42. Right to Die
Durable Power of Attorney
Euthanasia
Living Wills
Euthanasia laws, living wills, and the durable power of attorney, often referred to as the “Right-to-Die” laws, are concerned with how an individual who has become incapacitated may exert some influence and control over certain decisions that will be made concerning his or her care. Living wills and the durable power of attorney permit individuals to instruct his or her survivors, guardians, or attending physicians to either administer or withhold life support if they are near death and unable to communicate, such as when in a coma.
The moral questions raised by the right-to-die laws are a direct result of developments in modern technology. From the earliest times, the primary goal of doctors has been to cure the sick and comfort the dying. However, modern technology has now allowed them to prolong life beyond the body’s natural ability to maintain itself. Machines can artificially breathe for a person; intravenous feeding can artificially supply sustenance. Indeed, technology can keep a patient’s body completely alive even when its brain is dead.
A major problem arises in situations such as these when the patient’s desires are not known; it is then up to others to decide how long artificial life-sustaining procedures should be administered. Next of kin are nearly always the ones to whom this emotionally difficult decision falls, and the complexity of right-to-die laws reveals just how legally complicated the decision can be as well.
Next of kin are very often the persons most anxious to end their loved one’s suffering. On the other hand, physicians, who are trained to prolong life, maintain an ethical and moral, as well as a legal, obligation to sustain life and are loathe to do anything that will end life unless they are protected from all liability stemming from charges of homicide or wrongful death or violations of codes of professional responsibility. In the past, every time the question of “pulling the plug” arose it was “taken care of quietly” or ended up in court, where a judge determined if the doctor should end life support. If the judge ruled that life support could be withheld, the attending physician and the health care provider were completely protected from liability.
Obviously, this was a very inefficient method of dealing with this situation. After one or two high-profile cases, the public generally accepted “pulling the plug” as an option for the terminally ill. Where once medical practitioners and the public looked upon the act as murder, many have come to see it as merciful. This change in attitude has manifested itself, in most states, in a body of rather dark statutes falling into three specific categories, living wills, durable power of attorney, and euthanasia.
A durable power of attorney is an instrument that is similar to a living will except that it gives authority to a named individual to decide whether or not to begin or discontinue artificial life support. Any decision the holder of the durable power of attorney makes regarding life support is said to have the exact same legal effect as though the patient had made the decision himself or herself.
Oregon is the only state which explicitly allows for physician assisted suicide of the terminally ill. Several other states have considered statutes similar to Oregon’s.
There is considerable diversity among states regarding the handling of the right-to-die issue, but the variance is entirely in the detail. While every state recognizes some form of durable power of attorney or living will, each has added its own character. Many states require state-sanctioned forms, while some allow as little as “some form of communication” to execute or revoke a durable power of attorney or living will.
A living will is a legal instrument that is executed by a person of sound mind and witnessed in much the same manner as a will. A living will expresses the individual’s desires regarding life support should he or she become incapacitated as a result of a terminal illness: specifically, whether or not to administer artificial life-sustaining procedures in the event of an incurable or irreversible terminal condition that would otherwise result in death in a short time.
Note: Because laws governing the right to die are fast changing, all users of this book are advised to consult local statutes before acting on any information contained in this chapter.
| Table 42a: Right to Die: Durable Power of Attorney |
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| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
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ALABAMA
§26-1-2 | Agent may authorize withholding or withdrawal of life-sustaining treatment, and make all other health care decisions. | Must designate person as attorney and state, “This power of attorney shall not be affected by disability, incompetency, or incapacity of the principal.” | Revocable by written revocation, destruction of document, or verbal expression of intent to cancel. | Directives prepared in other states are valid if in compliance with Alabama law. | | Health care providers who rely in good faith on agent’s directions are immune from civil and criminal liability. |
ALASKA
13.26.332, 335, et seq. | Consent or refusal to consent to medical care or relief for the principal from pain but agent may not authorize the termination of life-sustaining procedures; may include provision indicating whether a living will has been executed | (1) Must be set out in substantially the same form as found in statute §13.26.332; (2) designate health care decisions to agent | Revocable at any time | | A third party shall honor the terms of a properly executed power of attorney, but physician may withdraw after services of another physician have been obtained | A third party who relies on reasonable representations of an attorney-in-fact does not incur a liability to the principal or principal’s heirs, assigns, or estate |
ARIZONA
36-3221, et seq. Health Care Power of Attorney | Power to give or refuse consent to all medical, surgical, hospital, and make health care decisions on that persons behalf | (1) Adult; (2) in writing; (3) language clearly indicating intent to create a health care power of attorney; (4) dated; (5) signed; (6) witnessed by at least one adult or a notary public and who is not related to principal by blood, marriage, or adoption & not entitled to any of principal’s estate | Person may revoke health care directive or disqualify a surrogate by (1) written revocation; (2) orally notifying surrogate or health care provider; (3) making new health care directive; (4) any other act demonstrating specific intent to revoke | Health care directive prepared in another state is valid in this state if it was valid where and at the time it was adopted to the extent it does not conflict with the criminal laws of Arizona | | Health care provider making good faith decisions in reliance on apparently genuine health care directive or decision of a surrogate is immune from civil, criminal, and professional discipline for that reliance |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
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ARKANSAS
20-17-201, et seq. Arkansas Rights of the Terminally Ill & Permanently Unconscious Act | Any medical procedure or intervention that will serve only to prolong the dying process or to maintain the patient in a condition of permanent unconsciousness | The declaration may appoint a health care proxy who is at least 18 yrs. old as attorney-in-fact to make health care decisions including withholding or withdrawing of life-sustaining treatment | Revocable at any time in any manner by the declarant without regard to declarant’s mental/physical condition. Effective upon communication to attending physician | A declaration executed in another state in compliance with the laws of that state or Arkansas law is validly executed | Physician shall as promptly as practicable take all reasonable steps to transfer care to another physician | Physician whose actions under this chapter are in accord with reasonable medical standards is not subject to criminal, civil, or professional liability with respect to them |
CALIFORNIA Probate
§4650, §4700 et seq. Durable Powers of Attorney for Health Care | Decisions on any care, treatment, service, or procedure to maintain, diagnose, or treat an individual’s physical or mental condition; including decision to begin, continue, increase, limit, discontinue or not begin any health care. Same right as principal to receive information and consent regarding health care decisions and records except to consent to commitment, convulsive treatment, or psychosurgery, sterilization or abortion. | Durable power of attorney must specifically authorize the attorney-in-fact to make health care decisions; dated; witnessed by 2 attesting to the principal’s signature and signing statutory declaration (§4701) or by a notary public; prevails over declaration (§7185 et seq.); substantially same form as §4703 (statutory form) | No authority while principal can give informed consent to a health care decision. Anytime while principal has capacity to give a durable power of attorney, he may (1) revoke the appointment of the attorney-in-fact orally or in writing; (2) revoke the agent’s authority by notifying the physician orally or in writing; (3) a subsequent durable power of attorney revokes prior one; (4) divorce revokes any designation of former spouse | Enforceable if executed in another state or jurisdiction in compliance with the laws of that state or jurisdiction or in substantial compliance with the laws of California | | Subject to limitations, a physician acting in good faith on decision of attorney-in-fact is not subject to criminal, civil, or professional liability except to the same extent that would be the case if the principal, having had capacity to give informed consent, had made the health care decision on his/her own behalf under like circumstances |
COLORADO
15-14-503, et seq. Colorado Patient Autonomy Act | Authority of an agent to act on behalf of principal who lacks decisional capacity in consenting to or refusing medical treatment including artificial nourishment and hydration; may include conditions or limitations of agent’s authority | Directive must contain the words, “This power of attorney shall not be affected by disability of the principal.” | Divorce, dissolution, annulment, or legal separation revokes any designation of former spouse as agent; otherwise can be revoked at any time | A durable power of attorney executed in another state shall be presumed to comply with this law and may, in good faith, be relied on by a health care provider | Physician must provide for prompt transfer; physician must not provide care and comfort pending transfer | No criminal or civil liability or regulatory sanction for complying in good faith with medical treatment decision of agent acting in accordance with advanced medical directive |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
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CONNECTICUT
19a-570, et seq. | Consent, refuse consent, or withdraw consent to any medical treatment other than that designed solely to maintain physical comfort, the withdrawal of life support systems, or of nutrition or hydration; does not apply to pregnant patient | See statutory form §1-43 for power of attorney or appointment of attorney-in-fact for health care decisions see form in §19a-575a—must be 18 yrs., signed, dated in presence of two adult witnesses | May be revoked at any time, in any manner; automatically revoked by divorce, legal separation, annulment, or dissolution of marriage if spouse is appointed as health care agent, unless principal specifies otherwise | | Physician shall act as promptly as practicable and take all reasonable steps to transfer patient to complying physician | Physician withholding, removing life-support system of an incapacitated patient shall not be civilly or criminally liable if decision was based on physician’s (1) best medical judgment; (2) physician deems patient in a terminal condition; (3) patient’s wishes were considered according to an executed document |
DELAWARE
16 §2501, et seq. | Grant, refuse, withdraw consent to provision of medical treatment, including right to refuse medical treatment which would extend appointer’s life | (1) Adult; (2) written declaration; (3) attending physician judges appointer incapable due to condition resulting from illness or injury of making decision to accept or refuse medical treatment; (4) signed by appointer or another person at his express direction and in his presence; (5) dated; (6) 2 or more adult witnesses | Revocable at any time without regard to declarant’s mental state or competency by (1) destruction of declaration with intent to revoke; (2) oral statement in presence of 2 persons 18 yrs. or older expressing intent to revoke; (3) written revocation signed and dated by declarant or (4) new declaration with contrary intent | Directives of other states in compliance with the laws of that state or of Delaware are valid. | Must provide continuing care and not impede the transfer of the patient to another health care provider. | Physicians or nurses acting in reliance on properly executed document are presumed to be acting in good faith and there is no civil or criminal liability unless negligent |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
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DISTRICT OF COLUMBIA
21-2201 Health Care Decisions | To grant, refuse, withdraw consent to the provision of any health-care service, treatment, or procedure if principal is incapable of making or communicating decisions himself | (1) Competent adult; (2) in writing; (3) must include language clearly communicating the intent for attorney-in-fact to have authority to make health-care decisions on behalf of the principal with language that power is effectuated upon principal’s incapacity; (4) dated; (5) signed; (6) in presence of 2 adult witnesses; sample form §21-2207 | Revocable at any time by notifying health care provider or attorney-in-fact orally or in writing. Divorce automatically revokes designation of former spouse | | | |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
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FLORIDA
765.201, et seq. Health Care Surrogate Act | All health care decisions regarding principal’s health care during principal’s incapacity, including life-prolonging procedures: any medical procedure, treatment, or intervention which utilizes mechanical or other artificial means to sustain, restore, supplant a spontaneous vital function and serves only to prolong the dying process of a patient in terminal condition. Does not include medication or medical procedure to provide comfort care or to alleviate pain; cannot withhold or withdraw life prolonging procedures from pregnant patient prior to viability | (1) Competent adult (2)signed; (3) in presence of 2 adult witnesses | Revocable at any time by principal by (1) signed, dated writing; (2) destruction of declaration; (3) oral expression of intent to revoke; (4) subsequent advance health care directive materially different from the previously executed advance directive; (5) divorce revokes any designation of the former spouse as surrogate | An advance directive executed in another state in compliance with the laws of that state or Florida is validly executed | Physician should make reasonable efforts to transfer to a willing health care provider. Physician unwilling to carry out the patient’s wishes because of moral or ethical beliefs must within 7 days: (1) transfer the patient and pay the cost of transporting the patient to another health care provider or (2) carry out the wishes of the patient unless provisions of judicial intervention | Health care facility, provider, or other person acting under their direction is not subject to criminal, civil, or professional liability for carrying out health care decision |
GEORGIA
31-36-1, et seq. Durable Power of Attorney for Health Care | All powers the individual may have to be informed about and to consent or refuse to consent to any type of health care for the individual including withholding or withdrawal of life-sustaining or death-delaying procedures or after death, anatomical gifts, autopsies or disposition of remains | (1) In writing; (2) signed by principal; (3) attested and subscribed by 2 or more competent adult witnesses; (4) statutory form §31-36-10 may be used | Revocable at any time by principal without regard to physical or mental condition by (1) destruction of the document; (2) written revocation signed and dated by the principal; (3) by oral or any other expression of intent to revoke in presence of an adult witness who within 30 days must sign and date in writing confirming the expression of such intent; (4) divorce revokes agency in former spouse | | Physician should promptly inform the agent who is responsible to make the transfer, but physician will continue to afford consultation and care in connection with the pending transfer | No health care provider subject to any civil, criminal, or professional liability solely for complying with decision of agent |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
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HAWAII
551D-1, et seq. Uniform Durable Power of Attorney Act | Agent authorized to make any lawful health care decisions that could have been made by principal at time of election. Agent may decide that principal’s life should not be prolonged through surgery, resuscitation, life-sustaining medicine, or procedures for provision of nutrition or hydration if explicitly appointed | (1) Competent adult; (2) in writing and signed by principal or another in his or her presence at expressed direction; (3) dated; (4) in presence of 2 or more adult witnesses; (5) signature notarized; (6) with words such as “This power of attorney shall not be affected by the disability (or become effective upon disability) of principal.” (Sample form §551D-2.6) | Effective only during period of incapacity of principal as determined by licensed physician. Not revoked until notice of actual death or disability of principal is given to attorney-in-fact (durable or otherwise). | | | |
IDAHO
39-4505, et seq. Natural Death Act | Health care decisions for principal, meaning consent, refusal of consent, or withdrawal of consent to any care, treatment, services, or procedure to maintain, diagnose, or treat an individual’s physical condition. Also includes life-prolonging care decisions (see Living Wills for description of life-prolonging measures) | (1) Signed by principal; (2) dated; (3) signed by 2 witnesses; (4) person must be adult; (5) may list alternative holders of power (sample form §39-4505) | Effective only when competent person is unable to communicate rationally. Revocable at any time by the maker without regard to competence by (1) destruction of the document; (2) by written, signed revocation; (3) by verbal expression of intent to revoke. | | Physician may withdraw without civil or criminal liability provided physician makes a good faith effort to assist patient in transferring before his/her withdrawal | No civil or criminal liability for physician acting in accordance with wishes of patient as expressed by statutory procedure |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
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ILLINOIS
755 ILCS 45/4-1 Powers of Attorney for Health Care Law | Health care powers may be delegated to an agent and include consent or refusal or withdrawal of any type of health care for individual. May extend beyond principal’s death if necessary to permit anatomical gift, autopsy, or disposition of remains | Neither attending physician nor health care provider may act as agent (statutory short form at 45/4-10). Living will not operative as long as properly authorized agent is available. | Revocable at any time by principal without regard to mental or physical condition by (1) written revocation signed and dated; (2) oral expression in presence of witness who signs and dates a written confirmation; (3) destruction of power of attorney in manner indicating intent to revoke | | Agent responsible for transfer after being promptly informed by attending physician of his refusal or failure to comply, but attending physician must afford all reasonably necessary consultation and care in connection with transfer | No civil, criminal, or professional liability if good faith reliance on any decision or direction by agent not clearly contrary to terms of a health care agency |
INDIANA
16-36-1-1, et seq. Health Care Consent | Appoint a representative to act in matters affecting the appointer’s health care: any care, treatment, service, or procedure to maintain, diagnose, or treat an individual’s physical or mental condition including admission to a health care facility and disclosure of medical records to health care provide; this appointment does not affect individual’s authorization re: life-prolonging measures (i.e. a living will) | (1) In writing; (2) signed by appointer; (3) witnessed by adult; (4) may specify conditions and terms of the authority delegated; (5) begins when appointer becomes incapable of consenting | Individual capable of consenting to health care may revoke appointment at any time by notifying representative or health care provider orally or in writing. Individual who may consent to his own health care may disqualify others from consenting or revoking appointment for the individual (disqualification must be in writing) | | | No criminal, civil, or professional liability for a physician acting in good faith in reliance on the agent’s direction |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
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IOWA
144B.1, et seq. Durable Power of Attorney for Health Care | Consent, refusal of consent, or withdrawal of consent to health care. Attorney-in-fact has priority over court-appointed guardian to make health care decisions; does not include provision of nutrition or hydration except when required parenterally through intubation | (1) Explicitly authorizes attorney-in-fact to make health care decisions; (2) 2 adult witnesses signing in the presence of each other and the principal; (3) notarized; (4) substantially complies with requirements (sample form 1448.5) | May be revoked at any time in any manner by which principal is able to communicate intent to revoke. Power revoked in case of divorce where spouse designated durable power of attorney for health care. | Similar document executed in another state in compliance with the laws of that state is valid and enforceable in Iowa; to the extent the document is consistent with Iowa law. | Unwilling physician must make provisions to transfer patient to willing health care provider | Health care provider not subject to civil or criminal liability or professional disciplinary action if acting in good faith on decision of attorney-in-fact |
KANSAS
58-625 et seq. Durable Power of Attorney for Health Care Decisions | Consent, refuse consent, or withdraw consent to any care, treatment, service, or procedure to maintain, diagnose, or treat a physical or mental condition and make decisions about organ donation, autopsy, and disposition of body; make all necessary arrangements for principal at any hospital/facility and employ health care personnel; request and review and execute any information regarding principal’s affairs, including medical and hospital records. | (1) Writing must have words of intent that principal conferred authority to be exercised notwithstanding principal’s subsequent incapacity; (2) dated; (3) signed; (4) in presence of 2 adult witnesses or notarized; (5) substantially in statutory form of §58-632 (6) effective upon occurrence of principal’s disability or incapacity | By an instrument in writing witnessed as required for power of attorney or “set out another manner of revocation, if desired.” | Any durable power of attorney for health care decisions which is valid under the laws of the state of the principal’s residence at the time it was signed is valid under the act. | | |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
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KENTUCKY
311.621 et seq. Kentucky Living Will Directive Act. | Surrogate may make health care decisions grantor could make if he or she had decisional capacity, provided all decisions are in accordance with granter’s wishes and surrogate has considered recommendations of attending physician; these decisions include withholding or withdrawal of artificial nutrition or hydration if (1) death is imminent (i.e. death is expected within a few days); (2) provision of nutrition cannot be physically assimilated; (3) burden or provision of such nutrition and hydration outweighs benefit. (Artificial nutrition or hydration not to be withdrawn if needed for comfort or relief of pain.); (4) When patient is in permanently unconscious state and advanced directive has authorized withdrawal or withholding of such nutrition and hydration. | (1) Grantor with decisional capability; (2) may designate 1 or 2 adults as surrogates; (3) if 2 or more, any decisions must be unanimous; (4) in writing, dated and signed by grantor; (5) 2 adult witnesses, signed in presence of grantor and in presence of each other or notarized; (6) surrogate may not make decisions when physician has determined in good faith that grantor has decisional capability | (1) May be revoked in whole or in part or surrogate’s powers reduced or limited at any time if grantor has decisional capacity; (2) oral statement of intent to revoke in presence of 2 adults, one of whom is a health care provider; (3) destruction of declaration with intent to revoke; (4) effective immediately for attending physician once revocation received; (5) oral statement by grantor with decisional capacity to revoke overrides previous written directive | Directives made outside the provisions of this act does not restrict health care providers from following such directives if they are consistent with accepted medical practice. | Physician must immediately inform patient and family or guardian and shall not impede transfer to complying physician or health care facility; patient’s medical records and information shall be supplied to receiving physician or facility | Unlawful for any health care facility or licensing agency to discriminate against health care professional that is unwilling to comply with advanced directive of patient as long as he or she complies with notification and transfer provisions of act. Not subject to criminal prosecution or civil liability or deemed to have engaged in unprofessional conduct as a result of withholding or withdrawing life prolonging treatment in accordance with directive unless shown by preponderance of evidence that there was bad faith |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
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LOUISIANA R.S.
40:1299.58.1 (c) et seq. Declarations Concerning Life-sustaining Procedures | Any medical procedure or intervention, including but not limited to invasive administration of nutrition and hydration, which would serve only to prolong the dying process for a person diagnosed as having a terminal and irreversible condition. Does not include any measure necessary for comfort care | The declaration made under statutory “Declarations Concerning Life-sustaining Procedures” may include designation of another person to make treatment decision for the declarant should s/he be diagnosed with terminal or irreversible condition and be comatose, incompetent or otherwise mentally or physically incapable of communication (sample form §1299.58.3 (c)) | Revocable at any time by declarant without regard to mental state or competency by (1) destruction of document; (2) written revocation signed and dated by declarant; (3) oral or nonverbal expression by declarant of intent to revoke. Effective upon communication to physician | Declaration properly executed in and under the laws of another states is deemed to be validly executed. | Physician shall make reasonable effort to transfer patient to another physician | Any health care facility, physician or other person acting under their direction shall not be criminally, civilly, or professionally liable for withholding life-sustaining procedures in accordance with the provisions of this chapter |
MAINE
18A §5-501, et seq. Durable Power of Attorney; 18A 5-801 et seq. | Consent or withhold consent or approval relating to any medical or other health care treatment of the principal including life-sustaining treatment when principal is in terminal condition or persistent vegetative state | (1) Signed by principal or another at principal’s direction; (2) 2 witnesses other than designated attorney-in-fact (unless prior to effective date of statute); (3) contains words to the effect that authority is exercisable not withstanding incapacity or disability (sample form §5-702(c)) | May be revoked or terminated by a fiduciary of principal only with prior approval of court upon petition by any interested person | Declaration executed in another state in compliance with laws of that state and Maine is valid | Attending physician or other health care provider who is unwilling shall take all reasonable steps as promptly as practicable to transfer to another physician willing to comply. Willful failure to transfer is a Class E crime | Physician or other health care provider whose action is in accord with reasonable medical standards and in good faith is not subject to criminal or civil liability or discipline for unprofessional conduct |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
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| MARYLAND Health-Gen. 5-601 et seq. Health Care Decisions Act | Appointment by declarant under advance directive to make health care decisions for declarant under circumstances stated in directive based on wishes of declarant; decision regarding the provision, withholding of life-sustaining procedures should be based, in whole or in part, on the patients preexisting, long-term mental or physical disability or a patient’s economic disadvantage; can’t authorize sterilization or treatment for mental disorder | (1) Voluntary; (2) dated and in writing; (3) signed by declarant or at express direction of declarant; (4) subscribed by 2 witnesses; (5) effective when attending physician and second physician certify in writing that patient is incapable of making an informed decision on basis of physical examination within 2 hours of certification (if patient is unconscious, second physician is not required); (6) communicated to physician who shall made it part of declarant’s medical records | Revocable at any time by (1) signed and dated writing; oral statement to health care practitioner; (3) execution of subsequent directive | Declaration executed outof-state by nonresident is effective if declaration is in compliance with the laws of Maryland or the laws of the state where executed (to the extent permitted by the laws of Maryland) | Attending physician shall make every reasonable effort to transfer declarant to another healthcare provider; assist in transfer; and pending transfer comply with competent individual or healthcare agent/surrogate for person incapable of making a decision if failure to comply would likely result in death of individual | Any healthcare provider who withholds or withdraws health care or life-sustaining procedures in accordance with this subtitle and in good faith, is not subject to civil or criminal liability and may not be found to have committed professional misconduct |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
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| MASSACHUSETTS Ch. 201D §1, et seq. Health Care Proxies | Any and all health care decisions on principal’s behalf that principal could make including decisions about life-sustaining treatment (which do not include those procedures to provide comfort care or pain alleviation), subject to any express limitations of health care proxy’s authority (proxy has priority over other persons, including one with durable power of attorney unless limited by principal or court order) | (1) Competent adult; (2) in writing; (3) signed; (4) in presence and subscribed by 2 adult witnesses, that the principal appeared to be 18, of sound mind and under no constraint or undue influence; (5) Health care proxy must contain identities of principal and health care agent and indicate principal intends agent to have authority to make health care decisions on his behalf and describe any limitations and indicate agent’s authority effective if it is determined that principal lacks decisional capacity | Revocable by (1) notification of agent or health care provider orally or in writing or by any other act evidencing specific intent to revoke the proxy; (2) execution of subsequent health care proxy; (3) divorce or legal separation where spouse was principal’s agent under health care proxy | Effective if executed in another state or jurisdiction if in compliance with laws of that state or jurisdiction provided §14 and §15 of Chap. 201D are not violated (re: refusal to honor proxy) | Physician should arrange for transfer of patient to equivalent facility “reasonably accessible” to patient’s family; if unable to do so, physician shall seek judicial relief or honor agent’s decision | No civil, criminal, or professional liability for carrying out in good faith a health care decision by an agent pursuant to a health care proxy |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
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| MICHIGAN §700.5501 et seq. Uniform Durable Power of Attorney Act | Designation may include statement of patient’s desires on care, custody, and medical treatment decisions (effective only when patient is unable to participate in medical treatment decisions); may authorize patient advocate to exercise 1 or more powers concerning patient’s care, custody, and medical treatment that patient could have exercised on own behalf. Patient advocate may make decision to withhold or withdraw treatment which would allow patient to die only if patient has expressed in a clear and convincing manner that patient advocate is allowed to do so and that patient acknowledges that such a decision would allow death | (1) 18 yrs.; (2) sound mind; (3) signed in writing; (4) in the presence of and signed by 2 witnesses; (5) proposed patient advocate must sign acceptance; (6) executed voluntarily; (7) made part of patient’s medical record before implementation; (8) exercisable only when patient is unable to participate in decisions; (9) cannot be used for pregnant patient | (1) Revocable at any time and in any manner sufficient to communicate intent by patient to revoke; (2) resignation or removal of patient advocate; (3) subsequent designation that revokes prior designation, either expressly or by inconsistency; (4) divorce revokes designation of patient advocate in former spouse; (5) death of patient; (6) order of probate court; (7) occurrence of provision for revocation contained in designation; (8) any current desires of patient are binding on patient advocate | | Physician or health care provider is bound by sound medical practice and instructions of patient advocate if patient advocate complies with law | Person providing, performing, withholding, withdrawing medical treatment reasonably relying on decisions of patient advocate is liable in same manner and to same extent as if patient had made decision on his or her own behalf |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
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| MINNESOTA 145C.01, et seq. Health Care Directives | Power to consent, refuse to consent, withdraw consent to any care, treatment, procedure or health care decision to maintain, diagnose, or treat mental or physical condition of principal including food and water by artificial means | (1) signed by principal; (2) dated; (3) signed by 2 adult witnesses or acknowledged by principal before a notary public; (4) when inconsistencies arise between proxy, living will, or agent, most recently executed document takes precedence (suggested statutory form §145C.05) | Divorce revokes any designation of former spouse as agent to make health care decisions. Revocable at any time by (1) destroying; (2) written statement expressing intent to revoke; (3) verbally expressing intent to revoke in presence of 2 witnesses; (4) executing subsequent instrument | Power of attorney document, when executed in another state in compliance with that state’s law is valid and enforceable in Minnesota to the extent it is consistent with Minnesota law | Provider who has legal and actual capability of providing transfer and who is unwilling to provide directed health care may transfer patient to complying provider but must take all reasonable steps to provide directed health care until patient is transferred | Health care provider not subject to criminal prosecution, civil liability or professional disciplinary action who relies in good faith on health care decision made by agent; no criminal, civil, or professional liability for health care provider who administers health care to keep patient alive (despite agent’s decision) if all reasonable steps were promptly taken to transfer patient to complying provider |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
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| MISSISSIPPI 41-41-201, et seq. Uniformed Health-Care Decisions Act | Consent, refuse consent, or withdraw consent to any care, treatment, service, or procedure to maintain, diagnose, or treat an individual’s physical or mental condition; may include decisions after death such as anatomical gift, autopsy, etc. Does not affect health care treatment in an emergency | (1) Durable power of attorney must specifically authorize the attorney-in-fact to make health care decisions; (2) dated; (3) witnessed by 2 individuals or notarized according to form set out in §41-41-159(b); (4) should follow substantially statutory form (§41-41-163) | Unless the document provides a shorter time, it shall be effective until revoked by principal. Durable power of attorney revocable at any time the principal has capacity to give a durable power of attorney for health care by notifying the attorney-in-fact in writing or notifying the health care provider in writing or by executing subsequent valid durable power of attorney for health care (revokes prior durable power of attorney for health care) | | Must promptly inform the patient of refusal and assist patient in being transferred to another institution | No civil, criminal, or professional responsibility if health care provider relies in good faith on health care decision |
MISSOURI
404.800, et seq. Durable Power of Attorney- for Health Care | May make health care decisions, but no agent may authorize withdrawal of artificially supplied nutrition and hydration which the patient may ingest through natural means | (1) Signed; (2) dated; (3) includes provision that durable power shall not terminate if principal becomes disabled or incapacitated; (4) powers generally commence upon certification by 2 licensed physicians that patient is incapacitated | Revocable at any time in any manner by which patient is able to communicate the intent to revoke. Effective upon communication to agent or to physician | | Physician may not impede the attorney-in-fact from transferring patient to another physician or facility | Any third party acting in good faith may rely on the instructions of the attorney-in-fact without liability to the patient or the patient’s successors-in-interest |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
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| MONTANA 50-9-101 et seq. Rights of the Terminally Ill Act | Withholding or withdrawal of life-sustaining treatment, defined as any medical procedure or intervention that will serve only to prolong the dying process. Qualified patient may designate another individual to make decisions governing withholding or withdrawal of life-sustaining treatment. Life-sustaining procedures may not be withdrawn when qualified patient is known to be pregnant and when it is likely fetus will result in live birth | (1) 18 yrs. and of sound mind; (2) signed by declarant or another at his request; (3) 2 witnesses; (4) communicated to physician and made part of patient’s medical record; (5) declared to be terminal and no longer able to make decisions regarding life-sustaining treatment; (7) declarant may designate another individual, 18 yrs. old and of sound mind, to make decisions regarding life-sustaining treatment (sample form §50-9-103) | Revocable at any time in any manner without regard to physical or mental condition. Effective upon notice | Declaration made in another state in compliance with that state’s laws executed in a substantially similar manner to laws of Montana is effective | Unwilling physician shall take all reasonable steps as promptly as practicable to transfer to another who is willing | Individual appointed under this section not criminally or civilly liable for decisions made pursuant to executed declaration; attending physician or health care provider not subject to civil or criminal liability or guilty of unprofessional conduct if acting in accordance with reasonable medical standards and in good faith. |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
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| NEBRASKA 30-3401 et seq. Health Care Power of Attorney | Consent, refusal of consent, withdrawal of consent to health care. Shall not include (1) withdrawal of routine comfort care; (2) withdrawal of usual and typical provision of nutrition and hydration; (3) withdrawal or withholding of life-sustaining procedures or artificially administered nutrition or hydration except if declarant gives that authority. (Note that an attempted suicide by the principal shall not be construed as indicating the principal’s wishes with regard to health care.) | (1) In writing; (2) identify parties; (3) specifically authorize attorney-in-fact to make decisions when principal is incapable (this must be documented by physician indicating cause and nature of incapacity); (4) signed and witnessed by 2 adults; (5) show date of execution; (6) substantially in form of §30-3408; (7) not operative when principal is known to be pregnant and live birth is probable | Revocable at any time by competent principal in any manner he/she is able to communicate an intent to revoke; withdrawal at any time by attorney-in-fact. Otherwise, effective until death of principal; divorce or legal separation, unless otherwise noted in divorce decree, shall be deemed to revoke power of attorney for health care in spouse. | Declaration executed in another state is valid according to its terms if valid under the laws of that state | Unwilling physician shall inform attorney-in-fact and promptly assist in transferring principal to willing physician | No criminal, civil, or professional liability if acting in good faith. Does not limit liability for negligence |
| NEVADA 449.800 et seq. Durable Power of Attorney for Health Care | Attorney-in-fact has power to make health care decisions before or after death for disabled principal including consent, refusal of consent, or withdrawal of consent to any care, treatment, service, or procedure to maintain, diagnose, or treat physical or mental condition except treatment specifically stated: commitment to mental facility, convulsive treatment, psychosurgery, sterilization, or abortion or any other specifically designated treatments. | (1) Signed; (2) notarized or 2 witnesses; (3) sample form: §449-613 to designate person to make decision re: life-sustaining treatment; §449-830 mandatory form to create durable power of attorney. | Divorce revokes designation of former spouse. Power of attorney remains valid indefinitely unless principal designates shorter period or it is revoked or another power of attorney is executed subsequently. | | | |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
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| NEW HAMPSHIRE 137-J:1 et seq. Durable Power of Attorney for Health Care | Document delegating health care decisions to agent; includes consent, refusal to consent or withdrawal of consent to any care, treatment, admission to a health care facility, any service or procedure to maintain, diagnose or treat an individual’s physical or mental condition. Artificial nutrition and hydration may not be withdrawn or withheld unless clear expression of such power in document. Does not include power to consent to voluntary admission to state institution, voluntary sterilization or consent to withholding of life-sustaining treatment for pregnant patient unless treatment will not permit continuing development and live birth of unborn child. | (1) In writing; (2) substantially statutory form; (3) 2 subscribing witnesses who affirm that principal appeared to be of sound mind and free from duress and that he was aware of the nature of the document and signed it voluntarily; (4) include disclosure statement in substantially same form as §137-J:14 prior to execution | Revocable by (1) notifying attorney-in-fact or health care provider orally or in writing or in any other way communicating specific intent to revoke; (2) execution of subsequent durable power of attorney; (3) filing of action of divorce if spouse is agent. Revocation effective upon notice to health care provider or to attorney-in-fact. Person who is directly interested or related to patient may file an action to revoke durable power of attorney on grounds that principal was not of sound mind or under duress, fraud, or undue influence. | Documents executed in another state are enforceable if they are in compliance with the law of that state or jurisdiction; foreign instruments are restricted to and must be in compliance with the laws of New Hampshire. | Unwilling physician or health care provider must inform attorney-in-fact and allow for transfer of patient to another facility | No person acting in good faith pursuant to durable power of attorney terms shall be subject to criminal or civil liability or unprofessional conduct. No liability for facility which refuses to carry out terms of agent’s direction provided they informed agent of their refusal. |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
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| NEW JERSEY 26:2H-53, et seq. Advanced Directives for Health Care | Decisions to accept or refuse treatment, service, or procedure used to diagnose, treat, or care for a patient’s physical or mental condition including life-sustaining treatment. Includes decisions on acceptance or rejection of services of particular physician or health care provider or transfer of care; on the use of any medical device or procedure, artificially provided fluids and nutrition, drugs, surgery or therapy that uses mechanical or other artificial means to sustain, restore, or supplant a vital bodily function and thereby increase the expected life span of a patient; does not include provision of comfort care or alleviation of pain | (1) Competent adult; (2) signed; (3) dated; (4) 2 witnesses who shall attest that declarant is of sound mind and free of duress and undue influence or notarized or other person authorized to administer oaths. May be supplemented by video or audio tape recording; (5) directive implemented when determination of lack of decision-making capacity is documented and confirmed by physicians | Revocable by (1) oral or written notification; (2) execution of subsequent directive; (3) divorce revokes former spouse’s designation as representative. Patient’s clearly expressed wishes take precedent over any patient’s decision or proxy directive | Effective if executed in compliance with New Jersey law or the laws of that state. Effective if executed in a foreign country in compliance with that country’s laws or the laws of New Jersey and is not contrary to public policy of New Jersey | Unwilling physician should act as soon as practicable to effect an appropriate, respectful and timely transfer of care and to assure patient is not abandoned or treated disrespectfully | No civil, criminal, or professional liability for any physician acting in good faith and pursuant to this act |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
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| NEW MEXICO 24-7A-1 et seq. Uniform Health Care Decisions Act | Agent has power of attorney for health care to make health care decisions including selection and discharge of health care providers, approval and disapproval of diagnostic tests, surgical procedures, programs of medication, orders not to resuscitate, and directions to provide, withhold or withdraw artificial nutrition and hydration and all others forms of treatment or health care which maintains, diagnoses, or otherwise affects an individual’s mental or physical condition. | (1) Adult or emancipated minor having capacity; (2) in writing; (3) signed by principal; (4) may include individual instructions; (5) effective upon determination that principal lacks capacity | Individual with capacity may revoke by (1) signed writing; (2) personally informing supervising health care provider; (3) in any manner that communicates intent to revoke; (4) filing for divorce or legal separation revokes designation of spouse as agent (revived by remarriage); (5) conflicting earlier health care directive (to the extent of the conflict) | Valid if it complies with provisions of Uniform Health Care Decisions Act regardless of where it was executed or communicated. | Physicians or health care provider who declines to comply with health care decision must inform patient or agent; provide continuing care until a transfer can be effected, and make reasonable efforts to assist in transfer to willing health care provider or physician. | No civil or criminal liability or discipline for unprofessional conduct if health care provider acting in good faith and in accordance with generally accepted health care standards in complying with provisions of this act. |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
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| NEW YORK Pub. Health Law §2980, et seq. Health Care Agent and Proxies | Any decision to consent or refuse consent of any treatment, service, or procedure to diagnose or treat an individual’s physical or mental condition | (1) Competent adult; (2) signed; (3) dated; (4) 2 adult witnesses who shall sign proxy and state that principal appeared to execute proxy willingly and free from duress; (5) indicate that principal wants agent to make health care decisions for him; (6) agent’s authority begins when it is determined that principal lacks capacity to make health care decisions (made by attending physician to a reasonable degree of medical certainty and in writing; in case of decision to withhold or withdraw life-sustaining treatment another physician must confirm determination; (7) sample form §2981 (5) (d) | Proxy may provide that it expires on a specified date or occurrence of condition; otherwise in effect until revoked. Revocable by (1) notifying agent or health care provider orally, in writing, or any other act evidencing intent to revoke; (2) divorce if former spouse was agent; (3) upon execution of a subsequent health care proxy | Effective if executed in another state in compliance with laws of that state | If agent’s health care decision can not be honored, agent must be informed prior to admission if possible and transferred promptly to another hospital that is reasonably accessible under the circumstances and willing to honor agent’s decision. Health care provider shall cooperate in facilitating such transfer. | No criminal, civil, or professional liability for acting in good faith pursuant to statute |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
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| NORTH CAROLINA §32A-15 et seq. Health Care Powers of Attorney | Decisions regarding life-sustaining procedures, including those which serve to artificially prolong the dying process and may include mechanical ventilation, dialysis, antibiotics, artificial nutrition and hydration and other forms of treatment which sustain, restore, or supplant vital bodily functions but do not include care necessary to provide comfort or alleviate pain | (1) 18 yrs. old; (2) understanding and capacity to make and communicate health care decisions; (3) in writing; (4) signed in presence of 2 witnesses and acknowledged before a notary (suggested form §32A-25) | May be revoked at anytime by principal capable of making and communicating health care decisions or by death of principal or by execution of a subsequent instrument or written instrument of revocation or any other method where intent to revoke is communicated (effective upon communication). Revoked on decree of divorce if spouse is agent, except if alternate has been appointed. If all health care attorneys-in-fact are unwilling or unable to act, the health care power of attorney will cease to be effective | | | No person acting on the authority of the health care attorney shall be liable for actions taken pursuant to decision of health care attorney. Withholding or discontinuing life-sustaining procedures shall not be considered suicide or cause of death for criminal or civil purpose. |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
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| NORTH DAKOTA 23-06.5-01 et seq. Durable Power of Attorney for Health Care | Agent has power to make any health care decisions principal could if he did not lack capacity (lack of capacity must be certified in writing by principal’s attending physician), decisions including consent, refusal to consent or withdrawal of consent or request any care, treatment, service, or procedure to maintain, diagnose, or treat individual’s physical or mental condition; does not include admission to mental health facility, psychosurgery, abortion, or sterilization. | (1) Signed; (2) 2 witnesses who affirm principal was of sound mind and signed it freely and voluntarily; (3) agent must accept appointment in writing; (4) statutory form of durable power of attorney (§23-06.5-17) is preferred format | Revocable by (1) notification of agent orally, in writing, or any other act evidencing specific intent to revoke; (2) execution of subsequent durable power of attorney; (3) divorce where spouse was principal’s agent | Effective if executed in another state in compliance with the law of that state | Physician has duty to inform principal or agent and take all reasonable steps to transfer care to another who is willing to honor agent’s directive | No civil, criminal, or professional liability if acting in good faith and with ordinary care pursuant to directives of durable power of attorney |
OHIO
1337.11, et seq. Durable Power of Attorney for Health Care | Medical procedure, treatment, intervention, or other measure that will serve to prolong the process of dying, including right to give informed consent and make other decisions principal could if s/he had capacity | (1) Adult; (2) sound mind; (3) signed; (4) dated; (5) signed in presence of 2 adult witnesses or notarized (including attestation that principal is of sound mind and free from duress) | Does not expire unless principal specifies an expiration date in the instrument. Revocable at any time in any manner; effective when expressed, but if physician had knowledge of the durable power of attorney, revocation is effective on communication to physician. Valid Durable Power of Attorney for health care revokes prior instrument | Effective if document complies with the laws of the state where executed and that substantially complies with Ohio law | Physician may not prevent or delay patient’s transfer to another physician | No civil, criminal, or professional liability for good faith reliance which is in accordance with reasonable medical standards on agent’s health care decisions |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
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| OKLAHOMA Tit. 58 §1071, et seq.; Ch. 17A Uniformed Durable Power of Attorney Act | Agent may grant complete or limited authority to make health and medical care decisions but not life-sustaining treatment decisions unless the power complies with requirements for a “health care proxy” under Oklahoma Rights of Terminally Ill or Persistently Unconscious Act, Tit. 63 §3101 et seq. | (1) Signed; (2) 2 adult witnesses who sign in the presence of the principal and each other; (3) substantially the same form as Tit. 58 §1072.2 (4)(3) | Revocable in whole or in part in any manner at any time without regard to declarant’s mental or physical condition. Effective upon communication to physician | Effective if executed in another state if substantially complies with the Uniform Durable Power of Attorney Act | Physician shall take all reasonable steps to arrange for care by another physician | No civil, criminal, or professional liability for carrying out the directives of durable power of attorney in good faith and in accordance with reasonable medical standards |
OREGON
127.505 et seq. Advanced Directives for Health Care & 127.800 Death With Dignity Act | Power to make health care decisions for principal regarding life-sustaining procedures including any medical procedure or intervention that uses mechanical or other artificial means to sustain, restore, or supplant a vital function only when authorized or when principal is terminally ill and such treatment only serves to artificially prolong the moment of death; does not include procedures to sustain patient cleanliness and comfort | (1) In writing; (2) signed by two witnesses who make written declarations; (3) mandatory statutory form §127.531 ORS; (4) agent must accept appointment | Agent may withdraw up to time of principal’s incapacity. Principal may revoke (1) in any manner by which s/he is able to communicate to health care provider or attorney-in-fact intent to revoke; (2) by execution of subsequent durable power of attorney; (3) upon divorce if spouse is agent | Valid execution in compliance with formalities of that state where principal is resident or is located or with state of Oregon | Physician must promptly notify health care representative if unable or unwilling to comply with durable power of attorney and representative shall make a reasonable effort to transfer the principal to a complying physician | Health care provider acting on a durable power of attorney or health care agent in good faith is not liable for criminal, civil, or professional disciplinary actions |
| PENNSYLVANIA 20 Pa CSA §5601-5604 Powers of Attorney | Authorize admission to medical facility and enter into agreements for principal’s care and to consent, arrange, and authorize medical and surgical procedures including administration of drugs | (1) In writing; (2) signed; (3) in the presence of 2 witnesses; (4) presumed durable | Durable power of attorney not affected by subsequent disability or incapacity. Agent must have actual notice of revocation for it to be effective. Divorce revokes power of attorney for spouse. | Documents executed in other states valid except to extent they allow agents to make decisions inconsistent with Pennsylvania law | | Person acting in good faith reliance on power of attorney shall incur no liability as a result. |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
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| RHODE ISLAND 23-4.10-1, et seq. Health Care Power of Attorney | Any medical procedure or intervention that will only prolong the dying process; it shall not include intervention necessary to alleviate pain or provide comfort | (1) 18 yrs.; (2) resident of Rhode Island; (3) 2 adult witnesses; (4) only in statutory form set forth in §23-4.10-2; (5) no effect or force to document if patient is pregnant and live birth is probable with continued application of treatment | Revocable at any time in any manner declarant is able to communicate intent to revoke, without regard to physical or mental condition. Effective upon communication to physician. Controls over living will executed by same person for any inconsistent provisions | Durable power of attorney executed in another state in compliance with laws of that state is valid | Unwilling physician must make necessary arrangements to effect transfer to complying physician | No civil, criminal, or professional liability when acting in accordance with the statute and in accordance with reasonable medical standards. |
SOUTH CAROLINA
62-5-501, et seq. Powers of Attorney | Medical procedure or intervention serving only to prolong the dying process, not including medication or treatment for pain alleviation or comfort care. Principal should indicate whether provision of nutrition and hydration through surgically implanted tubes is desired | (1) Substantially in statutory form §62-5-504 (D); (2) signed; (3) dated; (4) 2 witnesses; (5) state name and address of adult agent; (6) can’t withhold or withdraw life-sustaining procedures during pregnancy | Revocable by (1) written or oral statement or other act constituting notification to agent or health care provider of specific intent to revoke; (2) principal’s execution of subsequent health care power of attorney | Effective if executed in compliance with South Carolina law or laws of another state and recorded as required by §62-5-501 (c) | Physician must make reasonable effort to locate a physician who will follow directive and has a duty to transfer patient to that physician. | No civil, criminal, or professional liability for relying in good faith on agent’s health care decisions |
SOUTH DAKOTA
59-7-2.1, et seq. Termination of Agency | Any health care decisions for principal which principal could have made if s/he had decisional capacity including rejection or withdrawal of consent for medical procedures, treatment, or intervention. Agent may not authorize withholding artificial nutrition and hydration for comfort care or pain relief. Artificial nutrition or hydration may be withheld under certain circumstances or if specifically authorized. | Specific intent must be included in document for durable power of attorney to extend even when principal is disabled but life-sustaining treatment must be given to a pregnant woman unless live birth unlikely to a reasonable degree of medical certainty. | Revocation must be recorded with register of deeds | | | No civil, criminal, or professional liability for physician acting in good faith on a health care decision by agent or attorney-in-fact |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
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| TENNESSEE 34-6-201, et seq. Durable Power of Attorney for Health Care Act | Any procedure, treatment to diagnose, assess, or treat a disease, illness, or injury, including surgery, drugs, transfusions, mechanical ventilation, dialysis, CPR, artificial nourishment, hydration or other nutrients, radiation. Death by starvation or dehydration allowed only if specifically directed with statutory phrase. | Signed before 2 witnesses and notary public and specifically authorizes health care decisions | Revocable by (1) notifying the attorney-in-fact orally or in writing; (2) notifying health care giver orally or in writing; (3) executing subsequent durable power of attorney; (4) divorce if former spouse was designated; (5) principal’s current wishes supersede durable power of attorney | Effective if document complies with laws of Tennessee or laws of the state of principal’s residence | Prompt and orderly transfer required | No criminal, civil, or professional liability for physician acting in good faith |
TEXAS Health
& Safety Code §166.151, et seq. Durable Power of Attorney for Health Care | Decisions regarding consent to health care, treatment, service, or procedure to maintain, diagnose, or treat individual’s physical or mental condition. Agent may not consent to voluntary in-patient mental health services, convulsive treatment, psychosurgery, abortion, or neglect of principal through omission of care primarily intended to provide for comfort of principal | (1) Signed; (2) in presence of 2 or more subscribing witnesses; (3) substantially statutory to form (§135.015 and .016) and accompanied by disclosure statement. Principal may designate alternative agents | Effective indefinitely upon execution and delivery of document unless revoked. Revocable orally or in writing with specific intent to revoke or execution of subsequent power of attorney; divorce if spouse is agent. Effective upon receipt and notice to agent and health care provider. | Durable power of attorney executed in another state valid if it complies with the law of that state or jurisdiction | Physician must notify agent immediately to arrange for transfer | Agent not liable for health care decision made in good faith. Physician not liable for acts or decisions made under durable power of attorney if done in good faith and does not constitute a failure to exercise due care in the provision of health care services |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
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| UTAH 75-2-1106 Special Power of Attorney; 75-2-1101 et seq. Personal Choice and Living Will Act | Any medical procedure or intervention that would serve only to prolong the dying process including artificial nutrition and hydration unless declaration specifically excludes; does not include medication, sustenance, or any procedure to alleviate pain; separate procedure for “do not resuscitate” directive. | Agent/proxy:(1) 18 yrs.; (2) in writing; (3) dated and signed; (4)suggested form §75-2-1105. For power of attorney: must be before notary public and the suggested form is §75-2-1106; power of attorney takes precedent over earlier signed directives | Current wishes of declarant take precedent over any directive. Revocable at any time by (1) signed revocation; (2) destruction of document; (3) oral expression of intent to revoke in presence of witness. Effective on receipt by physician | A similar instrument executed in another state is presumed to comply with Utah law and may be relied upon in good faith. | Unwilling physician required to transfer patient promptly | No civil, criminal, or professional liability for good faith compliance with directive |
VERMONT
Tit. 14 §3451, et seq. Durable Power of Attorney for Health Care | To make health care decisions for principal during periods of incapacity as certified in writing by principal’s attending physician including withdrawal of consent to any care, treatment, service, or procedure or to maintain, diagnose, or treat an individual’s physical or mental condition; does not include consent to sterilization or admission to state institution | (1) Signed; (2) 2 witnesses; (3) signed statement that principal understands a disclosure statement on durable powers of attorney; (4) substantially same form as §3466 | Principal’s current wishes supersede directives at all times. Revocable by (1) notifying agent or health care provider orally or in writing or any other act evidencing specific intent to revoke; (2) executing a subsequent durable power of attorney; (3) divorce, if former spouse was principal’s agent | Effective if in compliance with the law of the state in which it was executed | Unwilling physician must inform agent and principal if possible and assist in selecting another physician willing to honor agent’s directive | No civil, criminal, or professional liability if physician acts in good faith; no immunity for failure to exercise due care in provision of services |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
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| VIRGINIA 54.1-2981 Health Care Decisions Act | Any medical procedure, treatment, intervention, utilizing mechanical or other artificial means to sustain, restore, or supplant a vital function, or is of a nature to afford patient no reasonable expectation of recovery from a terminal condition and when applied to a patient in terminal condition, would serve only to prolong the dying process. Includes artificially administered hydration and nutrition and CPR by emergency medical services personnel, but does not include any medication or procedure to alleviate pain or provide comfort care | (1) Competent adult; (2) written advance directive; (3) signed in presence of 2 subscribing witnesses; (4) oral declaration in presence of physician and 2 witnesses for those in terminal condition; (5) responsibility of declarant to provide notification of advance directive to attending physician. (suggested form §54.1-2984)) | Revocable at any time by (1) signed, dated writing; (2) physical cancellation or destruction; (3) oral expression of intent to revoke. Effective upon communication to attending physician | Directive executed in another state valid if in compliance with Virginia law or law of state where executed. Such directives shall be construed in accordance with Virginia laws | If physician thinks treatment is medically or ethically inappropriate or is contrary to terms of advanced directive, unwilling physician must make reasonable effort to transfer patient to another physician | No civil, criminal, or professional liability if acting in good faith. It would have to be shown by preponderance of the evidence that the person authorizing life-prolonging procedures acted in bad faith |
| WASHINGTON 11.94.010, et seq. Power of Attorney | Appointed attorney-in-fact may make health care decisions on principal’s behalf or provide informed consent | (1) In writing; (2) principal designates another as his attorney-in-fact; must include words showing intent of principal that authority be conferred notwithstanding principal’s disability | Continues until revoked or terminated by principal, court-appointed guardian or court order | | | Anyone acting in good faith and without negligence shall incur no liability |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
|---|
| WEST VIRGINIA §16-30-1, et seq. Health Care Decisions Act | To affect a patient’s decision to accept or reject medical or surgical treatments which prolong the dying process artificially | (1) 18 yrs.; (2) in writing; (3) signed by declarant or someone at his or her directive; (4) dated; (5) 2 witnesses; (6) notarized; (7) with words indicating effective upon patient’s incapacity; substantially same form as §16-30A-18 | Desires of principal at all times supersede effect of medical power of attorney. Revocable at any time by (1) destruction of document; (2) written revocation signed and dated; (3) verbal expression with witness present; (4) divorce if former spouse was designated | Valid if in compliance with laws of West Virginia or state where executed and expressly delegates health care decisions | Unwilling physician shall cause the transfer of principal to a complying physician | No criminal civil liability for good faith compliance with directions of medical power of attorney or representative |
| WISCONSIN 155.01 et seq. Power of Attorney for Health Care | Designation of another for purpose of making informed decisions in the exercise of the right to accept, maintain, discontinue, or refuse any care, treatment, service or procedure to diagnose, maintain, or treat physical or mental condition. Feeding tube may be withheld or withdrawn unless it would cause pain. Agent may not consent to withholding or withdrawing of orally ingested nutrition or hydration unless provision is medically contra-indicated | (1) 18 yrs. and sound mind; (2) in writing; (3) signed; (4) dated; (5) 2 witnesses; (6) voluntarily executed; (7) takes effect upon finding of incapacity by 2 physicians; (8) substantially same form as §155.30; (9) may file with register in probate | Revocable at any time by (1) canceling or destroying document; (2) revocation in writing signed and dated; (3) verbal revocation in presence of 2 witnesses; (4) executing a subsequent power of attorney; (5) divorce if former spouse was attorney-in-fact. | | Must make good faith attempt to transfer principal to complying physician. | No civil, criminal, or professional liability if acting in good faith |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
|---|
| WYOMING 35-22-401, et seq. Wyoming Health Care Decisions Act | Consent, refusal of consent, or withdrawal of consent to any medical procedure, care, treatment, intervention, or nourishment by artificial means in the event of a terminal condition except for alleviation of pain and comfort care and consent to convulsive treatment, psychosurgery, or commitment to mental facility; does not affect health care treatment in an emergency | (1) Signed; (2) dated; (3) 2 witnesses; (4) notarized; (5) attorney-in-fact authorized to make health care decisions | Principal’s wishes if able to give informed consent take precedent over durable power of attorney. Revocable by (1) notifying attorney-in-fact in writing; (2) notifying health care provider in writing; (3) divorce if former spouse was attorney-in-fact; (4) a subsequent valid durable power of attorney for health care | | | No criminal, civil, or professional liability if acting in good faith |
| Table 42b: Right to Die: Euthanasia |
|---|
| State | Code Section | Mercy Killing Condoned | Operative Facts |
|---|
| ALABAMA | 22-8A-10; 22-8A-9(a) | Euthanasia not condoned or authorized nor is allowed any affirmative act or omission to end life other than to permit the natural process of dying | Withholding or withdrawal of life-sustaining procedures in accordance with chapter 22-8A shall not constitute assisting suicide. |
| ALASKA | 11.41.120(a) No statutory provisions | | Intentionally aiding another person to commit suicide constitutes manslaughter |
| ARIZONA | 36-3201, et seq. (Chapter 32) | Euthanasia, suicide, or assisted suicide is not authorized, or approved by Arizona law. | Authorized surrogate or health care provider complying with provisions of chapter are immune from liability. |
| ARKANSAS | 20-17-210(a), (g) | Euthanasia or mercy killing not condoned, authorized, or approved by Arkansas law. | Death resulting from withholding or withdrawal of life-sustaining treatment pursuant to declaration and in accordance with this section does not constitute suicide or homicide. |
| CALIFORNIA | Probate §4653 | Nothing condones, authorizes, or approves mercy killing or permits an affirmative act or omission to end life other than the withholding of health care pursuant to a durable power of attorney so as to permit the natural process of dying. In making health care decisions under a durable power of attorney, an attempted suicide shall not be construed to indicate a decision of the principal that health care treatment be restricted or inhibited. | Death resulting from withholding or withdrawing life-sustaining treatment in accordance with the Natural Death Act does not constitute for any purposes suicide or homicide. |
| COLORADO | 15-14-504; 15-18-111, 112 | Nothing condones, authorizes, or approves euthanasia or mercy killing or shall be construed as permitting any affirmative or deliberate act to end a person’s life except to permit natural death. | Withholding or withdrawing life-sustaining procedures pursuant to a declaration or the law shall not constitute a suicide or homicide. |
| CONNECTICUT | No statutory provisions | | |
| DELAWARE | 16 §2512 | Nothing in this act condones, authorizes, or approves of mercy killing; permits any affirmative act or omission to end life other than to permit the natural process of dying | Neither execution of declaration nor fact that maintenance medical treatment is withheld from patient in accordance with the declaration shall constitute suicide. |
| DISTRICT OF COLUMBIA | 7-630; 21-2212; 7-628 | Euthanasia not condoned, authorized, or approved nor is any affirmative or deliberate act or omission to end a human life other than to permit the natural process of dying. | Withholding or withdrawing life-sustaining procedures in accordance with the Natural Death chapter shall not constitute the crime of assisting suicide. |
| FLORIDA | 765.309 | Nothing 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. | The withdrawing of life-prolonging procedures from a patient in accordance with any provision of this chapter does not for any purpose constitute a suicide. |
| State | Code Section | Mercy Killing Condoned | Operative Facts |
|---|
| GEORGIA | 31-32-9; 31-32-11 | Mercy killing is not condoned, authorized, or approved nor is any affirmative or deliberate act or omission permitted to end life other than to permit the process of dying. | The making of a living will pursuant to this chapter shall not for any purpose constitute a suicide. |
| HAWAII | 327E-13 | Mercy killing or euthanasia not condoned, authorized, or approved by Hawaii law. | Death resulting from withholding or withdrawal of life sustaining procedures does not constitute suicide. Execution of declaration does not constitute attempted suicide |
| IDAHO | 56-1022 | Does not make legal or condone mercy killing, euthanasia, or assisted suicide | |
| ILLINOIS | 755 ILCS 35/9 and 45/4-8e | Nothing in this Act shall be construed to condone mercy killing or to permit any affirmative or deliberate act or omission to end life other than to permit natural process of dying. | Withholding or withdrawal of death delaying procedures from a qualified patient or in accordance with terms of this Act or a health care agency shall not constitute suicide or homicide or murder. |
| INDIANA | 16-36-1-13, 16-36-4-19 | Euthanasia not condoned or authorized by Indiana law. This chapter does not authorize euthanasia or any affirmative or deliberate act or omission to end life other than to permit the natural process of dying, including the withholding or withdrawing of life prolonging procedures under this chapter | |
| IOWA | 144A.11.6 and 144B.12 | This chapter should not be construed to condone, authorize, or approve mercy killing or euthanasia or any affirmative or deliberate act or omission to end life other than to permit the natural process of dying. | Death resulting from withholding or withdrawal of life-sustaining procedures pursuant to a declaration and in accordance with this chapter does not, for any purpose, constitute a suicide or homicide |
| KANSAS | 65-28,108; 65-28,109 | Nothing in this act shall be construed to condone, authorize, or approve mercy killing or to permit any affirmative or deliberate act or omission to end life other than to permit the natural process of dying. | Acting in accordance with the Natural Death Act shall not for any purpose constitute a suicide or the crime of assisting suicide. |
| KENTUCKY | 311.637 and 311.639 | Nothing shall be construed to condone mercy killing or euthanasia or to permit any affirmative or deliberate act to end life other than to permit natural process of dying. | Withholding or withdrawal of life prolonging treatment or artificially provided nutrition and hydration shall not constitute suicide. |
| LOUISIANA | 40:1299.58.10(A), (B)(1) | Nothing in this section 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. | The withholding of life-sustaining procedures in accordance with this part shall not for any purpose constitute suicide. |
| State | Code Section | Mercy Killing Condoned | Operative Facts |
|---|
| MAINE | 18A §5-813 | (c) This part does not authorize mercy killing, assisted suicide, euthanasia or the provision, withholding, or withdrawal of health care to the extent prohibited by other statutes of this state. | (b) Death resulting from the withholding or withdrawal of health care in accordance with this part does not constitute a suicide or homicide. |
| MARYLAND | Health-Gen. §§5-611 and 5-614 | Nothing in this subtitle should be construed to condone, authorize, or approve of 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. | Withdrawal or withholding of life-sustaining procedures in accordance with this subtitle shall not for any purpose be considered to be a suicide. |
| MASSACHUSETTS | Ch. 201D §12 | Nothing in this chapter shall be construed to constitute, condone, authorize, or approve suicide or mercy killing or to permit any affirmative or deliberate act to end one’s own life other than to permit the natural process of dying. | |
| MICHIGAN | 333.5660 | Designation of a patient advocate shall not be construed to condone, allow, permit, authorize, or approve suicide or homicide. | |
| MINNESOTA | 145B.14; 145C:14 | Euthanasia, mercy killing, suicide, or assisted suicide is not condoned or authorized or approved by Minnesota law. | |
| MISSISSIPPI | 41-41-227 | This act does not authorize mercy killing, assisted suicide, or euthanasia. | The act does not authorize the provision, withholding, or withdrawal of healthcare to the extent prohibited by other statutes. |
| MISSOURI | 404.845; 459.055 | Euthanasia or mercy killing is not condoned or authorized by Missouri law, nor does it permit any affirmative or deliberate act or omission to shorten or end life. | When patient’s death results from withholding or withdrawing life-sustaining treatment in accordance with a durable power of attorney, the death shall not constitute a suicide or homicide for any purpose. |
| MONTANA | 50-9-205; 50-10-104 | Montana’s Right of the Terminally Ill Act does not condone, authorize, or approve mercy killing or euthanasia. | Death resulting from the withholding or withdrawal of life-sustaining procedures pursuant to a valid DNR order is not, for any purpose, suicide or homicide. |
| NEBRASKA | 20-412; 28-307; 30-3401 | This Act does not confer any new rights regarding provision or rejection of specific medical care and does not alter laws regarding homicide, suicide, or assisted suicide. Nor does it approve, authorize, or condone homicide, suicide, or assisted suicide. Assisting suicide is a Class IV felony. | Death from withholding or withdrawal of life-sustaining treatment in accordance with this Act shall not constitute, for any purpose, homicide or suicide |
| State | Code Section | Mercy Killing Condoned | Operative Facts |
|---|
| NEVADA | 449.650; 449.670 | Euthanasia or mercy killing not condoned or authorized or approved by Nevada law. | Death resulting from withholding or withdrawal of life-sustaining treatment in accordance with Nevada law does not for any purpose constitute suicide or homicide. |
| NEW HAMPSHIRE | 137-H:10, 13 | Euthanasia, mercy killing, or assisted suicide are not condoned or authorized by New Hampshire law. Nor does New Hampshire law permit any affirmative or deliberate act or omission to end life other than to permit the natural process of dying of those in a terminal or permanently unconscious condition. | Withdrawing or withholding life-sustaining procedures from a patient according to living will or consistent with 137-H:3 shall not be construed as suicide for any legal purpose. |
| NEW JERSEY | 26:2H-77; 26:2H-54 | No one has the right to or is authorized to practice active euthanasia. | Withholding or withdrawing of life-sustaining treatment pursuant to an advanced directive for health care when performed in good faith shall not constitute homicide, suicide, assisted suicide, or active euthanasia. |
| NEW MEXICO | 24-7A-13 | Uniform Health Care Decisions Act does not authorize mercy killing, assisted suicide, euthanasia, or the provision, withholding or withdrawal of health care to the extent prohibited by other statutes | Withholding of medical treatment pursuant to Right to Die Act shall not for any purpose constitute suicide. |
| NEW YORK | Pub. Health Law §2989 | Statute not intended to promote or permit suicide, assisted suicide, or euthanasia; nor to be construed to permit agent to consent to any act or omission to which the principal could not consent under law. | |
| NORTH CAROLINA | 90-320(b); §32A-24 | Provisions in the act do not authorize any affirmative or deliberate act or omission to end life other than to permit natural process of dying. | Withholding life support is not considered suicide or cause of death for civil or criminal purposes. |
| NORTH DAKOTA | 23-06.4-01 and 11; 23-06.5-01 | Euthanasia, mercy killing, or assisted suicide is not condoned or authorized by North Dakota law, nor is any other act or omission other than to allow the natural process of dying. | Death resulting from withholding or withdrawal of life-prolonging treatment does not constitute for any purpose, suicide or homicide. |
| OHIO | 2133.12(A), (D) | Euthanasia, mercy killing, or assisted suicide is not condoned or authorized by Ohio law. | Death of any patient resulting from withholding life-sustaining treatment does not constitute suicide, murder or any homicide offense for any purpose. |
| OKLAHOMA | Tit. 63 §§3101.2, 3101.12 | Euthanasia, mercy killing, or assisted suicide is not condoned or authorized by Oklahoma law. | Death from withdrawing life-sustaining treatment shall not constitute homicide or suicide. |
| OREGON | 127.570 & 127.800 | Nothing in statute is intended to condone, authorize, or approve mercy killing or permit affirmative or deliberate act or omission to end life, other than to allow the natural process of dying. | Withholding or withdrawal of life-sustaining procedures or artificially administered nutrition and hydration does not constitute suicide, assisted suicide, homicide, or mercy killing. |
| State | Code Section | Mercy Killing Condoned | Operative Facts |
|---|
| PENNSYLVANIA | 20 §5402; §5410 | Mercy killing, euthanasia, aided suicide is not condoned, authorized, or approved; nor is any affirmative or deliberate act to end life other than defined by this Act. | Withholding or withdrawal of life-sustaining treatment in accordance with this chapter shall not constitute suicide or homicide. |
| RHODE ISLAND | 23-4.10-9; 23-4.11-10 | Euthanasia or mercy killing is not condoned or authorized by Rhode Island law. | Death resulting from withdrawal or withholding of life-sustaining procedures does not constitute suicide or homicide. |
| SOUTH CAROLINA | 44-77-110, 130 | Euthanasia or mercy killing is not condoned or authorized by South Carolina law, nor is any act or omission other than to allow the natural process of dying. | Effectuation of health care power of attorney or execution of declaration does not constitute suicide for any purpose. |
| SOUTH DAKOTA | 34-12D-14, 20 | Euthanasia, mercy killing, or assisted suicide is not condoned or authorized by South Dakota law. | Death by withdrawing or withholding life-sustaining treatment does not constitute suicide or homicide. |
| TENNESSEE | 32-11-110; 39-13-216 | Assisted suicide is a class D felony. | Withdrawal or withholding of medical care in accordance with provisions of this Act does not constitute suicide, euthanasia, or homicide. |
| TEXAS | Health & Safety 166.045, 166.050 | Mercy killing or euthanasia is not condoned or authorized by Texas law, nor is any act or omission other than to allow the natural process of dying. | Withdrawal or withholding of life-sustaining procedures does not constitute offense of Aiding Suicide |
| UTAH | 75-2-1116, 1118 | Euthanasia, mercy killing, or suicide is not condoned or authorized by Utah law. | Withholding or withdrawal of life-sustaining procedures does not constitute suicide or assisting suicide |
| VERMONT | Tit. 18, §5260 | | Acting pursuant to terminal care document in withholding or withdrawal of life-sustaining procedures from patient is not suicide. |
| VIRGINIA | §§54.1-2990, 2991 | Mercy killing or euthanasia is not condoned, approved, or authorized by Virginia law, nor is any affirmative or deliberate act or omission other than to allow the natural process of dying permitted. | Acting in accordance with Health Care Decisions Act in withholding or withdrawing life-prolonging procedures does not constitute suicide. |
| WASHINGTON | 70.122.100 and .070 | Euthanasia or physician-assisted suicide is not condoned or authorized by Washington law, nor is any act or omission other than to allow the natural process of dying. | Withholding or withdrawal of life-sustaining treatment shall not constitute suicide or homicide |
| WEST VIRGINIA | 16-30-15 | Euthanasia or mercy killing is not condoned or authorized by West Virginia law, nor is any act or omission other than to allow the natural process of dying. | |
| State | Code Section | Mercy Killing Condoned | Operative Facts |
|---|
| WISCONSIN | 154.11; 155.70 | Euthanasia is not condoned or authorized by Wisconsin law, nor is any affirmative or deliberate act or omission other than to allow the natural process of dying. | Withholding or withdrawal of life-sustaining procedures or feeding tubes does not constitute suicide. Execution of declaration does not constitute attempted suicide. |
| WYOMING | 35-22-410, 35-22-414(c) | Euthanasia or mercy killing is not condoned or authorized by Wyoming law, nor is any affirmative or deliberate act or omission other than to allow the natural process of dying. | Withholding or withdrawal of life-sustaining procedures from a qualified patient in accordance with this chapter does not constitute a crime. |
| Table 42c: Right to Die: Living Wills |
|---|
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
|---|
ALABAMA
22-8A Natural Death Act | Any medical procedure or intervention serving only to prolong the dying process and where death will occur whether or not such intervention is utilized; does not include medication or any medical procedure deemed necessary to provide comfort care or pain alleviation | (1) Competent adult; (2) in writing; (3) signed by declarant; (4) dated; (5) signed in presence of 2 or more witnesses over 19; (6) declaration should be substantially in statutory format | Revocable at any time by (1) destruction of document in manner intending to cancel; (2) execution of written revocation by declarant; (3) oral revocation in presence of adult witness (over 19) | Declaration executed in another state is valid if valid under laws of that state | Physician shall permit the patient to be transferred | No criminal, civil, or professional liability for physician acting in good faith pursuant to reasonable medical standards and pursuant to a declaration |
| ALASKA No statutory provisions | | | | | | |
ARIZONA
36-3201 et seq. Living Wills and Health Care Directives | Does not include comfort care or alleviation of pain but may include life-sustaining treatment artificially delaying the moment of death, CPR, drugs, electric shock, artificial breathing, artificially administered food and fluids | (1) Adult; (2) in writing; (3) language clearly indicating intent to create a living will; (4) dated; (5) signed; (6) witnessed by at least one adult or a notary public | Person may revoke health care directive or disqualify a surrogate by (1) written revocation; (2) orally notifying surrogate or health care provider; (3) making new health care directive; (4) any other act demonstrating specific intent to revoke | Health care directive prepared in another state is valid in this state if it was valid where and at the time it was adopted to the extent it does not conflict with the criminal laws of Arizona | Physician must effect prompt transfer to a physician willing to comply | Health care provider making good faith decisions in reliance on apparently genuine health care directive or decision of a surrogate or living will is immune from criminal, civil, and professional discipline for that reliance (unless negligent) |
ARKANSAS
20-17-201, et seq. | Any medical procedure or intervention that will serve only to prolong the dying process or to maintain the patient in a condition of permanent unconsciousness | (1) Sound mind; (2) 18 yrs.; (3) signed by declarant; (4) witnessed by 2 individuals | Revocable at any time, in any manner by the declarant without regard to the declarant’s mental/physical condition; effective upon communication to attending physician | A declaration executed in another state in compliance with the laws of that state or Arkansas law is validly executed | Physician shall as promptly as practicable take all reasonable steps to transfer care to another physician | Physician whose actions under this chapter are in accord with reasonable medical standards is not subject to criminal, civil, or professional liability with respect to them |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
|---|
| CALIFORNIA Probate §4600 et seq. Natural Death Act | Any medical procedure or intervention that will serve only to prolong the process of dying or an irreversible coma or persistent negative state; does not include treatment to alleviate pain or provide comfort care | (1) Sound mind; (2) over 18; (3) signed by declarant; (4) witnessed by 2; (5) declaration shall contain substantially same information as form; (6) operative when declarant in terminal condition as certified in writing by 2 physicians; (7) not effective while patient is pregnant | Revocable at any time in any manner without regard to declarant’s mental/physical condition; revocation is effective upon its communication to the attending physician | Declaration executed in another state in compliance with the laws of that state or California law is valid | Physician shall take all reasonable steps as promptly as practicable to transfer the patient to a physician who is willing to comply | Physician is not subject to civil, criminal, or professional liability for acting in good faith pursuant to declaration |
COLORADO
15-18-102, et seq. Colorado Medical Treatment Decision Act | Any medical procedure or intervention that would serve only to prolong the dying process; it shall not include any medical procedure for nourishment or considered by attending physician to provide comfort or alleviate pain; however, artificial nourishment may be withdrawn pursuant to declaration that artificial nutrition (1) not be provided or continued when it is the only procedure being provided; (2) be continued for a specified period when it is the only procedure being provided | (1) Competent; (2) adult; (3) executed before 2 competent witnesses | Revocable by declarant orally, in writing, or by burning, tearing, cancelling; obliterating, or destroying the declaration | | | No hospital or physician acting under direction of physician and participating in the withholding or withdrawal of life-sustaining procedures in compliance with a declaration shall be subject to any civil or criminal liability or licensing sanction in the absence of revocation, fraud, misrepresentation, or improper execution. |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
|---|
| CONNECTICUT 19a-570, et seq. Removal of Life Support Systems | Any medical procedure or intervention serving only to postpone the moment of death or maintain individual in a state of permanent unconsciousness including artificial means of nutrition/hydration, artificial respiration, CPR, but does not include comfort care and pain alleviation | (1) 18 yrs.; (2) signed; (3) dated; (4) presence of 2 witnesses; (5) in substantially form of §19a-575a | May be revoked at any time in any manner | | Physician shall act as promptly as practicable and take all reasonable steps to transfer patient to complying physician. | Physician withholding, removing life-support system of an incapacitated patient shall not be civilly or criminally liable if decision was based on physician’s (1) best medical judgment; (2) physician deems patient in a terminal condition; (3) patient’s wishes were considered according to an executed document |
DELAWARE
16 §2501, et seq. Health Care Decisions | Right to refuse medical or surgical treatment via written declaration instructing any physician to cease or refrain from medical or surgical treatment | (1) Legally adult, competent, of sound mind; (2) written declaration; (3) declarant in terminal condition confirmed in writing by 2 physicians; (4) signed by declarant or another person in declarant’s presence and at his express direction; (5) dated; (6) 2 or more adult witnesses who state in writing that they are not prohibited from being a witness; (7) not pregnant | Revocable at any time without regard to declarant’s mental state or competency by (1) destruction of declaration with intent to revoke; (2) oral statement in presence of 2 persons 18 years or older expressing intent to revoke; (3) written revocation signed and dated by declarant or; (4) new declaration with contrary intent; (5) receipt of emergency treatment | Declarations executed in other states are valid if valid in that state | | Physicians or nurses acting in reliance on properly executed document are presumed to be acting in good faith and there is no civil or criminal liability or discipline for unprofessional conduct. |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
|---|
| DISTRICT OF COLUMBIA 7-621, et seq. Natural Death Act | Any medical procedure or intervention which would serve only to artificially prolong the dying process and where death will occur whether or not such procedures are utilized; does not include medication or any medical procedure necessary to alleviate pain or provide comfort care | (1) 18 yrs.; (2) in writing; (3) dated; (4) signed; (5) in presence of 2 or more witnesses over 18; (6) declaration should be in substantially the statutory form of §6-2422 | Revocable at any time by declarant without regard to declarant’s mental state by (1) destruction of documents; (2) written revocation signed and dated; (3) verbal expression of intent to revoke in presence of an 18 year old witness; desires of qualified patient at all times supersede the effect of the declaration | | Physician must effect a transfer and failure to do so shall constitute unprofessional conduct | No civil, criminal, professional liability for physician who acts in good faith pursuant to reasonable medical standard and to a declaration made |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
|---|
| FLORIDA 765.101, et seq. Health Care Advance Directives | Any medical procedure, treatment, or intervention which utilizes mechanical or other artificial means to sustain, restore, supplant a spontaneous vital function and serves only to prolong the dying process of a patient in terminal condition; does not include medication or a medical procedure to provide comfort care or to alleviate pain | (1) Competent; (2) adult; (3) signed by principal; (4) in presence of 2 subscribing witnesses (suggested form in 765.302) one of whom is neither a spouse nor a blood relative | Revocable at any time by principal by (1) signed, dated writing; (2) destruction of the declaration; (3) oral expression of intent to revoke; (4) subsequent advance directive materially different from the previously executed advance directive; (5) divorce revokes the designation of former spouse as surrogate. Revocation effective when properly communicated. | An advanced directive executed in another state in compliance with the laws of that state or Florida is validly executed | Physician should make reasonable efforts to transfer to a health care provider who will comply with the declaration; a physician unwilling to carry out the patient’s wishes because of moral or ethical beliefs must within 7 days: (1) transfer the patient and pay the cost of transporting the patient to another health care provider or (2) carry out the wishes of the patient unless provisions of judicial intervention apply | Health care facility, provider or other person who acts under the direction of a health care facility, or provider is not subject to criminal prosecution or civil or professional liability for carrying out a health care decision |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
|---|
| GEORGIA 31-32-1, et seq. | Any medical procedures or interventions which would serve only to prolong the dying process for a patient in a terminal condition, a coma, or persistent vegetative state with no reasonable expectation of regaining consciousness or cognitive function; may include the provision of nourishment and hydration but shall not include medication or any medical procedure to alleviate pain | (1) Competent; (2) adult; (3) signed by declarant; (4) in presence of 2 competent adults not related to declarant; (5) any declaration constituting declarant’s intent shall be honored regardless of the form or when executed | Revocable at any time by declarant without regard to mental state or competency by (1) destruction of document; (2) declarant signs and dates a written revocation expressing intent to revoke; (3) any verbal or nonverbal expression by declarant of intent to revoke which clearly revokes the living will as opposed to a will relating to the disposition of property after death | Any declaration regardless of form which constitutes declarant’s intent shall be honored | Advise promptly the next of kin or guardian and at their electionmake a good faith attempt to effect a transfer or permit the next of kin or guardian to obtain complying physician | No physician acting in good faith in accordance with the requirements of this chapter shall be subject to any civil liability, guilty of any criminal act, or unprofessional conduct |
HAWAII
327E-1, et seq. Uniformed Health-Care Decisions Act | Execute declaration directing provision, continuation, withholding, or withdrawal of any medical procedure or intervention including artificial provisions of fluids, nourishment, medication that when administered to patient will only serve to prolong dying process; does not include procedure necessary for patient comfort or relief | (1) Competent person, age of majority; (2) in writing; (3) signed by declarant or another person in his presence and at his expressed direction; (4) dated; (5) signed in presence of 2 or more adult witnesses; (6) all signatures notarized; (7) not pregnant; (8) in terminal condition or permanent loss of ability to communicate concerning medical treatment (sample form §327D-4) | Revocable at any time by various methods including: (1) in writing signed and dated by declarant; (2) unambiguous verbal expression by declarant in front of 2 witnesses; (3) canceling, destroying declaration in declarant’s presence and at his direction; (4) unambiguous verbal expression to attending physician | Document executed in another state is valid if it substantially complies with requirements of this chapter | Physician shall without delay make necessary arrangements to transfer patient and medical records to another physician; transfer without unreasonable delay or with good faith attempt to transfer is not abandonment and not subject to liability | No criminal prosecution or civil liability or deemed to have engaged in unprofessional conduct as result of withholding or withdrawal of life sustaining procedures unless absence of actual notice of revocation is result of negligence of health care provider, physician, or other person. Failure to transfer is professional misconduct |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
|---|
| IDAHO 39-4501. et seq. Natural Death Act | Any medical procedure or intervention which utilizes mechanical means to sustain or supplant a vital function serving only to artificially prolong the moment of death and where death is imminent whether or not procedures are utilized; does not include the administration of medication or a medical procedure to alleviate pain | (1) Of sound mind; (2) emancipated minor or 18 yrs. or older; (3) voluntarily made; (4) 2 witnesses must sign; (5) not enforced during course of pregnancy | Revocable at any time by declarant without regard to competence by (1) destruction of the document; (2) by written, signed revocation; (3) by verbal expression of intent to revoke | | Physician may withdraw without civil or criminal liability provided the physician makes a good faith effort to assist the patient in transferring before his/her withdrawal | No civil or criminal liability for a physician acting in accordance with the wishes of the patient as expressed by statutory procedure |
ILLINOIS
755 ILCS 35/1, et seq. Illinois Living Will Act | Individual may execute document directing that if he is suffering from a terminal condition and no longer able to participate actively in decisions about himself, then death–delaying procedure shall not be utilized for the prolongation of his life. These procedures include any which serve to postpone the moment of death and specifically include, but are not limited to, assisted ventilation, artificial kidney treatment, intravenous feeding/medication, blood transfusions and tube feedings, but does not include procedures providing for patient’s comfort care or alleviation of pain | (1) Sound mind and age of majority or status of emancipated person (sample form at 35/3e); (2) signed by declarant or another at declarant’s direction; (3) 2 witnesses over 18; (4) not pregnant (or at point where could develop to point of live birth with continued application of death delaying procedures); (5) notify attending physician | Revocable by declarant at any time without regard to mental or physical condition (1) in writing signed and dated by declarant or person acting at his/her direction; (2) by oral expression in presence of witness who signs and dates a written confirmation; (3) by destroying declaration in manner indicating intent to cancel; revocation is effective upon communication to attending physician | Declaration executed in another state in compliance with law of that state or Illinois is valid | Patient is responsible to initiate transfer; if patient not able to initiate transfer then attending physician shall without delay notify person with highest priority who is available, able, and willing to make arrangements for transfer for effectuation of patient’s declaration | No physician, health care provider, or health care expert who in good faith and pursuant to reasonable medical standards causes or participates in withholding or withdrawal of death delaying procedure from qualified patient per declaration shall be subject to criminal or civil liability or be found to have committed an act of unprofessional conduct |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
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| INDIANA §16-36-4-1 et seq. Living Wills and Life Prolonging Procedures Act | Living will declarant may ask that life prolonging procedures that would sustain, restore, or supplant a vital function or that would serve to prolong the dying process not be used in case of terminal diagnosis and incapacity; this does not include any medical procedure or medication necessary to provide comfort care or alleviate pain. | (1) Person of sound mind, 18 yrs. old; (2) voluntary; (3) in writing; (4) dated; (5) signed in presence of 2 adult witnesses; (6) notice to declarant’s attending physician; (7) is presumptive evidence of declarant’s intent; (8) not enforced if pregnant (sample form §16-36-4-10). Witnesses must not be related to declarant. | Living will declaration is presumed valid. Revocable at any time by (1) signed and dated in writing; (2) physical destruction by declarant or at declarant’s direction; (3) oral expression of revocation | | Physician who refuses to comply shall transfer to another physician who will comply unless (1) physician believes declaration is not validly executed and (2) patient is unable to validate declaration. If patient not transferred for above reason, physician should try and ascertain patient’s intent and declaration’s validity from persons listed in §16-36-4-13 (g)(1-7). | Act of withdrawing or withholding life-prolonging procedures for qualified patient is lawful, and physician is not subject to criminal or civil liability or unprofessional conduct if done in good faith and in accordance with reasonable medical standards. Violation of any provisions of act subjects physician to disciplinary sanctions by medical licensing board. |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
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| IOWA 144A.2 Life-Sustaining Procedures Act | Declarant may declare desire to not have life-sustaining procedures employed to prolong life; life sustaining procedures are those that utilize mechanical or artificial means to sustain, restore, or supplant a spontaneous vital function and/or when applied to a patient in a terminal condition would only serve to prolong the dying process, does not include provision of nutrition or hydration except when required parenterally or though intubation or the administration of medication or performance of medical procedures which provide comfort care or alleviate pain; declaration shall not be in effect when declarant is pregnant as long as fetus can develop to point of live birth | (1) Declarant competent adult; (2) signed in presence of 2 witnesses and in the presence of each other; (3) physician may presume declaration is valid; (4) actual notice of declaration to attending physician; (5) declaration given effect when declarant’s condition is terminal and he is unable to make treatment decisions. (sample form 144A.3(5)) At least one witness must not be related to declarant. | Revocable at any time in any manner that declarant can communicate intent, without regard to mental or physical condition. Physician shall make revocation part of medical records | Similar document executed in another state in compliance with the laws of that state is valid and enforceable in Iowa, to the extent the document is consistent with Iowa law. | Physician shall take reasonable steps to transfer patient to another physician or facility | Individual or health care provider is not liable civilly or criminally or guilty of unprofessional conduct for complying in good faith with provisions in declaration indicating withholding or withdrawal of life-sustaining procedures. |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
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| KANSAS 65-28, 101 et seq. Natural Death Act | Any medical procedure or intervention which would serve only to prolong the dying process and where death will occur whether or not such procedure is utilized. Does not include medication or any medical procedures necessary to alleviate pain or provide comfort care Declaration not in effect during declarant’s pregnancy. | (1) Any adult; (2) in writing; (3) signed by declarant; (4) dated; (5) in presence of 2 or more adult witnesses; (6) no effect during course of pregnancy; (7) responsibility of declarant to notify attending physician; (8) substantially same form as 65-28, 103(c). No witness can be related to declarant. | Revocable at any time by declarant by (1) destruction of document; (2) written revocation signed and dated by principal; (3) verbal expression in presence of adult witnesses who signs and dates a written confirmation. Effective upon receipt by physician. Desires of patient at all times supersede the declaration | | Physician shall effect the transfer—failure to do so constitutes unprofession al conduct | No criminal, civil, or professional liability for acting in good faith and pursuant to reasonable medical standards when acting pursuant to a declaration |
KENTUCKY
311.621, et seq. Kentucky Living Will Directive Act | Any medical procedure, treatment, or intervention which utilizes mechanical or other artificial means to sustain prolong, restore, or supplant a spontaneous vital function or when administered would only prolong dying process. Does not include medication or procedure to alleviate pain. | (1) Adult with decisional capacity; (2) in writing; (3) dated; (4) either witnessed by 2 or more adults in presence of grantor and in presence of each other or acknowledged before notary; (5) in substantially the same form as §311.625(1). No witness can be related to grantor. | Revocable by (1) written declaration signed and dated by declarant; (2) oral statement of intent to revoke in presence of 2 adults, one of which is a health care provider; (3) destruction of declaration with intent to revoke; (4) effective immediately for attending physician once revocation received; (5) oral statement by grantor with decisional capacity to revoke overrides previous written directive | Directives made outside the provisions of this act does not restrict health care providers from following such directives if they are consistent with accepted medical practice. | Physician must immediately inform patient and family or guardian and shall not impede transfer to complying physician or health care facility; patient’s medical records and information shall be supplied to receiving physician or facility | Not subject to criminal prosecution or civil liability or deemed to have engaged in unprofessional conduct as a result of withholding or withdrawing life prolonging treatment in accordance with directive unless shown by preponderance of evidence that there was bad faith |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
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| LOUISIANA 40:1299.58.1, et seq. Declarations Concerning Life-Sustaining Procedures | Any medical procedure or intervention, including but not limited to invasive administration of nutrition and hydration, which would serve only to prolong the dying process for a person diagnosed as having a terminal and irreversible condition. Does not include any measure necessary for comfort care | (1) Any adult; (2) written declaration; (3) signed by declarant; (4) in presence of 2 adult witnesses; (5) oral or nonverbal declaration may be made in presence of 2 adult witnesses by any nonwritten means of communication at any time subsequent to the diagnosis of a terminal and irreversible condition (sample form §1299.58.3(c)) | Revocable at any time by declarant without regard to mental state or competency by (1) destruction of document; (2) written revocation signed and dated by declarant; (3) oral or nonverbal expression by the declarant of the intent to revoke. Effective upon communication to physician | Declaration properly executed in and under the laws of another state is deemed to be validly executed | Physician shall make a reasonable effort to transfer the patient to another physician | Any health care facility, physician, or other person acting under the direction of a physician shall not be civilly, criminally, or professionally liable for withholding life-sustaining procedures in accordance with the provisions of this chapter |
MAINE
18-A§§5-801, et seq. Uniform Health-Care Decision Act. | Any medical procedure or intervention administered only to prolong process of dying. May include artificially administered nutrition and hydration | (1) In writing and signed of sound mind and over 18; (2) signed by declarant or another at his direction; (3) witnessed by 2 people; (4) communicated to attending physician; (5) effective upon determination that principal lacks capacity (6) physician records terms of declaration and determination of terminal condition | Revocable at any time and in any manner without regard to declarant’s mental or physical condition. Revocation effective upon communication to attending physician or health care provider by declarant or witness to revocation | Declaration executed in another state in compliance with laws of that state and Maine is valid | Attending physician or other health care provider who is unwilling shall take all reasonable steps as promptly as practicable to transfer to another physician willing to comply and provide continuing care until transfer is effected. Willful failure to transfer is Class E crime | Physician or other health care provider whose action is in accord with reasonable medical standards and in good faith is not subject to criminal or civil liability or discipline for unprofessional conduct |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
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| MARYLANDHG §5-601, et seq. Health Care Decisions Act | Any medical procedure, treatment, or intervention which uses mechanical or other artificial means to maintain, restore a spontaneous vital function or of such a nature as to afford patient no reasonable expectation of recovery from a terminal condition, persistent vegetative state, or end-stage condition; includes artificially administered hydration, nutrition, and CPR. Does not include medication or procedure necessary to alleviate pain or provide comfort care; may include an anatomical gift directive | (1) Voluntary; (2) dated and in writing; (3) signed by declarant or at express direction of declarant; (4) subscribed by 2 witnesses; (5) effective when attending physician and second physician certify in writing that patient is incapable of making an informed decision on basis of physical examination within 2 hrs. of certification (if patient is unconscious, 2nd physician not required); (6) oral directives must be made in presence of attending physician and one witness; physician must sign and date documentation in patient’s medical record. (suggested forms §5-603) | Revocable at any time by (1) signed and dated in writing; (2) oral statement to health care practitioner; (3) execution of subsequent directive; (4) destruction of directive. | Declaration executed outof-state by nonresident is effective if declaration is in compliance with the laws of Maryland or the laws of the state where executed (to the extent permitted by the laws of Maryland) | Attending physician shall make every reasonable effort to transfer declarant to another health care provider; assist in transfer; and pending transfer, comply with competent individual or health care agent/surrogate for person incapable of making a decision if failure to comply would likely result in death of individual. | Any health care provider who withholds or withdraws health care or life-sustaining procedures in accordance with this subtitle and in good faith, is not subject to civil or criminal liability and may not be found to have committed professional misconduct |
| MASSACHUSETTS No statutory provisions (But see Health Care Proxies Chap. 201D et seq.) | | | | | | |
| MICHIGAN No statutory provisions (But see Uniform Durable Power of Attorney Act §700.496) | | | | | | |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
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| MINNESOTA 145B.01, et seq. Living Will Act; 145C.01 Health Care Directive | Decisions on whether to administer, withhold, or withdraw medical treatment, services, or procedures to maintain, diagnose, or treat an individual’s physical condition when the individual is in a terminal condition. Decisions must be based on reasonable medical practice including (1) continuation of appropriate care to maintain comfort, hygiene, human dignity, and to alleviate pain; (2) oral administration of food and water to a patient who accepts it, except for clearly documented medical reasons | (1) Competent adult; (2) signed by declarant; (3) signed by 2 witnesses or notary public; (4) must state preference regarding artificial administration of nutrition and hydration or give decision to proxy; (5) must be in substantially the statutory form of §145B.04; (6) operative when delivered to physician or health care provider; (7) not given effect if patient is pregnant and it is possible that fetus could develop to live birth with continued treatment | Revocable at any time in any manner in whole or in part by declarant without regard to declarant’s physical or mental condition. Effective upon communication to physician. Divorce revokes any designation of the former spouse as a proxy to make health care decisions | Effective when executed in another state if it substantially complies with Minnesota law | Physician must notify competent declarant of unwillingness but has no duty to transfer. If physician received living will from competent patient and did not notify declarant of unwillingness to comply and declarant subsequently becomes incompetent, physician must take all reasonable steps to transfer to complying physician | Physician acting in good faith and in accordance with applicable standards of care is immune from criminal prosecution, civil liability, or professional disciplinary action |
MISSISSIPPI
41-41-201, et seq. Uniform Health-Care Decisions Act | May authorize the withdrawal of life-sustaining mechanisms defined as cessation of use of extraordinary techniques and applications including mechanical devises which prolong life through artificial means | (1) Adult or emancipated minor; (2) in writing; (3) dated; (4) signed by principal; (5) signed by 2 adult witnesses, at least one of whom is not related to principal; (6) acknowledged by notary public. | Revocable at any time in any manner that communicates an intent to revoke. Designation of agent revoked only by signed writing or by personally informing physician. | | Physician must promptly inform patient; provide continuing care until transfer can be effectuated; make all reasonable efforts to assist in transfer. | Physician acting in good faith and in accordance with provisions of this Act, who causes withdrawal of life-sustaining mechanisms is not guilty of a criminal offense, or civil or professional liability |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
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| MISSOURI 459.010, et seq. Declaration; Life Support | Any medical procedure or intervention which would serve only to prolong artificially the dying process where death will occur within a short time whether or not such procedure or intervention is utilized. Does not include medication or procedure to provide comfort care or alleviate pain or any procedure to provide nutrition or hydration | (1) Competent person; (2) in writing; (3) signed by declarant; (4) dated; (5) if not wholly in declarant’s handwriting, signed in presence of 2 adult witnesses (sample form §459.015(3)); (6) operative only when declarant’s condition is determined to be terminal or declarant is unable to make treatment decisions; (7) declaration shall have no effect during course of declarant’s pregnancy | Revocable at any time in any manner declarant is able to communicate intent to revoke, without regard for mental or physical condition. Directions of declarant shall at all times supersede declaration | | Physician must take all reasonable steps to effect the transfer of a declarant | No criminal, civil, or professional liability for acting in good faith pursuant to usual and customary medical standards who withholds or withdraws death-prolonging procedures from patient pursuant to a declaration |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
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| MONTANA 50-9-101 et seq. Rights of the Terminally Ill Act | Withholding or withdrawal of life-sustaining treatment, defined as any medical procedure or intervention that will serve only to prolong the dying process. Qualified patient may designate another individual to make decisions governing withholding or withdrawal of life-sustaining treatment. Life-sustaining procedures may not be withdrawn when qualified patient is known to be pregnant and when it is likely fetus will result in live birth | (1) 18 years or more and of sound mind; (2) signed by declarant or another at declarant’s direction; (3) witnessed by 2 individuals; (4) communicated to physician and made part of patient’s medical record; (5) declared to be terminal and no longer able to make decisions regarding life-sustaining treatment; (6) absent contrary actual notice, physician or health care provider may presume that declaration is valid (sample form §50-9-103) | Revocable at any time in any manner without regard to physical or mental condition. Effective upon communication to attending physician or health care provider. Health care provider or emergency medical services personnel in receipt of such communication shall act upon revocation an communicate it to attending physician at earliest opportunity. Revocation shall become part of declarant’s medical record | Declaration made in another state in compliance with that state’s laws executed in a substantially similar manner to laws of Montana is effective | Attending physician or health care provider who is unable or unwilling to comply shall take all reasonable steps as promptly as practicable to transfer to another who is willing | Attending physician or health care provider not subject to civil or criminal liability or guilty of unprofessional conduct as long as acting in accordance with reasonable medical standards and in good faith |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
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| NEBRASKA 20-401, et seq. Rights of the Terminally Ill Act | Any medical procedure or intervention that will serve only to prolong the process of dying or maintain the patient in a persistent vegetative act, meaning that to a reasonable degree of medical certainty one has a total and irreversible loss of consciousness and capacity for cognitive interaction with the environment with no reasonable hope of improvement. Does not affect physician’s responsibility to provide treatment, including nutrition and hydration for patient’s comfort care or alleviation of pain. Life-sustaining treatment shall be provided if declarant is pregnant and fetus is likely to develop to the point of live birth with continued application of life-sustaining treatment | (1) Adult of sound mind; (2) signed by declarant or another at declarant’s direction; (3) witnessed by 2 adults or notary public (adult is one who is over 19 yrs. or is or has been married); (4) communicated to attending physician; (5) patient in terminal condition, persistent vegetative state, or unable to make decisions regarding administration of life-sustaining treatment (sample form §20-404) | Revocable at any time in any manner without regard to declarant’s mental or physical condition effective upon communication to physician or other health care provider. Revocation shall become part of declarant’s medical record. | Declaration executed in another state in compliance with that state or Nebraska is valid | Physician shall take all prompt and reasonable steps to transfer to a willing physician | Not subject to civil, criminal, or professional discipline in the absence of knowledge of revocation or whose action under this Act is in accord with reasonable medical standards. Unjustifiable violation of patient’s directions shall be a civil cause of action maintainable by patient or patient’s next officer |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
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| NEVADA 449.535, et seq. Uniform Act on Rights of the Terminally Ill | Any medical procedure which utilizes mechanical or other artificial methods to sustain, restore, or supplant a vital function; does not include medication or procedures necessary to alleviate pain. Artificial nutrition and hydration by way of gastro-intestinal tract is considered medical procedure or life sustaining treatment and must be withheld unless different desire is expressed in writing or agent has authority to withhold consent. | (1) 18 yrs. or older; (2) may designate another to make decisions governing withholding or withdrawing; (3) signed by declarant or another at declarant’s direction; (4) 2 witnesses; (5) sample form §449-610 and 449-613; (6) not operative if patient is known to be pregnant and live birth is probable (7) declaration part of medical record | Revocable at any time and in any manner. Effective upon communication to the attending physician or other provider of health care | Declaration executed in another state in compliance with the law of that state or of this state is valid | Physician shall take all reasonable steps as promptly as possible to transfer care of declarant to another physician | Not subject to civil, criminal liability or professional discipline if acted in good faith and in accordance with reasonable medical standards. No liability for failure to follow patient’s directions; physician may consider “other factors” in determining whether the circumstances warrant following the directions |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
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| NEW HAMPSHIRE 137-H:1 et seq. Living Wills | Qualified patient may instruct physician not to use life-sustaining procedures in the event the person is in a terminal condition or is permanently unconscious. “Life-sustaining procedures” means any medical procedure or intervention which utilizes mechanical or artificial means to sustain, restore, or supplant a vital function which would only serve to artificially postpone the moment of death where in the written judgement of the attending and consulting physician, the patient is in a terminal condition or permanently unconscious; does not include medication, sustenance, or performance of any medical procedure to alleviate pain or provide comfort. There must be a clear expression of one’s intent to withdraw or withhold artificial nutrition and hydration. | (1) Person of sound mind, 18 yrs. or older; (2) document signed voluntarily by declarant (3) 2 subscribing witnesses not a spouse or heir at law; (4) upon request, physician shall made document part of medical record; (5) effective if person is permanently incapable of participating in decisions about his care; (6) suggested form §137-H:3; (7) not permitted when physician has knowledge that patient is pregnant | Revocable by (1) destroying document; (2) oral or written revocation before 2 witnesses. Revocation effective upon communication to attending physician | Documents executed in another state are enforceable if in compliance with the law of that state or jurisdiction; foreign living wills are restricted by, and must be in compliance with laws and requirements of New Hampshire | Physician unwilling or unable to comply shall notify and inform the patient and/or patient’s family. Patient or his family may then request transfer to another physician. Physician shall make necessary arrangements without delay to effect transfer to chosen physician | Physician or health care professional is immune from civil or criminal liability for good faith actions in keeping with reasonable medical standards pursuant to the living will and in accordance with New Hampshire Law |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
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| NEW JERSEY 26:2H-53, et seq. Advanced Directives for Health Care | Decisions to accept or refuse any treatment, service, or procedure used to diagnose, treat, or care for a patient’s physical or mental condition including life-sustaining treatment; includes decisions to accept or refuse services of a particular physician or health care provider or a transfer of care; or use of any medical device or procedure, artificially provided fluids and nutrition drugs, surgery, or therapy that uses mechanical or other artificial means to sustain, restore, or supplant a vital bodily function and thereby increase the expected life span of a patient; does not include providing comfort care or to alleviate pain. | (1) Competent; (2) adult; (3) signed; (4) dated; (5) in presence of 2 witnesses who shall attest that declarant is of sound mind and free of duress and undue influence or in front of a notary public, attorney, or another person authorized to administer oaths. May be supplemented by video or audio tape recording; (6) directive implemented when determination of lack of decision-making capacity is documented and confirmed by physicians | Revocable by oral or written notification or execution of subsequent directive. Divorce revokes former spouse’s designation as the health care representative. Patient’s clearly expressed wishes take precedent over any patient’s decision or instruction directive | Effective if executed in compliance with New Jersey law or the laws of that state. Effective if executed in a foreign country in compliance with that country’s laws or the laws of New Jersey and is not contrary to the public policy of New Jersey | Physician should act as soon as practicable to effect an appropriate, respectful, and timely transfer of care and to assure that patient is not abandoned or treated disrespectfully | No civil, criminal, or professional liability for any physician acting in good faith and pursuant to this act |
NEW MEXICO
24-7A-1, et seq. Uniform Health-Care Decisions Act | Any medical treatment or procedure without which the individual is likely to die within a short time | (1) Of sound mind; (2) age of majority; (3) written or oral; (4) dated; (5) 2 adult witnesses; (6) effective when patient no longer able to make own health-care decisions. | Revocable at any time in any way that communicates an intent to revoke. | Document Uniformly applied and construed among states enacting Uniform Health-Care Decisions Act. | Physician must take appropriate steps to transfer the patient to another qualified physician and provide continuing care to patient until transfer. | No civil or criminal liability or professional discipline for acting pursuant to statute in good faith |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
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| NEW YORK No statutory provisions (But see Health Care Agents and Proxies Public Health Art.29-C §2980 et seq.) | | | | | | |
NORTH CAROLINA
90-320, et seq. Right to Natural Death | Declarant may instruct attending physicians to withhold extraordinary means to keep declarant alive whose condition is either terminal and incurable or who is in a persistent vegetative state as confirmed in writing by second physician which would only serve to postpone artificially the moment of death by sustaining, restoring, or supplanting a vital function | (1) Signed; (2) in the presence of 2 witnesses who believe declarant is of sound mind; (3) dated; (4) notarized or proved before a clerk; (5) specific form §90-321(a) | Revocable in any manner by which declarant is able to communicate his intent to revoke without regard for mental or physical state—effective upon communication to physician | | | Withholding or discontinuing of extraordinary means shall not be considered cause of death for civil or criminal purposes. These provisions may be asserted as a defense to any civil or criminal suits or charges filed against a health care provider |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
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| NORTH DAKOTA 23-06.4-01, et seq. Uniform Rights of Terminally Ill Act | Any medical procedure, treatment, or intervention that serves only to prolong the process of dying. Does not include the provision of the appropriate nutrition and hydration (presumed to be in the best interests of the patient) or any medical procedure necessary to provide comfort care or to alleviate pain or procedures performed in emergency, pre-hospital situations; medical treatment must be provided to a pregnant patient—unless to a reasonable degree of certainty, such treatment won’t maintain patient to ensure live birth or is physically harmful | (1) Sound mind; (2) 18 yrs.; (3) signed by declarant; (4) witnessed by 2 persons; (5) substantially same form as §23-06.4-03 (3) (may add specific directives) | Revocable at any time in any manner as long as declarant is competent, including (1) by signed, dated writing; (2) destruction of document; (3) oral expression of intent to revoke. Effective upon communication to physician or other health care provider | Effective if executed in another state by a resident of that state in compliance with the laws of that state or the laws of North Dakota | Physician must take all reasonable steps to transfer patient as promptly as practical to physician willing to comply with statute | No civil, criminal, or professional liability for actions authorized by statute unless done in a grossly negligent manner |
OHIO
2133.01, et seq. Modified Uniform Rights of the Terminally Ill Act | Any medical procedure, treatment, intervention, or other measure that will serve principally to prolong the process of dying. Declarant may authorize withholding hydration and nutrition; cannot withdraw or withhold life-sustaining treatment from pregnant patient, unless it is believed to a reasonable degree of certainty, that the fetus would not be born alive. | (1) Adult; (2) of sound mind; (3) signed by declarant; (4) dated; (5) in presence of 2 witnesses or a notary public who attests that principal is of sound mind and free from duress | Revocable at any time and in any manner; effective when expressed and communicated to a witness or physician | Effective if executed in another state in compliance with that law or in substantial compliance with Ohio law | Physician may not prevent or unreasonably delay a transfer | No civil, criminal, or professional liability for physician acting in good faith within the scope of their authority |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
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| OKLAHOMA Tit. 63 §3101.1 et seq.; Oklahoma Advanced Directive Act | Any medical procedure or intervention that will serve only to prolong the dying process including artificial administration of nutrition and hydration but only if declarant has specifically authorized its withdrawal. Does not include treatment to alleviate pain or the normal consumption of food and water | (1) 18 yrs.; (2) of sound mind; (3) signed by declarant; (4) witnessed by 2 adults; (5) in substantially the same form as §3103.4(C); (6) operative when communicated to attending physician and when declarant can no longer make decisions regarding the administration of life-sustaining treatment; not operative during course of pregnancy unless patient in her own words specifically authorizes it | Revocable in whole or in part in any manner at any time without regard to declarant’s mental or physical condition. Effective upon communication to physician | Effective if complies with Oklahoma law or in compliance with law of that state so long as it does not exceed authorization s allowed under Oklahoma law | Physician shall take all reasonable steps to arrange for care by another physician; must comply with decision until transfer. | No civil, criminal, or professional liability for carrying out the advance directive pursuant to statute in good faith and in accord with reasonable medical standards |
OREGON
127.505, et seq. Advance Directives for Health Care | Life-sustaining acts means mechanical or other artificial means to sustain, restore, or supplant a vital function that is used to maintain life of a person suffering from a terminal condition and serves only to prolong artificially the moment of death; does not include procedures to sustain patient cleanliness and comfort | (1) In writing; (2) signed by two witnesses who make written declaration; (3) mandatory statutory form §127.531 ORS; (4) at least one witness must not be related to declarant | Principal may revoke (1) in any manner by which s/he is able to communicate to health care provider or attorney-in-fact, intent to revoke; (2) by execution of subsequent durable power of attorney; (3) upon divorce if spouse is agent | Valid subject to laws of Oregon if executed in compliance with the laws of the state where principal is located or resides or with the laws of the state of Oregon. | Physician shall notify any representativ e or discharge patient (without abandoning) or make a reasonable effort to locate and transfer to a willing physician. | No liability, if in good faith has acted on fully executed directive, for criminal or civil liability or professional disciplinary action |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
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| PENNSYLVANIA 20§5401 et seq. Advanced Directive for Health Care Act | Any medical procedure or intervention that serves only to prolong the process of dying or maintain the patient in a state of permanent unconsciousness; includes artificially or invasively administered nutrition and hydration if specifically provided for in declaration. Does not apply to emergency medical services. | (1) sound mind; (2) 18 yrs. or graduated from high school or married; (3) signed by declarant; (4) 2 adult witnesses; (5) suggested form 20§5404(b); (6) operative when declarant determined to be incompetent by attending physician as certified in writing; (7) not operative during pregnancy unless it will not maintain woman so as to permit live birth | Revoked at any time in any manner without regard to declarant’s mental or physical condition. Effective upon communication to physician. | | Unwilling physician must inform declarant, surrogate, or family, and make every reasonable effort to assist in the transfer of declarant to complying physician | No civil, criminal, or professional liability in following wishes of declarant pursuant to declaration executed according to statute. |
RHODE ISLAND
23-4.11-1, et seq. Rights of Terminally Ill Act | Any medical procedure or intervention serving only to prolong the dying process. Does not include anything necessary to alleviate pain or provide comfort and care; must wear DNR bracelet in order to effectuate “do not resuscitate” order. | (1) 18 yrs.; (2) signed; (3) in presence of 2 witnesses (suggested form §23-4.11-3(a)); (4) given no force or effect as long as live birth is probable for pregnant patient; neither witness related to declarant. | Revocable at any time in any manner by which declarant is able to communicate the intent to revoke without regard to physical or mental condition. Only effective upon communication to physician by declarant or one witnessing the revocation | Declaration executed in another state in compliance with the laws of that state is valid. | Physician shall make necessary arrangements to effect a transfer | No civil, criminal, or professional liability for acting in accordance with requirements of the statute and in accordance with reasonable medical standards |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
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| SOUTH CAROLINA 44-77-10, et seq. Death with Dignity Act | Medical procedures or intervention serving only to prolong the dying process; does not include treatment for comfort care or pain alleviation; declarant should indicate whether nutrition and hydration through surgically implanted tubes is desired; if declarant fails to do so, nutrition and hydration necessary for comfort care and pain alleviation will be provided. | (1) Declaration must set out intent for no life-sustaining procedures; (2) signed; (3) dated; (4) in presence of officer authorized to administer oaths; (5) presence of 2 witnesses; (6) substantially same as §44-77-50; (7) not effective during course of declarant’s pregnancy; (8) terminal condition must be certified by 2 examining physicians (permanent unconsciousness must be at least for 90 days; or with high degree of medical certainty and must be given active treatment for at least 6 hrs. following diagnosis before physician can give effect to declaration). | (1) Destruction of document when communicated to physician; (2) written revocation signed and dated upon communication to physician; oral expression of intent to revoke when communicated to physician; (3) communication of oral revocation may be made by someone present when revocation made, if communicated within reasonable time and declarant is physically or mentally able to confirm or by designee if declarant is incompetent; (4) execution of subsequent declaration | For patients in terminal condition, document with same intent as this chapter and in compliance with the laws of that state is effective. | Physician must make a reasonable effort to locate a physician who will effectuate patient’s declaration and has a duty to transfer patient to such physician | No criminal or civil liability for acting in good faith and in accordance with the standards of reasonable medical care pursuant to the statute |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
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| SOUTH DAKOTA 34-12D-1, et seq. Living Wills | Any medical procedure or intervention that will serve only to postpone death or maintain person in state of permanent unconsciousness. Does not include comfort care, hygiene and human dignity, oral administration of food and water, or medical procedure to alleviate pain | (1) Competent adult; (2) signed by declarant; (3) witnessed by 2 adults; (4) may be in presence of notary public (suggested form §34-12D.3); (5) not operative for pregnant woman unless live birth unlikely to a reasonable degree of medical certainty | Revocable at any time in any manner without regard to declarant’s physical or mental condition. Effective upon communication to physician or other health care provider | Document is valid if it meets execution requirements of place where executed, place where declarant was a resident, or requirements of the state of South Dakota | Unwilling physician must make a reasonable effort to locate and transfer a patient to a physician who will honor the declaration; must continue treatment or care until transfer is effectuated | No civil, criminal, or professional liability for giving effect to a declaration |
TENNESSEE
32-11-101, et seq. Right to Natural Death Act | Any procedure, treatment to diagnose, assess, or treat a disease, illness, or injury. Includes surgery, drugs, transfusions, mechanical ventilation, dialysis, CPR, artificial nourishment, hydration or other nutrients, radiation. Death by starvation or dehydration allowed only if specifically directed by using statutory phrase. | (1) Competent adult; (2) signed; (3) in presence of 2 witnesses; (4) substantially in form of §32-11-105. Witnesses must not be related to declarant. | Revocable at any time by declarant regardless of mental state if effectively communicated to the physician by written revocation dated and signed or oral statement made to physician | Effective if in compliance with Tennessee law or the law of the state of declarant’s residence | Unwilling physician must make every reasonable effort to assist in a transfer. | No civil, criminal, or professional liability if acting in accord with reasonable medical standards |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
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| TEXAS Health & Safety Code §166.031, et seq. Natural Death Act | Medical procedure or intervention that uses mechanical or other artificial means to sustain, restore, or supplant a vital function and artificially postpone the moment of death of a patient in terminal condition whose death is imminent within a relatively short time without the procedure. Does not include administration of medication or performance of procedure to provide comfort or alleviate pain. May designate a person to make treatment decisions in the event declarant becomes comatose or otherwise incompetent. | (1) Competent adult; (2) 2 witnesses; (3) may be oral with 2 witnesses and attending physician; (4) directive shall become a part of medical record of declarant (if oral, witnesses must sign medical records); (5) not operative for pregnant patients | Revocable at any time without regard to declarant’s mental state or competency. May be revoked by declarant or someone in presence destroying document; by signed and dated written revocation; orally stating intent to revoke. Effective when delivered or mailed to attending physician, or when physician notified of oral revocation. Directive effective until revoked. Desire of qualified competent patient supersedes directive | | Unwilling physician must make reasonable effort to transfer patient to another physician | Immune from effects of revocation if not adequately notified. No criminal or civil liability for failing to effectuate a directive if there is no knowledge of it. By complying with legal directive, one does not commit act of criminally aiding suicide. No civil, criminal, or professional liability for acting in accordance with this Act unless negligent. |
| UTAH 75-2-1101; Personal Choice and Living Will Act | Any medical procedure or intervention that would serve only to prolong the dying process including artificial nutrition and hydration unless declaration specifically excludes; does not include medication, sustenance, or any procedure to alleviate pain or provide comfort care. Separate procedure for do not resuscitate directive | (1) 18 yrs.; (2) in writing; (3) signed by declarant or at his directive; (4) dated; (5) signed in presence of 2 or more adult witnesses; (6) substantially same form as §75-2-1104(4); (7) no force during course of declarant’s pregnancy | Current wishes of declarant take precedent over any directive. Revocable at any time by signed revocation or destruction of document or oral expression of intent to revoke in presence of adult witness. Effective on receipt by physician | Similar instrument executed in another state is presumed to comply with Utah law and may be relied upon in good faith | Unwilling physician required to transfer patient promptly | No civil, criminal, or professional liability for good faith compliance with a directive |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
|---|
| VERMONT Tit. 18 §§5251, et seq. Terminal Care Document | Any medical procedure or intervention utilizing mechanical or other artificial means to sustain, restore, supplant a vital function serving only to postpone the moment of death and where patient is in a terminal state according to judgment of physician | (1) 18 yrs.; (2) of sound mind; (3) in presence of 2 or more witnesses; (4) suggested form: §5253 | Revocable only orally in presence of 2 or more witnesses or by destroying the document | | Unwilling physician must actively assist in selecting another physician willing to honor patient’s directive | No civil or criminal liability for physician acting pursuant to the terminal care document |
VIRGINIA
54.1-2981, et seq. Health Care Decision Act | Any medical procedure, treatment, intervention, utilizing mechanical or other artificial means to sustain, restore, or supplant a vital function, or is of a nature to afford a patient no reasonable expectation of recovery from a terminal condition, and when applied to a patient in terminal condition, would serve only to prolong the dying process. Includes artificially administered hydration and nutrition and CPR by emergency medical services personnel but does not include any medication or procedure to alleviate pain or provide comfort care. | (1) Competent adult; (2) written advance directive; (3) signed in presence of 2 subscribing witnesses; (4) oral declaration in presence of physician and 2 witnesses for those in terminal condition; (5) responsibility of declarant to provide notification of advanced directive to attending physician (suggested form §54.1-2984) | Revocable at any time by (1) signed, dated writing; (2) physical cancellation or destruction of declaration; (3) oral expression of intent to revoke. Effective upon communication to attending physician | Directive executed in another state valid if in compliance with Virginia law or law of state where executed. Such directives shall be construed in accordance with Virginia laws. | If physician thinks treatment is medically or ethically inappropriate or contrary to terms of advanced directive, unwilling physician shall make reasonable effort to transfer patient to another physician. | No civil, criminal, or professional liability if acting in good faith. |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
|---|
| WASHINGTON 70.122.010, et seq. Natural Death Act | Withdrawal or withholding of any medical or surgical intervention which utilizes mechanical or other artificial means including artificially provided nutrition and hydration to sustain, restore, or supplant a vital function which would serve only to artificially prolong life. Shall not include administration of medication to alleviate pain | (1) Any adult; (2) signed by declarant; (3) presence of 2 witnesses; (4) suggested form: §70.122.030. Witnesses must not be related to declarer. | Revocable at any time without regard to declarer’s mental state or competency by defacing or destroying document; written revocation signed and dated and communicated to attending physician; oral revocation to physician by declarant or one acting on behalf of declarant | Valid to the extent permitted by Washington law and federal constitution law | Attending physician must inform patient or agent of any policy that would preclude the honoring of patient’s directive. If patient chooses to retain that physician, a written plan is filed showing physician’s intended actions should directive become operative. | No civil, criminal, or professional liability if acting in good faith unless otherwise negligent |
WEST VIRGINIA
16-30-1, et seq. West Virginia Health Care Decisions Act | Any medical procedure or intervention which should serve solely to artificially prolong the dying process or maintain the person in a persistent vegetative state; does not include medication or other medical procedure necessary for comfort or to alleviate pain | (1) 18 yrs.; (2) in writing; (3) executed by declarant or at his direction; (4) dated; (5) in presence of 2 witnesses; (6) in front of notary public; (7) suggested form: §16-30-3(e) | Revocable at any time without regard to declarant’s mental state by destruction of document, written revocation effective on delivery or verbal expression in presence of a witness; desires of capable declarant always supersede effect-of-living will | Valid in West Virginia if executed in compliance with West Virginia law or the law of state where executed and expressly provides for withholding or withdrawal of life-prolonging intervention or termination of life-sustaining procedure | Unwilling physician must effect a transfer to physician willing to honor the living will | No criminal or civil liability if acting in good faith and pursuant to reasonable medical standards |
| State/Code Section | Specific Powers, Life-Prolonging Acts | Operative Facts | Revocation/Duration | Reciprocity | Transfer of Patient if Physician Unwilling | Immunity for Attending Physician |
|---|
| WISCONSIN 154.01, et seq. Natural Death | Any medical procedure or intervention that would serve to prolong the dying process but not avert death; includes assistance in respiration, artificial maintenance of blood pressure and heart rate, blood transfusion, kidney dialysis, and similar procedures but does not include pain alleviation or provision of nutrition or hydration | (1) 18 yrs. and of sound mind; (2) signed; (3) in presence of 2 witnesses; (4) notify physician; (5) form: §154.03; (6) no effect during pregnancy; (7) may file with register in probate. Witnesses must not be related to declarant. | Revocable at any time by destruction of document, written revocation signed and dated, or verbal expression of revocation effective upon notifying physician. Desires of qualified patient supersede declaration at all times | Declarations made in other states valid to the extent consistent with the laws of this state | Must make good faith effort to transfer | No criminal, civil, or professional liability when acting in good faith |
WYOMING
35-22-401 et seq. Wyoming Health Care Decisions Act | Any medical procedure, intervention, or nourishment by artificial means which would serve only to prolong the dying process of a qualified patient; does not include medication or procedure necessary for comfort care or alleviation of pain | (1) Adult; (2) in writing; (3) signed and dated; (4) in presence of 2 or more adult witnesses; (5) no effect during course of qualified patient’s pregnancy; (6) terminal condition must be certified in writing by 2 physicians. Witnesses must not be related to declarant. | Revocable by destruction of document, written revocation, verbal expression of intent to revoke in presence of adult witness. Patient’s immediate desires at all times supersede the document | | Unwilling physician must attempt to effect transfer of patient | No criminal or civil liability for physician acting in good faith and pursuant to reasonable medical standards |
