Download Zipped Introduced WordPerfect SB0117S01.ZIP
[Status][Bill Documents][Fiscal Note][Bills Directory]

First Substitute S.B. 117

Senator Allen M. Christensen proposes the following substitute bill:


             1     
ADVANCE HEALTH CARE DIRECTIVE ACT

             2     
AMENDMENTS

             3     
2009 GENERAL SESSION

             4     
STATE OF UTAH

             5     
Chief Sponsor: Allen M. Christensen

             6     
House Sponsor: Steven R. Mascaro

             7     
             8      LONG TITLE
             9      General Description:
             10          This bill amends the Advance Health Care Directive Act to expand the list of health
             11      care professionals authorized to determine whether an adult lacks health care decision
             12      making capacity and to sign a life with dignity order.
             13      Highlighted Provisions:
             14          This bill:
             15          .    defines terms;
             16          .    authorizes a physician assistant or a psychologist to determine whether an adult
             17      lacks health care decision making capacity;
             18          .    provides that a physician assistant may sign a life with dignity order; and
             19          .    makes technical changes.
             20      Monies Appropriated in this Bill:
             21          None
             22      Other Special Clauses:
             23          None
             24      Utah Code Sections Affected:
             25      AMENDS:


             26          75-2a-103, as last amended by Laws of Utah 2008, Chapters 3 and 107
             27          75-2a-104, as last amended by Laws of Utah 2008, Chapter 107
             28          75-2a-106, as repealed and reenacted by Laws of Utah 2008, Chapter 107
             29          75-2a-109, as last amended by Laws of Utah 2008, Chapter 107
             30          75-2a-117, as last amended by Laws of Utah 2008, Chapter 107
             31     
             32      Be it enacted by the Legislature of the state of Utah:
             33          Section 1. Section 75-2a-103 is amended to read:
             34           75-2a-103. Definitions.
             35          As used in this chapter:
             36          (1) "Adult" means a person who is:
             37          (a) at least 18 years of age; or
             38          (b) an emancipated minor.
             39          (2) "Advance health care directive":
             40          (a) includes:
             41          (i) a designation of an agent to make health care decisions for an adult when the adult
             42      cannot make or communicate health care decisions; or
             43          (ii) an expression of preferences about health care decisions;
             44          (b) may take one of the following forms:
             45          (i) a written document, voluntarily executed by an adult in accordance with the
             46      requirements of this chapter; or
             47          (ii) a witnessed oral statement, made in accordance with the requirements of this
             48      chapter; and
             49          (c) does not include a life with dignity order.
             50          (3) "Agent" means a person designated in an advance health care directive to make
             51      health care decisions for the declarant.
             52          (4) "APRN" means a person who is:
             53          (a) certified or licensed as an advance practice registered nurse under Subsection
             54      58-31b-301 (2)(d);
             55          (b) an independent practitioner;
             56          (c) acting under a consultation and referral plan with a physician; and


             57          (d) acting within the scope of practice for that person, as provided by law, rule, and
             58      specialized certification and training in that person's area of practice.
             59          (5) "Best interest" means that the benefits to the person resulting from a treatment
             60      outweigh the burdens to the person resulting from the treatment, taking into account:
             61          (a) the effect of the treatment on the physical, emotional, and cognitive functions of the
             62      person;
             63          (b) the degree of physical pain or discomfort caused to the person by the treatment or
             64      the withholding or withdrawal of treatment;
             65          (c) the degree to which the person's medical condition, the treatment, or the
             66      withholding or withdrawal of treatment, result in a severe and continuing impairment of the
             67      dignity of the person by subjecting the person to humiliation and dependency;
             68          (d) the effect of the treatment on the life expectancy of the person;
             69          (e) the prognosis of the person for recovery with and without the treatment;
             70          (f) the risks, side effects, and benefits of the treatment, or the withholding or
             71      withdrawal of treatment; and
             72          (g) the religious beliefs and basic values of the person receiving treatment, to the extent
             73      these may assist the decision maker in determining the best interest.
             74          (6) "Capacity to appoint an agent" means that the adult understands the consequences
             75      of appointing a particular person as agent.
             76          (7) "Declarant" means an adult who has completed and signed or directed the signing
             77      of an advance health care directive.
             78          (8) "Default surrogate" means the adult who may make decisions for an individual
             79      when either:
             80          (a) an agent or guardian has not been appointed; or
             81          (b) an agent is not able, available, or willing to make decisions for an adult.
             82          (9) "Emergency medical services provider" means a person who is licensed,
             83      designated, or certified under Title 26, Chapter 8a, Utah Emergency Medical Services System
             84      Act.
             85          (10) "Generally accepted health care standards":
             86          (a) is defined only for the purpose of:
             87          (i) this chapter and does not define the standard of care for any other purpose under


             88      Utah law; and
             89          (ii) enabling health care providers to interpret the statutory form set forth in Section
             90      75-2a-117 ; and
             91          (b) means the standard of care that justifies a provider in declining to provide life
             92      sustaining care because the proposed life sustaining care:
             93          (i) will not prevent or reduce the deterioration in the health or functional status of a
             94      person;
             95          (ii) will not prevent the impending death of a person; or
             96          (iii) will impose more burden on the person than any expected benefit to the person.
             97          (11) "Health care" means any care, treatment, service, or procedure to improve,
             98      maintain, diagnose, or otherwise affect a person's physical or mental condition.
             99          (12) "Health care decision":
             100          (a) means a decision about an adult's health care made by, or on behalf of, an adult, that
             101      is communicated to a health care provider;
             102          (b) includes:
             103          (i) selection and discharge of a health care provider and a health care facility;
             104          (ii) approval or disapproval of diagnostic tests, procedures, programs of medication,
             105      and orders not to resuscitate; and
             106          (iii) directions to provide, withhold, or withdraw artificial nutrition and hydration and
             107      all other forms of health care; and
             108          (c) does not include decisions about an adult's financial affairs or social interactions
             109      other than as indirectly affected by the health care decision.
             110          (13) "Health care decision making capacity" means an adult's ability to make an
             111      informed decision about receiving or refusing health care, including:
             112          (a) the ability to understand the nature, extent, or probable consequences of health
             113      status and health care alternatives;
             114          (b) the ability to make a rational evaluation of the burdens, risks, benefits, and
             115      alternatives of accepting or rejecting health care; and
             116          (c) the ability to communicate a decision.
             117          (14) "Health care facility" means:
             118          (a) a health care facility as defined in Title 26, Chapter 21, Health Care Facility


             119      Licensing and Inspection Act; and
             120          (b) private offices of physicians, dentists, and other health care providers licensed to
             121      provide health care under Title 58, Occupations and Professions.
             122          (15) "Health care provider" is as defined in Section 78B-3-403 , except that it does not
             123      include an emergency medical services provider.
             124          (16) (a) "Life sustaining care" means any medical intervention, including procedures,
             125      administration of medication, or use of a medical device, that maintains life by sustaining,
             126      restoring, or supplanting a vital function.
             127          (b) "Life sustaining care" does not include care provided for the purpose of keeping a
             128      person comfortable.
             129          (17) "Life with dignity order" means an order, designated by the Department of Health
             130      under Section 75-2a-106 (5)(a), that gives direction to health care providers, health care
             131      facilities, and emergency medical services providers regarding the specific health care
             132      decisions of the person to whom the order relates.
             133          (18) "Minor" means a person who:
             134          (a) is under 18 years of age; and
             135          (b) is not an emancipated minor.
             136          (19) "Physician" means a physician and surgeon or osteopathic surgeon licensed under
             137      Title 58, Chapter 67, Utah Medical Practice Act or Chapter 68, Utah Osteopathic Medical
             138      Practice Act.
             139          (20) "Physician assistant" means a person licensed as a physician assistant under Title
             140      58, Chapter 70a, Physician Assistant Act.
             141          (21) "Psychologist" means a person licensed as a psychologist under Title 58, Chapter
             142      61, Psychologist Licensing Act.
             143          [(20)] (22) "Reasonably available" means:
             144          (a) readily able to be contacted without undue effort; and
             145          (b) willing and able to act in a timely manner considering the urgency of the
             146      circumstances.
             147          [(21)] (23) "Substituted judgment" means the standard to be applied by a surrogate
             148      when making a health care decision for an adult who previously had the capacity to make
             149      health care decisions, which requires the surrogate to consider:


             150          (a) specific preferences expressed by the adult:
             151          (i) when the adult had the capacity to make health care decisions; and
             152          (ii) at the time the decision is being made;
             153          (b) the surrogate's understanding of the adult's health care preferences;
             154          (c) the surrogate's understanding of what the adult would have wanted under the
             155      circumstances; and
             156          (d) to the extent that the preferences described in Subsections [(21)] (23)(a) through (c)
             157      are unknown, the best interest of the adult.
             158          [(22)] (24) "Surrogate" means a health care decision maker who is:
             159          (a) an appointed agent;
             160          (b) a default surrogate under the provisions of Section 75-2a-108 ; or
             161          (c) a guardian.
             162          Section 2. Section 75-2a-104 is amended to read:
             163           75-2a-104. Capacity to make health care decisions -- Presumption -- Overcoming
             164      presumption.
             165          (1) An adult is presumed to have:
             166          (a) health care decision making capacity; and
             167          (b) capacity to make or revoke an advance health care directive.
             168          (2) To overcome the presumption of capacity described in Subsection (1)(a), a
             169      physician, physician assistant, psychologist, or an APRN who has personally examined the
             170      adult and assessed the adult's health care decision making capacity must:
             171          (a) find that the adult lacks health care decision making capacity;
             172          (b) record the finding in the adult's medical chart including an indication of whether
             173      the adult is likely to regain health care decision making capacity; and
             174          (c) make a reasonable effort to communicate the determination to:
             175          (i) the adult;
             176          (ii) other health care providers or health care facilities that the [physician or APRN]
             177      person who makes the finding would routinely inform of such a finding; and
             178          (iii) if the adult has a surrogate, any known surrogate.
             179          (3) (a) [If a physician or APRN finds that an adult lacks] An adult who is found to lack
             180      health care decision making capacity in accordance with Subsection (2)[, the adult] may, at any


             181      time, challenge the finding by:
             182          (i) submitting to a health care provider a written notice stating that the adult disagrees
             183      with the physician's finding; or
             184          (ii) orally informing the health care provider that the adult disagrees with the finding.
             185          (b) A health care provider who is informed of a challenge under Subsection (3)(a),
             186      shall, if the adult has a surrogate, promptly inform the surrogate of the adult's challenge.
             187          (c) A surrogate informed of a challenge to a finding under this section, or the adult if
             188      no surrogate is acting on the adult's behalf, shall inform the following of the adult's challenge:
             189          (i) any other health care providers involved in the adult's care; and
             190          (ii) the health care facility, if any, in which the adult is receiving care.
             191          (d) Unless otherwise ordered by a court, a finding [by a physician], under Subsection
             192      (2), that the adult lacks health care decision making capacity, is not in effect if the adult
             193      challenges the finding under Subsection (3)(a).
             194          (e) If an adult does not challenge the finding described in Subsection (2), the health
             195      care provider and health care facility may rely on a surrogate, pursuant to the provisions of this
             196      chapter, to make health care decisions for the adult.
             197          (4) A health care provider or health care facility that relies on a surrogate to make
             198      decisions on behalf of an adult has an ongoing obligation to consider whether the adult
             199      continues to lack health care decision making capacity.
             200          (5) If at any time a health care provider finds, based on an examination and assessment,
             201      that the adult has regained health care decision making capacity, the health care provider shall
             202      record the results of the assessment in the adult's medical record, and the adult can direct the
             203      adult's own health care.
             204          Section 3. Section 75-2a-106 is amended to read:
             205           75-2a-106. Emergency medical services -- Life with dignity order.
             206          (1) A life with dignity order may be created by or on behalf of a person as described in
             207      this section.
             208          (2) A life with dignity order shall, in consultation with the person authorized to consent
             209      to the order pursuant to this section, be prepared by:
             210          (a) the physician, physician assistant, or APRN of the person to whom the life with
             211      dignity order relates; or


             212          (b) a health care provider who:
             213          (i) is acting under the supervision of a person described in Subsection (2)(a); and
             214          (ii) is:
             215          (A) a nurse, licensed under Title 58, Chapter 31b, Nurse Practice Act;
             216          (B) a physician assistant, licensed under Title 58, Chapter 70a, Physician Assistant
             217      Act;
             218          (C) a mental health professional, licensed under Title 58, Chapter 60, Mental Health
             219      Professional Practice Act; or
             220          (D) another health care provider, designated by rule as described in Subsection (10).
             221          (3) A life with dignity order shall be signed:
             222          (a) personally, by the physician, physician assistant, or APRN of the person to whom
             223      the life with dignity order relates; and
             224          (b) (i) if the person to whom the life with dignity order relates is an adult with health
             225      care decision making capacity, by:
             226          (A) the person; or
             227          (B) an adult who is directed by the person to sign the life with dignity order on behalf
             228      of the person;
             229          (ii) if the person to whom the life with dignity order relates is an adult who lacks health
             230      care decision making capacity, by:
             231          (A) the surrogate with the highest priority under Section 75-2a-111 ;
             232          (B) the majority of the class of surrogates with the highest priority under Section
             233      75-2a-111 ; or
             234          (C) a person directed to sign the order by, and on behalf of, the persons described in
             235      Subsection (3)(b)(ii)(A) or (B); or
             236          (iii) if the person to whom the life with dignity order relates is a minor, by a parent or
             237      guardian of the minor.
             238          (4) If a life with dignity order relates to a minor and directs that life sustaining
             239      treatment be withheld or withdrawn from the minor, the order shall include a certification by
             240      two physicians that, in their clinical judgment, an order to withhold or withdraw life sustaining
             241      treatment is in the best interest of the minor.
             242          (5) A life with dignity order:


             243          (a) shall be in writing, on a form approved by the Department of Health;
             244          (b) shall state the date on which the order was made;
             245          (c) may specify the level of life sustaining care to be provided to the person to whom
             246      the order relates; and
             247          (d) may direct that life sustaining care be withheld or withdrawn from the person to
             248      whom the order relates.
             249          (6) A health care provider or emergency medical service provider, licensed or certified
             250      under Title 26, Chapter 8a, Utah Emergency Medical Services System Act, is immune from
             251      civil or criminal liability, and is not subject to discipline for unprofessional conduct, for:
             252          (a) complying with a life with dignity order in good faith; or
             253          (b) providing life sustaining treatment to a person when a life with dignity order directs
             254      that the life sustaining treatment be withheld or withdrawn.
             255          (7) To the extent that the provisions of a life with dignity order described in this
             256      section conflict with the provisions of an advance health care directive made under Section
             257      75-2a-107 , the provisions of the life with dignity order take precedence.
             258          (8) An adult, or a parent or guardian of a minor, may revoke a life with dignity order
             259      by:
             260          (a) orally informing emergency service personnel;
             261          (b) writing "void" across the form;
             262          (c) burning, tearing, or otherwise destroying or defacing:
             263          (i) the form; or
             264          (ii) a bracelet or other evidence of the life with dignity order;
             265          (d) asking another adult to take the action described in this Subsection (8) on the
             266      person's behalf;
             267          (e) signing or directing another adult to sign a written revocation on the person's
             268      behalf;
             269          (f) stating, in the presence of an adult witness, that the person wishes to revoke the
             270      order; or
             271          (g) completing a new life with dignity order.
             272          (9) (a) Except as provided in Subsection (9)(c), a surrogate for an adult who lacks
             273      health care decision making capacity may only revoke a life with dignity order if the revocation


             274      is consistent with the substituted judgment standard.
             275          (b) Except as provided in Subsection (9)(c), a surrogate who has authority under this
             276      section to sign a life with dignity order may revoke a life with dignity order, in accordance with
             277      Subsection (9)(a), by:
             278          (i) signing a written revocation of the life with dignity order; or
             279          (ii) completing and signing a new life with dignity order.
             280          (c) A surrogate may not revoke a life with dignity order during the period of time
             281      beginning when an emergency service provider is contacted for assistance, and ending when
             282      the emergency ends.
             283          (10) (a) The Department of Health shall adopt rules, in accordance with Title 63G,
             284      Chapter 3, Utah Administrative Rulemaking Act, to:
             285          (i) create the forms and systems described in this section; and
             286          (ii) develop uniform instructions for the form established in Section 75-2a-117 .
             287          (b) The Department of Health may adopt rules, in accordance with Title 63G, Chapter
             288      3, Utah Administrative Rulemaking Act, to designate health care professionals, in addition to
             289      those described in Subsection (2)(b)(ii), who may prepare a life with dignity order.
             290          (c) The Department of Health may assist others with training of health care
             291      professionals regarding this chapter.
             292          Section 4. Section 75-2a-109 is amended to read:
             293           75-2a-109. Effect of current health care preferences -- When a surrogate may act.
             294          (1) An adult with health care decision making capacity retains the right to make health
             295      care decisions as long as the adult has health care decision making capacity as defined in
             296      Section 75-2a-103 . For purposes of this chapter, the inability to communicate through speech
             297      does not mean that the adult lacks health care decision making capacity.
             298          (2) An adult's current health care decisions, however expressed or indicated, always
             299      supersede an adult's prior decisions or health care directives.
             300          (3) Unless otherwise directed in an advance health care directive, an advance health
             301      care directive or the authority of a surrogate to make health care decisions on behalf of an
             302      adult:
             303          (a) is effective only after a physician, physician assistant, psychologist, or APRN
             304      makes a determination of incapacity as provided in Section 75-2a-104 ;


             305          (b) remains in effect during any period of time in which the declarant lacks capacity to
             306      make health care decisions; and
             307          (c) ceases to be effective when:
             308          (i) a declarant disqualifies a surrogate or revokes the advance health care directive;
             309          (ii) a health care provider finds that the declarant has health care decision making
             310      capacity;
             311          (iii) a court issues an order invalidating a health care directive; or
             312          (iv) the declarant has challenged the finding of incapacity under the provisions of
             313      Subsection 75-2a-104 (3).
             314          Section 5. Section 75-2a-117 is amended to read:
             315           75-2a-117. Optional form.
             316          (1) The form created in Subsection (2), or a substantially similar form, is presumed
             317      valid under this chapter.
             318          (2) The following form is presumed valid under Subsection (1):
             319     
Utah Advance Health Care Directive

             320     
(Pursuant to Utah Code Section 75-2a-117 )

             321      Part I: Allows you to name another person to make health care decisions for you when you
             322      cannot make decisions or speak for yourself.
             323      Part II: Allows you to record your wishes about health care in writing.
             324      Part III: Tells you how to revoke or change this directive.
             325      Part IV: Makes your directive legal.
             326      __________________________________________________________________________
             327     
My Personal Information

             328      Name: ____________________________________________________________________
             329      Street Address: _____________________________________________________________
             330      City, State, Zip Code:
             331      _____________________________________________________________
             332      Telephone: _________________________ Cell Phone: ____________________________
             333      Birth date: _____________
             334      ____________________________________________________________________________
             335     
Part I: My Agent (Health Care Power of Attorney)


             336      A. No Agent
             337      If you do not want to name an agent: initial the box below, then go to Part II; do not name an
             338      agent in B or C below. No one can force you to name an agent.
             339      ______    I do not want to choose an agent.
             340      B. My Agent
             341      Agent's Name:
             342      ______________________________________________________________
             343      Street Address:
             344      ______________________________________________________________
             345      City, State, Zip Code:
             346      ______________________________________________________________
             347      Home Phone: ( ) _________ Cell Phone: ( ) _________ Work Phone: ( ) __________
             348      C. My Alternate Agent
             349      This person will serve as your agent if your agent, named above, is unable or unwilling to
             350      serve.
             351      Alternate Agent's Name:
             352      ______________________________________________________
             353      Street Address:
             354      ______________________________________________________________
             355      City, State, Zip Code:
             356      ______________________________________________________________
             357      Home Phone: ( ) _________ Cell Phone: ( ) _________ Work Phone: ( ) __________
             358      D. Agent's Authority
             359      If I cannot make decisions or speak for myself (in other words, after my physician or [APRN]
             360      another authorized provider finds that I lack health care decision making capacity under
             361      Section 75-2a-104 of the Advance Health Care Directive Act), my agent has the power to make
             362      any health care decision I could have made such as, but not limited to:
             363      * Consent to, refuse, or withdraw any health care. This may include care to prolong my life
             364      such as food and fluids by tube, use of antibiotics, CPR (cardiopulmonary resuscitation), and
             365      dialysis, and mental health care, such as convulsive therapy and psychoactive medications.
             366      This authority is subject to any limits in paragraph F of Part I or in Part II of this directive.


             367      * Hire and fire health care providers.
             368      * Ask questions and get answers from health care providers.
             369      * Consent to admission or transfer to a health care provider or health care facility, including a
             370      mental health facility, subject to any limits in paragraphs E and F of Part I.
             371      * Get copies of my medical records.
             372      * Ask for consultations or second opinions.
             373      My agent cannot force health care against my will, even if a physician has found that I lack
             374      health care decision making capacity.
             375      E. Other Authority
             376      My agent has the powers below ONLY IF I initial the "yes" option that precedes the statement.
             377      I authorize my agent to:
             378      YES _____ NO _____    Get copies of my medical records at any time, even when I can
             379      speak for myself.
             380      YES _____ NO _____    Admit me to a licensed health care facility, such as a hospital,
             381      nursing home, assisted living, or other facility for long-term placement other than convalescent
             382      or recuperative care.
             383      F. Limits/Expansion of Authority
             384      I wish to limit or expand the powers of my health care agent as follows:
             385      ____________________________________________________________________________
             386      ____________________________________________________________________________
             387      G. Nomination of Guardian
             388      Even though appointing an agent should help you avoid a guardianship, a guardianship may
             389      still be necessary. Initial the "YES" option if you want the court to appoint your agent or, if
             390      your agent is unable or unwilling to serve, your alternate agent, to serve as your guardian, if a
             391      guardianship is ever necessary.
             392      YES _____ NO _____    
             393      I, being of sound mind and not acting under duress, fraud, or other undue influence, do hereby
             394      nominate my agent, or if my agent is unable or unwilling to serve, I hereby nominate my
             395      alternate agent, to serve as my guardian in the event that, after the date of this instrument, I
             396      become incapacitated.
             397      H. Consent to Participate in Medical Research


             398      YES _____ NO _____    I authorize my agent to consent to my participation in medical
             399      research or clinical trials, even if I may not benefit from the results.
             400      I. Organ Donation
             401      YES _____ NO _____    If I have not otherwise agreed to organ donation, my agent may
             402      consent to the donation of my organs for the purpose of organ transplantation.
             403      __________________________________________________________________________
             404     
Part II: My Health Care Wishes (Living Will)

             405      I want my health care providers to follow the instructions I give them when I am being treated,
             406      even if my instructions conflict with these or other advance directives. My health care
             407      providers should always provide health care to keep me as comfortable and functional as
             408      possible.
             409      Choose only one of the following options, numbered Option 1 through Option 4, by placing
             410      your initials before the numbered statement. Do not initial more than one option. If you do not
             411      wish to document end-of-life wishes, initial Option 4. You may choose to draw a line through
             412      the options that you are not choosing.
             413      Option 1
             414      ________ Initial
             415      I choose to let my agent decide. I have chosen my agent carefully. I have talked with my agent
             416      about my health care wishes. I trust my agent to make the health care decisions for me that I
             417      would make under the circumstances.
             418      Additional Comments:
             419      _____________________________________________________________________
             420      Option 2
             421      ________ Initial
             422      I choose to prolong life. Regardless of my condition or prognosis, I want my health care team
             423      to try to prolong my life as long as possible within the limits of generally accepted health care
             424      standards.
             425      Other:
             426      _____________________________________________________________________
             427      Option 3
             428      ________ Initial


             429      I choose not to receive care for the purpose of prolonging life, including food and fluids by
             430      tube, antibiotics, CPR, or dialysis being used to prolong my life. I always want comfort care
             431      and routine medical care that will keep me as comfortable and functional as possible, even if
             432      that care may prolong my life.
             433      If you choose this option, you must also choose either (a) or (b), below.
             434      ______ Initial
             435      (a) I put no limit on the ability of my health care provider or agent to withhold or withdraw
             436      life-sustaining care.
             437      If you selected (a), above, do not choose any options under (b).
             438      ______ Initial
             439      (b) My health care provider should withhold or withdraw life-sustaining care if at least one of
             440      the following initialed conditions is met:
             441      _____ I have a progressive illness that will cause death.
             442      _____ I am close to death and am unlikely to recover.
             443      _____ I cannot communicate and it is unlikely that my condition will improve.
             444      _____ I do not recognize my friends or family and it is unlikely that my condition will
             445      improve.
             446      _____ I am in a persistent vegetative state.
             447      Other:
             448      _____________________________________________________________________
             449      Option 4
             450      ________ Initial
             451      I do not wish to express preferences about health care wishes in this directive.
             452      Other:
             453      _____________________________________________________________________
             454      Additional instructions about your health care wishes:
             455      ____________________________________________________________________________
             456      ____________________________________________________________________________
             457      If you do not want emergency medical service providers to provide CPR or other life sustaining
             458      measures, you must work with a physician or APRN to complete an order that reflects your
             459      wishes on a form approved by the Utah Department of Health.


             460     
Part III: Revoking or Changing a Directive

             461      I may revoke or change this directive by:
             462      1. Writing "void" across the form, or burning, tearing, or otherwise destroying or defacing this
             463      document or directing another person to do the same on my behalf;
             464      2. Signing a written revocation of the directive, or directing another person to sign a
             465      revocation on my behalf;
             466      3. Stating that I wish to revoke the directive in the presence of a witness who: is 18 years of
             467      age or older; will not be appointed as my agent in a substitute directive; will not become a
             468      default surrogate if the directive is revoked; and signs and dates a written document confirming
             469      my statement; or
             470      4. Signing a new directive. (If you sign more than one Advance Health Care Directive, the
             471      most recent one applies.)
             472     
Part IV: Making My Directive Legal

             473      I sign this directive voluntarily. I understand the choices I have made and declare that I am
             474      emotionally and mentally competent to make this directive. My signature on this form revokes
             475      any living will or power of attorney form, naming a health care agent, that I have completed in
             476      the past.
             477      ____________________________________
             478      Date
             479      ________________________________________________
             480      Signature
             481      ____________________________________________________________________________
             482      City, County, and State of Residence
             483      I have witnessed the signing of this directive, I am 18 years of age or older, and I am not:
             484      1. related to the declarant by blood or marriage;
             485      2. entitled to any portion of the declarant's estate according to the laws of intestate succession
             486      of any state or jurisdiction or under any will or codicil of the declarant;
             487      3. a beneficiary of a life insurance policy, trust, qualified plan, pay on death account, or
             488      transfer on death deed that is held, owned, made, or established by, or on behalf of, the
             489      declarant;
             490      4. entitled to benefit financially upon the death of the declarant;


             491      5. entitled to a right to, or interest in, real or personal property upon the death of the declarant;
             492      6. directly financially responsible for the declarant's medical care;
             493      7. a health care provider who is providing care to the declarant or an administrator at a health
             494      care facility in which the declarant is receiving care; or
             495      8. the appointed agent or alternate agent.
             496      _____________________________________ __________________________________
             497      Signature of Witness                    Printed Name of Witness
             498      _____________________________________    ___________     _________ _________
             499      Street Address                    City         State     Zip Code
             500      If the witness is signing to confirm an oral directive, describe below the circumstances under
             501      which the directive was made.
             502      ____________________________________________________________________________
             503      ____________________________________________________________________________


[Bill Documents][Bills Directory]