This document includes House Committee Amendments incorporated into the bill on Thu, Feb 1, 2024 at 9:51 AM by housengrossing.
1     
ORDER FOR LIFE SUSTAINING TREATMENT

2     
AMENDMENTS

3     
2024 GENERAL SESSION

4     
STATE OF UTAH

5     
Chief Sponsor: Stephanie Gricius

6     
Senate Sponsor: Michael S. Kennedy

7     

8     LONG TITLE
9     General Description:
10          This bill modifies provisions related to orders for life sustaining treatment.
11     Highlighted Provisions:
12          This bill:
13          ▸     modifies professional conduct standards for physicians, advance practice registered
14     nurses, and physician assistants Ĥ→ [to include obtaining a parent or guardian signature
15     when completing an order for life sustaining treatment for a minor] related to do not resuscitate
15a     orders ←Ĥ ; and
16          ▸     makes technical and conforming changes Ĥ→ related orders for life sustaining
16a     treatment ←Ĥ .
17     Money Appropriated in this Bill:
18          None
19     Other Special Clauses:
20          None
21     Utah Code Sections Affected:
22     AMENDS:
23          58-31b-502, as last amended by Laws of Utah 2023, Chapters 223, 301 and 329
24          58-67-502, as last amended by Laws of Utah 2023, Chapters 2, 301, 317, and 329
25          58-68-502, as last amended by Laws of Utah 2023, Chapters 2, 301, 317, and 329
26          58-70a-503, as last amended by Laws of Utah 2023, Chapter 329
27          75-2a-103, as last amended by Laws of Utah 2023, Chapters 139, 330
28          75-2a-106, as last amended by Laws of Utah 2023, Chapter 330
29     

30     Be it enacted by the Legislature of the state of Utah:
31          Section 1. Section 58-31b-502 is amended to read:
32          58-31b-502. Unprofessional conduct.
33          (1) "Unprofessional conduct" includes:
34          (a) failure to safeguard a patient's right to privacy as to the patient's person, condition,
35     diagnosis, personal effects, or any other matter about which the licensee is privileged to know
36     because of the licensee's or person with a certification's position or practice as a nurse or
37     practice as a medication aide certified;
38          (b) failure to provide nursing service or service as a medication aide certified in a
39     manner that demonstrates respect for the patient's human dignity and unique personal character
40     and needs without regard to the patient's race, religion, ethnic background, socioeconomic
41     status, age, sex, or the nature of the patient's health problem;
42          (c) engaging in sexual relations with a patient during any:
43          (i) period when a generally recognized professional relationship exists between the
44     person licensed or certified under this chapter and the patient; or
45          (ii) extended period when a patient has reasonable cause to believe a professional
46     relationship exists between the person licensed or certified under the provisions of this chapter
47     and the patient;
48          (d) (i) as a result of any circumstance under Subsection (1)(c), exploiting or using
49     information about a patient or exploiting the licensee's or the person with a certification's
50     professional relationship between the licensee or holder of a certification under this chapter and
51     the patient; or
52          (ii) exploiting the patient by use of the licensee's or person with a certification's
53     knowledge of the patient obtained while acting as a nurse or a medication aide certified;
54          (e) unlawfully obtaining, possessing, or using any prescription drug or illicit drug;
55          (f) unauthorized taking or personal use of nursing supplies from an employer;
56          (g) unauthorized taking or personal use of a patient's personal property;
57          (h) unlawful or inappropriate delegation of nursing care;
58          (i) failure to exercise appropriate supervision of persons providing patient care services
59     under supervision of the licensed nurse;
60          (j) employing or aiding and abetting the employment of an unqualified or unlicensed
61     person to practice as a nurse;
62          (k) failure to file or record any medical report as required by law, impeding or
63     obstructing the filing or recording of such a report, or inducing another to fail to file or record
64     such a report;
65          (l) breach of a statutory, common law, regulatory, or ethical requirement of
66     confidentiality with respect to a person who is a patient, unless ordered by a court;
67          (m) failure to pay a penalty imposed by the division;
68          (n) violating Section 58-31b-801;
69          (o) violating the dispensing requirements of Section 58-17b-309 or Chapter 17b, Part
70     8, Dispensing Medical Practitioner and Dispensing Medical Practitioner Clinic Pharmacy, if
71     applicable;
72          (p) performing or inducing an abortion in violation of the requirements of Section
73     76-7-302 or Section 76-7a-201, regardless of whether the person licensed or certified under the
74     provisions of this chapter is found guilty of a crime in connection with the violation;
75          (q) falsely making an entry in, or altering, a medical record with the intent to conceal:
76          (i) a wrongful or negligent act or omission of an individual licensed under this chapter
77     or an individual under the direction or control of an individual licensed under this chapter; or
78          (ii) conduct described in Subsections (1)(a) through (n) or Subsection 58-1-501(1); [or]
79          (r) violating the requirements of Title 26B, Chapter 4, Part 2, Cannabinoid Research
80     and Medical Cannabis[.]; or
81          (s) for an advance practice registered nurse, Ĥ→ [failing to comply with Subsection
82     75-2a-106(3)(b)(iii) when completing an order for life sustaining treatment for the minor]     
82a     designating a child as do not resuscitate without parental consent ←Ĥ .
83          (2) "Unprofessional conduct" does not include, in accordance with Title 26B, Chapter
84     4, Part 2, Cannabinoid Research and Medical Cannabis, when registered as a qualified medical
85     provider, or acting as a limited medical provider, as those terms are defined in Section
86     26B-4-201, recommending the use of medical cannabis.
87          (3) Notwithstanding Subsection (2), the division, in consultation with the board and in
88     accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, shall define
89     unprofessional conduct for an advanced practice registered nurse described in Subsection (2).
90          Section 2. Section 58-67-502 is amended to read:
91          58-67-502. Unprofessional conduct.
92          (1) "Unprofessional conduct" includes, in addition to the definition in Section
93     58-1-501:
94          (a) using or employing the services of any individual to assist a licensee in any manner
95     not in accordance with the generally recognized practices, standards, or ethics of the
96     profession, state law, or division rule;
97          (b) making a material misrepresentation regarding the qualifications for licensure under
98     Section 58-67-302.7 or 58-67-302.8;
99          (c) violating the dispensing requirements of Chapter 17b, Part 8, Dispensing Medical
100     Practitioner and Dispensing Medical Practitioner Clinic Pharmacy, if applicable;
101          (d) violating the requirements of Title 26B, Chapter 4, Part 2, Cannabinoid Research
102     and Medical Cannabis;
103          (e) performing or inducing an abortion in violation of the requirements of Section
104     76-7-302 or Section 76-7a-201, regardless of whether the individual licensed under this chapter
105     is found guilty of a crime in connection with the violation;
106          (f) falsely making an entry in, or altering, a medical record with the intent to conceal:
107          (i) a wrongful or negligent act or omission of an individual licensed under this chapter
108     or an individual under the direction or control of an individual licensed under this chapter; or
109          (ii) conduct described in Subsections (1)(a) through (e) or Subsection 58-1-501(1); [or]
110          (g) performing, or causing to be performed, upon an individual who is less than 18
111     years old:
112          (i) a primary sex characteristic surgical procedure; or
113          (ii) a secondary sex characteristic surgical procedure[.]; or
114          (h) Ĥ→ [failing to comply with Subsection 75-2a-106(3)(b)(iii) when completing an order
115     for life sustaining treatment for the minor] designating a child as do not resuscitate without
115a     parental consent ←Ĥ .
116          (2) "Unprofessional conduct" does not include:
117          (a) in compliance with Section 58-85-103:
118          (i) obtaining an investigational drug or investigational device;
119          (ii) administering the investigational drug to an eligible patient; or
120          (iii) treating an eligible patient with the investigational drug or investigational device;
121     or
122          (b) in accordance with Title 26B, Chapter 4, Part 2, Cannabinoid Research and
123     Medical Cannabis:
124          (i) when registered as a qualified medical provider or acting as a limited medical
125     provider, as those terms are defined in Section 26B-4-201, recommending the use of medical
126     cannabis; or
127          (ii) when registered as a pharmacy medical provider, as that term is defined in Section
128     26B-4-201, providing pharmacy medical provider services in a medical cannabis pharmacy.
129          (3) Notwithstanding Subsection (2)(b), the division, in consultation with the board and
130     in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, shall define
131     unprofessional conduct for a physician described in Subsection (2)(b).
132          Section 3. Section 58-68-502 is amended to read:
133          58-68-502. Unprofessional conduct.
134          (1) "Unprofessional conduct" includes, in addition to the definition in Section
135     58-1-501:
136          (a) using or employing the services of any individual to assist a licensee in any manner
137     not in accordance with the generally recognized practices, standards, or ethics of the
138     profession, state law, or division rule;
139          (b) violating the dispensing requirements of Chapter 17b, Part 8, Dispensing Medical
140     Practitioner and Dispensing Medical Practitioner Clinic Pharmacy, if applicable;
141          (c) making a material misrepresentation regarding the qualifications for licensure under
142     Section 58-68-302.5;
143          (d) violating the requirements of Title 26B, Chapter 4, Part 2, Cannabinoid Research
144     and Medical Cannabis;
145          (e) performing or inducing an abortion in violation of the requirements of Section
146     76-7-302 or Section 76-7a-201, regardless of whether the individual licensed under this chapter
147     is found guilty of a crime in connection with the violation;
148          (f) falsely making an entry in, or altering, a medical record with the intent to conceal:
149          (i) a wrongful or negligent act or omission of an individual licensed under this chapter
150     or an individual under the direction or control of an individual licensed under this chapter; or
151          (ii) conduct described in Subsections (1)(a) through (e) or Subsection 58-1-501(1); [or]
152          (g) performing or causing to be performed, upon an individual who is less than 18
153     years old[;]:
154          (i) a primary sex characteristic surgical procedure; or
155          (ii) a secondary sex characteristic surgical procedure[.]; or
156          (h) Ĥ→ [failing to comply with Subsection 75-2a-106(3)(b)(iii) when completing an order
157     for life sustaining treatment for the minor] designating a child as do not resuscitate without
157a     parental consent ←Ĥ .
158          (2) "Unprofessional conduct" does not include:
159          (a) in compliance with Section 58-85-103:
160          (i) obtaining an investigational drug or investigational device;
161          (ii) administering the investigational drug to an eligible patient; or
162          (iii) treating an eligible patient with the investigational drug or investigational device;
163     or
164          (b) in accordance with Title 26B, Chapter 4, Part 2, Cannabinoid Research and
165     Medical Cannabis:
166          (i) when registered as a qualified medical provider or acting as a limited medical
167     provider, as those terms are defined in Section 26B-4-201, recommending the use of medical
168     cannabis; or
169          (ii) when registered as a pharmacy medical provider, as that term is defined in Section
170     26B-4-201, providing pharmacy medical provider services in a medical cannabis pharmacy.
171          (3) Notwithstanding Subsection (2)(b), the division, in consultation with the board and
172     in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, shall define
173     unprofessional conduct for a physician described in Subsection (2)(b).
174          Section 4. Section 58-70a-503 is amended to read:
175          58-70a-503. Unprofessional conduct.
176          (1) "Unprofessional conduct" includes:
177          (a) violation of a patient confidence to any person who does not have a legal right and a
178     professional need to know the information concerning the patient;
179          (b) knowingly prescribing, selling, giving away, or directly or indirectly administering,
180     or offering to prescribe, sell, furnish, give away, or administer any prescription drug except for
181     a legitimate medical purpose upon a proper diagnosis indicating use of that drug in the amounts
182     prescribed or provided;
183          (c) prescribing prescription drugs for oneself or administering prescription drugs to
184     oneself, except those that have been legally prescribed for the physician assistant by a licensed
185     practitioner and that are used in accordance with the prescription order for the condition
186     diagnosed;
187          (d) in a practice that has physician assistant ownership interests, failure to allow a
188     physician the independent final decision making authority on treatment decisions for the
189     physician's patient;
190          (e) violating the dispensing requirements of Chapter 17b, Part 8, Dispensing Medical
191     Practitioner and Dispensing Medical Practitioner Clinic Pharmacy, if applicable;
192          (f) falsely making an entry in, or altering, a medical record with the intent to conceal:
193          (i) a wrongful or negligent act or omission of an individual licensed under this chapter
194     or an individual under the direction or control of an individual licensed under this chapter; or
195          (ii) conduct described in Subsections (1)(a) through (e) or Subsection 58-1-501(1);
196     [and]
197          (g) violating the requirements of Title 26B, Chapter 4, Part 2, Cannabinoid Research
198     and Medical Cannabis[.]; or
199          (h) Ĥ→ [failing to comply with Subsection 75-2a-106(3)(b)(iii) when completing an order
200     for life sustaining treatment for the minor]       designating a child as do not resuscitate without
200a     parental consent ←Ĥ .
201          (2) (a) "Unprofessional conduct" does not include, in accordance with Title 26B,
202     Chapter 4, Part 2, Cannabinoid Research and Medical Cannabis, when registered as a qualified
203     medical provider or acting as a limited medical provider, as those terms are defined in Section
204     26B-4-201, recommending the use of medical cannabis.
205          (b) Notwithstanding Subsection (2)(a), the division, in consultation with the board and
206     in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, shall define
207     unprofessional conduct for a physician assistant described in Subsection (2)(a).
208          Section 5. Section 75-2a-103 is amended to read:
209          75-2a-103. Definitions.
210          As used in this chapter:
211          (1) "Adult" means an individual who is:
212          (a) at least 18 years old; or
213          (b) an emancipated minor.
214          (2) "Advance health care directive":
215          (a) includes:
216          (i) a designation of an agent to make health care decisions for an adult when the adult
217     cannot make or communicate health care decisions; or
218          (ii) an expression of preferences about health care decisions;
219          (b) may take one of the following forms:
220          (i) a written document, voluntarily executed by an adult in accordance with the
221     requirements of this chapter; or
222          (ii) a witnessed oral statement, made in accordance with the requirements of this
223     chapter; and
224          (c) does not include [a POLST order] an order for life sustaining treatment.
225          (3) "Agent" means an adult designated in an advance health care directive to make
226     health care decisions for the declarant.
227          (4) "APRN" means an individual who is:
228          (a) certified or licensed as an advance practice registered nurse under Subsection
229     58-31b-301(2)(e);
230          (b) an independent practitioner; and
231          [(c) acting under a consultation and referral plan with a physician; and]
232          [(d)] (c) acting within the scope of practice for that individual, as provided by law, rule,
233     and specialized certification and training in that individual's area of practice.
234          (5) "Best interest" means that the benefits to the [person] individual resulting from a
235     treatment outweigh the burdens to the [person] individual resulting from the treatment, taking
236     into account:
237          (a) the effect of the treatment on the physical, emotional, and cognitive functions of the
238     [person] individual;
239          (b) the degree of physical pain or discomfort caused to the [person] individual by the
240     treatment or the withholding or withdrawal of treatment;
241          (c) the degree to which the [person] individual's medical condition, the treatment, or
242     the withholding or withdrawal of treatment, result in a severe and continuing impairment of the
243     dignity of the [person] individual by subjecting the [person] individual to humiliation and
244     dependency;
245          (d) the effect of the treatment on the life expectancy of the [person] individual;
246          (e) the prognosis of the [person] individual for recovery with and without the
247     treatment;
248          (f) the risks, side effects, and benefits of the treatment, or the withholding or
249     withdrawal of treatment; and
250          (g) the religious beliefs and basic values of the [person] individual receiving treatment,
251     to the extent these may assist the decision maker in determining the best interest.
252          (6) "Capacity to appoint an agent" means that the adult understands the consequences
253     of appointing a particular [person] individual as agent.
254          (7) "Declarant" means an adult who has completed and signed or directed the signing
255     of an advance health care directive.
256          (8) "Default surrogate" means the adult who may make decisions for an individual
257     when either:
258          (a) an agent or guardian has not been appointed; or
259          (b) an agent is not able, available, or willing to make decisions for an adult.
260          (9) "Emergency medical services provider" means a person that is licensed, designated,
261     or certified under Title 26B, Chapter 4, Part 1, Utah Emergency Medical Services System.
262          (10) "Generally accepted health care standards":
263          (a) is defined only for the purpose of:
264          (i) this chapter and does not define the standard of care for any other purpose under
265     Utah law; and
266          (ii) enabling health care providers to interpret the statutory form set forth in Section
267     75-2a-117; and
268          (b) means the standard of care that justifies a provider in declining to provide life
269     sustaining care because the proposed life sustaining care:
270          (i) will not prevent or reduce the deterioration in the health or functional status of an
271     individual;
272          (ii) will not prevent the impending death of an individual; or
273          (iii) will impose more burden on the individual than any expected benefit to the
274     individual.
275          (11) "Health care" means any care, treatment, service, or procedure to improve,
276     maintain, diagnose, or otherwise affect an individual's physical or mental condition.
277          (12) "Health care decision":
278          (a) means a decision about an adult's health care made by, or on behalf of, an adult, that
279     is communicated to a health care provider;
280          (b) includes:
281          (i) selection and discharge of a health care provider and a health care facility;
282          (ii) approval or disapproval of diagnostic tests, procedures, programs of medication,
283     and orders not to resuscitate; and
284          (iii) directions to provide, withhold, or withdraw artificial nutrition and hydration and
285     all other forms of health care; and
286          (c) does not include decisions about an adult's financial affairs or social interactions
287     other than as indirectly affected by the health care decision.
288          (13) "Health care decision making capacity" means an adult's ability to make an
289     informed decision about receiving or refusing health care, including:
290          (a) the ability to understand the nature, extent, or probable consequences of health
291     status and health care alternatives;
292          (b) the ability to make a rational evaluation of the burdens, risks, benefits, and
293     alternatives of accepting or rejecting health care; and
294          (c) the ability to communicate a decision.
295          (14) "Health care facility" means:
296          (a) a health care facility as defined in Title 26B, Chapter 2, Part 2, Health Care Facility
297     Licensing and Inspection; and
298          (b) private offices of physicians, dentists, and other health care providers licensed to
299     provide health care under Title 58, Occupations and Professions.
300          (15) "Health care provider" means the same as that term is defined in Section
301     78B-3-403, except that "health care provider" does not include an emergency medical services
302     provider.
303          (16) (a) "Life sustaining care" means any medical intervention, including procedures,
304     administration of medication, or use of a medical device, that maintains life by sustaining,
305     restoring, or supplanting a vital function.
306          (b) "Life sustaining care" does not include care provided for the purpose of keeping an
307     individual comfortable.
308          (17) "Order for life sustaining treatment" means an order related to life sustaining
309     treatment, on a form designated by the Department of Health and Human Services under
310     Section 75-2a-106, that gives direction to health care providers, health care facilities, and
311     emergency medical services providers regarding the specific health care decisions of the
312     individual to whom the order relates.
313          [(17)] (18) "Minor" means an individual who:
314          (a) is under 18 years old; and
315          (b) is not an emancipated minor.
316          [(18)] (19) "Physician" means a physician and surgeon or osteopathic surgeon licensed
317     under Title 58, Chapter 67, Utah Medical Practice Act, or Chapter 68, Utah Osteopathic
318     Medical Practice Act.
319          [(19)] (20) "Physician assistant" means an individual licensed as a physician assistant
320     under Title 58, Chapter 70a, Utah Physician Assistant Act.
321          [(20) "POLST order" means an order, on a form designated by the Department of
322     Health and Human Services under Section 75-2a-106, that gives direction to health care
323     providers, health care facilities, and emergency medical services providers regarding the
324     specific health care decisions of the individual to whom the order relates.]
325          (21) "Reasonably available" means:
326          (a) readily able to be contacted without undue effort; and
327          (b) willing and able to act in a timely manner considering the urgency of the
328     circumstances.
329          (22) "Substituted judgment" means the standard to be applied by a surrogate when
330     making a health care decision for an adult who previously had the capacity to make health care
331     decisions, which requires the surrogate to consider:
332          (a) specific preferences expressed by the adult:
333          (i) when the adult had the capacity to make health care decisions; and
334          (ii) at the time the decision is being made;
335          (b) the surrogate's understanding of the adult's health care preferences;
336          (c) the surrogate's understanding of what the adult would have wanted under the
337     circumstances; and
338          (d) to the extent that the preferences described in Subsections (22)(a) through (c) are
339     unknown, the best interest of the adult.
340          (23) "Surrogate" means a health care decision maker who is:
341          (a) an appointed agent;
342          (b) a default surrogate under the provisions of Section 75-2a-108; or
343          (c) a guardian.
344          Section 6. Section 75-2a-106 is amended to read:
345          75-2a-106. Emergency medical services -- Order for life sustaining treatment.
346          (1) [A POLST order] An order for life sustaining treatment may be created by or on
347     behalf of [a person] an individual as described in this section.
348          (2) [A POLST order] An order for life sustaining treatment shall, in consultation with
349     the [person] individual authorized to consent to the order pursuant to this section, be prepared
350     by:
351          (a) the physician, APRN, or[, subject to Subsection (11),] physician assistant of the
352     [person] individual to whom the [POLST order] order for life sustaining treatment relates; or
353          (b) a health care provider who:
354          (i) is acting under the supervision of [a person] an individual described in Subsection
355     (2)(a); and
356          (ii) is:
357          (A) a nurse, licensed under Title 58, Chapter 31b, Nurse Practice Act;
358          (B) a physician assistant, licensed under Title 58, Chapter 70a, Utah Physician
359     Assistant Act;
360          (C) a mental health professional, licensed under Title 58, Chapter 60, Mental Health
361     Professional Practice Act; or
362          (D) another health care provider, designated by rule as described in Subsection (10).
363          (3) [A POLST order] An order for life sustaining treatment shall be signed:
364          (a) personally, by the physician, APRN, or[, subject to Subsection (11),] physician
365     assistant of the [person] individual to whom the [POLST order] order for life sustaining
366     treatment relates; and
367          (b) (i) if the [person] individual to whom the [POLST order] order for life sustaining
368     treatment relates is an adult with health care decision making capacity, by:
369          (A) the [person] individual; or
370          (B) an adult who is directed by the [person] individual to sign the [POLST order] order
371     for life sustaining treatment on behalf of the [person] individual;
372          (ii) if the [person] individual to whom the [POLST order] order for life sustaining
373     treatment relates is an adult who lacks health care decision making capacity, by:
374          (A) the surrogate with the highest priority under Section 75-2a-111;
375          (B) the majority of the class of surrogates with the highest priority under Section
376     75-2a-111; or
377          (C) [a person] an individual directed to sign the [POLST order] order for life sustaining
378     treatment by, and on behalf of, the [persons] individuals described in Subsection (3)(b)(ii)(A)
379     or (B); or
380          (iii) if the [person] individual to whom the [POLST order] order for life sustaining
381     treatment relates is a minor, by a parent or guardian of the minor.
382          (4) If [a POLST order] an order for life sustaining treatment relates to a minor and
383     directs that life sustaining treatment be withheld or withdrawn from the minor, the order shall
384     include a certification by two physicians that, in their clinical judgment, an order to withhold or
385     withdraw life sustaining treatment is in the best interest of the minor.
386          (5) [A POLST order] An order for life sustaining treatment:
387          (a) shall be in writing, on a form designated by the Department of Health and Human
388     Services;
389          (b) shall state the date on which the [POLST order] order for life sustaining treatment
390     was made;
391          (c) may specify the level of life sustaining care to be provided to the [person]
392     individual to whom the order relates; and
393          (d) may direct that life sustaining care be withheld or withdrawn from the [person]
394     individual to whom the order relates.
395          (6) A health care provider or emergency medical service provider, licensed or certified
396     under Title 26B, Chapter 4, Part 1, Utah Emergency Medical Services System, is immune from
397     civil or criminal liability, and is not subject to discipline for unprofessional conduct, for:
398          (a) complying with [a POLST order] an order for life sustaining treatment in good
399     faith; or
400          (b) providing life sustaining treatment to [a person] an individual when [a POLST
401     order] an order for life sustaining treatment directs that the life sustaining treatment be
402     withheld or withdrawn.
403          (7) To the extent that the provisions of [a POLST order] an order for life sustaining
404     treatment described in this section conflict with the provisions of an advance health care
405     directive made under Section 75-2a-107, the provisions of the [POLST order] order for life
406     sustaining treatment take precedence.
407          (8) An adult, or a parent or guardian of a minor, may revoke [a POLST order] an order
408     for life sustaining treatment by:
409          (a) orally informing emergency service personnel;
410          (b) writing "void" across the [POLST order] order for life sustaining treatment form;
411          (c) burning, tearing, or otherwise destroying or defacing:
412          (i) the [POLST order] order for life sustaining treatment form; or
413          (ii) a bracelet or other evidence of the [POLST order] order for life sustaining
414     treatment;
415          (d) asking another adult to take the action described in this Subsection (8) on the
416     [person] individual's behalf;
417          (e) signing or directing another adult to sign a written revocation on the [person]
418     individual's behalf;
419          (f) stating, in the presence of an adult witness, that the [person] individual wishes to
420     revoke the order; or
421          (g) completing a new [POLST order] order for life sustaining treatment.
422          (9) (a) Except as provided in Subsection (9)(c), a surrogate for an adult who lacks
423     health care decision making capacity may only revoke [a POLST order] an order for life
424     sustaining treatment if the revocation is consistent with the substituted judgment standard.
425          (b) Except as provided in Subsection (9)(c), a surrogate who has authority under this
426     section to sign [a POLST order] an order for life sustaining treatment may revoke [a POLST
427     order] an order for life sustaining treatment, in accordance with Subsection (9)(a), by:
428          (i) signing a written revocation of the [POLST order] order for life sustaining
429     treatment; or
430          (ii) completing and signing a new [POLST order] order for life sustaining treatment.
431          (c) A surrogate may not revoke [a POLST order] an order for life sustaining treatment
432     during the period of time beginning when an emergency service provider is contacted for
433     assistance, and ending when the emergency ends.
434          (10) (a) The Department of Health and Human Services shall make rules, in
435     accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, to:
436          (i) create the forms and systems described in this section; and
437          (ii) develop uniform instructions for the form established in Section 75-2a-117.
438          (b) The Department of Health and Human Services may make rules, in accordance
439     with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, to designate health care
440     professionals, in addition to those described in Subsection (2)(b)(ii), who may prepare [a
441     POLST order] an order for life sustaining treatment.
442          (c) The Department of Health and Human Services may assist others with training of
443     health care professionals regarding this chapter.
444          [(11) A physician assistant may not prepare or sign a POLST order, unless the
445     physician assistant is permitted to prepare or sign the POLST order under the physician
446     assistant's delegation of services agreement, as defined in Section 58-70a-102.]
447          [(12)] (11) (a) Notwithstanding any other provision of this section:
448          (i) the provisions of Title 46, Chapter 4, Uniform Electronic Transactions Act, apply to
449     any signature required on the [POLST order] order for life sustaining treatment; and
450          (ii) a verbal confirmation satisfies the requirement for a signature from an individual
451     under Subsection (3)(b)(ii) or (iii), if:
452          (A) requiring the individual described in Subsection (3)(b)(i)(B), (ii), or (iii) to sign the
453     [POLST order] order for life sustaining treatment in person or electronically would require
454     significant difficulty or expense; and
455          (B) a licensed health care provider witnesses the verbal confirmation and signs the
456     [POLST order] order for life sustaining treatment attesting that the health care provider
457     witnessed the verbal confirmation.
458          (b) The health care provider described in Subsection [(12)(a)(ii)(B)] (11)(a)(ii)(B):
459          (i) may not be the same individual who signs the [POLST order] order for life
460     sustaining treatment under Subsection (3)(a); and
461          (ii) shall verify, in accordance with HIPAA as defined in Section 26B-3-126, the
462     identity of the individual who is providing the verbal confirmation.
463          Section 7. Effective date.
464          This bill takes effect on May 1, 2024.