
12 have not been found to be incapable of making mental health
13 decisions.
14 My revocation will be effective upon communication to my
15 attending physician or other mental health care provider,
16 either by me or a witness to my revocation. If I choose to
17 revoke a particular instruction contained in this declaration
18 in the manner specified, I understand that the other
19 instructions contained in this declaration will remain
20 effective until:
21 (1) I revoke this declaration in its entirety;
22 (2) I make a new mental health care declaration; or
23 (3) until the date I have specified as the termination
24 date.
25 ( ) This declaration will remain effective until the time
26 specified for termination.
27 D. Termination.
28 I understand that I may specify a date upon which this
29 declaration will automatically terminate.
30 ( ) This declaration will automatically terminate upon the
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1 date specified unless I am deemed incapable of making mental
2 health care decisions at the time that the declaration would
3 expire.
4 (Specify date)
5 ( ) This declaration will continue until I revoke it in its
6 entirety or I make a new mental health care declaration.
7 E. Preference as to a court-appointed guardian.
8 I understand that I may nominate a guardian of my person for
9 consideration by the court if incapacity proceedings are
10 commenced pursuant to 20 Pa.C.S. § 5511. I understand that
11 the court will appoint a guardian in accordance with my most
12 recent nomination except for good cause or disqualification.
13 In the event a court decides to appoint a guardian, I desire
14 the following person to be appointed:
15 (Insert name, address and telephone number
16 of designated person)
17 ( ) The appointment of a guardian of my person will not give
18 the guardian the power to revoke, suspend or terminate this
19 declaration.
20 ( ) Upon appointment of a guardian, I authorize the guardian
21 to revoke, suspend or terminate this declaration.
22 I am making this declaration on the (insert day)
23 day of (insert month), (insert year).
24 My signature: (My name, address, telephone number)
25 Witnesses' signatures: (Names, addresses, telephone numbers
26 of witnesses)
27 If the principal making this declaration is unable to sign
28 it, another individual may sign on behalf of and at the
29 direction of the principal.
30 Signature of person signing on my behalf:
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1 (Name, address and telephone number)
2 § 5824. Operation.
3 (a) When operative.--A declaration becomes operative when:
4 (1) A copy is provided to the attending physician.
5 (2) The conditions stated in the declaration are met.
6 (b) Compliance.--When a declaration becomes operative, the
7 attending physician and other mental health care providers shall
8 act in accordance with its provisions or comply with the
9 transfer provisions of section 5804 (relating to compliance).
10 (c) Invalidity of specific direction.--If a specific
11 direction in the declaration is held to be invalid, the
12 invalidity shall not be construed to negate other directions in
13 the declaration that can be effected without the invalid
14 direction.
15 (d) Mental health record.--A physician or other mental
16 health care provider to whom a copy of a declaration is
17 furnished shall make it a part of the mental record of the
18 declarant and, if unwilling to comply with the declaration,
19 promptly so advise the declarant.
20 (e) Duration.--Unless a declaration states a time of
21 termination, it shall be valid until revoked by the declarant.
22 If a declaration for mental health treatment has been invoked
23 and is in effect at the specified expiration date after its
24 execution, the declaration shall remain effective until the
25 principal is no longer incapable.
26 (f) Absence of declaration.--If an individual does not make
27 a declaration, a presumption does not arise regarding the intent
28 of the individual to consent to or to refuse a mental health
29 treatment.
30 § 5825. Revocation.
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1 (a) When declaration may be revoked.--An individual shall
2 specify in a declaration whether it may be revoked by the
3 individual:
4 (1) at any time and in any manner, only if the
5 individual has not been found to be incapable of making
6 mental health treatment decisions; or
7 (2) at the time specified for termination.
8 (b) Effect of revocation.--A revocation of a declaration
9 shall be effective upon communication to the attending physician
10 or other mental health care provider by the declarant or a
11 witness to the revocation.
12 (c) Mental health record.--An attending physician or other
13 mental health care provider shall make revocation or a
14 declaration part of the mental health record of the declarant.
15 § 5826. Amendment.
16 While of sound mind, a declarant may amend a declaration by a
17 writing executed in accordance with the provisions of section
18 5822 (relating to execution).
19 SUBCHAPTER C
20 MENTAL HEALTH CARE POWERS OF ATTORNEY
21 Sec.
22 5831. Short title of subchapter.
23 5832. Execution.
24 5833. Form.
25 5834. Operation.
26 5835. Appointment of mental health care agents.
27 5836. Authority of mental health care agent.
28 5837. Removal of agent.
29 5838. Effect of divorce.
30 5839. Revocation.
20030H2036B4166 - 24 -
1 5840. Amendment.
2 5841. Relation of mental health care agent to court-appointed
3 guardian and other agents.
4 5842. Duties of attending physician and mental health care
5 provider.
6 5843. Construction.
7 5844. Conflicting mental health care powers of attorney.
8 5845. Validity.
9 § 5831. Short title of subchapter.
10 This subchapter shall be known and may be cited as the Mental
11 Health Care Agents Act.
12 § 5832. Execution.
13 (a) Who may make.--An individual who is at least 18 years of
14 age and has not been deemed incapacitated pursuant to section
15 5511 (relating to petition and hearing; independent evaluation)
16 or found to be severely mentally disabled pursuant to section
17 302 of the act of July 9, 1976 (P.L.817, No.143), known as the
18 Mental Health Procedures Act, may make a power of attorney
19 governing the initiation, continuation, withholding or
20 withdrawal of mental health treatment.
21 (b) Requirements.--A power of attorney must be:
22 (1) Dated and signed by the principal by signature or
23 mark or by another individual on behalf of and at the
24 direction of the principal.
25 (2) Witnessed by two individuals, each of whom must be
26 at least 18 years of age.
27 (c) Witnesses.--
28 (1) An individual who signs a power of attorney on
29 behalf of and at the direction of a principal may not witness
30 the power of attorney.
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1 (2) A mental health care provider and its agent may not
2 sign a power of attorney on behalf of and at the direction of
3 a principal if the mental health care provider or agent
4 provides mental health care services to the principal.
5 § 5833. Form.
6 (a) Requirements.--A mental health care power of attorney
7 must do the following:
8 (1) Identify the principal and appoint the mental health
9 care agent.
10 (2) Declare that the principal authorizes the mental
11 health care agent to make mental health care decisions on
12 behalf of the principal.
13 (b) Optional provisions.--A mental health care power of
14 attorney may:
15 (1) Describe any limitations that the principal imposes
16 upon the authority of the mental health care agent.
17 (2) Indicate the intent of the principal regarding the
18 initiation, continuation or refusal of mental health
19 treatment.
20 (3) Nominate a guardian of the person of the principal
21 as provided in section 5841 (relating to relation of mental
22 health care agent to court-appointed guardian and other
23 agents).
24 (4) Contain other provisions as the principal may
25 specify regarding the implementation of mental health care
26 decisions and related actions by the mental health care
27 agent.
28 (c) Written form.--A mental health care power of attorney
29 may be in the following form or any other written form
30 identifying the principal, appointing a mental health care agent
20030H2036B4166 - 26 -
1 and declaring that the principal authorizes the mental health
2 care agent to make mental health care decisions on behalf of the
3 principal.
4 Mental Health Care Power of Attorney
5 I, , being of sound mind, authorize my
6 designated health care agent to make certain decisions on my
7 behalf regarding my mental health care. If I have not
8 expressed a choice in this document, I authorize my agent to
9 make the decision that my agent determines is the decision I
10 would make if I were competent to do so.
11 I understand that mental health care includes any care,
12 treatment, service or procedure to maintain, diagnose, treat
13 or provide for mental health, including any medication
14 program and therapeutic treatment. Mental health care does
15 not include electroconvulsive therapy, laboratory trials or
16 research, or commitment to a mental health facility unless
17 specifically provided for in this document. Mental health
18 care does not include psychosurgery or termination of
19 parental rights.
20 I understand that my incapacity will be determined by
21 examination by a psychiatrist and one of the following:
22 another psychiatrist, psychologist, family physician,
23 attending physician or mental health treatment professional.
24 Whenever possible, one of the decision makers shall be one of
25 my treating professionals.
26 A. Designation of agent. I hereby designate and appoint the
27 following person as my agent to make mental health care
28 decisions for me as authorized in this document:
29 (Insert name of designated person)
30 Signed:
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1 (My name, address, telephone number)
2 (Witnesses' signatures)
3 (Names, addresses, telephone numbers of witnesses)
4 Agent's acceptance:
5 I hereby accept designation as mental health care agent for
6 (Insert name of declarant)
7 Agent's signature:
8 (Insert name, address, telephone number of designated person)
9 B. Designation of alternative agent.
10 In the event that my first agent is unavailable or unable to
11 serve as my mental health care agent, I hereby designate and
12 appoint the following individual as my alternative mental
13 health care agent to make mental health care decisions for me
14 as authorized in this document:
15 (Insert name of designated person)
16 Signed:
17 (Witnesses' signatures)
18 (Names, addresses, telephone numbers of witnesses)
19 Alternative agent's acceptance:
20 I hereby accept designation as alternative mental health care
21 agent for
22 (Insert name of declarant)
23 Alternative agent's signature: .
24 (Insert name, address, telephone number)
25 C. When this power of attorney becomes effective.
26 This power of attorney will become effective at the following
27 designated time:
28 ( ) When I am deemed incapable of making mental health care
29 decisions.
30 ( ) When the following condition is met:
20030H2036B4166 - 28 -
1 (List condition)
2 D. Authority granted to my mental health care agent.
3 I hereby grant to my agent full power and authority to make
4 mental health care decisions for me consistent with the
5 instructions and limitations set forth in this power of
6 attorney. If I have not expressed a choice in this power of
7 attorney, I authorize my agent to make the decision that my
8 agent determines is the decision I would make if I were
9 competent to do so.
10 1. Treatment preferences.
11 (a) Choice of treatment facility.
12 My agent ( ) does ( ) does not have the power to consent to
13 having me admitted to a psychiatric treatment facility.
14 ( ) In the event that I require commitment to a psychiatric
15 treatment facility, I would prefer to be admitted to the
16 following facility:
17 (Insert name and address of facility)
18 ( ) In the event that I require commitment to a psychiatric
19 treatment facility, I do not wish to be committed to the
20 following facility:
21 (Insert name and address of facility)
22 I understand that my physician may have to place me in a
23 facility that is not my preference.
24 (b) Preferences regarding medications for psychiatric
25 treatment.
26 ( ) My agent is not authorized to consent to the use of any
27 medications.
28 ( ) I consent to the medications that my agent agrees to
29 after consultation with my treating physician and any other
30 persons my agent considers appropriate.
20030H2036B4166 - 29 -
1 ( ) I consent to the medications that my agent agrees to,
2 with the following exception or limitation:
3 (List exception or limitation)
4 This exception or limitation applies to generic, brand name
5 and trade name equivalents.
6 (c) Preferences regarding electroconvulsive therapy
7 (ECT).
8 ( ) My agent is not authorized to consent to the
9 administration of electroconvulsive therapy.
10 ( ) My agent is authorized to consent to the administration
11 of electroconvulsive therapy.
12 (d) Preferences for experimental studies or drug trials.
13 ( ) My agent is not authorized to consent to my
14 participation in experimental studies.
15 ( ) My agent is authorized to consent to my participation in
16 experimental studies if, after consultation with my treating
17 physician and any other individuals my agent deems
18 appropriate, my agent believes that the potential benefits to
19 me outweigh the possible risks to me.
20 ( ) My agent is not authorized to consent to my
21 participation in drug trials.
22 ( ) My agent is authorized to consent to my participation in
23 drug trials if, after consultation with my treating physician
24 and any other individuals my agent deems appropriate, my
25 agent believes that the potential benefits to me outweigh the
26 possible risks to me.
27 (e) Additional information and instructions.
28 Examples of other information that may be included:
29 Activities that help or worsen symptoms.
30 Type of intervention preferred in the event of a
20030H2036B4166 - 30 -
1 crisis.
2 Mental and physical health history.
3 Dietary requirements.
4 Religious preferences.
5 Temporary custody of children.
6 Family notification.
7 Visitors that you do or do not want to have.
8 Limitations on release or disclosure of mental
9 health records.
10 Instructions related to preferences if you are
11 pregnant.
12 Other matters of importance.
13 E. Revocation.
14 This power of attorney may be revoked in whole or in part in
15 the following manner:
16 ( ) At any time, either orally or in writing, as long as I
17 have not been found to be incapable of making mental health
18 decisions.
19 My revocation will be effective upon communication to my
20 attending physician or other mental health care provider,
21 either by me or a witness to my revocation. If I choose to
22 revoke a particular instruction contained in this power of
23 attorney in the manner specified, I understand that the other
24 instructions contained in this power of attorney will remain
25 effective until:
26 (1) I revoke this power of attorney in its entirety;
27 (2) I make a new mental health care power of attorney;
28 or
29 (3) until the date that I have specified as the
30 termination date.
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1 ( ) This power of attorney will remain effective until the
2 time specified for termination.
3 F. Termination.
4 I also understand that I may specify a date upon which this
5 power of attorney will automatically terminate.
6 ( ) This power of attorney will automatically terminate upon
7 the date specified unless I am deemed incapable of making
8 mental health care decisions at the time that the power of
9 attorney would expire.
10 (Specify date)
11 ( ) This power of attorney will continue until I revoke it
12 in its entirety or until I make a new mental health care
13 power of attorney.
14 G. Preference as to a court-appointed guardian.
15 I understand that I may nominate a guardian of my person for
16 consideration by the court if incapacity proceedings are
17 commenced pursuant to 20 Pa.C.S. § 5511. I understand that
18 the court will appoint a guardian in accordance with my most
19 recent nomination except for good cause or disqualification.
20 In the event a court decides to appoint a guardian, I desire
21 the following person to be appointed:
22 (Insert name, address, telephone number of designated person)
23 ( ) The appointment of a guardian of my person will not give
24 the guardian the power to revoke, suspend or terminate this
25 power of attorney.
26 ( ) Upon appointment of a guardian, I authorize the guardian
27 to revoke, suspend or terminate this power of attorney.
28 I am making this power of attorney on the (insert day) of
29 (insert month), (insert year).
30 My signature
20030H2036B4166 - 32 -
1 (My Name, address, telephone number)
2 Witnesses' signatures:
3 (Names, addresses, telephone numbers of witnesses)
4 If the principal making this power of attorney is unable to
5 sign it, another individual may sign on behalf of and at the
6 direction of the principal.
7 Signature of person signing on my behalf:
8 Signature
9 (Name, address telephone number)
10 § 5834. Operation.
11 (a) When operative.--A mental health care power of attorney
12 shall become operative when:
13 (1) A copy is provided to the attending physician.
14 (2) The conditions stated in the power of attorney are
15 met.
16 (b) Invalidity of specific direction.--If a specific
17 direction in a mental health care power of attorney is held to
18 be invalid, the invalidity does not negate other directions in
19 the mental health care power of attorney that can be effected
20 without the invalid direction.
21 (c) Duration.--Unless a power of attorney states a time of
22 termination, it shall be valid until revoked by the principal.
23 If a power of attorney for mental health treatment has been
24 invoked and is in effect at the specified date of expiration
25 after its execution, the power of attorney shall remain
26 effective until the principal is no longer incapable.
27 (d) Court approval unnecessary.--A mental health care
28 decision made by a mental health care agent for a principal
29 shall be effective without court approval.
30 § 5835. Appointment of mental health care agents.
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1 (a) Successor mental health care agents.--A principal may
2 appoint one or more successor agents who shall serve in the
3 order named in the mental health care power of attorney unless
4 the principal expressly directs to the contrary.
5 (b) Who may not be appointed mental health care agent.--
6 Unless related to the principal by blood, marriage or adoption,
7 a principal may not appoint any of the following to be the
8 mental health care agent:
9 (1) The principal's attending physician or other mental
10 health care provider, or an employee of the attending
11 physician or other mental health care provider.
12 (2) An owner, operator or employee of a residential
13 facility in which the principal receives care.
14 § 5836. Authority of mental health care agent.
15 (a) Extent of authority.--Except as expressly provided
16 otherwise in a mental health care power of attorney and subject
17 to subsections (b) and (c), a mental health care agent may make
18 any mental health care decision and exercise any right and power
19 regarding the principal's care, custody and mental health care
20 treatment that the principal could have made and exercised.
21 (b) Powers not granted.--A mental health care power of
22 attorney may not convey the power to relinquish parental rights
23 or consent to psychosurgery.
24 (c) Powers and duties only specifically granted.--Unless
25 specifically included in a mental health care power of attorney,
26 the agent shall not have the power to admit the principal to an
27 institution, consent to electroconvulsive therapy or to
28 experimental procedures or research.
29 (d) Mental health care decisions.--After consultation with
30 mental health care providers and after consideration of the
20030H2036B4166 - 34 -
1 prognosis and acceptable alternatives regarding diagnosis,
2 treatments and side effects, a mental health care agent shall
3 make mental health care decisions in accordance with the mental
4 health care agent's understanding and interpretation of the
5 instructions given by the principal at a time when the principal
6 had the capacity to make and communicate mental health care
7 decisions. Instructions include a declaration made by the
8 principal and any clear written or verbal directions that cover
9 the situation presented. In the absence of instructions, the
10 mental health care agent shall make mental health care decisions
11 conforming with the mental health care agent's assessment of the
12 principal's preferences.
13 (e) Mental health care information.--
14 (1) Unless specifically provided otherwise in a mental
15 health care power of attorney, a mental health care agent
16 shall have the same rights and limitations as the principal
17 to request, examine, copy and consent or refuse to consent to
18 the disclosure of mental health care information.
19 (2) Disclosure of mental health care information to a
20 mental health care agent shall not be construed to constitute
21 a waiver of any evidentiary privilege or right to assert
22 confidentiality.
23 (3) A mental health care provider that discloses mental
24 health care information to a mental health care agent in good
25 faith shall not be liable for the disclosure.
26 (4) A mental health care agent may not disclose mental
27 health care information regarding the principal except as is
28 reasonably necessary to perform the agent's obligations to
29 the principal or as otherwise required by law.
30 (f) Liability of agent.--A mental health care agent shall
20030H2036B4166 - 35 -
1 not be personally liable for the costs of care and treatment of
2 the principal.
3 § 5837. Removal of agent.
4 (a) Grounds for removal.--A health care agent can be removed
5 for any of the following reasons:
6 (1) Death or incapacity.
7 (2) Noncompliance with a power of attorney.
8 (3) Physical assault or threats of harm.
9 (4) Coercion.
10 (5) Voluntary withdrawal by the agent.
11 (6) Divorce.
12 (b) Notice of voluntary withdrawal.--
13 (1) A mental health care agent who voluntarily withdraws
14 shall inform the principal.
15 (2) If the power of attorney is in effect, the agent
16 shall notify providers of mental health treatment.
17 (c) Challenges.--Third parties may challenge the authority
18 of a mental health agent in the orphan's court division of the
19 court of common pleas.
20 (d) Effect of removal.--If a power of attorney provides for
21 a substitute agent, then the substitute agent shall assume
22 responsibility when the agent is removed. If the power of
23 attorney does not provide for a substitute, then a mental health
24 care provider shall follow any instructions in the power of
25 attorney.
26 § 5838. Effect of divorce.
27 If the spouse of a principal is designated as the principal's
28 mental health care agent and thereafter either spouse files an
29 action in divorce, the designation of the spouse as mental
30 health care agent shall be revoked as of the time the action is
20030H2036B4166 - 36 -
1 filed unless it clearly appears from the mental health care
2 power of attorney that the designation was intended to continue
3 to be effective notwithstanding the filing of an action in
4 divorce by either spouse.
5 § 5839. Revocation.
6 (a) When mental health care power of attorney may be
7 revoked.--An individual shall specify in the mental health care
8 power of attorney whether it may be revoked by the principal:
9 (1) at any time and in any manner only if the principal
10 has not been found to be incapable of making mental health
11 treatment decisions; or
12 (2) at the time designated for termination.
13 (b) Effect of revocation.--A revocation shall be effective
14 upon communication to the attending physician or other mental
15 health care provider by the principal or a witness to the
16 revocation.
17 (c) Mental health record.--The attending physician or other
18 mental health care provider shall make the revocation part of
19 the mental health record of the declarant.
20 (d) Reliance on mental health care power of attorney.--A
21 physician or other mental health care provider may rely on the
22 effectiveness of a mental health care power of attorney unless
23 notified of its revocation.
24 (e) Subsequent action by agent.--A mental health care agent
25 who has notice of the revocation of a mental health care power
26 of attorney may not make or attempt to make mental health care
27 decisions for the principal.
28 § 5840. Amendment.
29 While of sound mind, a principal may amend a mental health
30 care power of attorney by a writing executed in accordance with
20030H2036B4166 - 37 -
1 the provisions of section 5832 (relating to execution).
2 § 5841. Relation of mental health care agent to court-appointed
3 guardian and other agents.
4 (a) Accountability of mental health care agent.--If a
5 principal who has executed a mental health care power of
6 attorney is later adjudicated an incapacitated person, the power
7 of attorney shall remain in effect. The guardian shall not be
8 granted powers already granted in the mental health care power
9 of attorney.
10 (b) Nomination of guardian of person.--In a mental health
11 care power of attorney, a principal may nominate the guardian of
12 the person for the principal for consideration by the court if
13 incapacity proceedings for the principal's person are thereafter
14 commenced. If the court determines that the appointment of a
15 guardian is necessary, the court shall appoint in accordance
16 with the principal's most recent nomination except for good
17 cause or disqualification.
18 § 5842. Duties of attending physician and mental health care
19 provider.
20 (a) Compliance with decisions of mental health care agent.--
21 Subject to any limitation specified in a mental health care
22 power of attorney, an attending physician or mental health care
23 provider shall comply with a mental health care decision made by
24 a mental health care agent to the same extent as if the decision
25 had been made by the principal.
26 (b) Mental health record.--
27 (1) An attending physician or mental health care
28 provider who is given a mental health care power of attorney
29 shall arrange for the mental health care power of attorney or
30 a copy to be placed in the mental health record of the
20030H2036B4166 - 38 -
1 principal.
2 (2) An attending physician or mental health care
3 provider to whom an amendment or revocation of a mental
4 health care power of attorney is communicated shall promptly
5 enter the information in the mental health record of the
6 principal and maintain a copy if one is furnished.
7 (c) Record of determination.--An attending physician who
8 determines that a principal is unable to make or has regained
9 the capacity to make mental health treatment decisions or makes
10 a determination that affects the authority of a mental health
11 care agent shall enter the determination in the mental health
12 record of the principal and, if possible, promptly inform the
13 principal and any mental health care agent of the determination.
14 § 5843. Construction.
15 (a) General rule.--Nothing in this subchapter shall be
16 construed to:
17 (1) Affect the requirements of other laws of this
18 Commonwealth regarding consent to observation, diagnosis,
19 treatment or hospitalization for a mental illness.
20 (2) Authorize a mental health care agent to consent to
21 any mental health care prohibited by the laws of this
22 Commonwealth.
23 (3) Affect the laws of this Commonwealth regarding any
24 of the following:
25 (i) The standard of care of a mental health care
26 provider required in the administration of mental health
27 care or the clinical decision-making authority of the
28 mental health care provider.
29 (ii) When consent is required for mental health
30 care.
20030H2036B4166 - 39 -
1 (iii) Informed consent for mental health care.
2 (b) Disclosure.--
3 (1) The disclosure requirements of section 5836(e)
4 (relating to authority of mental health care agent) shall
5 supersede any provision in any other State statute or
6 regulation that requires a principal to consent to disclosure
7 or which otherwise conflicts with section 5836(e), including,
8 but not limited to, the following:
9 (i) The act of April 14, 1972 (P.L.221, No.63),
10 known as the Pennsylvania Drug and Alcohol Abuse Control
11 Act.
12 (ii) Section 111 of the act of July 9, 1976
13 (P.L.817, No.143), known as the Mental Health Procedures
14 Act.
15 (iii) The act of October 5, 1978 (P.L.1109, No.261),
16 known as the Osteopathic Medical Practice Act.
17 (iv) Section 41 of the act of December 20, 1985
18 (P.L.457, No.112), known as the Medical Practice Act of
19 1985.
20 (v) The act of November 29, 1990 (P.L.585, No.148),
21 known as the Confidentiality of HIV-Related Information
22 Act.
23 (2) The disclosure requirements under section 5836(e)
24 shall not apply to the extent that the disclosure would be
25 prohibited by Federal law and implementing regulations.
26 (c) Notice and acknowledgment requirements.--The notice and
27 acknowledgment requirements of section 5601(c) and (d) (relating
28 to general provisions) shall not apply to a power of attorney
29 that provides exclusively for mental health care decision
30 making.
20030H2036B4166 - 40 -
1 § 5844. Conflicting mental health care powers of attorney.
2 If a provision of a mental health care power of attorney
3 conflicts with another provision of a mental health care power
4 of attorney or with a provision of a declaration, the provision
5 of the instrument latest in date of execution shall prevail to
6 the extent of the conflict.
7 § 5845. Validity.
8 This subchapter shall not be construed to limit the validity
9 of a mental health care power of attorney executed prior to the
10 effective date of this subchapter. A mental health care power of
11 attorney executed in another state or jurisdiction and in
12 conformity with the laws of that state or jurisdiction shall be
13 considered valid in this Commonwealth, except to the extent that
14 the mental health care power of attorney executed in another
15 state or jurisdiction would allow a mental health care agent to
16 make a mental health care decision inconsistent with the laws of
17 this Commonwealth.
18 Section 2. The following acts and parts of acts are repealed
19 insofar as they are inconsistent with this act:
20 The provisions of 20 Pa.C.S. Ch. 54.
21 The provisions of 20 Pa.C.S. § 5602(a)(8) and (9).
22 The provisions of 20 Pa.C.S. § 5603(h).
23 Section 3. (a) The repeal of the form of the declaration in
24 20 Pa.C.S. § 5404(b) shall not affect the validity of any
25 declaration executed pursuant to that form before, on or after
26 the effective date of this act.
27 (b) The repeal of 20 Pa.C.S. §§ 5602(a)(8) and (9) and
28 5603(h) shall not affect the authority of an agent operating
29 under any power of attorney relying on those provisions,
30 executed before the effective date of the repeal of those
20030H2036B4166 - 41 -
1 provisions.
2 Section 4. This act shall take effect in 60 days.
3 CHAPTER 58 <--
4 MENTAL HEALTH CARE
5 SUBCHAPTER
6 A. GENERAL PROVISIONS
7 B. MENTAL HEALTH CARE DECLARATIONS
8 C. MENTAL HEALTH CARE POWERS OF ATTORNEY
9 SUBCHAPTER A
10 GENERAL PROVISIONS
11 SEC.
12 5801. APPLICABILITY.
13 5802. DEFINITIONS.
14 5803. LEGISLATIVE FINDINGS AND INTENT.
15 5804. COMPLIANCE.
16 5805. LIABILITY.
17 5806. PENALTIES.
18 5807. RIGHTS AND RESPONSIBILITIES.
19 5808. COMBINING MENTAL HEALTH CARE INSTRUMENTS.
20 § 5801. APPLICABILITY.
21 (A) GENERAL RULE.--THIS CHAPTER APPLIES TO MENTAL HEALTH
22 CARE DECLARATIONS AND MENTAL HEALTH CARE POWERS OF ATTORNEY.
23 (B) PRESERVATION OF EXISTING RIGHTS.--THE PROVISIONS OF THIS
24 CHAPTER SHALL NOT BE CONSTRUED TO IMPAIR OR SUPERSEDE ANY
25 EXISTING RIGHTS OR RESPONSIBILITIES NOT ADDRESSED IN THIS
26 CHAPTER.
27 § 5802. DEFINITIONS.
28 THE FOLLOWING WORDS AND PHRASES WHEN USED IN THIS CHAPTER
29 SHALL HAVE THE MEANINGS GIVEN TO THEM IN THIS SECTION UNLESS THE
30 CONTEXT CLEARLY INDICATES OTHERWISE:
20030H2036B4166 - 42 -
1 "ATTENDING PHYSICIAN." A PHYSICIAN WHO HAS PRIMARY
2 RESPONSIBILITY FOR THE TREATMENT AND CARE OF THE DECLARANT OR
3 PRINCIPAL.
4 "DECLARANT." AN INDIVIDUAL WHO MAKES A DECLARATION IN
5 ACCORDANCE WITH THIS CHAPTER.
6 "DECLARATION." A WRITING MADE IN ACCORDANCE WITH THIS
7 CHAPTER THAT EXPRESSES A DECLARANT'S WISHES AND INSTRUCTIONS FOR
8 MENTAL HEALTH CARE AND MENTAL HEALTH CARE DIRECTIONS AND WHICH
9 MAY CONTAIN OTHER SPECIFIC DIRECTIONS.
10 "MENTAL HEALTH CARE." ANY CARE, TREATMENT, SERVICE OR
11 PROCEDURE TO MAINTAIN, DIAGNOSE, TREAT OR PROVIDE FOR MENTAL
12 HEALTH, INCLUDING ANY MEDICATION PROGRAM AND THERAPEUTICAL
13 TREATMENT.
14 "MENTAL HEALTH CARE AGENT." AN INDIVIDUAL DESIGNATED BY A
15 PRINCIPAL IN A MENTAL HEALTH CARE POWER OF ATTORNEY.
16 "MENTAL HEALTH CARE POWER OF ATTORNEY." A WRITING MADE BY A
17 PRINCIPAL DESIGNATING AN INDIVIDUAL TO MAKE MENTAL HEALTH CARE
18 DECISIONS FOR THE PRINCIPAL.
19 "MENTAL HEALTH CARE PROVIDER." A PERSON WHO IS LICENSED,
20 CERTIFIED OR OTHERWISE AUTHORIZED BY THE LAWS OF THIS
21 COMMONWEALTH TO ADMINISTER OR PROVIDE MENTAL HEALTH CARE IN THE
22 ORDINARY COURSE OF BUSINESS OR PRACTICE OF A PROFESSION.
23 "MENTAL HEALTH TREATMENT PROFESSIONAL." A LICENSED PHYSICIAN
24 WHO HAS SUCCESSFULLY COMPLETED A RESIDENCY PROGRAM IN PSYCHIATRY
25 OR A PERSON TRAINED AND LICENSED IN SOCIAL WORK, PSYCHOLOGY OR
26 NURSING WHO HAS A GRADUATE DEGREE AND CLINICAL EXPERIENCE IN
27 MENTAL HEALTH.
28 "PRINCIPAL." AN INDIVIDUAL WHO MAKES A MENTAL HEALTH CARE
29 POWER OF ATTORNEY IN ACCORDANCE WITH THIS CHAPTER.
30 § 5803. LEGISLATIVE FINDINGS AND INTENT.
20030H2036B4166 - 43 -
1 (A) INTENT.--THIS CHAPTER PROVIDES A MEANS FOR COMPETENT
2 ADULTS TO CONTROL THEIR MENTAL HEALTH CARE EITHER DIRECTLY
3 THROUGH INSTRUCTIONS WRITTEN IN ADVANCE OR INDIRECTLY THROUGH A
4 MENTAL HEALTH CARE AGENT.
5 (B) PRESUMPTION NOT CREATED.--THIS CHAPTER SHALL NOT BE
6 CONSTRUED TO CREATE ANY PRESUMPTION REGARDING THE INTENT OF AN
7 INDIVIDUAL WHO HAS NOT EXECUTED A DECLARATION OR MENTAL HEALTH
8 CARE POWER OF ATTORNEY TO CONSENT TO THE USE OR WITHHOLDING OF
9 TREATMENT.
10 (C) FINDINGS IN GENERAL.--THE GENERAL ASSEMBLY FINDS THAT
11 ALL CAPABLE ADULTS HAVE A QUALIFIED RIGHT TO CONTROL DECISIONS
12 RELATING TO THEIR OWN MENTAL HEALTH CARE.
13 § 5804. COMPLIANCE.
14 (A) DUTY TO COMPLY.--
15 (1) AN ATTENDING PHYSICIAN AND MENTAL HEALTH CARE
16 PROVIDER SHALL COMPLY WITH MENTAL HEALTH DECLARATIONS AND
17 POWERS OF ATTORNEY.
18 (2) IF AN ATTENDING PHYSICIAN OR OTHER MENTAL HEALTH
19 CARE PROVIDER CANNOT IN GOOD CONSCIENCE COMPLY WITH A
20 DECLARATION OR MENTAL HEALTH CARE DECISION OF A MENTAL HEALTH
21 CARE AGENT BECAUSE THE INSTRUCTIONS ARE CONTRARY TO ACCEPTED
22 CLINICAL PRACTICE AND MEDICAL STANDARDS OR BECAUSE TREATMENT
23 IS UNAVAILABLE OR IF THE POLICIES OF A MENTAL HEALTH CARE
24 PROVIDER PRECLUDE COMPLIANCE WITH A DECLARATION OR MENTAL
25 HEALTH CARE DECISION OF A MENTAL HEALTH CARE AGENT,
26 IMMEDIATELY UPON RECEIPT OF THE DECLARATION OR POWER OF
27 ATTORNEY, AND AS SOON AS ANY POSSIBILITY OF NONCOMPLIANCE
28 BECOMES APPARENT, THE ATTENDING PHYSICIAN OR MENTAL HEALTH
29 CARE PROVIDER SHALL SO INFORM THE FOLLOWING:
30 (I) THE DECLARANT, IF THE DECLARANT IS COMPETENT.
20030H2036B4166 - 44 -
1 (II) THE SUBSTITUTE NAMED IN THE DECLARATION, IF THE
2 DECLARANT IS INCOMPETENT.
3 (III) THE GUARDIAN OR OTHER LEGAL REPRESENTATIVE OF
4 THE DECLARANT, IF THE DECLARANT IS INCOMPETENT AND A
5 SUBSTITUTE IS NOT NAMED IN THE DECLARATION.
6 (IV) THE MENTAL HEALTH CARE AGENT OF THE PRINCIPAL.
7 (3) THE PHYSICIAN OR MENTAL HEALTH CARE PROVIDER SHALL
8 DOCUMENT THE REASONS FOR NONCOMPLIANCE.
9 (B) TRANSFER.--AN ATTENDING PHYSICIAN OR MENTAL HEALTH CARE
10 PROVIDER UNDER SUBSECTION (A)(2) SHALL MAKE EVERY REASONABLE
11 EFFORT TO ASSIST IN THE TRANSFER OF THE DECLARANT OR PRINCIPAL
12 TO ANOTHER PHYSICIAN OR MENTAL HEALTH CARE PROVIDER WHO WILL
13 COMPLY WITH THE DECLARATION OR MENTAL HEALTH CARE DECISION OF
14 THE MENTAL HEALTH CARE AGENT.
15 § 5805. LIABILITY.
16 (A) GENERAL RULE.--A PERSON WHO IS A PHYSICIAN, ANOTHER
17 MENTAL HEALTH CARE PROVIDER OR ANOTHER PERSON WHO ACTS IN GOOD
18 FAITH AND CONSISTENT WITH THIS CHAPTER MAY NOT BE SUBJECT TO
19 CRIMINAL OR CIVIL LIABILITY, DISCIPLINE FOR UNPROFESSIONAL
20 CONDUCT OR ADMINISTRATIVE SANCTIONS AND MAY NOT BE FOUND TO HAVE
21 COMMITTED AN ACT OF UNPROFESSIONAL CONDUCT BY ANY PROFESSIONAL
22 BOARD OR ADMINISTRATIVE BODY WITH SUCH AUTHORITY AS A RESULT OF
23 ANY OF THE FOLLOWING:
24 (1) COMPLYING WITH A DIRECTION OR DECISION OF AN
25 INDIVIDUAL WHO THE PERSON BELIEVES IN GOOD FAITH HAS
26 AUTHORITY TO ACT AS A PRINCIPAL'S MENTAL HEALTH CARE AGENT SO
27 LONG AS THE DIRECTION OR DECISION IS NOT CLEARLY CONTRARY TO
28 THE TERMS OF THE MENTAL HEALTH CARE POWER OF ATTORNEY.
29 (2) REFUSING TO COMPLY WITH A DIRECTION OR DECISION OF
30 AN INDIVIDUAL BASED ON A GOOD FAITH BELIEF THAT THE
20030H2036B4166 - 45 -
1 INDIVIDUAL LACKS AUTHORITY TO ACT AS A PRINCIPAL'S MENTAL
2 HEALTH CARE AGENT.
3 (3) COMPLYING WITH A MENTAL HEALTH CARE POWER OF
4 ATTORNEY OR DECLARATION UNDER THE ASSUMPTION THAT IT WAS
5 VALID WHEN MADE AND HAS NOT BEEN AMENDED OR REVOKED.
6 (4) DISCLOSING MENTAL HEALTH CARE INFORMATION TO ANOTHER
7 PERSON BASED UPON A GOOD FAITH BELIEF THAT THE DISCLOSURE IS
8 AUTHORIZED, PERMITTED OR REQUIRED BY THIS CHAPTER.
9 (5) REFUSING TO COMPLY WITH THE DIRECTION OR DECISION OF
10 AN INDIVIDUAL DUE TO CONFLICTS WITH A PROVIDER'S CONTRACTUAL,
11 NETWORK OR PAYMENT POLICY RESTRICTIONS.
12 (6) REFUSING TO COMPLY WITH A MENTAL HEALTH DIRECTIVE
13 WHICH VIOLATES ACCEPTED CLINICAL STANDARDS OR MEDICAL
14 STANDARDS OF CARE.
15 (7) MAKING A DETERMINATION THAT THE PATIENT LACKS
16 CAPACITY TO MAKE MENTAL HEALTH DECISIONS THAT CAUSES A MENTAL
17 HEALTH ADVANCE DIRECTIVE TO BECOME EFFECTIVE.
18 (B) SAME EFFECT AS IF DEALING WITH PRINCIPAL.--ANY ATTENDING
19 PHYSICIAN, MENTAL HEALTH CARE PROVIDER AND OTHER PERSON WHO ACTS
20 UNDER SUBSECTION (A) SHALL BE PROTECTED AND RELEASED TO THE SAME
21 EXTENT AS IF DEALING DIRECTLY WITH A COMPETENT PRINCIPAL.
22 (C) GOOD FAITH OF MENTAL HEALTH CARE AGENT.--A MENTAL HEALTH
23 CARE AGENT WHO ACTS ACCORDING TO THE TERMS OF A MENTAL HEALTH
24 CARE POWER OF ATTORNEY MAY NOT BE SUBJECT TO CIVIL OR CRIMINAL
25 LIABILITY FOR ACTING IN GOOD FAITH FOR A PRINCIPAL OR FAILING IN
26 GOOD FAITH TO ACT FOR A PRINCIPAL.
27 § 5806. PENALTIES.
28 (A) OFFENSE DEFINED.--A PERSON COMMITS A FELONY OF THE THIRD
29 DEGREE BY WILLFULLY:
30 (1) CONCEALING, CANCELING, ALTERING, DEFACING,
20030H2036B4166 - 46 -
1 OBLITERATING OR DAMAGING A DECLARATION WITHOUT THE CONSENT OF
2 THE DECLARANT.
3 (2) CONCEALING, CANCELING, ALTERING, DEFACING,
4 OBLITERATING OR DAMAGING A MENTAL HEALTH CARE POWER OF
5 ATTORNEY OR ANY AMENDMENT OR REVOCATION THEREOF WITHOUT THE
6 CONSENT OF THE PRINCIPAL.
7 (3) CAUSING A PERSON TO EXECUTE A DECLARATION OR POWER
8 OF ATTORNEY UNDER THIS CHAPTER BY UNDUE INFLUENCE, FRAUD OR
9 DURESS.
10 (4) FALSIFYING OR FORGING A MENTAL HEALTH CARE POWER OF
11 ATTORNEY OR DECLARATION OR ANY AMENDMENT OR REVOCATION
12 THEREOF, THE RESULT OF WHICH IS A DIRECT CHANGE IN THE MENTAL
13 HEALTH CARE PROVIDED TO THE PRINCIPAL.
14 (B) REMOVAL AND LIABILITY.--AN AGENT WHO WILLFULLY FAILS TO
15 COMPLY WITH A POWER OF ATTORNEY MAY BE REMOVED AND SUED FOR
16 ACTUAL DAMAGES.
17 § 5807. RIGHTS AND RESPONSIBILITIES.
18 (A) DECLARANTS AND PRINCIPALS.--PERSONS WHO EXECUTE A
19 DECLARATION OR A POWER OF ATTORNEY SHALL HAVE THE FOLLOWING
20 RIGHTS AND RESPONSIBILITIES:
21 (1) PERSONS ARE PRESUMED CAPABLE OF MAKING MENTAL HEALTH
22 DECISIONS UNLESS THEY ARE ADJUDICATED INCAPACITATED,
23 INVOLUNTARILY COMMITTED OR FOUND TO BE INCAPABLE OF MAKING
24 MENTAL HEALTH DECISIONS AFTER EXAMINATION BY A PSYCHIATRIST
25 AND ONE OF THE FOLLOWING: ANOTHER PSYCHIATRIST, PSYCHOLOGIST,
26 FAMILY PHYSICIAN, ATTENDING PHYSICIAN OR MENTAL HEALTH
27 TREATMENT PROFESSIONAL. WHENEVER POSSIBLE, AT LEAST ONE OF
28 THE DECISION MAKERS SHALL BE A TREATING PROFESSIONAL OF THE
29 DECLARANT OR PRINCIPAL.
30 (2) PERSONS SHALL BE REQUIRED TO NOTIFY THEIR MENTAL
20030H2036B4166 - 47 -
1 HEALTH CARE PROVIDER OF THE EXISTENCE OF ANY DECLARATION OR
2 POWER OF ATTORNEY.
3 (3) PERSONS SHALL EXECUTE OR AMEND THEIR DECLARATIONS OR
4 POWERS OF ATTORNEY EVERY TWO YEARS, HOWEVER IF A PERSON IS
5 INCAPABLE OF MAKING MENTAL HEATH CARE DECISIONS AT THE TIME
6 THIS DOCUMENT WOULD EXPIRE, THE DOCUMENT SHALL REMAIN IN
7 EFFECT AND BE REVIEWED AT THE TIME WHEN THE PERSON REGAINS
8 CAPACITY.
9 (4) PERSONS SHALL GIVE NOTICE OF AMENDMENT AND
10 REVOCATION TO PROVIDERS, AGENTS AND GUARDIANS, IF ANY.
11 (B) PROVIDERS.--MENTAL HEALTH TREATMENT PROVIDERS SHALL HAVE
12 THE FOLLOWING RIGHTS AND RESPONSIBILITIES:
13 (1) INQUIRE AS TO THE EXISTENCE OF DECLARATIONS OR
14 POWERS OF ATTORNEY FOR PERSONS IN THEIR CARE.
15 (2) INFORM PERSONS WHO ARE BEING DISCHARGED FROM
16 TREATMENT ABOUT THE AVAILABILITY OF MENTAL HEALTH
17 DECLARATIONS AND POWERS OF ATTORNEY AS PART OF DISCHARGE
18 PLANNING.
19 (3) NOT REQUIRE DECLARATIONS OR POWERS OF ATTORNEY AS
20 CONDITIONS OF TREATMENT. MENTAL HEALTH TREATMENT PROVIDERS
21 MAY NOT CHOOSE WHETHER TO ACCEPT A PERSON FOR TREATMENT BASED
22 ON THE EXISTENCE, ABSENCE OR CONTENTS OF A MENTAL HEALTH
23 DECLARATION OR POWER OF ATTORNEY.
24 § 5808. COMBINING MENTAL HEALTH CARE INSTRUMENTS.
25 (A) GENERAL RULE.--A DECLARATION AND MENTAL HEALTH CARE
26 POWER OF ATTORNEY MAY BE COMBINED INTO ONE MENTAL HEALTH CARE
27 DOCUMENT.
28 (B) FORM.--A COMBINED DECLARATION AND MENTAL HEALTH CARE
29 POWER OF ATTORNEY MAY BE IN THE FOLLOWING FORM OR ANY OTHER
30 WRITTEN FORM WHICH CONTAINS THE INFORMATION REQUIRED UNDER
20030H2036B4166 - 48 -
1 SUBCHAPTERS B (RELATING TO MENTAL HEALTH CARE DECLARATIONS) AND
2 C (RELATING TO MENTAL HEALTH CARE POWERS OF ATTORNEY):
3 COMBINED MENTAL HEALTH CARE DECLARATION
4 AND POWER OF ATTORNEY FORM
5 PART I. INTRODUCTION.
6 I, , HAVING CAPACITY TO MAKE MENTAL HEALTH
7 DECISIONS, WILLFULLY AND VOLUNTARILY MAKE THIS DECLARATION
8 AND POWER OF ATTORNEY REGARDING MY MENTAL HEALTH CARE.
9 I UNDERSTAND THAT MENTAL HEALTH CARE INCLUDES ANY CARE,
10 TREATMENT, SERVICE OR PROCEDURE TO MAINTAIN, DIAGNOSE, TREAT
11 OR PROVIDE FOR MENTAL HEALTH, INCLUDING ANY MEDICATION
12 PROGRAM AND THERAPEUTIC TREATMENT. MENTAL HEALTH CARE DOES
13 NOT INCLUDE ELECTROCONVULSIVE THERAPY, LABORATORY TRIALS OR
14 RESEARCH. MENTAL HEALTH CARE DOES NOT INCLUDE PSYCHOSURGERY
15 OR TERMINATION OF PARENTAL RIGHTS.
16 I UNDERSTAND THAT MY INCAPACITY WILL BE DETERMINED BY
17 EXAMINATION BY A PSYCHIATRIST AND ONE OF THE FOLLOWING:
18 ANOTHER PSYCHIATRIST, PSYCHOLOGIST, FAMILY PHYSICIAN,
19 ATTENDING PHYSICIAN OR MENTAL HEALTH TREATMENT PROFESSIONAL.
20 WHENEVER POSSIBLE, ONE OF THE DECISION MAKERS WILL BE ONE OF
21 MY TREATING PROFESSIONALS.
22 PART II. MENTAL HEALTH CARE DECLARATION.
23 A. WHEN THIS DECLARATION BECOMES EFFECTIVE.
24 THIS DECLARATION BECOMES EFFECTIVE AT THE FOLLOWING
25 DESIGNATED TIME:
26 ( ) WHEN I AM DEEMED INCAPABLE OF MAKING MENTAL HEALTH CARE
27 DECISIONS.
28 ( ) WHEN THE FOLLOWING CONDITION IS MET:
29 (LIST CONDITION)
30 B. TREATMENT PREFERENCES.
20030H2036B4166 - 49 -
1 1. CHOICE OF TREATMENT FACILITY.
2 ( ) IN THE EVENT THAT I REQUIRE COMMITMENT TO A PSYCHIATRIC
3 TREATMENT FACILITY, I WOULD PREFER TO BE ADMITTED TO THE
4 FOLLOWING FACILITY:
5 (INSERT NAME AND ADDRESS OF FACILITY)
6 ( ) IN THE EVENT THAT I REQUIRE COMMITMENT TO A PSYCHIATRIC
7 TREATMENT FACILITY, I DO NOT WISH TO BE COMMITTED TO THE
8 FOLLOWING FACILITY:
9 (INSERT NAME AND ADDRESS OF FACILITY)
10 I UNDERSTAND THAT MY PHYSICIAN MAY HAVE TO PLACE ME IN A
11 FACILITY THAT IS NOT MY PREFERENCE.
12 2. PREFERENCES REGARDING MEDICATIONS FOR PSYCHIATRIC
13 TREATMENT.
14 ( ) I CONSENT TO THE MEDICATIONS THAT MY TREATING PHYSICIAN
15 RECOMMENDS.
16 ( ) I CONSENT TO THE MEDICATIONS THAT MY TREATING PHYSICIAN
17 RECOMMENDS WITH THE FOLLOWING EXCEPTION OR LIMITATION:
18 (LIST MEDICATION AND REASON FOR EXCEPTION OR LIMITATION)
19 THE EXCEPTION OR LIMITATION APPLIES TO GENERIC, BRAND NAME
20 AND TRADE NAME EQUIVALENTS. I UNDERSTAND THAT DOSAGE
21 INSTRUCTIONS ARE NOT BINDING ON MY PHYSICIAN.
22 ( ) I DO NOT CONSENT TO THE USE OF ANY MEDICATIONS.
23 ( ) I HAVE DESIGNATED AN AGENT UNDER THE POWER OF ATTORNEY
24 PORTION OF THIS DOCUMENT TO MAKE DECISIONS RELATED TO
25 MEDICATION.
26 3. PREFERENCES REGARDING ELECTROCONVULSIVE THERAPY
27 (ECT).
28 ( ) I CONSENT TO THE ADMINISTRATION OF ELECTROCONVULSIVE
29 THERAPY.
30 ( ) I DO NOT CONSENT TO THE ADMINISTRATION OF
20030H2036B4166 - 50 -
1 ELECTROCONVULSIVE THERAPY.
2 ( ) I HAVE DESIGNATED AN AGENT UNDER THE POWER OF ATTORNEY
3 PORTION OF THIS DOCUMENT TO MAKE DECISIONS RELATED TO
4 ELECTROCONVULSIVE THERAPY.
5 4. PREFERENCES FOR EXPERIMENTAL STUDIES OR DRUG TRIALS.
6 ( ) I CONSENT TO PARTICIPATION IN EXPERIMENTAL STUDIES IF MY
7 TREATING PHYSICIAN BELIEVES THAT THE POTENTIAL BENEFITS TO ME
8 OUTWEIGH THE POSSIBLE RISKS TO ME.
9 ( ) I HAVE DESIGNATED AN AGENT UNDER THE POWER OF ATTORNEY
10 PORTION OF THIS DOCUMENT TO MAKE DECISIONS RELATED TO
11 EXPERIMENTAL STUDIES.
12 ( ) I DO NOT CONSENT TO PARTICIPATION IN EXPERIMENTAL
13 STUDIES.
14 ( ) I CONSENT TO PARTICIPATION IN DRUG TRIALS IF MY TREATING
15 PHYSICIAN BELIEVES THAT THE POTENTIAL BENEFITS TO ME OUTWEIGH
16 THE POSSIBLE RISKS TO ME.
17 ( ) I HAVE DESIGNATED AN AGENT UNDER THE POWER OF ATTORNEY
18 PORTION OF THIS DOCUMENT TO MAKE DECISIONS RELATED TO DRUG
19 TRIALS.
20 ( ) I DO NOT CONSENT TO PARTICIPATION IN ANY DRUG TRIALS.
21 5. ADDITIONAL INSTRUCTIONS OR INFORMATION.
22 EXAMPLES OF OTHER INSTRUCTIONS OR INFORMATION THAT MAY BE
23 INCLUDED:
24 ACTIVITIES THAT HELP OR WORSEN SYMPTOMS.
25 TYPE OF INTERVENTION PREFERRED IN THE EVENT OF A
26 CRISIS.
27 MENTAL AND PHYSICAL HEALTH HISTORY.
28 DIETARY REQUIREMENTS.
29 RELIGIOUS PREFERENCES.
30 TEMPORARY CUSTODY OF CHILDREN.
20030H2036B4166 - 51 -
1 FAMILY NOTIFICATION.
2 LIMITATIONS ON THE RELEASE OR DISCLOSURE OF
3 MENTAL HEALTH RECORDS.
4 INSTRUCTIONS RELATED TO PREFERENCES IF YOU ARE
5 PREGNANT.
6 OTHER MATTERS OF IMPORTANCE.
7 C. REVOCATION.
8 THIS DECLARATION MAY BE REVOKED IN WHOLE OR IN PART AT ANY
9 TIME, EITHER ORALLY OR IN WRITING, AS LONG AS I HAVE NOT BEEN
10 FOUND TO BE INCAPABLE OF MAKING MENTAL HEALTH DECISIONS.
11 MY REVOCATION WILL BE EFFECTIVE UPON COMMUNICATION TO MY
12 ATTENDING PHYSICIAN OR OTHER MENTAL HEALTH CARE PROVIDER,
13 EITHER BY ME OR A WITNESS TO MY REVOCATION, OF THE INTENT TO
14 REVOKE. IF I CHOOSE TO REVOKE A PARTICULAR INSTRUCTION
15 CONTAINED IN THIS DECLARATION IN THE MANNER SPECIFIED, I
16 UNDERSTAND THAT THE OTHER INSTRUCTIONS CONTAINED IN THIS
17 DECLARATION WILL REMAIN EFFECTIVE UNTIL:
18 (1) I REVOKE THIS DECLARATION IN ITS ENTIRETY;
19 (2) I MAKE A NEW COMBINED MENTAL HEALTH CARE DECLARATION
20 AND POWER OF ATTORNEY; OR
21 (3) TWO YEARS AFTER THE DATE THIS DOCUMENT WAS EXECUTED.
22 D. TERMINATION.
23 I UNDERSTAND THAT THIS DECLARATION WILL AUTOMATICALLY
24 TERMINATE TWO YEARS FROM THE DATE OF EXECUTION, UNLESS I AM
25 DEEMED INCAPABLE OF MAKING MENTAL HEALTH CARE DECISIONS AT
26 THE TIME THAT THIS DECLARATION WOULD EXPIRE.
27 (SPECIFY DATE)
28 E. PREFERENCE AS TO A COURT-APPOINTED GUARDIAN.
29 I UNDERSTAND THAT I MAY NOMINATE A GUARDIAN OF MY PERSON FOR
30 CONSIDERATION BY THE COURT IF INCAPACITY PROCEEDINGS ARE
20030H2036B4166 - 52 -
1 COMMENCED UNDER 20 PA.C.S. § 5511. I UNDERSTAND THAT THE
2 COURT WILL APPOINT A GUARDIAN IN ACCORDANCE WITH MY MOST
3 RECENT NOMINATION EXCEPT FOR GOOD CAUSE OR DISQUALIFICATION.
4 IN THE EVENT A COURT DECIDES TO APPOINT A GUARDIAN, I DESIRE
5 THE FOLLOWING PERSON TO BE APPOINTED:
6 (INSERT NAME, ADDRESS, TELEPHONE NUMBER OF THE DESIGNATED
7 PERSON)
8 ( ) THE APPOINTMENT OF A GUARDIAN OF MY PERSON WILL NOT GIVE
9 THE GUARDIAN THE POWER TO REVOKE, SUSPEND OR TERMINATE THIS
10 DECLARATION.
11 ( ) UPON APPOINTMENT OF A GUARDIAN, I AUTHORIZE THE GUARDIAN
12 TO REVOKE, SUSPEND OR TERMINATE THIS DECLARATION.
13 PART III. MENTAL HEALTH CARE POWER OF ATTORNEY.
14 I, , HAVING THE CAPACITY TO MAKE MENTAL HEALTH
15 DECISIONS, AUTHORIZE MY DESIGNATED HEALTH CARE AGENT TO MAKE
16 CERTAIN DECISIONS ON MY BEHALF REGARDING MY MENTAL HEALTH
17 CARE. IF I HAVE NOT EXPRESSED A CHOICE IN THIS DOCUMENT OR IN
18 THE ACCOMPANYING DECLARATION, I AUTHORIZE MY AGENT TO MAKE
19 THE DECISION THAT MY AGENT DETERMINES IS THE DECISION I WOULD
20 MAKE IF I WERE COMPETENT TO DO SO.
21 A. DESIGNATION OF AGENT.
22 I HEREBY DESIGNATE AND APPOINT THE FOLLOWING PERSON AS MY
23 AGENT TO MAKE MENTAL HEALTH CARE DECISIONS FOR ME AS
24 AUTHORIZED IN THIS DOCUMENT. THIS AUTHORIZATION APPLIES ONLY
25 TO MENTAL HEALTH DECISIONS THAT ARE NOT ADDRESSED IN THE
26 ACCOMPANYING SIGNED DECLARATION.
27 (INSERT NAME OF DESIGNATED PERSON)
28 SIGNED:
29 (MY NAME, ADDRESS, TELEPHONE NUMBER)
30 (WITNESSES SIGNATURES)
20030H2036B4166 - 53 -
1 (INSERT NAMES, ADDRESSES, TELEPHONE NUMBERS OF WITNESSES)
2 AGENT'S ACCEPTANCE:
3 I HEREBY ACCEPT DESIGNATION AS MENTAL HEALTH CARE AGENT FOR
4 (INSERT NAME OF DECLARANT)
5 AGENT'S SIGNATURE:
6 (INSERT NAME, ADDRESS, TELEPHONE NUMBER OF DESIGNATED PERSON)
7 B. DESIGNATION OF ALTERNATIVE AGENT.
8 IN THE EVENT THAT MY FIRST AGENT IS UNAVAILABLE OR UNABLE TO
9 SERVE AS MY MENTAL HEALTH CARE AGENT, I HEREBY DESIGNATE AND
10 APPOINT THE FOLLOWING INDIVIDUAL AS MY ALTERNATIVE MENTAL
11 HEALTH CARE AGENT TO MAKE MENTAL HEALTH CARE DECISIONS FOR ME
12 AS AUTHORIZED IN THIS DOCUMENT:
13 (INSERT NAME OF DESIGNATED PERSON)
14 SIGNED:
15 (MY NAME, ADDRESS, TELEPHONE NUMBER)
16 (WITNESSES SIGNATURES)
17 (INSERT NAMES, ADDRESSES, TELEPHONE NUMBERS OF WITNESSES)
18 ALTERNATIVE AGENT'S ACCEPTANCE:
19 I HEREBY ACCEPT DESIGNATION AS ALTERNATIVE MENTAL HEALTH CARE
20 AGENT FOR (INSERT NAME OF DECLARANT)
21 ALTERNATIVE AGENT'S SIGNATURE:
22 (INSERT NAME, ADDRESS, TELEPHONE NUMBER OF ALTERNATIVE AGENT)
23 C. WHEN THIS POWER OF ATTORNEY BECOME EFFECTIVE.
24 THIS POWER OF ATTORNEY WILL BECOME EFFECTIVE AT THE FOLLOWING
25 DESIGNATED TIME:
26 ( ) WHEN I AM DEEMED INCAPABLE OF MAKING MENTAL HEALTH CARE
27 DECISIONS.
28 ( ) WHEN THE FOLLOWING CONDITION IS MET:
29 (LIST CONDITION)
30 D. AUTHORITY GRANTED TO MY MENTAL HEALTH CARE AGENT.
20030H2036B4166 - 54 -
1 I HEREBY GRANT TO MY AGENT FULL POWER AND AUTHORITY TO MAKE
2 MENTAL HEALTH CARE DECISIONS FOR ME CONSISTENT WITH THE
3 INSTRUCTIONS AND LIMITATIONS SET FORTH IN THIS DOCUMENT. IF I
4 HAVE NOT EXPRESSED A CHOICE IN THIS POWER OF ATTORNEY, OR IN
5 THE ACCOMPANYING DECLARATION, I AUTHORIZE MY AGENT TO MAKE
6 THE DECISION THAT MY AGENT DETERMINES IS THE DECISION I WOULD
7 MAKE IF I WERE COMPETENT TO DO SO.
8 (1) PREFERENCES REGARDING MEDICATIONS FOR PSYCHIATRIC
9 TREATMENT.
10 ( ) MY AGENT IS AUTHORIZED TO CONSENT TO THE USE OF ANY
11 MEDICATIONS AFTER CONSULTATION WITH MY TREATING PSYCHIATRIST
12 AND ANY OTHER PERSONS MY AGENT CONSIDERS APPROPRIATE.
13 ( ) MY AGENT IS NOT AUTHORIZED TO CONSENT TO THE USE OF ANY
14 MEDICATIONS.
15 (2) PREFERENCES REGARDING ELECTROCONVULSIVE THERAPY
16 (ECT).
17 ( ) MY AGENT IS AUTHORIZED TO CONSENT TO THE ADMINISTRATION
18 OF ELECTROCONVULSIVE THERAPY.
19 ( ) MY AGENT IS NOT AUTHORIZED TO CONSENT TO THE
20 ADMINISTRATION OF ELECTROCONVULSIVE THERAPY.
21 (3) PREFERENCES FOR EXPERIMENTAL STUDIES OR DRUG TRIALS.
22 ( ) MY AGENT IS AUTHORIZED TO CONSENT TO MY PARTICIPATION IN
23 EXPERIMENTAL STUDIES IF, AFTER CONSULTATION WITH MY TREATING
24 PHYSICIAN AND ANY OTHER INDIVIDUALS MY AGENT DEEMS
25 APPROPRIATE, MY AGENT BELIEVES THAT THE POTENTIAL BENEFITS TO
26 ME OUTWEIGH THE POSSIBLE RISKS TO ME.
27 ( ) MY AGENT IS NOT AUTHORIZED TO CONSENT TO MY PARTICIPATION
28 IN EXPERIMENTAL STUDIES.
29 ( ) MY AGENT IS AUTHORIZED TO CONSENT TO MY PARTICIPATION IN
30 DRUG TRIALS IF, AFTER CONSULTATION WITH MY TREATING PHYSICIAN
20030H2036B4166 - 55 -
1 AND ANY OTHER INDIVIDUALS MY AGENT DEEMS APPROPRIATE, MY
2 AGENT BELIEVES THAT THE POTENTIAL BENEFITS TO ME OUTWEIGH THE
3 POSSIBLE RISKS TO ME.
4 ( ) MY AGENT IS NOT AUTHORIZED TO CONSENT TO MY PARTICIPATION
5 IN DRUG TRIALS.
6 E. REVOCATION.
7 THIS POWER OF ATTORNEY MAY BE REVOKED IN WHOLE OR IN PART AT
8 ANY TIME, EITHER ORALLY OR IN WRITING, AS LONG AS I HAVE NOT
9 BEEN FOUND TO BE INCAPABLE OF MAKING MENTAL HEALTH DECISIONS.
10 MY REVOCATION WILL BE EFFECTIVE UPON COMMUNICATION TO MY
11 ATTENDING PHYSICIAN OR OTHER MENTAL HEALTH CARE PROVIDER,
12 EITHER BY ME OR A WITNESS TO MY REVOCATION, OF THE INTENT TO
13 REVOKE. IF I CHOOSE TO REVOKE A PARTICULAR INSTRUCTION
14 CONTAINED IN THIS POWER OF ATTORNEY IN THE MANNER SPECIFIED,
15 I UNDERSTAND THAT THE OTHER INSTRUCTIONS CONTAINED IN THIS
16 POWER OF ATTORNEY WILL REMAIN EFFECTIVE UNTIL:
17 (1) I REVOKE THIS POWER OF ATTORNEY IN ITS ENTIRETY;
18 (2) I MAKE A NEW COMBINED MENTAL HEALTH CARE DECLARATION
19 AND POWER OF ATTORNEY; OR
20 (3) TWO YEARS FROM THE DATE THIS DOCUMENT WAS EXECUTED.
21 I UNDERSTAND THAT THIS POWER OF ATTORNEY WILL AUTOMATICALLY
22 TERMINATE TWO YEARS FROM THE DATE OF EXECUTION UNLESS I AM
23 DEEMED INCAPABLE OF MAKING MENTAL HEALTH CARE DECISIONS AT
24 THE TIME THAT THE POWER OF ATTORNEY WOULD EXPIRE.
25 I AM MAKING THIS COMBINED MENTAL HEALTH CARE DECLARATION AND
26 POWER OF ATTORNEY ON THE (INSERT DAY) DAY OF (INSERT MONTH),
27 (INSERT YEAR).
28 MY SIGNATURE:
29 (MY NAME, ADDRESS, TELEPHONE NUMBER)
30 WITNESSES SIGNATURES:
20030H2036B4166 - 56 -
1 (NAMES, ADDRESSES, TELEPHONE NUMBERS OF WITNESSES).
2 IF THE PRINCIPAL MAKING THIS COMBINED MENTAL HEALTH CARE
3 DECLARATION AND POWER OF ATTORNEY IS UNABLE TO SIGN THIS
4 DOCUMENT, ANOTHER INDIVIDUAL MAY SIGN ON BEHALF OF AND AT THE
5 DIRECTION OF THE PRINCIPAL.
6 SIGNATURE OF PERSON SIGNING ON MY BEHALF:
7 SIGNATURE
8 (NAME, ADDRESS, TELEPHONE NUMBER)
9 SUBCHAPTER B
10 MENTAL HEALTH CARE DECLARATIONS
11 SEC.
12 5821. SHORT TITLE OF SUBCHAPTER.
13 5822. EXECUTION.
14 5823. FORM.
15 5824. OPERATION.
16 5825. REVOCATION.
17 5826. AMENDMENT.
18 § 5821. SHORT TITLE OF SUBCHAPTER.
19 THIS SUBCHAPTER SHALL BE KNOWN AND MAY BE CITED AS THE
20 ADVANCE DIRECTIVE FOR MENTAL HEALTH CARE ACT.
21 § 5822. EXECUTION.
22 (A) WHO MAY MAKE.--AN INDIVIDUAL WHO IS AT LEAST 18 YEARS OF
23 AGE OR AN EMANCIPATED MINOR AND HAS NOT BEEN DEEMED
24 INCAPACITATED PURSUANT TO SECTION 5511 (RELATING TO PETITION AND
25 HEARING; INDEPENDENT EVALUATION) OR SEVERELY MENTALLY DISABLED
26 PURSUANT TO SECTION 301 OF THE ACT OF JULY 9, 1976 (P.L.817,
27 NO.143), KNOWN AS THE MENTAL HEALTH PROCEDURES ACT, MAY MAKE A
28 DECLARATION GOVERNING THE INITIATION, CONTINUATION, WITHHOLDING
29 OR WITHDRAWAL OF MENTAL HEALTH TREATMENT.
30 (B) REQUIREMENTS.--A DECLARATION MUST BE:
20030H2036B4166 - 57 -
1 (1) DATED AND SIGNED BY THE DECLARANT BY SIGNATURE OR
2 MARK OR BY ANOTHER INDIVIDUAL ON BEHALF OF AND AT THE
3 DIRECTION OF THE DECLARANT.
4 (2) WITNESSED BY TWO INDIVIDUALS, EACH OF WHOM MUST BE
5 AT LEAST 18 YEARS OF AGE.
6 (C) WITNESSES.--
7 (1) AN INDIVIDUAL WHO SIGNS A DECLARATION ON BEHALF OF
8 AND AT THE DIRECTION OF A DECLARANT MAY NOT WITNESS THE
9 DECLARATION.
10 (2) A MENTAL HEALTH CARE PROVIDER AND ITS AGENT MAY NOT
11 SIGN A DECLARATION ON BEHALF OF AND AT THE DIRECTION OF A
12 DECLARANT IF THE MENTAL HEALTH CARE PROVIDER OR AGENT
13 PROVIDES MENTAL HEALTH CARE SERVICES TO THE DECLARANT.
14 § 5823. FORM.
15 A DECLARATION MAY BE IN THE FOLLOWING FORM OR ANY OTHER
16 WRITTEN FORM THAT EXPRESSES THE WISHES OF A DECLARANT REGARDING
17 THE INITIATION, CONTINUATION OR REFUSAL OF MENTAL HEALTH
18 TREATMENT AND MAY INCLUDE OTHER SPECIFIC DIRECTIONS, INCLUDING,
19 BUT NOT LIMITED TO, DESIGNATION OF ANOTHER INDIVIDUAL TO MAKE
20 MENTAL HEALTH TREATMENT DECISIONS FOR THE DECLARANT IF THE
21 DECLARANT IS INCAPABLE OF MAKING MENTAL HEALTH DECISIONS:
22 MENTAL HEALTH CARE DECLARATION.
23 I, , HAVING THE CAPACITY TO MAKE MENTAL
24 HEALTH DECISIONS, WILLFULLY AND VOLUNTARILY MAKE THIS
25 DECLARATION REGARDING MY MENTAL HEALTH CARE.
26 I UNDERSTAND THAT MENTAL HEALTH CARE INCLUDES ANY CARE,
27 TREATMENT, SERVICE OR PROCEDURE TO MAINTAIN, DIAGNOSE, TREAT
28 OR PROVIDE FOR MENTAL HEALTH, INCLUDING ANY MEDICATION
29 PROGRAM AND THERAPEUTIC TREATMENT. MENTAL HEALTH CARE DOES
30 NOT INCLUDE ELECTROCONVULSIVE THERAPY, LABORATORY TRIALS OR
20030H2036B4166 - 58 -
1 RESEARCH, UNLESS SPECIFICALLY PROVIDED FOR IN THIS DOCUMENT.
2 MENTAL HEALTH CARE DOES NOT INCLUDE PSYCHOSURGERY OR
3 TERMINATION OF PARENTAL RIGHTS.
4 I UNDERSTAND THAT MY INCAPACITY WILL BE DETERMINED BY
5 EXAMINATION BY A PSYCHIATRIST AND ONE OF THE FOLLOWING:
6 ANOTHER PSYCHIATRIST, PSYCHOLOGIST, FAMILY PHYSICIAN,
7 ATTENDING PHYSICIAN OR MENTAL HEALTH TREATMENT PROFESSIONAL.
8 WHENEVER POSSIBLE, ONE OF THE DECISION MAKERS WILL BE ONE OF
9 MY TREATING PROFESSIONALS.
10 A. WHEN THIS DECLARATION BECOMES EFFECTIVE.
11 THIS DECLARATION BECOMES EFFECTIVE AT THE FOLLOWING
12 DESIGNATED TIME:
13 ( ) WHEN I AM DEEMED INCAPABLE OF MAKING MENTAL HEALTH CARE
14 DECISIONS.
15 ( ) WHEN THE FOLLOWING CONDITION IS MET:
16 (LIST CONDITION)
17 B. TREATMENT PREFERENCES.
18 1. CHOICE OF TREATMENT FACILITY.
19 ( ) IN THE EVENT THAT I REQUIRE COMMITMENT TO A PSYCHIATRIC
20 TREATMENT FACILITY, I WOULD PREFER TO BE ADMITTED TO THE
21 FOLLOWING FACILITY:
22 (INSERT NAME AND ADDRESS OF FACILITY)
23 ( ) IN THE EVENT THAT I REQUIRE COMMITMENT TO A PSYCHIATRIC
24 TREATMENT FACILITY, I DO NOT WISH TO BE COMMITTED TO THE
25 FOLLOWING FACILITY:
26 (INSERT NAME AND ADDRESS OF FACILITY)
27 I UNDERSTAND THAT MY PHYSICIAN MAY HAVE TO PLACE ME IN A
28 FACILITY THAT IS NOT MY PREFERENCE.
29 2. PREFERENCES REGARDING MEDICATIONS FOR PSYCHIATRIC
30 TREATMENT.
20030H2036B4166 - 59 -
1 ( ) I CONSENT TO THE MEDICATIONS THAT MY TREATING PHYSICIAN
2 RECOMMENDS WITH THE FOLLOWING EXCEPTION OR LIMITATION:
3 (LIST MEDICATION AND REASON FOR EXCEPTION OR LIMITATION)
4 THIS EXCEPTION OR LIMITATION APPLIES TO GENERIC, BRAND NAME
5 AND TRADE NAME EQUIVALENTS. I UNDERSTAND THAT DOSAGE
6 INSTRUCTIONS ARE NOT BINDING ON MY PHYSICIAN.
7 ( ) I DO NOT CONSENT TO THE USE OF ANY MEDICATIONS.
8 3. PREFERENCES REGARDING ELECTROCONVULSIVE THERAPY
9 (ECT).
10 ( ) I CONSENT TO THE ADMINISTRATION OF ELECTROCONVULSIVE
11 THERAPY.
12 ( ) I DO NOT CONSENT TO THE ADMINISTRATION OF
13 ELECTROCONVULSIVE THERAPY.
14 4. PREFERENCES FOR EXPERIMENTAL STUDIES OR DRUG TRIALS.
15 ( ) I CONSENT TO PARTICIPATION IN EXPERIMENTAL STUDIES IF MY
16 TREATING PHYSICIAN BELIEVES THAT THE POTENTIAL BENEFITS TO ME
17 OUTWEIGH THE POSSIBLE RISKS TO ME.
18 ( ) I DO NOT CONSENT TO PARTICIPATION IN EXPERIMENTAL
19 STUDIES.
20 ( ) I CONSENT TO PARTICIPATION IN DRUG TRIALS IF MY TREATING
21 PHYSICIAN BELIEVES THAT THE POTENTIAL BENEFITS TO ME OUTWEIGH
22 THE POSSIBLE RISKS TO ME.
23 ( ) I DO NOT CONSENT TO PARTICIPATION IN ANY DRUG TRIALS.
24 5. ADDITIONAL INSTRUCTIONS OR INFORMATION:
25 EXAMPLES OF OTHER INSTRUCTIONS OR INFORMATION THAT MAY BE
26 INCLUDED:
27 ACTIVITIES THAT HELP OR WORSEN SYMPTOMS.
28 TYPE OF INTERVENTION PREFERRED IN THE EVENT OF A
29 CRISIS.
30 MENTAL AND PHYSICAL HEALTH HISTORY.
20030H2036B4166 - 60 -
1 DIETARY REQUIREMENTS.
2 RELIGIOUS PREFERENCES.
3 TEMPORARY CUSTODY OF CHILDREN.
4 FAMILY NOTIFICATION.
5 LIMITATIONS ON THE RELEASE OR DISCLOSURE OF MENTAL
6 HEALTH RECORDS.
7 INSTRUCTIONS RELATED TO PREFERENCES IF YOU ARE
8 PREGNANT.
9 OTHER MATTERS OF IMPORTANCE.
10 C. REVOCATION.
11 THIS DECLARATION MAY BE REVOKED IN WHOLE OR IN PART AT ANY
12 TIME, EITHER ORALLY OR IN WRITING, AS LONG AS I HAVE NOT BEEN
13 FOUND TO BE INCAPABLE OF MAKING MENTAL HEALTH DECISIONS.
14 MY REVOCATION WILL BE EFFECTIVE UPON COMMUNICATION TO MY
15 ATTENDING PHYSICIAN OR OTHER MENTAL HEALTH CARE PROVIDER,
16 EITHER BY ME OR A WITNESS TO MY REVOCATION, OF THE INTENT TO
17 REVOKE. IF I CHOOSE TO REVOKE A PARTICULAR INSTRUCTION
18 CONTAINED IN THIS DECLARATION IN THE MANNER SPECIFIED, I
19 UNDERSTAND THAT THE OTHER INSTRUCTIONS CONTAINED IN THIS
20 DECLARATION WILL REMAIN EFFECTIVE UNTIL:
21 (1) I REVOKE THIS DECLARATION IN ITS ENTIRETY;
22 (2) I MAKE A NEW MENTAL HEALTH CARE DECLARATION; OR
23 (3) TWO YEARS AFTER THE DATE THIS DOCUMENT WAS EXECUTED.
24 D. TERMINATION.
25 I UNDERSTAND THAT THIS DECLARATION WILL AUTOMATICALLY
26 TERMINATE TWO YEARS FROM THE DATE OF EXECUTION UNLESS I AM
27 DEEMED INCAPABLE OF MAKING MENTAL HEALTH CARE DECISIONS AT
28 THE TIME THAT THE DECLARATION WOULD EXPIRE.
29 E. PREFERENCE AS TO A COURT-APPOINTED GUARDIAN.
30 I UNDERSTAND THAT I MAY NOMINATE A GUARDIAN OF MY PERSON FOR
20030H2036B4166 - 61 -
1 CONSIDERATION BY THE COURT IF INCAPACITY PROCEEDINGS ARE
2 COMMENCED PURSUANT TO 20 PA.C.S. § 5511. I UNDERSTAND THAT
3 THE COURT WILL APPOINT A GUARDIAN IN ACCORDANCE WITH MY MOST
4 RECENT NOMINATION EXCEPT FOR GOOD CAUSE OR DISQUALIFICATION.
5 IN THE EVENT A COURT DECIDES TO APPOINT A GUARDIAN, I DESIRE
6 THE FOLLOWING PERSON TO BE APPOINTED:
7 (INSERT NAME, ADDRESS AND TELEPHONE NUMBER
8 OF DESIGNATED PERSON)
9 ( ) THE APPOINTMENT OF A GUARDIAN OF MY PERSON WILL NOT GIVE
10 THE GUARDIAN THE POWER TO REVOKE, SUSPEND OR TERMINATE THIS
11 DECLARATION.
12 ( ) UPON APPOINTMENT OF A GUARDIAN, I AUTHORIZE THE GUARDIAN
13 TO REVOKE, SUSPEND OR TERMINATE THIS DECLARATION.
14 I AM MAKING THIS DECLARATION ON THE (INSERT DAY)
15 DAY OF (INSERT MONTH), (INSERT YEAR).
16 MY SIGNATURE: (MY NAME, ADDRESS, TELEPHONE NUMBER)
17 WITNESSES' SIGNATURES: (NAMES, ADDRESSES, TELEPHONE NUMBERS
18 OF WITNESSES)
19 IF THE PRINCIPAL MAKING THIS DECLARATION IS UNABLE TO SIGN
20 IT, ANOTHER INDIVIDUAL MAY SIGN ON BEHALF OF AND AT THE
21 DIRECTION OF THE PRINCIPAL.
22 SIGNATURE OF PERSON SIGNING ON MY BEHALF:
23 (NAME, ADDRESS AND TELEPHONE NUMBER)
24 § 5824. OPERATION.
25 (A) WHEN OPERATIVE.--A DECLARATION BECOMES OPERATIVE WHEN:
26 (1) A COPY IS PROVIDED TO THE ATTENDING PHYSICIAN.
27 (2) THE CONDITIONS STATED IN THE DECLARATION ARE MET.
28 (B) COMPLIANCE.--WHEN A DECLARATION BECOMES OPERATIVE, THE
29 ATTENDING PHYSICIAN AND OTHER MENTAL HEALTH CARE PROVIDERS SHALL
30 ACT IN ACCORDANCE WITH ITS PROVISIONS OR COMPLY WITH THE
20030H2036B4166 - 62 -
1 TRANSFER PROVISIONS OF SECTION 5804 (RELATING TO COMPLIANCE).
2 (C) INVALIDITY OF SPECIFIC DIRECTION.--IF A SPECIFIC
3 DIRECTION IN THE DECLARATION IS HELD TO BE INVALID, THE
4 INVALIDITY SHALL NOT BE CONSTRUED TO NEGATE OTHER DIRECTIONS IN
5 THE DECLARATION THAT CAN BE EFFECTED WITHOUT THE INVALID
6 DIRECTION.
7 (D) MENTAL HEALTH RECORD.--A PHYSICIAN OR OTHER MENTAL
8 HEALTH CARE PROVIDER TO WHOM A COPY OF A DECLARATION IS
9 FURNISHED SHALL MAKE IT A PART OF THE MENTAL HEALTH RECORD OF
10 THE DECLARANT, FOR AT LEAST TWO YEARS FROM THE DATE OF
11 EXECUTION, AND IF UNWILLING TO COMPLY WITH THE DECLARATION,
12 PROMPTLY SO ADVISE THOSE LISTED IN SECTION 5804(A)(2).
13 (E) DURATION.--A DECLARATION SHALL BE VALID UNTIL REVOKED BY
14 THE DECLARANT OR UNTIL TWO YEARS FROM THE DATE OF EXECUTION. IF
15 A DECLARATION FOR MENTAL HEALTH TREATMENT HAS BEEN INVOKED AND
16 IS IN EFFECT AT THE SPECIFIED EXPIRATION DATE AFTER ITS
17 EXECUTION, THE DECLARATION SHALL REMAIN EFFECTIVE UNTIL THE
18 PRINCIPAL IS NO LONGER INCAPABLE.
19 (F) ABSENCE OF DECLARATION.--IF AN INDIVIDUAL DOES NOT MAKE
20 A DECLARATION, A PRESUMPTION DOES NOT ARISE REGARDING THE INTENT
21 OF THE INDIVIDUAL TO CONSENT TO OR TO REFUSE A MENTAL HEALTH
22 TREATMENT.
23 § 5825. REVOCATION.
24 (A) WHEN DECLARATION MAY BE REVOKED.--AN INDIVIDUAL SHALL
25 SPECIFY IN A DECLARATION WHETHER IT MAY BE REVOKED BY THE
26 INDIVIDUAL AT ANY TIME AND IN ANY MANNER, ONLY IF THE INDIVIDUAL
27 HAS NOT BEEN FOUND TO BE INCAPABLE OF MAKING MENTAL HEALTH
28 TREATMENT DECISIONS.
29 (B) EFFECT OF REVOCATION.--A REVOCATION OF A DECLARATION
30 SHALL BE EFFECTIVE UPON COMMUNICATION TO THE ATTENDING PHYSICIAN
20030H2036B4166 - 63 -
1 OR OTHER MENTAL HEALTH CARE PROVIDER BY THE DECLARANT OR A
2 WITNESS TO THE REVOCATION OF THE INTENT TO REVOKE.
3 (C) MENTAL HEALTH RECORD.--AN ATTENDING PHYSICIAN OR OTHER
4 MENTAL HEALTH CARE PROVIDER SHALL MAKE REVOCATION OR A
5 DECLARATION PART OF THE MENTAL HEALTH RECORD OF THE DECLARANT.
6 § 5826. AMENDMENT.
7 WHILE HAVING THE CAPACITY TO MAKE MENTAL HEALTH DECISIONS, A
8 DECLARANT MAY AMEND A DECLARATION BY A WRITING EXECUTED IN
9 ACCORDANCE WITH THE PROVISIONS OF SECTION 5822 (RELATING TO
10 EXECUTION).
11 SUBCHAPTER C
12 MENTAL HEALTH CARE POWERS OF ATTORNEY
13 SEC.
14 5831. SHORT TITLE OF SUBCHAPTER.
15 5832. EXECUTION.
16 5833. FORM.
17 5834. OPERATION.
18 5835. APPOINTMENT OF MENTAL HEALTH CARE AGENTS.
19 5836. AUTHORITY OF MENTAL HEALTH CARE AGENT.
20 5837. REMOVAL OF AGENT.
21 5838. EFFECT OF DIVORCE.
22 5839. REVOCATION.
23 5840. AMENDMENT.
24 5841. RELATION OF MENTAL HEALTH CARE AGENT TO COURT-APPOINTED
25 GUARDIAN AND OTHER AGENTS.
26 5842. DUTIES OF ATTENDING PHYSICIAN AND MENTAL HEALTH CARE
27 PROVIDER.
28 5843. CONSTRUCTION.
29 5844. CONFLICTING MENTAL HEALTH CARE POWERS OF ATTORNEY.
30 5845. VALIDITY.
20030H2036B4166 - 64 -
1 § 5831. SHORT TITLE OF SUBCHAPTER.
2 THIS SUBCHAPTER SHALL BE KNOWN AND MAY BE CITED AS THE MENTAL
3 HEALTH CARE AGENTS ACT.
4 § 5832. EXECUTION.
5 (A) WHO MAY MAKE.--AN INDIVIDUAL WHO IS AT LEAST 18 YEARS OF
6 AGE OR AN EMANCIPATED MINOR AND WHO HAS NOT BEEN DEEMED
7 INCAPACITATED PURSUANT TO SECTION 5511 (RELATING TO PETITION AND
8 HEARING; INDEPENDENT EVALUATION) OR FOUND TO BE SEVERELY
9 MENTALLY DISABLED PURSUANT TO SECTION 302 OF THE ACT OF JULY 9,
10 1976 (P.L.817, NO.143), KNOWN AS THE MENTAL HEALTH PROCEDURES
11 ACT, MAY MAKE A POWER OF ATTORNEY GOVERNING THE INITIATION,
12 CONTINUATION, WITHHOLDING OR WITHDRAWAL OF MENTAL HEALTH
13 TREATMENT.
14 (B) REQUIREMENTS.--A POWER OF ATTORNEY MUST BE:
15 (1) DATED AND SIGNED BY THE PRINCIPAL BY SIGNATURE OR
16 MARK OR BY ANOTHER INDIVIDUAL ON BEHALF OF AND AT THE
17 DIRECTION OF THE PRINCIPAL.
18 (2) WITNESSED BY TWO INDIVIDUALS, EACH OF WHOM MUST BE
19 AT LEAST 18 YEARS OF AGE.
20 (C) WITNESSES.--
21 (1) AN INDIVIDUAL WHO SIGNS A POWER OF ATTORNEY ON
22 BEHALF OF AND AT THE DIRECTION OF A PRINCIPAL MAY NOT WITNESS
23 THE POWER OF ATTORNEY.
24 (2) A MENTAL HEALTH CARE PROVIDER AND ITS AGENT MAY NOT
25 SIGN A POWER OF ATTORNEY ON BEHALF OF AND AT THE DIRECTION OF
26 A PRINCIPAL IF THE MENTAL HEALTH CARE PROVIDER OR AGENT
27 PROVIDES MENTAL HEALTH CARE SERVICES TO THE PRINCIPAL.
28 § 5833. FORM.
29 (A) REQUIREMENTS.--A MENTAL HEALTH CARE POWER OF ATTORNEY
30 MUST DO THE FOLLOWING:
20030H2036B4166 - 65 -
1 (1) IDENTIFY THE PRINCIPAL AND APPOINT THE MENTAL HEALTH
2 CARE AGENT.
3 (2) DECLARE THAT THE PRINCIPAL AUTHORIZES THE MENTAL
4 HEALTH CARE AGENT TO MAKE MENTAL HEALTH CARE DECISIONS ON
5 BEHALF OF THE PRINCIPAL.
6 (B) OPTIONAL PROVISIONS.--A MENTAL HEALTH CARE POWER OF
7 ATTORNEY MAY:
8 (1) DESCRIBE ANY LIMITATIONS THAT THE PRINCIPAL IMPOSES
9 UPON THE AUTHORITY OF THE MENTAL HEALTH CARE AGENT.
10 (2) INDICATE THE INTENT OF THE PRINCIPAL REGARDING THE
11 INITIATION, CONTINUATION OR REFUSAL OF MENTAL HEALTH
12 TREATMENT.
13 (3) NOMINATE A GUARDIAN OF THE PERSON OF THE PRINCIPAL
14 AS PROVIDED IN SECTION 5841 (RELATING TO RELATION OF MENTAL
15 HEALTH CARE AGENT TO COURT-APPOINTED GUARDIAN AND OTHER
16 AGENTS).
17 (4) CONTAIN OTHER PROVISIONS AS THE PRINCIPAL MAY
18 SPECIFY REGARDING THE IMPLEMENTATION OF MENTAL HEALTH CARE
19 DECISIONS AND RELATED ACTIONS BY THE MENTAL HEALTH CARE
20 AGENT.
21 (C) WRITTEN FORM.--A MENTAL HEALTH CARE POWER OF ATTORNEY
22 MAY BE IN THE FOLLOWING FORM OR ANY OTHER WRITTEN FORM
23 IDENTIFYING THE PRINCIPAL, APPOINTING A MENTAL HEALTH CARE AGENT
24 AND DECLARING THAT THE PRINCIPAL AUTHORIZES THE MENTAL HEALTH
25 CARE AGENT TO MAKE MENTAL HEALTH CARE DECISIONS ON BEHALF OF THE
26 PRINCIPAL.
27 MENTAL HEALTH CARE POWER OF ATTORNEY
28 I, , HAVING THE CAPACITY TO MAKE MENTAL
29 HEALTH DECISIONS, AUTHORIZE MY DESIGNATED HEALTH CARE AGENT
30 TO MAKE CERTAIN DECISIONS ON MY BEHALF REGARDING MY MENTAL
20030H2036B4166 - 66 -
1 HEALTH CARE. IF I HAVE NOT EXPRESSED A CHOICE IN THIS
2 DOCUMENT, I AUTHORIZE MY AGENT TO MAKE THE DECISION THAT MY
3 AGENT DETERMINES IS THE DECISION I WOULD MAKE IF I WERE
4 COMPETENT TO DO SO.
5 I UNDERSTAND THAT MENTAL HEALTH CARE INCLUDES ANY CARE,
6 TREATMENT, SERVICE OR PROCEDURE TO MAINTAIN, DIAGNOSE, TREAT
7 OR PROVIDE FOR MENTAL HEALTH, INCLUDING ANY MEDICATION
8 PROGRAM AND THERAPEUTIC TREATMENT. MENTAL HEALTH CARE DOES
9 NOT INCLUDE ELECTROCONVULSIVE THERAPY, LABORATORY TRIALS OR
10 RESEARCH, UNLESS SPECIFICALLY PROVIDED FOR IN THIS DOCUMENT.
11 MENTAL HEALTH CARE DOES NOT INCLUDE PSYCHOSURGERY OR
12 TERMINATION OF PARENTAL RIGHTS.
13 I UNDERSTAND THAT MY INCAPACITY WILL BE DETERMINED BY
14 EXAMINATION BY A PSYCHIATRIST AND ONE OF THE FOLLOWING:
15 ANOTHER PSYCHIATRIST, PSYCHOLOGIST, FAMILY PHYSICIAN,
16 ATTENDING PHYSICIAN OR MENTAL HEALTH TREATMENT PROFESSIONAL.
17 WHENEVER POSSIBLE, ONE OF THE DECISION MAKERS SHALL BE ONE OF
18 MY TREATING PROFESSIONALS.
19 A. DESIGNATION OF AGENT. I HEREBY DESIGNATE AND APPOINT THE
20 FOLLOWING PERSON AS MY AGENT TO MAKE MENTAL HEALTH CARE
21 DECISIONS FOR ME AS AUTHORIZED IN THIS DOCUMENT:
22 (INSERT NAME OF DESIGNATED PERSON)
23 SIGNED:
24 (MY NAME, ADDRESS, TELEPHONE NUMBER)
25 (WITNESSES' SIGNATURES)
26 (NAMES, ADDRESSES, TELEPHONE NUMBERS OF WITNESSES)
27 AGENT'S ACCEPTANCE:
28 I HEREBY ACCEPT DESIGNATION AS MENTAL HEALTH CARE AGENT FOR
29 (INSERT NAME OF DECLARANT)
30 AGENT'S SIGNATURE:
20030H2036B4166 - 67 -
1 (INSERT NAME, ADDRESS, TELEPHONE NUMBER OF DESIGNATED PERSON)
2 B. DESIGNATION OF ALTERNATIVE AGENT.
3 IN THE EVENT THAT MY FIRST AGENT IS UNAVAILABLE OR UNABLE TO
4 SERVE AS MY MENTAL HEALTH CARE AGENT, I HEREBY DESIGNATE AND
5 APPOINT THE FOLLOWING INDIVIDUAL AS MY ALTERNATIVE MENTAL
6 HEALTH CARE AGENT TO MAKE MENTAL HEALTH CARE DECISIONS FOR ME
7 AS AUTHORIZED IN THIS DOCUMENT:
8 (INSERT NAME OF DESIGNATED PERSON)
9 SIGNED:
10 (WITNESSES' SIGNATURES)
11 (NAMES, ADDRESSES, TELEPHONE NUMBERS OF WITNESSES)
12 ALTERNATIVE AGENT'S ACCEPTANCE:
13 I HEREBY ACCEPT DESIGNATION AS ALTERNATIVE MENTAL HEALTH CARE
14 AGENT FOR
15 (INSERT NAME OF DECLARANT)
16 ALTERNATIVE AGENT'S SIGNATURE: .
17 (INSERT NAME, ADDRESS, TELEPHONE NUMBER)
18 C. WHEN THIS POWER OF ATTORNEY BECOMES EFFECTIVE.
19 THIS POWER OF ATTORNEY WILL BECOME EFFECTIVE AT THE FOLLOWING
20 DESIGNATED TIME:
21 ( ) WHEN I AM DEEMED INCAPABLE OF MAKING MENTAL HEALTH CARE
22 DECISIONS.
23 ( ) WHEN THE FOLLOWING CONDITION IS MET:
24 (LIST CONDITION)
25 D. AUTHORITY GRANTED TO MY MENTAL HEALTH CARE AGENT.
26 I HEREBY GRANT TO MY AGENT FULL POWER AND AUTHORITY TO MAKE
27 MENTAL HEALTH CARE DECISIONS FOR ME CONSISTENT WITH THE
28 INSTRUCTIONS AND LIMITATIONS SET FORTH IN THIS POWER OF
29 ATTORNEY. IF I HAVE NOT EXPRESSED A CHOICE IN THIS POWER OF
30 ATTORNEY, I AUTHORIZE MY AGENT TO MAKE THE DECISION THAT MY
20030H2036B4166 - 68 -
1 AGENT DETERMINES IS THE DECISION I WOULD MAKE IF I WERE
2 COMPETENT TO DO SO.
3 1. TREATMENT PREFERENCES.
4 (A) CHOICE OF TREATMENT FACILITY.
5 ( ) IN THE EVENT THAT I REQUIRE COMMITMENT TO A PSYCHIATRIC
6 TREATMENT FACILITY, I WOULD PREFER TO BE ADMITTED TO THE
7 FOLLOWING FACILITY:
8 (INSERT NAME AND ADDRESS OF FACILITY)
9 ( ) IN THE EVENT THAT I REQUIRE COMMITMENT TO A PSYCHIATRIC
10 TREATMENT FACILITY, I DO NOT WISH TO BE COMMITTED TO THE
11 FOLLOWING FACILITY:
12 (INSERT NAME AND ADDRESS OF FACILITY)
13 I UNDERSTAND THAT MY PHYSICIAN MAY HAVE TO PLACE ME IN A
14 FACILITY THAT IS NOT MY PREFERENCE.
15 (B) PREFERENCES REGARDING MEDICATIONS FOR PSYCHIATRIC
16 TREATMENT.
17 ( ) I CONSENT TO THE MEDICATIONS THAT MY AGENT AGREES TO
18 AFTER CONSULTATION WITH MY TREATING PHYSICIAN AND ANY OTHER
19 PERSONS MY AGENT CONSIDERS APPROPRIATE.
20 ( ) I CONSENT TO THE MEDICATIONS THAT MY AGENT AGREES TO,
21 WITH THE FOLLOWING EXCEPTION OR LIMITATION:
22 (LIST EXCEPTION OR LIMITATION)
23 THIS EXCEPTION OR LIMITATION APPLIES TO GENERIC, BRAND NAME
24 AND TRADE NAME EQUIVALENTS.
25 ( ) MY AGENT IS NOT AUTHORIZED TO CONSENT TO THE USE OF ANY
26 MEDICATIONS.
27 (C) PREFERENCES REGARDING ELECTROCONVULSIVE THERAPY
28 (ECT).
29 ( ) MY AGENT IS AUTHORIZED TO CONSENT TO THE ADMINISTRATION
30 OF ELECTROCONVULSIVE THERAPY.
20030H2036B4166 - 69 -
1 ( ) MY AGENT IS NOT AUTHORIZED TO CONSENT TO THE
2 ADMINISTRATION OF ELECTROCONVULSIVE THERAPY.
3 (D) PREFERENCES FOR EXPERIMENTAL STUDIES OR DRUG TRIALS.
4 ( ) MY AGENT IS AUTHORIZED TO CONSENT TO MY PARTICIPATION IN
5 EXPERIMENTAL STUDIES IF, AFTER CONSULTATION WITH MY TREATING
6 PHYSICIAN AND ANY OTHER INDIVIDUALS MY AGENT DEEMS
7 APPROPRIATE, MY AGENT BELIEVES THAT THE POTENTIAL BENEFITS TO
8 ME OUTWEIGH THE POSSIBLE RISKS TO ME.
9 ( ) MY AGENT IS NOT AUTHORIZED TO CONSENT TO MY
10 PARTICIPATION IN EXPERIMENTAL STUDIES.
11 ( ) MY AGENT IS AUTHORIZED TO CONSENT TO MY PARTICIPATION IN
12 DRUG TRIALS IF, AFTER CONSULTATION WITH MY TREATING PHYSICIAN
13 AND ANY OTHER INDIVIDUALS MY AGENT DEEMS APPROPRIATE, MY
14 AGENT BELIEVES THAT THE POTENTIAL BENEFITS TO ME OUTWEIGH THE
15 POSSIBLE RISKS TO ME.
16 ( ) MY AGENT IS NOT AUTHORIZED TO CONSENT TO MY
17 PARTICIPATION IN DRUG TRIALS.
18 (E) ADDITIONAL INFORMATION AND INSTRUCTIONS.
19 EXAMPLES OF OTHER INFORMATION THAT MAY BE INCLUDED:
20 ACTIVITIES THAT HELP OR WORSEN SYMPTOMS.
21 TYPE OF INTERVENTION PREFERRED IN THE EVENT OF A
22 CRISIS.
23 MENTAL AND PHYSICAL HEALTH HISTORY.
24 DIETARY REQUIREMENTS.
25 RELIGIOUS PREFERENCES.
26 TEMPORARY CUSTODY OF CHILDREN.
27 FAMILY NOTIFICATION.
28 LIMITATIONS ON RELEASE OR DISCLOSURE OF MENTAL
29 HEALTH RECORDS.
30 INSTRUCTIONS RELATED TO PREFERENCES IF YOU ARE
20030H2036B4166 - 70 -
1 PREGNANT.
2 OTHER MATTERS OF IMPORTANCE.
3 E. REVOCATION.
4 THIS POWER OF ATTORNEY MAY BE REVOKED IN WHOLE OR IN PART AT
5 ANY TIME, EITHER ORALLY OR IN WRITING, AS LONG AS I HAVE NOT
6 BEEN FOUND TO BE INCAPABLE OF MAKING MENTAL HEALTH DECISIONS.
7 MY REVOCATION WILL BE EFFECTIVE UPON COMMUNICATION TO MY
8 ATTENDING PHYSICIAN OR OTHER MENTAL HEALTH CARE PROVIDER,
9 EITHER BY ME OR A WITNESS TO MY REVOCATION, OF THE INTENT TO
10 REVOKE. IF I CHOOSE TO REVOKE A PARTICULAR INSTRUCTION
11 CONTAINED IN THIS POWER OF ATTORNEY IN THE MANNER SPECIFIED,
12 I UNDERSTAND THAT THE OTHER INSTRUCTIONS CONTAINED IN THIS
13 POWER OF ATTORNEY WILL REMAIN EFFECTIVE UNTIL:
14 (1) I REVOKE THIS POWER OF ATTORNEY IN ITS ENTIRETY;
15 (2) I MAKE A NEW MENTAL HEALTH CARE POWER OF ATTORNEY;
16 OR
17 (3) TWO YEARS AFTER THE DATE THIS DOCUMENT WAS EXECUTED.
18 F. TERMINATION.
19 I UNDERSTAND THAT THIS POWER OF ATTORNEY WILL AUTOMATICALLY
20 TERMINATE TWO YEARS FROM THE DATE OF EXECUTION UNLESS I AM
21 DEEMED INCAPABLE OF MAKING MENTAL HEALTH CARE DECISIONS AT
22 THE TIME THE POWER OF ATTORNEY WOULD EXPIRE.
23 G. PREFERENCE AS TO A COURT-APPOINTED GUARDIAN.
24 I UNDERSTAND THAT I MAY NOMINATE A GUARDIAN OF MY PERSON FOR
25 CONSIDERATION BY THE COURT IF INCAPACITY PROCEEDINGS ARE
26 COMMENCED PURSUANT TO 20 PA.C.S. § 5511. I UNDERSTAND THAT
27 THE COURT WILL APPOINT A GUARDIAN IN ACCORDANCE WITH MY MOST
28 RECENT NOMINATION EXCEPT FOR GOOD CAUSE OR DISQUALIFICATION.
29 IN THE EVENT A COURT DECIDES TO APPOINT A GUARDIAN, I DESIRE
30 THE FOLLOWING PERSON TO BE APPOINTED:
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1 (INSERT NAME, ADDRESS, TELEPHONE NUMBER OF DESIGNATED PERSON)
2 ( ) THE APPOINTMENT OF A GUARDIAN OF MY PERSON WILL NOT GIVE
3 THE GUARDIAN THE POWER TO REVOKE, SUSPEND OR TERMINATE THIS
4 POWER OF ATTORNEY.
5 ( ) UPON APPOINTMENT OF A GUARDIAN, I AUTHORIZE THE GUARDIAN
6 TO REVOKE, SUSPEND OR TERMINATE THIS POWER OF ATTORNEY.
7 I AM MAKING THIS POWER OF ATTORNEY ON THE (INSERT DAY) OF
8 (INSERT MONTH), (INSERT YEAR).
9 MY SIGNATURE
10 (MY NAME, ADDRESS, TELEPHONE NUMBER)
11 WITNESSES' SIGNATURES:
12 (NAMES, ADDRESSES, TELEPHONE NUMBERS OF WITNESSES)
13 IF THE PRINCIPAL MAKING THIS POWER OF ATTORNEY IS UNABLE TO
14 SIGN IT, ANOTHER INDIVIDUAL MAY SIGN ON BEHALF OF AND AT THE
15 DIRECTION OF THE PRINCIPAL.
16 SIGNATURE OF PERSON SIGNING ON MY BEHALF:
17 SIGNATURE
18 (NAME, ADDRESS TELEPHONE NUMBER)
19 § 5834. OPERATION.
20 (A) WHEN OPERATIVE.--A MENTAL HEALTH CARE POWER OF ATTORNEY
21 SHALL BECOME OPERATIVE WHEN:
22 (1) A COPY IS PROVIDED TO THE ATTENDING PHYSICIAN.
23 (2) THE CONDITIONS STATED IN THE POWER OF ATTORNEY ARE
24 MET.
25 (B) INVALIDITY OF SPECIFIC DIRECTION.--IF A SPECIFIC
26 DIRECTION IN A MENTAL HEALTH CARE POWER OF ATTORNEY IS HELD TO
27 BE INVALID, THE INVALIDITY DOES NOT NEGATE OTHER DIRECTIONS IN
28 THE MENTAL HEALTH CARE POWER OF ATTORNEY THAT CAN BE EFFECTED
29 WITHOUT THE INVALID DIRECTION.
30 (C) DURATION.--A POWER OF ATTORNEY SHALL BE VALID UNTIL
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1 REVOKED BY THE PRINCIPAL OR UNTIL TWO YEARS AFTER THE DATE OF
2 EXECUTION. IF A POWER OF ATTORNEY FOR MENTAL HEALTH TREATMENT
3 HAS BEEN INVOKED AND IS IN EFFECT AT THE SPECIFIED DATE OF
4 EXPIRATION AFTER ITS EXECUTION, THE POWER OF ATTORNEY SHALL
5 REMAIN EFFECTIVE UNTIL THE PRINCIPAL IS NO LONGER INCAPABLE.
6 (D) COURT APPROVAL UNNECESSARY.--A MENTAL HEALTH CARE
7 DECISION MADE BY A MENTAL HEALTH CARE AGENT FOR A PRINCIPAL
8 SHALL BE EFFECTIVE WITHOUT COURT APPROVAL.
9 § 5835. APPOINTMENT OF MENTAL HEALTH CARE AGENTS.
10 (A) SUCCESSOR MENTAL HEALTH CARE AGENTS.--A PRINCIPAL MAY
11 APPOINT ONE OR MORE SUCCESSOR AGENTS WHO SHALL SERVE IN THE
12 ORDER NAMED IN THE MENTAL HEALTH CARE POWER OF ATTORNEY UNLESS
13 THE PRINCIPAL EXPRESSLY DIRECTS TO THE CONTRARY.
14 (B) WHO MAY NOT BE APPOINTED MENTAL HEALTH CARE AGENT.--
15 UNLESS RELATED TO THE PRINCIPAL BY BLOOD, MARRIAGE OR ADOPTION,
16 A PRINCIPAL MAY NOT APPOINT ANY OF THE FOLLOWING TO BE THE
17 MENTAL HEALTH CARE AGENT:
18 (1) THE PRINCIPAL'S ATTENDING PHYSICIAN OR OTHER MENTAL
19 HEALTH CARE PROVIDER, OR AN EMPLOYEE OF THE ATTENDING
20 PHYSICIAN OR OTHER MENTAL HEALTH CARE PROVIDER.
21 (2) AN OWNER, OPERATOR OR EMPLOYEE OF A RESIDENTIAL
22 FACILITY IN WHICH THE PRINCIPAL RECEIVES CARE.
23 § 5836. AUTHORITY OF MENTAL HEALTH CARE AGENT.
24 (A) EXTENT OF AUTHORITY.--EXCEPT AS EXPRESSLY PROVIDED
25 OTHERWISE IN A MENTAL HEALTH CARE POWER OF ATTORNEY AND SUBJECT
26 TO SUBSECTIONS (B) AND (C), A MENTAL HEALTH CARE AGENT MAY MAKE
27 ANY MENTAL HEALTH CARE DECISION AND EXERCISE ANY RIGHT AND POWER
28 REGARDING THE PRINCIPAL'S CARE, CUSTODY AND MENTAL HEALTH CARE
29 TREATMENT THAT THE PRINCIPAL COULD HAVE MADE AND EXERCISED.
30 (B) POWERS NOT GRANTED.--A MENTAL HEALTH CARE POWER OF
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1 ATTORNEY MAY NOT CONVEY THE POWER TO RELINQUISH PARENTAL RIGHTS
2 OR CONSENT TO PSYCHOSURGERY.
3 (C) POWERS AND DUTIES ONLY SPECIFICALLY GRANTED.--UNLESS
4 SPECIFICALLY INCLUDED IN A MENTAL HEALTH CARE POWER OF ATTORNEY,
5 THE AGENT SHALL NOT HAVE THE POWER TO CONSENT TO
6 ELECTROCONVULSIVE THERAPY OR TO EXPERIMENTAL PROCEDURES OR
7 RESEARCH.
8 (D) MENTAL HEALTH CARE DECISIONS.--AFTER CONSULTATION WITH
9 MENTAL HEALTH CARE PROVIDERS AND AFTER CONSIDERATION OF THE
10 PROGNOSIS AND ACCEPTABLE ALTERNATIVES REGARDING DIAGNOSIS,
11 TREATMENTS AND SIDE EFFECTS, A MENTAL HEALTH CARE AGENT SHALL
12 MAKE MENTAL HEALTH CARE DECISIONS IN ACCORDANCE WITH THE MENTAL
13 HEALTH CARE AGENT'S UNDERSTANDING AND INTERPRETATION OF THE
14 INSTRUCTIONS GIVEN BY THE PRINCIPAL AT A TIME WHEN THE PRINCIPAL
15 HAD THE CAPACITY TO MAKE AND COMMUNICATE MENTAL HEALTH CARE
16 DECISIONS. INSTRUCTIONS INCLUDE A DECLARATION MADE BY THE
17 PRINCIPAL AND ANY CLEAR WRITTEN OR VERBAL DIRECTIONS THAT COVER
18 THE SITUATION PRESENTED. IN THE ABSENCE OF INSTRUCTIONS, THE
19 MENTAL HEALTH CARE AGENT SHALL MAKE MENTAL HEALTH CARE DECISIONS
20 CONFORMING WITH THE MENTAL HEALTH CARE AGENT'S ASSESSMENT OF THE
21 PRINCIPAL'S PREFERENCES.
22 (E) MENTAL HEALTH CARE INFORMATION.--
23 (1) UNLESS SPECIFICALLY PROVIDED OTHERWISE IN A MENTAL
24 HEALTH CARE POWER OF ATTORNEY, A MENTAL HEALTH CARE AGENT
25 SHALL HAVE THE SAME RIGHTS AND LIMITATIONS AS THE PRINCIPAL
26 TO REQUEST, EXAMINE, COPY AND CONSENT OR REFUSE TO CONSENT TO
27 THE DISCLOSURE OF MENTAL HEALTH CARE INFORMATION.
28 (2) DISCLOSURE OF MENTAL HEALTH CARE INFORMATION TO A
29 MENTAL HEALTH CARE AGENT SHALL NOT BE CONSTRUED TO CONSTITUTE
30 A WAIVER OF ANY EVIDENTIARY PRIVILEGE OR RIGHT TO ASSERT
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1 CONFIDENTIALITY.
2 (3) A MENTAL HEALTH CARE PROVIDER THAT DISCLOSES MENTAL
3 HEALTH CARE INFORMATION TO A MENTAL HEALTH CARE AGENT IN GOOD
4 FAITH SHALL NOT BE LIABLE FOR THE DISCLOSURE.
5 (4) A MENTAL HEALTH CARE AGENT MAY NOT DISCLOSE MENTAL
6 HEALTH CARE INFORMATION REGARDING THE PRINCIPAL EXCEPT AS IS
7 REASONABLY NECESSARY TO PERFORM THE AGENT'S OBLIGATIONS TO
8 THE PRINCIPAL OR AS OTHERWISE REQUIRED BY LAW.
9 (F) LIABILITY OF AGENT.--A MENTAL HEALTH CARE AGENT SHALL
10 NOT BE PERSONALLY LIABLE FOR THE COSTS OF CARE AND TREATMENT OF
11 THE PRINCIPAL.
12 § 5837. REMOVAL OF AGENT.
13 (A) GROUNDS FOR REMOVAL.--A HEALTH CARE AGENT CAN BE REMOVED
14 FOR ANY OF THE FOLLOWING REASONS:
15 (1) DEATH OR INCAPACITY.
16 (2) NONCOMPLIANCE WITH A POWER OF ATTORNEY.
17 (3) PHYSICAL ASSAULT OR THREATS OF HARM.
18 (4) COERCION.
19 (5) VOLUNTARY WITHDRAWAL BY THE AGENT.
20 (6) DIVORCE.
21 (B) NOTICE OF VOLUNTARY WITHDRAWAL.--
22 (1) A MENTAL HEALTH CARE AGENT WHO VOLUNTARILY WITHDRAWS
23 SHALL INFORM THE PRINCIPAL.
24 (2) IF THE POWER OF ATTORNEY IS IN EFFECT, THE AGENT
25 SHALL NOTIFY PROVIDERS OF MENTAL HEALTH TREATMENT.
26 (C) CHALLENGES.--THIRD PARTIES MAY CHALLENGE THE AUTHORITY
27 OF A MENTAL HEALTH AGENT IN THE ORPHAN'S COURT DIVISION OF THE
28 COURT OF COMMON PLEAS.
29 (D) EFFECT OF REMOVAL.--IF A POWER OF ATTORNEY PROVIDES FOR
30 A SUBSTITUTE AGENT, THEN THE SUBSTITUTE AGENT SHALL ASSUME
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1 RESPONSIBILITY WHEN THE AGENT IS REMOVED. IF THE POWER OF
2 ATTORNEY DOES NOT PROVIDE FOR A SUBSTITUTE, THEN A MENTAL HEALTH
3 CARE PROVIDER SHALL FOLLOW ANY INSTRUCTIONS IN THE POWER OF
4 ATTORNEY.
5 § 5838. EFFECT OF DIVORCE.
6 IF THE SPOUSE OF A PRINCIPAL IS DESIGNATED AS THE PRINCIPAL'S
7 MENTAL HEALTH CARE AGENT AND THEREAFTER EITHER SPOUSE FILES AN
8 ACTION IN DIVORCE, THE DESIGNATION OF THE SPOUSE AS MENTAL
9 HEALTH CARE AGENT SHALL BE REVOKED AS OF THE TIME THE ACTION IS
10 FILED UNLESS IT CLEARLY APPEARS FROM THE MENTAL HEALTH CARE
11 POWER OF ATTORNEY THAT THE DESIGNATION WAS INTENDED TO CONTINUE
12 TO BE EFFECTIVE NOTWITHSTANDING THE FILING OF AN ACTION IN
13 DIVORCE BY EITHER SPOUSE.
14 § 5839. REVOCATION.
15 (A) WHEN MENTAL HEALTH CARE POWER OF ATTORNEY MAY BE
16 REVOKED.--AN INDIVIDUAL SHALL SPECIFY IN THE MENTAL HEALTH CARE
17 POWER OF ATTORNEY WHETHER IT MAY BE REVOKED BY THE PRINCIPAL:
18 (1) AT ANY TIME AND IN ANY MANNER ONLY IF THE PRINCIPAL
19 HAS NOT BEEN FOUND TO BE INCAPABLE OF MAKING MENTAL HEALTH
20 TREATMENT DECISIONS; OR
21 (2) AT THE TIME DESIGNATED FOR TERMINATION.
22 (B) EFFECT OF REVOCATION.--A REVOCATION SHALL BE EFFECTIVE
23 UPON COMMUNICATION TO THE ATTENDING PHYSICIAN OR OTHER MENTAL
24 HEALTH CARE PROVIDER BY THE PRINCIPAL OR A WITNESS TO THE
25 REVOCATION OF THE INTENT TO REVOKE.
26 (C) MENTAL HEALTH RECORD.--THE ATTENDING PHYSICIAN OR OTHER
27 MENTAL HEALTH CARE PROVIDER SHALL MAKE THE REVOCATION PART OF
28 THE MENTAL HEALTH RECORD OF THE DECLARANT.
29 (D) RELIANCE ON MENTAL HEALTH CARE POWER OF ATTORNEY.--A
30 PHYSICIAN OR OTHER MENTAL HEALTH CARE PROVIDER MAY RELY ON THE
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1 EFFECTIVENESS OF A MENTAL HEALTH CARE POWER OF ATTORNEY UNLESS
2 NOTIFIED OF ITS REVOCATION.
3 (E) SUBSEQUENT ACTION BY AGENT.--A MENTAL HEALTH CARE AGENT
4 WHO HAS NOTICE OF THE REVOCATION OF A MENTAL HEALTH CARE POWER
5 OF ATTORNEY MAY NOT MAKE OR ATTEMPT TO MAKE MENTAL HEALTH CARE
6 DECISIONS FOR THE PRINCIPAL.
7 § 5840. AMENDMENT.
8 WHILE HAVING THE CAPACITY TO MAKE MENTAL HEALTH DECISIONS, A
9 PRINCIPAL MAY AMEND A MENTAL HEALTH CARE POWER OF ATTORNEY BY A
10 WRITING EXECUTED IN ACCORDANCE WITH THE PROVISIONS OF SECTION
11 5832 (RELATING TO EXECUTION).
12 § 5841. RELATION OF MENTAL HEALTH CARE AGENT TO COURT-APPOINTED
13 GUARDIAN AND OTHER AGENTS.
14 (A) PROCEDURE.--
15 (1) UPON RECEIPT OF NOTICE OF A GUARDIANSHIP
16 PROCEEDING, A PROVIDER SHALL NOTIFY THE COURT, AND THE AGENT
17 AT THE GUARDIANSHIP PROCEEDING, OF THE EXISTENCE OF A MENTAL
18 HEALTH ADVANCE DIRECTIVE.
19 (2) UPON RECEIPT OF A NOTICE OF GUARDIANSHIP PROCEEDING,
20 THE AGENT SHALL INFORM THE COURT OF THE CONTENTS OF THE
21 MENTAL HEALTH ADVANCE DIRECTIVE.
22 (B) ACCOUNTABILITY OF MENTAL HEALTH CARE AGENT.--
23 (1) IF A PRINCIPAL WHO HAS EXECUTED A MENTAL HEALTH CARE
24 POWER OF ATTORNEY IS LATER ADJUDICATED AN INCAPACITATED
25 PERSON, THE POWER OF ATTORNEY SHALL REMAIN IN EFFECT.
26 (2) THE COURT SHALL GIVE PREFERENCE TO ALLOWING THE
27 AGENT TO CONTINUE MAKING MENTAL HEALTH CARE DECISIONS AS
28 PROVIDED IN THE MENTAL HEALTH ADVANCE DIRECTIVE UNLESS THE
29 PRINCIPAL SPECIFIED THAT THE GUARDIAN HAS THE POWER TO
30 TERMINATE, REVOKE, OR SUSPEND THE POWER OF ATTORNEY IN THE
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1 ADVANCE DIRECTIVE.
2 (3) IF, AFTER THOROUGH EXAMINATION, THE COURT GRANTS THE
3 POWERS CONTAINED IN THE MENTAL HEALTH ADVANCE DIRECTIVE TO
4 THE GUARDIAN, THE GUARDIAN SHALL BE BOUND BY THE SAME
5 OBLIGATIONS AS THE AGENT WOULD HAVE BEEN.
6 (C) NOMINATION OF GUARDIAN OF PERSON.--IN A MENTAL HEALTH
7 CARE POWER OF ATTORNEY, A PRINCIPAL MAY NOMINATE THE GUARDIAN OF
8 THE PERSON FOR THE PRINCIPAL FOR CONSIDERATION BY THE COURT IF
9 INCAPACITY PROCEEDINGS FOR THE PRINCIPAL'S PERSON ARE THEREAFTER
10 COMMENCED. IF THE COURT DETERMINES THAT THE APPOINTMENT OF A
11 GUARDIAN IS NECESSARY, THE COURT SHALL APPOINT IN ACCORDANCE
12 WITH THE PRINCIPAL'S MOST RECENT NOMINATION EXCEPT FOR GOOD
13 CAUSE OR DISQUALIFICATION.
14 § 5842. DUTIES OF ATTENDING PHYSICIAN AND MENTAL HEALTH CARE
15 PROVIDER.
16 (A) COMPLIANCE WITH DECISIONS OF MENTAL HEALTH CARE AGENT.--
17 SUBJECT TO ANY LIMITATION SPECIFIED IN A MENTAL HEALTH CARE
18 POWER OF ATTORNEY, AN ATTENDING PHYSICIAN OR MENTAL HEALTH CARE
19 PROVIDER SHALL COMPLY WITH A MENTAL HEALTH CARE DECISION MADE BY
20 A MENTAL HEALTH CARE AGENT TO THE SAME EXTENT AS IF THE DECISION
21 HAD BEEN MADE BY THE PRINCIPAL.
22 (B) MENTAL HEALTH RECORD.--
23 (1) AN ATTENDING PHYSICIAN OR MENTAL HEALTH CARE
24 PROVIDER WHO IS GIVEN A MENTAL HEALTH CARE POWER OF ATTORNEY
25 SHALL ARRANGE FOR THE MENTAL HEALTH CARE POWER OF ATTORNEY OR
26 A COPY TO BE PLACED IN THE MENTAL HEALTH RECORD OF THE
27 PRINCIPAL.
28 (2) AN ATTENDING PHYSICIAN OR MENTAL HEALTH CARE
29 PROVIDER TO WHOM AN AMENDMENT OR REVOCATION OF A MENTAL
30 HEALTH CARE POWER OF ATTORNEY IS COMMUNICATED SHALL PROMPTLY
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1 ENTER THE INFORMATION IN THE MENTAL HEALTH RECORD OF THE
2 PRINCIPAL AND MAINTAIN A COPY IF ONE IS FURNISHED.
3 (C) RECORD OF DETERMINATION.--AN ATTENDING PHYSICIAN WHO
4 DETERMINES THAT A PRINCIPAL IS UNABLE TO MAKE OR HAS REGAINED
5 THE CAPACITY TO MAKE MENTAL HEALTH TREATMENT DECISIONS OR MAKES
6 A DETERMINATION THAT AFFECTS THE AUTHORITY OF A MENTAL HEALTH
7 CARE AGENT SHALL ENTER THE DETERMINATION IN THE MENTAL HEALTH
8 RECORD OF THE PRINCIPAL AND, IF POSSIBLE, PROMPTLY INFORM THE
9 PRINCIPAL AND ANY MENTAL HEALTH CARE AGENT OF THE DETERMINATION.
10 § 5843. CONSTRUCTION.
11 (A) GENERAL RULE.--NOTHING IN THIS SUBCHAPTER SHALL BE
12 CONSTRUED TO:
13 (1) AFFECT THE REQUIREMENTS OF OTHER LAWS OF THIS
14 COMMONWEALTH REGARDING CONSENT TO OBSERVATION, DIAGNOSIS,
15 TREATMENT OR HOSPITALIZATION FOR A MENTAL ILLNESS.
16 (2) AUTHORIZE A MENTAL HEALTH CARE AGENT TO CONSENT TO
17 ANY MENTAL HEALTH CARE PROHIBITED BY THE LAWS OF THIS
18 COMMONWEALTH.
19 (3) AFFECT THE LAWS OF THIS COMMONWEALTH REGARDING ANY
20 OF THE FOLLOWING:
21 (I) THE STANDARD OF CARE OF A MENTAL HEALTH CARE
22 PROVIDER REQUIRED IN THE ADMINISTRATION OF MENTAL HEALTH
23 CARE OR THE CLINICAL DECISION-MAKING AUTHORITY OF THE
24 MENTAL HEALTH CARE PROVIDER.
25 (II) WHEN CONSENT IS REQUIRED FOR MENTAL HEALTH
26 CARE.
27 (III) INFORMED CONSENT FOR MENTAL HEALTH CARE.
28 (4) AFFECT THE ABILITY TO ADMIT A PERSON TO A MENTAL
29 HEALTH FACILITY UNDER THE VOLUNTARY AND INVOLUNTARY
30 COMMITMENT PROVISIONS OF THE ACT OF JULY 9, 1976 (P.L.817,
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1 NO.143), KNOWN AS THE MENTAL HEALTH PROCEDURES ACT.
2 (B) DISCLOSURE.--
3 (1) THE DISCLOSURE REQUIREMENTS OF SECTION 5836(E)
4 (RELATING TO AUTHORITY OF MENTAL HEALTH CARE AGENT) SHALL
5 SUPERSEDE ANY PROVISION IN ANY OTHER STATE STATUTE OR
6 REGULATION THAT REQUIRES A PRINCIPAL TO CONSENT TO DISCLOSURE
7 OR WHICH OTHERWISE CONFLICTS WITH SECTION 5836(E), INCLUDING,
8 BUT NOT LIMITED TO, THE FOLLOWING:
9 (I) THE ACT OF APRIL 14, 1972 (P.L.221, NO.63),
10 KNOWN AS THE PENNSYLVANIA DRUG AND ALCOHOL ABUSE CONTROL
11 ACT.
12 (II) SECTION 111 OF THE ACT OF JULY 9, 1976
13 (P.L.817, NO.143), KNOWN AS THE MENTAL HEALTH PROCEDURES
14 ACT.
15 (III) THE ACT OF OCTOBER 5, 1978 (P.L.1109, NO.261),
16 KNOWN AS THE OSTEOPATHIC MEDICAL PRACTICE ACT.
17 (IV) SECTION 41 OF THE ACT OF DECEMBER 20, 1985
18 (P.L.457, NO.112), KNOWN AS THE MEDICAL PRACTICE ACT OF
19 1985.
20 (V) THE ACT OF NOVEMBER 29, 1990 (P.L.585, NO.148),
21 KNOWN AS THE CONFIDENTIALITY OF HIV-RELATED INFORMATION
22 ACT.
23 (2) THE DISCLOSURE REQUIREMENTS UNDER SECTION 5836(E)
24 SHALL NOT APPLY TO THE EXTENT THAT THE DISCLOSURE WOULD BE
25 PROHIBITED BY FEDERAL LAW AND IMPLEMENTING REGULATIONS.
26 (C) NOTICE AND ACKNOWLEDGMENT REQUIREMENTS.--THE NOTICE AND
27 ACKNOWLEDGMENT REQUIREMENTS OF SECTION 5601(C) AND (D) (RELATING
28 TO GENERAL PROVISIONS) SHALL NOT APPLY TO A POWER OF ATTORNEY
29 THAT PROVIDES EXCLUSIVELY FOR MENTAL HEALTH CARE DECISION
30 MAKING.
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1 § 5844. CONFLICTING MENTAL HEALTH CARE POWERS OF ATTORNEY.
2 IF A PROVISION OF A MENTAL HEALTH CARE POWER OF ATTORNEY
3 CONFLICTS WITH ANOTHER PROVISION OF A MENTAL HEALTH CARE POWER
4 OF ATTORNEY OR WITH A PROVISION OF A DECLARATION, THE PROVISION
5 OF THE INSTRUMENT LATEST IN DATE OF EXECUTION SHALL PREVAIL TO
6 THE EXTENT OF THE CONFLICT.
7 § 5845. VALIDITY.
8 THIS SUBCHAPTER SHALL NOT BE CONSTRUED TO LIMIT THE VALIDITY
9 OF A MENTAL HEALTH CARE POWER OF ATTORNEY EXECUTED PRIOR TO THE
10 EFFECTIVE DATE OF THIS SUBCHAPTER. A MENTAL HEALTH CARE POWER OF
11 ATTORNEY EXECUTED IN ANOTHER STATE OR JURISDICTION AND IN
12 CONFORMITY WITH THE LAWS OF THAT STATE OR JURISDICTION SHALL BE
13 CONSIDERED VALID IN THIS COMMONWEALTH, EXCEPT TO THE EXTENT THAT
14 THE MENTAL HEALTH CARE POWER OF ATTORNEY EXECUTED IN ANOTHER
15 STATE OR JURISDICTION WOULD ALLOW A MENTAL HEALTH CARE AGENT TO
16 MAKE A MENTAL HEALTH CARE DECISION INCONSISTENT WITH THE LAWS OF
17 THIS COMMONWEALTH.
18 SECTION 2. THIS ACT SHALL TAKE EFFECT IN 60 DAYS.
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