HB-4382, As Passed House, April 18, 2013
March 6, 2013, Introduced by Rep. Cotter and referred to the Committee on Judiciary.
A bill to amend 1996 PA 193, entitled
"Michigan do-not-resuscitate procedure act,"
by amending the title and sections 2, 3, 4, 5, 6, 8, 9, 10, 11,
and 14 (MCL 333.1052, 333.1053, 333.1054, 333.1055, 333.1056,
333.1058, 333.1059, 333.1060, 333.1061, and 333.1064), section 2
as amended by 2004 PA 552, and by adding section 3a.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
1 TITLE
2 An act to provide for the execution of a do-not-resuscitate
3 order for a patient an
individual in a setting outside of a
4 hospital; , a nursing home, or a mental health facility owned
or
5 operated by the department of community health; to provide that
6 certain actions be taken and certain actions not be taken with
7 respect to such an a
do-not-resuscitate order; to provide
for the
1 revocation of a do-not-resuscitate order; to prohibit certain
2 persons and organizations from requiring the execution of such an
3 a do-not-resuscitate order as a condition of receiving coverage,
4 benefits, or services; to prohibit certain actions by certain
5 insurers; to exempt provide
immunity from liability for certain
6 persons; from penalties and liabilities; and to
prescribe
7 liabilities.penalties
and provide remedies.
8 Sec. 2. As used in this act:
9 (a) "Actual notice" includes the physical presentation of an
10 order, a revocation of an order, or other written document
11 authorized under this act from or on behalf of a declarant.
12 (b) (a) "Attending
physician" means the physician who has
13 primary responsibility for the treatment and care of a declarant.
14 (c) (b) "Declarant"
means a person an
individual who has
15 executed a do-not-resuscitate order on his or her own behalf or
16 on whose behalf a do-not-resuscitate order has been executed as
17 provided in section 3 or 5.this act.
18 (d) "Delegatee" means an individual to whom a physician has
19 delegated the authority to perform 1 or more selected acts,
20 tasks, or functions under section 16215 of the public health
21 code, MCL 333.16215.
22 (e) "Do-not-resuscitate identification bracelet" or
23 "identification bracelet" means a wrist bracelet that meets the
24 requirements of section 7 and that is worn by a declarant while a
25 do-not-resuscitate order is in effect.
26 (f) (c) "Do-not-resuscitate
order" or "order" means a
27 document executed as prescribed in section 3 or 5 under this act
1 directing that, in the event that a patient if an individual
2 suffers cessation of both spontaneous respiration and circulation
3 in a setting outside of a hospital, a nursing home, or a mental
4 health facility owned or operated by the department of community
5 health, resuscitation will
not be initiated.
6 (d) "Do-not-resuscitate identification bracelet" or
7 "identification bracelet" means a wrist bracelet that meets
the
8 requirements of section 7 and is worn by the declarant while a
9 do-not-resuscitate order is in effect.
10 (g) (e) "Emergency
medical technician" means that term as
11 defined in section 20904 of the public health code, MCL
12 333.20904.
13 (h) (f) "Emergency
medical technician specialist" means that
14 term as defined in section 20904 of the public health code, MCL
15 333.20904.
16 (i) "Guardian" means that term as defined in section 1104 of
17 the estates and protected individuals code, 1998 PA 386, MCL
18 700.1104.
19 (j) (g) "Hospital"
means that term as defined in section
20 20106 of the public health code, MCL 333.20106.
21 (k) (h) "Medical
first responder" means that term as defined
22 in section 20906 of the public health code, MCL 333.20906.
23 (l) (i) "Nurse" means a an individual licensed or otherwise
24 authorized to engage in the practice of nursing or practice of
25
nursing as a licensed practical nurse or
a registered
26 professional nurse as defined in section 17201 under part 172 of
27 the public health code, MCL 333.17201 to 333.17242.
1 (j) "Order" means a do-not-resuscitate order.
2 (m) (k) "Organization"
means a company, corporation, firm,
3 partnership, association, trust, or other business entity or a
4 governmental agency.
5 (n) (l) "Paramedic" means that term as defined in
section
6 20908 of the public health code, MCL 333.20908.
7 (o) "Patient advocate" means an individual designated to
8 make medical treatment decisions for a patient under sections
9 5506 to 5515 of the estates and protected individuals code, 1998
10 PA 386, MCL 700.5506 to 700.5515.
11 (p) (m) "Physician"
means an individual licensed or
12 otherwise authorized to engage in the practice of medicine or the
13 practice of osteopathic medicine and surgery pursuant to under
14 article 15 of the public health code, MCL 333.16101 to 333.18838.
15 (n) "Patient advocate" means an individual designated
to
16 make medical treatment decisions for a patient under sections
17 5506 to 5515 of the estates and protected individuals code, 1998
18 PA 386, MCL 700.5506 to 700.5515.
19 (q) (o) "Public
health code" means the
public health code,
20 1978 PA 368, MCL 333.1101 to 333.25211.
21 (r) (p) "Vital
sign" means a pulse or evidence of
22 respiration.
23 (s) "Ward" means that term as defined in section 1108 of the
24 estates and protected individuals code, 1998 PA 386, MCL
25 700.1108.
26 Sec. 3. (1) Subject to section 5, an individual who is 18
27 years of age or older and of sound mind may execute a do-not-
1 resuscitate order on his or her own behalf. A patient advocate of
2 an individual who is 18 years of age or older may execute a do-
3 not-resuscitate order on behalf of that individual.
4 (2) An order executed under this section shall be on a form
5 described in section 4. The order shall be dated and executed
6 voluntarily and signed by each of the following persons:
7 (a) The declarant, the declarant's patient advocate, or
8 another person who, at the time of the signing, is in the
9 presence of the declarant and acting pursuant to the directions
10 of the declarant.
11 (b) The declarant's attending physician.
12 (c) Two witnesses 18 years of age or older, at least 1 of
13 whom is not the declarant's spouse, parent, child, grandchild,
14 sibling, or presumptive heir.
15 (3) The names of the declarant, the attending physician, and
16 each witness all
signatories shall be printed or typed
below the
17 corresponding signatures. A witness shall not sign an order
18 unless the declarant or the declarant's patient advocate appears
19 to the witness to be of sound mind and under no duress, fraud, or
20 undue influence.
21 (4) At any time after an order is signed and witnessed, the
22 declarant, the declarant's patient advocate, or an individual
23 designated by the declarant may apply an identification bracelet
24 to the declarant's wrist.
25 (5) A declarant or patient advocate who executes an order
26 under this section shall maintain possession of the order and
27 shall have the order accessible within his or her the declarant's
1 place of residence or other setting outside of a hospital. ,
a
2 nursing home, or a mental health facility owned or operated by
3 the department of community health.
4 Sec. 3a. (1) A guardian with the power to execute a do-not-
5 resuscitate order under section 5314 of the estates and protected
6 individuals code, 1998 PA 386, MCL 700.5314, may execute a do-
7 not-resuscitate order on behalf of a ward after complying with
8 section 5314 of the estates and protected individuals code, 1998
9 PA 386, MCL 700.5314.
10 (2) An order executed under this section shall be on a form
11 described in section 4. The order shall be dated and executed
12 voluntarily and signed by each of the following individuals:
13 (a) The guardian.
14 (b) The ward's attending physician.
15 (c) Two witnesses 18 years of age or older, at least 1 of
16 whom is not the ward's spouse, parent, child, grandchild,
17 sibling, or presumptive heir.
18 (3) The names of all signatories shall be printed or typed
19 below the corresponding signatures. A witness shall not sign an
20 order unless the guardian appears to the witness to be of sound
21 mind and under no duress, fraud, or undue influence.
22 (4) At any time after an order is signed and witnessed, the
23 guardian, the attending physician or his or her delegatee, or an
24 individual designated by the guardian may apply an identification
25 bracelet to the ward's wrist.
26 (5) A guardian who executes an order under this section
27 shall maintain possession of the order and shall have the order
1 accessible within the ward's place of residence or other setting
2 outside of a hospital or, if applicable, provide a copy of the
3 order to the administrator of a facility in which the ward is a
4 patient or resident or to the administrator's designee.
5 Sec. 4. A do-not-resuscitate order executed under section 3
6 or 3a shall include, but is not limited to, the following
7 language, and shall be in substantially the following form:
8 "DO-NOT-RESUSCITATE ORDER
9
10 THIS DO-NOT-RESUSCITATE ORDER IS ISSUED BY
11 _______________________________________, ATTENDING PHYSICIAN FOR
12 _______________________________________.
13 (Type or print declarant's or ward's name)
14 Use the appropriate consent section below:
15 A. DECLARANT CONSENT
16
I have discussed my health status with my physician ,
17 _____________________________. named above. I request that
in
18 the event my heart and breathing should stop, no person shall
19 attempt to resuscitate me.
20
This order is effective will
remain in effect until it is
21 revoked
as provided by me.law.
22 Being of sound mind, I voluntarily execute this order, and
23 I understand its full import.
24 _____________________________________ _______________
25 (Declarant's signature) (Date)
26 _____________________________________
27 (Type or print declarant's full name)
28 _____________________________________ _______________
29 (Signature of person who signed for (Date)
30 declarant, if applicable)
1 _____________________________________
2 (Type or print full name)
3 B. PATIENT ADVOCATE CONSENT
4 I authorize that in the event the declarant's heart and
5 breathing should stop, no person shall attempt to resuscitate
6 the declarant. I understand the full import of this order and
7 assume responsibility for its execution. This order will remain
8 in effect until it is revoked as provided by law.
9 _____________________________________ _______________
10 (Patient advocate's signature) (Date)
11 _______________________________________
12 (Type or print patient advocate's name)
13 C. GUARDIAN CONSENT
14 I authorize that in the event the ward's heart and breathing
15 should stop, no person shall attempt to resuscitate the ward. I
16 understand the full import of this order and assume
17 responsibility for its execution. This order will remain in
18 effect until it is revoked as provided by law.
19 _____________________________________ _______________
20 (Guardian's signature) (Date)
21 _____________________________________
22 (Type or print guardian's name)
23 _____________________________________ _______________
24 (Physician's signature) (Date)
25 _____________________________________
26 (Type or print physician's full name)
27
28 ATTESTATION OF WITNESSES
29
30 The individual who has executed this order appears to be of
31 sound mind, and under no duress, fraud, or undue influence.
32 Upon
executing this order, the individual declarant has
1 (has not)received an identification bracelet.
2 ______________________________ ______________________________
3 (Witness signature) (Date) (Witness signature) (Date)
4 ______________________________ ______________________________
5 (Type or print witness's name) (Type or print witness's name)
6
7 THIS FORM WAS PREPARED PURSUANT TO, AND IS IN COMPLIANCE WITH,
8 THE MICHIGAN DO-NOT-RESUSCITATE PROCEDURE ACT.".
9 Sec. 5. (1) An individual who is 18 years of age or older,
10 of sound mind, and an adherent of a church or religious
11 denomination whose members depend upon spiritual means through
12 prayer alone for healing may execute a do-not-resuscitate order
13 on his or her own behalf. A patient advocate of an individual who
14 is 18 years of age or older and an adherent of a church or
15 religious denomination whose members depend upon spiritual means
16 through prayer alone for healing may execute a do-not-resuscitate
17 order on behalf of that individual.
18 (2) An order executed under this section shall be on a form
19 described in section 6. The order shall be dated and executed
20 voluntarily and signed by each of the following persons:
21 (a) The declarant, the declarant's patient advocate, or
22 another person who, at the time of the signing, is in the
23 presence of the declarant and acting pursuant to the directions
24 of the declarant.
25 (b) Two witnesses 18 years of age or older, at least 1 of
26 whom is not the declarant's spouse, parent, child, grandchild,
27 sibling, or presumptive heir.
28 (3) The name names
of the declarant and of each witness
all
1 signatories shall be printed or typed below the corresponding
2 signatures. A witness shall not sign an order unless the
3 declarant or the declarant's patient advocate appears to the
4 witness to be of sound mind and under no duress, fraud, or undue
5 influence.
6 (4) At any time after an order is signed and witnessed, the
7 declarant, the declarant's patient advocate, or an individual
8 designated by the declarant may apply an identification bracelet
9 to the declarant's wrist.
10 (5) A declarant or patient advocate who executes an order
11 under this section shall maintain possession of the order and
12 shall have the order accessible within his or her the declarant's
13 place of residence or other setting outside of a hospital.,
a
14 nursing home, or a mental health facility owned or operated by
15 the department of community health.
16 Sec. 6. A do-not-resuscitate order executed for an adherent
17 of a church or religious denomination under section 5 shall
18 include, but is not limited to, the following language, and shall
19 be in substantially the following form:
20 "DO-NOT-RESUSCITATE ORDER
21 Use the appropriate consent section below:
22
23 A. DECLARANT CONSENT
24 I request that in the event my heart and breathing should
25 stop, no person shall attempt to resuscitate me.
26
This order is effective will
remain in effect until it is
1 revoked
as provided by me law.
2 Being of sound mind, I voluntarily execute this order,
3 and I understand its full import.
4 ____________________________________________ _____________
5 (Declarant's signature) (Date)
6 ____________________________________________
7 (Type or print declarant's full name)
8 ____________________________________________ _____________
9 (Signature of person who signed for (Date)
10 declarant, if applicable)
11 ____________________________________________
12 (Type or print full name)
13 B. PATIENT ADVOCATE CONSENT
14 I authorize that in the event the declarant's heart and
15 breathing should stop, no person shall attempt to resuscitate
16 the declarant. I understand the full import of this order and
17 assume responsibility for its execution. This order will remain
18 in effect until it is revoked as provided by law.
19 _____________________________________ _______________
20 (Patient advocate's signature) (Date)
21 _______________________________________
22 (Type or print patient advocate's name)
23
24 ATTESTATION OF WITNESSES
25
26 The individual who has executed this order appears to be
27 of sound mind, and under no duress, fraud, or undue influence.
28 Upon
executing this order, the individual declarant has
29 (has not) received an identification bracelet.
30 ______________________________ ______________________________
31 (Witness signature) (Date) (Witness signature) (Date)
32 ______________________________ ______________________________
33 (Type or print witness's name) (Type or print witness's name)
1
2 THIS FORM WAS PREPARED PURSUANT TO, AND IS IN COMPLIANCE WITH,
3 THE MICHIGAN DO-NOT-RESUSCITATE PROCEDURE ACT.".
4 Sec. 8. An attending physician who signs a declarant's do-
5 not-resuscitate order under section 3 or 3a shall immediately
6 make obtain a copy or obtain from the declarant a
duplicate of
7 the executed order and make that copy or duplicate part of the
8 declarant's permanent medical record.
9 Sec. 9. If a person interested in the welfare of the
10 declarant has reason to believe that an order has been executed
11 contrary to the wishes of the declarant or, if the declarant is a
12 ward, contrary to the wishes or best interests of the ward, the
13 person may petition the probate court to have the order and the
14 conditions of its execution reviewed. If the probate court finds
15 that an order has been executed contrary to the wishes of the
16 declarant or, if the declarant is a ward, contrary to the wishes
17 or best interests of the ward, the probate court shall issue an
18 injunction voiding the effectiveness of the order and prohibiting
19 compliance with the order.
20 Sec. 10. (1) A declarant or a patient advocate who executes
21 an order on behalf of a declarant may revoke an order executed
by
22 himself or herself or executed on his or her behalf at any time
23 and in any manner by which he or she is able to communicate an
24 his or her intent to revoke the order. If the declarant's
25 revocation is not in writing, a person an individual who observes
26 the declarant's revocation of the order shall describe the
1 circumstances of the revocation in writing, and
sign the writing,
2 and deliver the writing to the declarant's attending physician or
3 his or her delegatee and, if the declarant is a patient or
4 resident of a facility, to the administrator of the facility or
5 the administrator's designee. A patient advocate or guardian may
6 revoke an order on behalf of a declarant at any time by issuing
7 the revocation in writing and provide actual notice of the
8 revocation by delivering the written revocation to the
9 declarant's attending physician or his or her delegatee and, if
10 the declarant is a patient or resident of a facility, to the
11 administrator of the facility or the administrator's designee.
12 Upon revocation, the declarant, patient advocate, guardian, or
13 attending physician or a his or her delegatee of
the attending
14 physician who has actual
notice of the a revocation of
an order
15
under this section shall destroy do all of the following:
16
(a) Write "void" on all pages of the order. and
17 (b) If applicable, remove the declarant's do-not-resuscitate
18 identification bracelet. , if the declarant is wearing a do-not-
19 resuscitate identification bracelet.
20 (2) A physician or physician's his or her delegatee who
21 receives actual notice of a revocation of an order shall
22 immediately make the revocation, including, if available, the
23 written description of the circumstances of the revocation
24 required by subsection (1), part of the revoking declarant's
25 permanent medical record. The administrator of a facility or his
26 or her designee who receives actual notice of a revocation of an
27 order of a declarant who is a patient or resident of the facility
1 shall immediately make the revocation part of the patient's or
2 resident's permanent medical record.
3 (3) A declarant's or patient advocate's revocation of an
4 order under this section is binding upon another person at the
5 time that other person receives actual notice of the revocation.
6 (4) For purposes of subsections (1) and (2), a
"delegatee"
7 is an individual to whom a physician has delegated the authority
8 to perform 1 or more selected acts, tasks, or functions under
9 section 16215 of the public health code, being section 333.16215
10 of the Michigan Compiled Laws.
11 Sec. 11. (1) One or more of the following health
12 professionals who arrive at a declarant's location outside of a
13 hospital , a nursing home, or a mental health facility owned
or
14 operated by the department of community health shall determine if
15 the declarant has 1 or more vital signs, whether or not the
16 health professional views or is provided with has actual notice
17
of an order described in section 3
or 5 that is alleged to have
18 been signed executed
by the declarant or other person
authorized
19 to execute an order on the declarant's behalf:
20 (a) A paramedic.
21 (b) An emergency medical technician.
22 (c) An emergency medical technician specialist.
23 (d) A physician.
24 (e) A nurse.
25 (f) A medical first responder.
26 (g) A respiratory therapist.
27 (2) If the health professional determines under subsection
House Bill No. 4382 as amended April 17, 2013
1 (1) that the declarant has no vital signs, and if the health
2 professional determines that the declarant is wearing a do-not-
3 resuscitate identification bracelet or is provided with has
4 actual notice of a do-not-resuscitate order for the declarant, he
5 or she shall not attempt to resuscitate the declarant.
6 Sec. 14. A person or organization shall not require the
7 execution of an order described in section 3 or 5 as a condition
8 for insurance coverage, admittance to a health care facility,
9 receiving health care benefits or services, or any other reason.
10 Enacting section 1. This amendatory act does not take effect
11 unless Senate Bill No. ____ or House Bill No. 4384(request no.
12 01830'13) of the 97th Legislature is enacted into law.
[Enacting section 2. This amendatory act takes effect upon the
expiration of 90 days after the date it is enacted into law.]