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Health Care Decisions Act ~ DNR § 54.1-2983. Procedure for making advance directive; notice to physician. § 54.1-2984. Suggested form of written advance directives. § 54.1-2985. Revocation of an advance directive. § 54.1-2987.1. Durable Do Not Resuscitate Orders. § 54.1-2988. Immunity from liability; burden of proof; presumption. § 54.1-2989. Willful destruction, concealment, etc., of declaration or revocation; penalties. § 54.1-2992. Preservation of existing rights. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ The
provisions of this article shall be known and may be cited as the "Health
Care Decisions Act." (1983,
c. 532, § 54-325.8:1; 1988, c. 765; 1992, cc. 748, 772.) ~
top ~ As
used in this article: "Advance
directive" means (i) a witnessed written document, voluntarily executed by
the declarant in accordance with the requirements of § 54.1-2983 or (ii) a
witnessed oral statement, made by the declarant subsequent to the time he is
diagnosed as suffering from a terminal condition and in accordance with the
provisions of § 54.1-2983. "Agent"
means an adult appointed by the declarant under an advance directive, executed
or made in accordance with the provisions of § 54.1-2983, to make health care
decisions for him, including visitation, provided the advance directive makes
express provisions for visitation and subject to physician orders and policies
of the institution to which the declarant is admitted. The declarant may also
appoint an adult to make, after the declarant's death, an anatomical gift of all
or any part of his body pursuant to Article 2 (§ 32.1-289 et seq.) of Chapter 8
of Title 32.1. "Attending
physician" means the primary physician who has responsibility for the
treatment and care of the patient. "Declarant"
means an adult who makes an advance directive, as defined in this article, while
capable of making and communicating an informed decision. "Durable
Do Not Resuscitate Order" means a written physician's order issued pursuant
to § 54.1-2987.1 to withhold cardiopulmonary resuscitation from a particular
patient in the event of cardiac or respiratory arrest. For purposes of this
article, cardiopulmonary resuscitation shall include cardiac compression,
endotracheal intubation and other advanced airway management, artificial
ventilation, and defibrillation and related procedures. As the terms
"advance directive" and "Durable Do Not Resuscitate Order"
are used in this article, a Durable Do Not Resuscitate Order is not and shall
not be construed as an advance directive. "Incapable
of making an informed decision" means the inability of an adult patient,
because of mental illness, mental retardation, or any other mental or physical
disorder which precludes communication or impairs judgment and which has been
diagnosed and certified in writing by his attending physician and a second
physician or licensed clinical psychologist after personal examination of such
patient, to make an informed decision about providing, withholding or
withdrawing a specific medical treatment or course of treatment because he is
unable to understand the nature, extent or probable consequences of the proposed
medical decision, or to make a rational evaluation of the risks and benefits of
alternatives to that decision. For purposes of this article, persons who are
deaf, dysphasic or have other communication disorders, who are otherwise
mentally competent and able to communicate by means other than speech, shall not
be considered incapable of making an informed decision. "Life-prolonging
procedure" means any medical procedure, treatment or intervention which (i)
utilizes mechanical or other artificial means to sustain, restore or supplant a
spontaneous vital function, or is otherwise of such a nature as to afford a
patient no reasonable expectation of recovery from a terminal condition and (ii)
when applied to a patient in a terminal condition, would serve only to prolong
the dying process. The term includes artificially administered hydration and
nutrition. However, nothing in this act shall prohibit the administration of
medication or the performance of any medical procedure deemed necessary to
provide comfort care or to alleviate pain, including the administration of pain
relieving medications in excess of recommended dosages in accordance with §§
54.1-2971.01 and 54.1-3408.1. For purposes of §§ 54.1-2988, 54.1-2989, and
54.1-2991, the term also shall include cardiopulmonary resuscitation. "Persistent
vegetative state" means a condition caused by injury, disease or illness in
which a patient has suffered a loss of consciousness, with no behavioral
evidence of self-awareness or awareness of surroundings in a learned manner,
other than reflex activity of muscles and nerves for low level conditioned
response, and from which, to a reasonable degree of medical probability, there
can be no recovery. "Physician"
means a person licensed to practice medicine in the Commonwealth of Virginia or
in the jurisdiction where the treatment is to be rendered or withheld. "Qualified
patient" means a patient who has made an advance directive in accordance
with this article and either (i) has been diagnosed and certified in writing by
the attending physician and a second physician or licensed clinical psychologist
after personal examination to be incapable of making an informed decision about
providing, withholding or withdrawing a specific medical treatment or course of
treatment, in accordance with § 54.1-2986 or (ii) has been diagnosed and
certified in writing by the attending physician to be afflicted with a terminal
condition. "Terminal
condition" means a condition caused by injury, disease or illness from
which, to a reasonable degree of medical probability a patient cannot recover
and (i) the patient's death is imminent or (ii) the patient is in a persistent
vegetative state. "Witness"
means a person who is not a spouse or blood relative of the patient. Employees
of health care facilities and physician's offices, who act in good faith, shall
be permitted to serve as witnesses for purposes of this article. (1983,
c. 532, § 54-325.8:2; 1984, c. 79; 1988, c. 765; 1991, c. 583; 1992, cc. 412,
748, 772; 1994, c. 956; 1997, c. 609; 1998, cc. 630, 803, 854; 1999, c. 814;
2000, c. 1034.) ~
top ~ §
54.1-2983. Procedure for making advance directive; notice to physician. Any
competent adult may, at any time, make a written advance directive authorizing
the providing, withholding or withdrawal of life-prolonging procedures in the
event such person should have a terminal condition. A written advance directive
may also appoint an agent to make health care decisions for the declarant under
the circumstances stated in the advance directive if the declarant should be
determined to be incapable of making an informed decision. A written advance
directive shall be signed by the declarant in the presence of two subscribing
witnesses. Further,
any competent adult who has been diagnosed by his attending physician as being
in a terminal condition may make an oral advance directive to authorize the
providing, withholding or withdrawing of life-prolonging procedures or to
appoint an agent to make health care decisions for the declarant under the
circumstances stated in the advance directive if the declarant should be
determined to be incapable of making an informed decision. An oral advance
directive shall be made in the presence of the attending physician and two
witnesses. It
shall be the responsibility of the declarant to provide for notification to his
attending physician that an advance directive has been made. In the event the
declarant is comatose, incapacitated or otherwise mentally or physically
incapable of communication, any other person may notify the physician of the
existence of an advance directive. An attending physician who is so notified
shall promptly make the advance directive or a copy of the advance directive, if
written, or the fact of the advance directive, if oral, a part of the
declarant's medical records. (1983,
c. 532, § 54-325.8:3; 1988, c. 765; 1992, cc. 748, 772; 1997, c. 801.) ~
top ~ §
54.1-2984. Suggested form of written advance directives. An
advance directive executed pursuant to this article may, but need not, be in the
following form, and may (i) direct a specific procedure or treatment to be
provided, such as artificially administered hydration and nutrition; (ii) direct
a specific procedure or treatment to be withheld; or (iii) appoint an agent to
make health care decisions for the declarant as specified in the advance
directive if the declarant is determined to be incapable of making an informed
decision, including the decision to make, after the declarant's death, an
anatomical gift of all of the declarant's body or an organ, tissue or eye
donation pursuant to Article 2 (§ 32.1-289 et seq.) of Chapter 8 of Title 32.1
and in compliance with any directions of the declarant. Should any other
specific directions be held to be invalid, such invalidity shall not affect the
advance directive. If the declarant appoints an agent in an advance directive,
that agent shall have the authority to make health care decisions for the
declarant as specified in the advance directive if the declarant is determined
to be incapable of making an informed decision and shall have decision-making
priority over any individuals authorized under § 54.1-2986 to make health care
decisions for the declarant. In no case shall the agent refuse or fail to honor
the declarant's wishes in relation to anatomical gifts or organ, tissue or eye
donation. ~
top ~
I, .........., willfully and
voluntarily make known my desire and do hereby declare:
If at any time my attending physician should determine that I have a
terminal condition where the application of life-prolonging procedures would
serve only to artificially prolong the dying process, I direct that such
procedures be withheld or withdrawn, and that I be permitted to die naturally
with only the administration of medication or the performance of any medical
procedure deemed necessary to provide me with comfort care or to alleviate pain
(OPTION: I specifically direct that the following procedures or treatments be
provided to me: ....................) In
the absence of my ability to give directions regarding the use of such
life-prolonging procedures, it is my intention that this advance directive shall
be honored by my family and physician as the final expression of my legal right
to refuse medical or surgical treatment and accept the consequences of such
refusal.
OPTION: APPOINTMENT OF AGENT (CROSS THROUGH IF YOU DO NOT WANT TO APPOINT
AN AGENT TO MAKE HEALTH CARE DECISIONS FOR YOU.)
I hereby appoint ....... (primary agent), of
....... (address and telephone number), as my agent to make health care
decisions on my behalf as authorized in this document. If
....... (primary agent) is not reasonably available or is unable or
unwilling to act as my agent, then I appoint
....... (successor agent), of .......
(address and telephone number), to serve in that capacity. I
hereby grant to my agent, named above, full power and authority to make health
care decisions on my behalf as described below whenever I have been determined
to be incapable of making an informed decision about providing, withholding or
withdrawing medical treatment. The phrase "incapable of making an informed
decision" means unable to understand the nature, extent and probable
consequences of a proposed medical decision or unable to make a rational
evaluation of the risks and benefits of a proposed medical decision as compared
with the risks and benefits of alternatives to that decision, or unable to
communicate such understanding in any way. My agent's authority hereunder is
effective as long as I am incapable of making an informed decision.
The
determination that I am incapable of making an informed decision shall be made
by my attending physician and a second physician or licensed clinical
psychologist after a personal examination of me and shall be certified in
writing. Such certification shall be required before treatment is withheld or
withdrawn, and before, or as soon as reasonably practicable after, treatment is
provided, and every 180 days thereafter while the treatment continues.
In
exercising the power to make health care decisions on my behalf, my agent shall
follow my desires and preferences as stated in this document or as otherwise
known to my agent. My agent shall be guided by my medical diagnosis and
prognosis and any information provided by my physicians as to the intrusiveness,
pain, risks, and side effects associated with treatment or nontreatment. My
agent shall not authorize a course of treatment which he knows, or upon
reasonable inquiry ought to know, is contrary to my religious beliefs or my
basic values, whether expressed orally or in writing. If my agent cannot
determine what treatment choice I would have made on my own behalf, then my
agent shall make a choice for me based upon what he believes to be in my best
interests. OPTION:
POWERS OF MY AGENT (CROSS THROUGH ANY LANGUAGE YOU DO NOT WANT AND ADD ANY
LANGUAGE YOU DO WANT.) The
powers of my agent shall include the following: A.
To consent to or refuse or withdraw consent to any type of medical care,
treatment, surgical procedure, diagnostic procedure, medication and the use of
mechanical or other procedures that affect any bodily function, including, but
not limited to, artificial respiration, artificially administered nutrition and
hydration, and cardiopulmonary resuscitation. This authorization specifically
includes the power to consent to the administration of dosages of pain-relieving
medication in excess of recommended dosages in an amount sufficient to relieve
pain, even if such medication carries the risk of addiction or inadvertently
hastens my death; B.
To request, receive, and review any information, verbal or written, regarding my
physical or mental health, including but not limited to, medical and hospital
records, and to consent to the disclosure of this information;
C.
To employ and discharge my health care providers; D.
To authorize my admission to or discharge (including transfer to another
facility) from any hospital, hospice, nursing home, adult home or other medical
care facility for services other than those for treatment of mental illness
requiring admission procedures provided in Article 1 (§ 37.1-63 et seq.) of
Chapter 2 of Title 37.1; and E.
To take any lawful actions that may be necessary to carry out these decisions,
including the granting of releases of liability to medical providers.
Further,
my agent shall not be liable for the costs of treatment pursuant to his
authorization, based solely on that authorization.
OPTION: APPOINTMENT OF AN AGENT TO MAKE AN ANATOMICAL GIFT OR ORGAN,
TISSUE OR EYE DONATION (CROSS THROUGH IF YOU DO NOT WANT TO APPOINT AN AGENT TO
MAKE AN ANATOMICAL GIFT OR ANY ORGAN, TISSUE OR EYE DONATION FOR YOU.)
Upon my death, I direct that an anatomical gift of all of my body or
certain organ, tissue or eye donations may be made pursuant to Article 2 (§
32.1-289 et seq.) of Chapter 8 of Title 32.1 and in accordance with my
directions, if any. I hereby appoint .......
as my agent, of ....... (address
and telephone number), to make any such anatomical gift or organ, tissue or eye
donation following my death. I further direct that:
....... (declarant's directions concerning anatomical gift or organ,
tissue or eye donation). This
advance directive shall not terminate in the event of my disability.
By signing below, I indicate that I am emotionally and mentally competent
to make this advance directive and that I understand the purpose and effect of
this document.
__________ ______________________________
(Date)
(Signature of Declarant)
The declarant signed the foregoing advance directive in my presence. I am
not the spouse or a blood relative of the declarant.
(Witness) ________________________________________
(Witness) ________________________________________ (1983,
c. 532, § 54-325.8:4; 1988, c. 765; 1989, c. 592; 1991, c. 583; 1992, cc. 748,
772; 1997, c. 609; 1999, c. 814; 2000, c. 810.) ~
top ~ §
54.1-2985. Revocation of an advance directive. An
advance directive may be revoked at any time by the declarant (i) by a signed,
dated writing; (ii) by physical cancellation or destruction of the advance
directive by the declarant or another in his presence and at his direction; or
(iii) by oral expression of intent to revoke. Any such revocation shall be
effective when communicated to the attending physician. No civil or criminal
liability shall be imposed upon any person for a failure to act upon a
revocation unless that person has actual knowledge of such revocation. (1983,
c. 532, § 54-325.8:5; 1988, c. 765; 1992, cc. 748, 772.) ~
top ~ A.
Whenever (i) the attending physician of an adult patient has determined after
personal examination that such patient, because of mental illness, mental
retardation, or any other mental disorder, or a physical disorder which
precludes communication or impairs judgment, is incapable of making an informed
decision about providing, withholding or withdrawing a specific medical
treatment or course of treatment and such adult patient has not made an advance
directive in accordance with this article or (ii) the attending physician of an
adult patient has determined after personal examination that such patient,
because of mental illness, mental retardation, or any other mental disorder, or
a physical disorder which precludes communication or impairs judgment, is
incapable of making an informed decision about providing, withholding or
withdrawing a specific medical treatment or course of treatment and the adult
patient has made an advance directive in accordance with this article which does
not indicate his wishes with respect to the specific course of treatment at
issue and does not appoint an agent to make health care decisions upon his
becoming incapable of making an informed decision, the attending physician may,
upon compliance with the provisions of this section, provide to, withhold or
withdraw from such patient medical or surgical care or treatment, including, but
not limited to, life-prolonging procedures, upon the authorization of any of the
following persons, in the specified order of priority, if the physician is not
aware of any available, willing and competent person in a higher class: 1.
A guardian or committee for the patient. This subdivision shall not be construed
to require such appointment in order that a treatment decision can be made under
this section; or 2.
The patient's spouse except where a divorce action has been filed and the
divorce is not final; or 3.
An adult child of the patient; or 4.
A parent of the patient; or 5.
An adult brother or sister of the patient; or 6.
Any other relative of the patient in the descending order of blood relationship.
If
two or more of the persons listed in the same class in subdivisions A 3 through
A 6 with equal decision-making priority inform the attending physician that they
disagree as to a particular treatment decision, the attending physician may rely
on the authorization of a majority of the reasonably available members of that
class. Any
person authorized to consent to the providing, withholding or withdrawing of
treatment pursuant to this article shall (i) prior to giving consent, make a
good faith effort to ascertain the risks and benefits of and alternatives to the
treatment and the religious beliefs and basic values of the patient receiving
treatment, and to inform the patient, to the extent possible, of the proposed
treatment and the fact that someone else is authorized to make a decision
regarding that treatment and (ii) base his decision on the patient's religious
beliefs and basic values and any preferences previously expressed by the patient
regarding such treatment to the extent they are known, and if unknown or
unclear, on the patient's best interests. Regardless of the absence of an
advance directive, if the patient has expressed his intent to be an organ donor
in any written document, no person noted in this section shall revoke, or in any
way hinder, such organ donation. B.
The absence of an advance directive by an adult patient shall not give rise to
any presumption as to his intent to consent to or refuse life-prolonging
procedures. C.
The provisions of this article shall not apply to authorization of
nontherapeutic sterilization, abortion, psychosurgery, or admission to a mental
retardation facility or psychiatric hospital, as defined in § 37.1-1; however,
the provisions of this article, if otherwise applicable, may be employed to
authorize a specific treatment or course of treatment for a person who has been
lawfully admitted to a mental retardation facility or psychiatric hospital.
Further,
the provisions of this article shall not authorize providing, continuing,
withholding or withdrawing of treatment if the provider of the treatment knows
that such an action is protested by the patient. No person shall authorize
treatment, or a course of treatment, pursuant to this article, that such person
knows, or upon reasonable inquiry ought to know, is contrary to the religious
beliefs or basic values of the patient unable to make a decision, whether
expressed orally or in writing. D.
Prior to withholding or withdrawing treatment for which authorization has been
obtained or will be sought pursuant to this article and prior to, or as soon as
reasonably practicable thereafter, the initiation of treatment for which
authorization has been obtained or will be sought pursuant to this article, and
no less frequently than every 180 days while the treatment continues, the
attending physician shall obtain written certification that the patient is
incapable of making an informed decision regarding the treatment from a licensed
physician or clinical psychologist which shall be based on a personal
examination of the patient. Whenever the authorization is being sought for
treatment of a mental illness, the second physician or licensed clinical
psychologist shall not be otherwise currently involved in the treatment of the
person assessed. The cost of the assessment shall be considered for all purposes
a cost of the patient's treatment. E.
On petition of any person to the circuit court of the county or city in which
any patient resides or is located for whom treatment will be or is currently
being provided, withheld or withdrawn pursuant to this article, the court may
enjoin such action upon finding by a preponderance of the evidence that the
action is not lawfully authorized by this article or by other state or federal
law. (1983,
c. 532, § 54-325.8:6; 1988, c. 765; 1992, cc. 748, 772; 1999, c. 814; 2000, c.
810.) Editor's
note. - Acts 1992, cc. 748 and 772, which amended this section, in cl. 3
provides: ~
top ~ §
54.1-2987. Transfer of patient by physician who refuses to comply with advance
directive or treatment decision. An
attending physician who refuses to comply with (i) the advance directive of a
qualified patient or (ii) the treatment decision of a person designated to make
the decision by the declarant in his advance directive pursuant to § 54.1-2984
or (iii) the treatment decision of an authorized person pursuant to § 54.1-2986
shall make a reasonable effort to transfer the patient to another physician and
shall comply with § 54.1-2990. This
section shall apply even if the attending physician determines the treatment
requested to be medically or ethically inappropriate. (1983,
c. 532, § 54-325.8:7; 1988, c. 765; 1992, cc. 748, 772; 2000, cc. 590, 598.) ~
top ~ §
54.1-2987.1. Durable Do Not Resuscitate Orders. A.
A Durable Do Not Resuscitate Order may be issued by a physician for his patient
with whom he has a bona fide physician/patient relationship as defined in the
guidelines of the Board of Medicine, and only with the consent of the patient
or, if the patient is a minor or is otherwise incapable of making an informed
decision regarding consent for such an order, upon the request of and with the
consent of the person authorized to consent on the patient's behalf. B.
This section shall not authorize any health care provider or practitioner to
follow a Durable Do Not Resuscitate Order for any patient who is able to, and
does, express to such health care provider or practitioner the desire to be
resuscitated in the event of cardiac or respiratory arrest. If
the patient is a minor or is otherwise incapable of making an informed decision,
the expression of the desire that the patient be resuscitated by the person
authorized to consent on the patient's behalf shall so revoke the provider's or
practitioner's authority to follow a Durable Do Not Resuscitate Order. The
expression of such desire to be resuscitated prior to cardiac or respiratory
arrest shall constitute revocation of the Order; however, a new Order may be
issued upon consent of the patient or the person authorized to consent on the
patient's behalf. C.
Durable Do Not Resuscitate Orders issued in accordance with this section shall
remain valid and in effect until revoked. In accordance with this section and
regulations promulgated by the Board of Health, (i) qualified emergency medical
services personnel as defined in § 32.1-111.1 and (ii) licensed health care
practitioners in any facility, program or organization operated or licensed by
the Board of Health or by the Department of Mental Health, Mental Retardation
and Substance Abuse Services or operated, licensed or owned by another state
agency are authorized to follow Durable Do Not Resuscitate Orders that are
available to them in a form approved by the Board of Health. D.
The provisions of this section shall not authorize any qualified emergency
medical services personnel or licensed health care provider or practitioner who
is attending the patient at the time of cardiac or respiratory arrest to
provide, continue, withhold or withdraw treatment if such provider or
practitioner knows that taking such action is protested by the patient incapable
of making an informed decision. No person shall authorize providing, continuing,
withholding or withdrawing treatment pursuant to this section that such person
knows, or upon reasonable inquiry ought to know, is contrary to the religious
beliefs or basic values of a patient incapable of making an informed decision or
the wishes of such patient fairly expressed when the patient was capable of
making an informed decision. Further, this section shall not authorize the
withholding of other medical interventions, such as intravenous fluids, oxygen
or other therapies deemed necessary to provide comfort care or to alleviate
pain. E.
For the purposes of this section: "Health
care provider" includes, but is not limited to, qualified emergency medical
services personnel. "Person
authorized to consent on the patient's behalf" means any person authorized
by law to consent on behalf of the patient incapable of making an informed
decision or, in the case of a minor child, the parent or parents having custody
of the child or the child's legal guardian or as otherwise provided by law.
F.
This section shall not prevent, prohibit or limit a physician from issuing a
written order, other than a Durable Do Not Resuscitate Order, not to resuscitate
a patient in the event of cardiac or respiratory arrest in accordance with
accepted medical practice. G.
Valid Do Not Resuscitate Orders or Emergency Medical Services Do Not Resuscitate
Orders issued before July 1, 1999, pursuant to the then-current law, shall
remain valid and shall be given effect as provided in this article. (1992,
c. 412; 1994, c. 956; 1998, cc. 564, 628, 630, 803, 854; 1999, c. 814.) ~
top ~ §
54.1-2988. Immunity from liability; burden of proof; presumption. A
health care facility, physician or other person acting under the direction of a
physician shall not be subject to criminal prosecution or civil liability or be
deemed to have engaged in unprofessional conduct as a result of issuing a
Durable Do Not Resuscitate Order or the withholding or the withdrawal of
life-prolonging procedures under authorization or consent obtained in accordance
with this article or as the result of the provision, withholding or withdrawal
of ongoing life-sustaining care in accordance with § 54.1-2990. No person or
facility providing, withholding or withdrawing treatment or physician issuing a
Durable Do Not Resuscitate Order under authorization or consent obtained
pursuant to this article or otherwise in accordance with § 54.1-2990 shall
incur liability arising out of a claim to the extent the claim is based on lack
of authorization or consent for such action. A
person who authorizes or consents to the providing, withholding or withdrawal of
ongoing life-sustaining care in accordance with § 54.1-2990 or of
life-prolonging procedures in accordance with a qualified patient's advance
directive or as provided in § 54.1-2986 or a Durable Do Not Resuscitate Order
pursuant to § 54.1-2987.1 shall not be subject, solely on the basis of that
authorization or consent, to (i) criminal prosecution or civil liability for
such action or (ii) liability for the cost of treatment. The
provisions of this section shall apply unless it is shown by a preponderance of
the evidence that the person authorizing or effectuating the withholding or
withdrawal of life-prolonging procedures, or issuing, consenting to, making or
following a Durable Do Not Resuscitate Order in accordance with § 54.1-2987.1
did not, in good faith, comply with the provisions of this article. The
distribution to patients of written advance directives in a form meeting the
requirements of § 54.1-2984 and assistance to patients in the completion and
execution of such forms by health care providers shall not constitute the
unauthorized practice of law pursuant to Chapter 39 (§ 54.1-3900 et seq.) of
this title. An
advance directive or Durable Do Not Resuscitate Order made, consented to or
issued in accordance with this article shall be presumed to have been made,
consented to, or issued voluntarily and in good faith by a competent adult,
physician or person authorized to consent on the patient's behalf. (1983,
c. 532, § 54-325.8:8; 1988, c. 765; 1992, cc. 412, 748, 772; 1998, cc. 803,
854; 1999, c. 814; 2000, cc. 590, 598.) ~
top ~ §
54.1-2989. Willful destruction, concealment, etc., of declaration or revocation;
penalties. Any
person who willfully conceals, cancels, defaces, obliterates, or damages the
advance directive or Durable Do Not Resuscitate Order of another without the
declarant's or patient's consent or the consent of the person authorized to
consent for the patient or who falsifies or forges a revocation of the advance
directive or Durable Do Not Resuscitate Order of another, thereby causing
life-prolonging procedures to be utilized in contravention of the previously
expressed intent of the patient or a Durable Do Not Resuscitate Order shall be
guilty of a Class 6 felony. Any
person who falsifies or forges the advance directive or Durable Do Not
Resuscitate Order of another, or willfully conceals or withholds personal
knowledge of the revocation of an advance directive or Durable Do Not
Resuscitate Order, with the intent to cause a withholding or withdrawal of
life-prolonging procedures, contrary to the wishes of the declarant or a
patient, and thereby, because of such act, directly causes life-prolonging
procedures to be withheld or withdrawn and death to be hastened, shall be guilty
of a Class 2 felony. (1983,
c. 532, § 54-325.8:9; 1988, c. 765; 1992, cc. 412, 748, 772; 1998, cc. 803,
854; 1999, c. 814.) Cross
references. - As to punishment for Class 2 and 6 felonies, see § 18.2-10.
~
top ~ A.
Nothing in this article shall be construed to require a physician to prescribe
or render medical treatment to a patient that the physician determines to be
medically or ethically inappropriate. However, in such a case, if the
physician's determination is contrary to the terms of an advance directive of a
qualified patient or the treatment decision of a person designated to make the
decision under this article or a Durable Do Not Resuscitate Order, the physician
shall make a reasonable effort to inform the patient or the patient's designated
decision-maker of such determination and the reasons for the determination. If
the conflict remains unresolved, the physician shall make a reasonable effort to
transfer the patient to another physician who is willing to comply with the
terms of the advance directive. The physician shall provide the patient or his
authorized decision-maker a reasonable time of not less than fourteen days to
effect such transfer. During this period, the physician shall continue to
provide any life-sustaining care to the patient which is reasonably available to
such physician, as requested by the patient or his designated decision-maker.
B.
For purposes of this section, "life-sustaining care" means any
ongoing medical treatment that utilizes mechanical or other artificial means to
sustain, restore or supplant a spontaneous vital function, including hydration,
nutrition, maintenance medication, and cardiopulmonary resuscitation. C.
Nothing in this section shall require the provision of treatment that the
physician is physically or legally unable to provide, or treatment that the
physician is physically or legally unable to provide without thereby denying the
same treatment to another patient. D.
Nothing in this article shall be construed to condone, authorize or approve
mercy killing or euthanasia, or to permit any affirmative or deliberate act or
omission to end life other than to permit the natural process of dying. (1983,
c. 532, § 54-325.8:10; 1988, c. 765; 1992, cc. 748, 772; 1999, c. 814; 2000,
cc. 590, 598.) ~
top ~ The
withholding or withdrawal of life-prolonging procedures in accordance with the
provisions of this article shall not, for any purpose, constitute a suicide. Nor
shall the making of an advance directive pursuant to this article affect the
sale, procurement or issuance of any policy of life insurance, nor shall the
making of an advance directive or the issuance of a Durable Do Not Resuscitate
Order pursuant to this article be deemed to modify the terms of an existing
policy of life insurance. No policy of life insurance shall be legally impaired
or invalidated by the withholding or withdrawal of life-prolonging procedures
from an insured patient in accordance with this article, notwithstanding any
term of the policy to the contrary. A person shall not be required to make an
advance directive or consent to a Durable Do Not Resuscitate order as a
condition for being insured for, or receiving, health care services. The
declaration of any qualified patient made prior to July 1, 1983, an advance
directive made prior to July 1, 1992, or the issuance, in accordance with the
then current law, of a Do Not Resuscitate Order or an Emergency Medical Services
Do Not Resuscitate Order prior to July 1, 1999, shall be given effect as
provided in this article. (1983,
c. 532, § 54-325.8:11; 1988, c. 765; 1992, cc. 412, 748, 772; 1999, c. 814.) Cross
references. - As to action for injunctive relief against assisted suicide,
action for damages against a person who assists in a suicide or attempted
suicide, and professional sanctions against a licensed health care provider who
does so, see § 8.01-622.1. ~
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54.1-2992. Preservation of existing rights. The
provisions of this article are cumulative with existing law regarding an
individual's right to consent or refuse to consent to medical treatment and
shall not impair any existing rights or responsibilities which a health care
provider, a patient, including a minor or incapacitated patient, or a patient's
family may have in regard to the providing, withholding or withdrawal of
life-prolonging medical procedures under the common law or statutes of the
Commonwealth; however, this section shall not be construed to authorize
violations of § 54.1-2990. (1983,
c. 532, § 54-325.8:12; 1988, c. 765; 1992, cc. 748, 772; 1997, c. 801; 2000,
cc. 590, 598.) ~
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advance directive executed in another state shall be deemed to be validly
executed for the purposes of this article if executed in compliance with the
laws of the Commonwealth of Virginia or the laws of the state where executed.
Such advance directives shall be construed in accordance with the laws of the
Commonwealth of Virginia. (1992,
cc. 748, 772.) ~
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