H. B. 4022
(By Delegates Brown, Amores, Caputo, Hartman,
Hrutkay, and Overington)
[Introduced January 16, 2006; referred to the
Committee on the Judiciary.]
A BILL to amend and reenact §16-30-3, §16-30-5, §16-30C-2, §16-30C-
3, §16-30C-6, and §16-30C-9 of the Code of West Virginia, 1931,
as amended, relating to the West Virginia Health Care Decisions
Act and the West Virginia Do Not Resuscitate Act providing
circumstances when health care facilities and providers are not
required to perform cardiopulmonary resuscitation.
Be it enacted by the Legislature of West Virginia:
That §16-30-3, §16-30-5, §16-30C-2, §16-30C-3, §16-30C-6, and
§16-30C-9 of the Code of West Virginia, 1931,
as amended, be
amended and reenacted to read as follows:
ARTICLE 30. WEST VIRGINIA HEALTH CARE DECISION ACT.
§16-30-3. Definitions.
For the purposes of this article:
(a) "Actual knowledge" means the possession of information of
the person's wishes communicated to the health care provider orally
or in writing by the person, the person's medical power of attorney representative, the person's health care surrogate or other
individuals resulting in the health care provider's personal
cognizance of these wishes. Constructive notice and other forms of
imputed knowledge are not actual knowledge.
(b) "Adult" means a person who is eighteen years of age or
older, an emancipated minor who has been established as such
pursuant to the provisions of section twenty-seven, article seven,
chapter forty-nine of this code or a mature minor.
(c) "Advanced nurse practitioner" means a registered nurse with
substantial theoretical knowledge in a specialized area of nursing
practice and proficient clinical utilization of the knowledge in
implementing the nursing process, and who has met the further
requirements of title 19, legislative rules for West Virginia board
of examiners for registered professional nurses, series 7 , who has
a mutually agreed upon association in writing with a physician and
has been selected by or assigned to the person and has primary
responsibility for treatment and care of the person.
(d) "Attending physician" means the physician selected by or
assigned to the person who has primary responsibility for treatment
and care of the person and who is a licensed physician. If more
than one physician shares that responsibility, any of those
physicians may act as the attending physician under this article.
(e) "Capable adult" means an adult who is physically and
mentally capable of making health care decisions and who is not considered a protected person pursuant to the provisions of chapter
forty-four-a of this code.
(f) "Close friend" means any adult who has exhibited
significant care and concern for an incapacitated person who is
willing and able to become involved in the incapacitated person's
health care and who has maintained regular contact with the
incapacitated person so as to be familiar with his or her
activities, health and religious and moral beliefs.
(g) "Death" means a finding made in accordance with accepted
medical standards of either: (1) The irreversible cessation of
circulatory and respiratory functions; or (2) the irreversible
cessation of all functions of the entire brain, including the brain
stem.
(h) "Guardian" means a person appointed by a court pursuant to
the provisions of chapter forty-four-a of this code who is
responsible for the personal affairs of a protected person and
includes a limited guardian or a temporary guardian.
(i) "Health care decision" means a decision to give, withhold
or withdraw informed consent to any type of health care, including,
but not limited to, medical and surgical treatments, including
life-prolonging interventions, psychiatric treatment, nursing care,
hospitalization, treatment in a nursing home or other facility,
home health care and organ or tissue donation.
(j) "Health care facility" means a facility commonly known by a wide variety of titles, including, but not limited to, hospital,
psychiatric hospital, medical center, ambulatory health care
facility, physicians' office and clinic, extended care facility
operated in connection with a hospital, nursing home, a hospital
extended care facility operated in connection with a rehabilitation
center, hospice, home health care and other facility established to
administer health care in its ordinary course of business or
practice.
(k) "Health care provider" means any licensed physician,
dentist, nurse, physician's assistant, paramedic, psychologist or
other person providing medical, dental, nursing, psychological or
other health care services of any kind.
(l) "Incapacity" means the inability because of physical or
mental impairment to appreciate the nature and implications of a
health care decision, to make an informed choice regarding the
alternatives presented and to communicate that choice in an
unambiguous manner.
(m) "Life-prolonging intervention" means any medical procedure
or intervention that, when applied to a person, would serve to
artificially prolong the dying process or to maintain the person in
a persistent vegetative state. Life-prolonging intervention
includes, among other things, nutrition and hydration administered
intravenously or through a feeding tube. The term "life-prolonging
intervention" does not include the administration of medication or the performance of any other medical procedure considered necessary
to provide comfort or to alleviate pain.
(n) "Living will" means a written, witnessed advance directive
governing the withholding or withdrawing of life-prolonging
intervention, voluntarily executed by a person in accordance with
the requirements of section four of this article.
(o) "Mature minor" means a person less than eighteen years of
age who has been determined by a qualified physician, a qualified
psychologist or an advanced nurse practitioner to have the capacity
to make health care decisions.
(p) "Medical information" or "medical records" means and
includes without restriction any information recorded in any form
of medium that is created or received by a health care provider,
health care facility, health plan, public health authority,
employer, life insurer, school or university or health care
clearinghouse that relates to the past, present or future physical
or mental health of the person, the provision of health care to the
person, or the past, present or future payment for the provision of
health care to the person.
(q)
"Medically ineffective cardiopulmonary resuscitation" means
that, to a reasonable degree of medical certainty, 1) attempted
cardiopulmonary resuscitation will be unsuccessful in restoring
cardiopulmonary function, or 2) after a brief period of restoration
of cardiopulmonary function the person will die within minutes to hours of the time of cardiopulmonary arrest, regardless of whether
cardiopulmonary resuscitation is repeated.
(r) "Medical power of attorney representative" or
"representative" means a person eighteen years of age or older
appointed by another person to make health care decisions pursuant
to the provisions of section six of this article or similar act of
another state and recognized as valid under the laws of this state.
(
r s) "Parent" means a person who is another person's natural
or adoptive mother or father or who has been granted parental
rights by valid court order and whose parental rights have not been
terminated by a court of law.
(
st) "Persistent vegetative state" means an irreversible state
as diagnosed by the attending physician or a qualified physician in
which the person has intact brain stem function but no higher
cortical function and has neither self-awareness or awareness of
the surroundings in a learned manner.
(
tu) "Person" means an individual, a corporation, a business
trust, a trust, a partnership, an association, a government, a
governmental subdivision or agency or any other legal entity.
(
u v ) "Physician orders for scope of treatment (POST) form"
means a standardized form containing orders by a qualified
physician that details a person's life-sustaining wishes as
provided by section twenty-five of this article.
(
vw) "Principal" means a person who has executed a living will or medical power of attorney.
(
wx) "Protected person" means an adult who, pursuant to the
provisions of chapter forty-four-a of this code, has been found by
a court, because of mental impairment, to be unable to receive and
evaluate information effectively or to respond to people, events
and environments to an extent that the individual lacks the
capacity to: (1) Meet the essential requirements for his or her
health, care, safety, habilitation or therapeutic needs without the
assistance or protection of a guardian; or (2) manage property or
financial affairs to provide for his or her support or for the
support of legal dependents without the assistance or protection of
a conservator.
(
xy) "Qualified physician" means a physician licensed to
practice medicine who has personally examined the person.
(
yz) "Qualified psychologist" means a psychologist licensed to
practice psychology who has personally examined the person.
(
zaa) "Surrogate decisionmaker" or "surrogate" means an
individual eighteen years of age or older who is reasonably
available, is willing to make health care decisions on behalf of an
incapacitated person, possesses the capacity to make health care
decisions and is identified or selected by the attending physician
or advanced nurse practitioner in accordance with the provisions of
this article as the person who is to make those decisions in
accordance with the provisions of this article.
(
aabb) "Terminal condition" means an incurable or irreversible
condition as diagnosed by the attending physician or a qualified
physician for which the administration of life-prolonging
intervention will serve only to prolong the dying process.
§ 16-30-5. Applicability and resolving actual conflict between
advance directives.
(a) The provisions of this article which directly conflict
with the written directives contained in a living will or medical
power of attorney executed prior to the effective date of this
statute shall not apply. An expressed directive contained in a
living will or medical power of attorney or by any other means the
health care provider determines to be reliable shall be followed
with the exception that a directive or decision requesting
medically ineffective cardiopulmonary resuscitation shall not be
followed: Provided, that the provisions of article 30C, section
6(h) of this chapter are followed.
(b) If there is a conflict between the person's expressed
directives, the physician orders for scope of treatment form and
the decisions of the medical power of attorney representative or
surrogate, the person's expressed directives shall be followed
except as provided in subsection (a) of this section.
(c) In the event there is a conflict between two advance
directives executed by the person, the one most recently completed
takes precedence only to the extent needed to resolve the inconsistency
except as provided in subsection(a) of this section.
(d) If there is a conflict between the decisions of the medical
power of attorney representative or surrogate and the person's best
interests as determined by the attending physician when the
person's wishes are unknown, the attending physician shall attempt
to resolve the conflict by consultation with a qualified physician,
an ethics committee or by some other means. If the attending
physician cannot resolve the conflict with the medical power of
attorney representative, the attending physician may transfer the
care of the person pursuant to subsection (b), section twelve of
this article.
ARTICLE 30C. DO NOT RESUSCITATE ACT.
§ 16-30C-2. Legislative findings and purposes.
(a) Findings.--The Legislature hereby finds that:
(1) Although cardiopulmonary resuscitation has saved the lives
of persons experiencing sudden, unexpected death, present medical
data indicates that cardiopulmonary resuscitation rarely leads to
prolonged survival in persons with chronic illnesses in whom death
is expected;
(2) In many circumstances, the performance of cardiopulmonary
resuscitation on persons may cause infliction of unwanted and
unnecessary pain and suffering;
(3) All persons have a right to make health care decisions
including the right to refuse cardiopulmonary resuscitation;
(4) Persons with incapacity have the right to have health care
decisions made for them by surrogate decision-makers;
(5) Existing emergency medical services protocols require their
personnel to proceed with cardiopulmonary resuscitation when they
find a person in a cardiac or respiratory arrest even if such
person has completed a living will or medical power of attorney,
indicating that he/she does not wish to receive cardiopulmonary
resuscitation;
and
(6) The administration of cardiopulmonary resuscitation by
emergency medical services personnel to persons who have indicated
by a living will or medical power of attorney or other means that
they do not wish to receive such resuscitation offends the dignity
of the person and conflicts with standards of accepted medical
practice
; and
(7) The performance of cardiopulmonary resuscitation, when it
has been determined to be medically ineffective, conflicts with
standards of accepted medical practice.
(b) Purpose.--It is the purpose of this article to ensure that
the right of a person to self-determination relating to
cardiopulmonary resuscitation is protected. It is the intent of
the Legislature by enacting this article to give direction to
emergency medical services personnel and other health care
providers in regard to the performance of cardiopulmonary
resuscitation.
§16-30C-3. Definitions.
As used in this article, unless the context clearly requires
otherwise, the following definitions apply:
(a) "Attending physician" means the physician selected by or
assigned to the person who has primary responsibility for treatment
or care of the person and who is a licensed physician. If more than
one physician shares that responsibility, any of those physicians
may act as the attending physician under the provisions of this
article.
(b)
"Authorized decision-maker" means the person according to
the provisions of this Code who is authorized to make health care
decisions for an incapacitated person.
(c) "Cardiopulmonary resuscitation" means those measures used
to restore or support cardiac or respiratory function in the event
of a cardiac or respiratory arrest.
(
cd) "Do-not-resuscitate identification" means a standardized
identification necklace, bracelet, card or physician orders for
scope of treatment form as set forth in this article that signifies
that a do-not-resuscitate order has been issued for the possessor.
(
de) "Do-not-resuscitate order" means an order issued by a
licensed physician that cardiopulmonary resuscitation should not be
administered to a particular person.
(
ef) "Emergency medical services personnel" means paid or
volunteer firefighters, law-enforcement officers, emergency medical technicians, paramedics or other emergency services personnel,
providers or entities acting within the usual course of their
professions.
(
fg) "Health care decision" means a decision to give, withhold
or withdraw informed consent to any type of health care, including,
but not limited to, medical and surgical treatments, including
life-prolonging interventions, nursing care, hospitalization,
treatment in a nursing home or other extended care facility, home
health care and the gift or donation of a body organ or tissue.
(
gh) "Health care facility" means a facility established to
administer and provide health care services and which is commonly
known by a wide variety of titles, including, but not limited to,
hospitals, medical centers, ambulatory health care facilities,
physicians' offices and clinics, extended care facilities operated
in connection with hospitals, nursing homes and extended care
facilities operated in connection with rehabilitation centers.
(
hi) "Health care provider" means any physician, dentist,
nurse, paramedic, psychologist or other person providing medical,
dental, nursing, psychological or other health care services of any
kind.
(
ij) "Home" means any place of residence other than a health
care facility and includes residential board and care homes and
personal care homes.
(
jk) "Incapacity" or words of like import means the inability because of physical or mental impairment, to appreciate the nature
and implications of a health care decision, to make an informed
choice regarding the alternatives presented and to communicate that
choice in an unambiguous manner.
(l) "Medically ineffective cardiopulmonary resuscitation" means
that, to a reasonable degree of medical certainty, 1) attempted
cardiopulmonary resuscitation will be unsuccessful in restoring
cardiopulmonary function, or 2) after a brief period of restoration
of cardiopulmonary function the person will die within minutes to
hours of the time of cardiopulmonary arrest, regardless of whether
cardiopulmonary resuscitation is repeated.
(
km) "Physician orders for scope of treatment (POST) form"
means a standardized form containing orders by a qualified
physician that details a person's life-sustaining wishes as
provided by section twenty-five, article thirty of this chapter.
(
ln) "Qualified physician" means a physician licensed to
practice medicine who has personally examined the person.
(
mo) "Representative" means a person designated by a principal
to make health care decisions in accordance with article thirty-a
of this chapter.
(
np) "Surrogate decision maker" or "surrogate" means an
individual eighteen years of age or older who is reasonably
available, is willing to make health care decisions on behalf of an
incapacitated person, possesses the capacity to make health care decisions and is identified or selected by the attending physician
or advanced nurse practitioner in accordance with applicable
provisions of article thirty of this chapter as the person or
persons who is to make decisions pursuant to this article:
Provided, That a representative named in the incapacitated person's
medical power of attorney, if such document has been completed,
shall have priority over a surrogate decision maker.
(
oq) "Trauma" means blunt or penetrating bodily injuries from
impact which occur in situations, including, but not limited to,
motor vehicle collisions, mass casualty incidents and industrial
accidents.
§16-30C-6. Issuance of a do-not-resuscitate order; order to be
written by a physician.
(a) An attending physician may issue a do-not-resuscitate
order for persons who are present in or residing at home or in a
health care facility if the person, representative or surrogate has
consented to the order
: Provided, That consent to issuance of a do
not resuscitate order for an incapacitated person is not necessary
if cardiopulmonary resuscitation has been determined to be
medically ineffective in accordance with the provisions of this
article. A do-not-resuscitate order shall be issued in writing in
the form as described in this section for a person not present or
residing in a health care facility. For persons present in health
care facilities, a do-not-resuscitate order shall be issued in accordance with the policies and procedures of the health care
facility or in accordance with the provisions of this article.
(b) Persons may request their physicians to issue
do-not-resuscitate orders for them.
(c) The representative or surrogate decision maker may consent
to a do-not-resuscitate order for a person with incapacity. A
do-not-resuscitate order written by a physician for a person with
incapacity with the consent of the representative or surrogate
decision maker is valid and shall be respected by health care
providers.
(d) A parent may consent to a do-not-resuscitate order for his
or her minor child, provided that a second physician who has
examined the child concurs with the opinion of the attending
physician that
the provision of cardiopulmonary resuscitation
would
be contrary to accepted medical standards would be medically
ineffective. If the minor is between the ages of sixteen and
eighteen and, in the opinion of the attending physician, the minor
is of sufficient maturity to understand the nature and effect of a
do-not-resuscitate order, then no such order shall be valid without
the consent of such minor. In the event of a conflict between the
wishes of the parents or guardians and the wishes of the mature
minor, the wishes of the mature minor shall prevail. For purposes
of this section, no minor less than sixteen years of age shall be
considered mature. Nothing in this article shall be interpreted to conflict with the provisions of the child abuse prevention and
treatment act and implementing regulations at 45 CFR 1340. In the
event conflict is unavoidable, federal law and regulation shall
govern.
(e) If a surrogate decision maker is not reasonably available
or capable of making a decision regarding a do-not-resuscitate
order, an attending physician may issue a do-not-resuscitate order
for a person with incapacity in a health care facility:
Provided,
That a second physician who has personally examined the person
concurs in the opinion of the attending physician that
the
provision of cardiopulmonary resuscitation would be
contrary to
accepted medical standardsmedically ineffective.
(f) For persons not present or residing in a health care
facility, the do-not-resuscitate order shall be noted on a
physician orders for scope of treatment form or in the following
form on a card suitable for carrying on the person:
Do-Not-Resuscitate Order
"As treating physician of _______________________and a licensed
physician, I order that this person SHALL NOT BE RESUSCITATED in
the event of cardiac or respiratory arrest. This order has been
discussed with ______________________________ or his/her
_____________________ representative
____________________________________________ or his/her surrogate
decisionmaker ______________________________ who has given consent as evidenced by his/her signature below.
Physician Name_______________
Physician Signature_______________
Address_______________
Person Signature_______________
Address_______________
Surrogate Decisionmaker Signature_______________
Address_______________"
(g) For persons residing in a health care facility, the
do-not-resuscitate order shall be reflected in at least one of the
following forms:
(1) Forms required by the policies and procedures of the health
care facility;
(2) The do-not-resuscitate card as set forth in subsection (f)
of this section; or
(3) The physician orders for scope of treatment form.
(h) When a person has requested cardiopulmonary resuscitation
in a living will, medical power of attorney, or physician orders
for scope of treatment form or a person's authorized decision-maker
requests cardiopulmonary resuscitation, an attending physician may
issue a do not resuscitate order for an incapacitated person if the
attending physician and a consulting physician certify in writing
in the medical record that cardiopulmonary resuscitation for the
person would be medically ineffective. If there is no request for cardiopulmonary resuscitation, a do not resuscitate order may be
issued in accordance with subsection (a) of this section. An
attending physician who declines to comply with a directive or
decision requesting cardiopulmonary resuscitation that has been
determined to be medically ineffective shall:
(1) before the issuance of the do not resuscitate order notify
the person, if possible, and the authorized decision-maker for the
person of the determination that cardiopulmonary resuscitation will
be medically ineffective and that the physician and other providers
will not order cardiopulmonary resuscitation for the person in the
event of cardiac arrest;
(2) inform the person, if possible, and the authorized decision
maker that the health care provider and/or the health care facility
has declined or will decline to comply with the directive or
decision requesting cardiopulmonary resuscitation made before the
issuance of the do not resuscitate order; and
(3) cooperate with the person or the person's authorized
decision-maker if a transfer of care to another health care
provider and health care facility is desired and possible. If
transfer is not possible because of the person's unstable medical
condition, or other reasons including but not limited to refusal of
another physician to accept the patient, then the health care
provider and health facility shall not be required to provide
medically ineffective cardiopulmonary resuscitation.
(i)
This article creates no presumption concerning the
effectiveness or ineffectiveness of medical treatments other than
cardiopulmonary resuscitation.
§16-30C-9. Protection of persons carrying out in good faith do not
resuscitate order; notification of representative or surrogate
decision-maker by physician refusing to comply with do not
resuscitate order.
(a) No health care provider, health care facility, or
individual employed by, acting as the agent of, or under contract
with any of the foregoing shall be subject to criminal prosecution
or civil liability for carrying out in good faith a do not
resuscitate order authorized by this article on behalf of a person
as instructed by the person, representative or surrogate
decision-maker or for those actions taken in compliance with the
standards and procedures set forth in this article.
(b) No health care provider, health care facility, individual
employed by, acting as agent of, or under contract with any of the
foregoing or other individual who witnesses a cardiac or
respiratory arrest shall be subject to criminal prosecution or
civil liability for providing cardiopulmonary resuscitation to a
person for whom a do not resuscitate order has been issued,
provided that such physician or individual:
(1) Reasonably and in good faith was unaware of the issuance of
a do not resuscitate order; or
(2) Reasonably and in good faith believed that consent to the
do not resuscitate order had been revoked or canceled.
(c) Any physician who refused to issue a do not resuscitate
order at a person's request or to comply with a do not resuscitate
order entered pursuant to this article shall take reasonable steps
to advise promptly the person, representative, or surrogate
decision-maker of the person that such physician is unwilling to
effectuate the order. The attending physician shall thereafter at
the election of the person, representative or surrogate
decision-maker permit the person, representative or surrogate
decision-maker to obtain another physician.
(d) Attending physicians, other health care providers, health
care facilities or employees or agents thereof acting in accordance
with the provisions of this article shall not be subject to
criminal or civil liability for declining to comply with an
incapacitated person's expressed directive or a health care
decision made by a person's authorized decision-maker requesting
medically ineffective cardiopulmonary resuscitation. No such
physician, other health care provider, facility, employee, or agent
shall be criminally or civilly liable for the withholding of
medically ineffective cardiopulmonary resuscitation in accordance
with the provisions of this article.
NOTE: The purpose of the bill is to define medically ineffective
cardiopulmonary resuscitation and to authorize an attending
physician to issue a do not resuscitate order for a person who lacks decision-making capacity when cardiopulmonary resuscitation
would be ineffective. The issuance of the do not resuscitate order
would not require consent when it has been determined to be
medically ineffective by the attending physician and another
physician.
Strike-throughs indicate language that would be stricken from the
present law, and underscoring indicates new language that would be
added.