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1998 Florida Statutes
HEALTH CARE ADVANCE DIRECTIVES
HEALTH CARE ADVANCE DIRECTIVES
GENERAL PROVISIONS (ss. 765.101-765.113)
HEALTH CARE SURROGATE (ss. 765.201-765.205)
LIFE-PROLONGING PROCEDURES (ss. 765.301-765.310)
ABSENCE OF ADVANCE DIRECTIVE (s. 765.401)
GENERAL PROVISIONS
765.101 Definitions.
765.102 Legislative findings and intent.
765.103 Existing advance directives.
765.104 Revocation.
765.105 Review of surrogate or proxy's decision.
765.106 Preservation of existing rights.
765.107 Construction.
765.108 Effect with respect to insurance.
765.109 Immunity from liability; weight of proof; presumption.
765.110 Health care facilities and providers; discipline.
765.112 Recognition of advance directive executed in another state.
765.113 Restrictions on providing consent.
765.101 Definitions.--As used in this chapter:
(1) "Advance directive" means a witnessed written document or oral statement in which instructions are given by a principal or in which the principal's desires are expressed concerning any aspect of the principal's health care, and includes, but is not limited to, the designation of a health care surrogate, a living will, or orders not to resuscitate issued pursuant to s. 401.45.
(2) "Attending physician" means the primary physician who has responsibility for the treatment and care of the patient.
(3) "Close personal friend" means any person 18 years of age or older who has exhibited special care and concern for the patient, and who presents an affidavit to the health care facility or to the attending or treating physician stating that he or she is a friend of the patient; is willing and able to become involved in the patient's health care; and has maintained such regular contact with the patient so as to be familiar with the patient's activities, health, and religious or moral beliefs.
(4) "Health care decision" means:
(a) Informed consent, refusal of consent, or withdrawal of consent to any and all health care, including life-prolonging procedures.
(b) The decision to apply for private, public, government, or veterans' benefits to defray the cost of health care.
(c) The right of access to all records of the principal reasonably necessary for a health care surrogate to make decisions involving health care and to apply for benefits.
(5) "Health care facility" means a hospital, nursing home, hospice, home health agency, or health maintenance organization licensed in this state, or any facility subject to part I of chapter 394.
(6) "Health care provider" or "provider" means any person licensed, certified, or otherwise authorized by law to administer health care in the ordinary course of business or practice of a profession.
(7) "Incapacity" or "incompetent" means the patient is physically or mentally unable to communicate a willful and knowing health care decision.
(8) "Informed consent" means consent voluntarily given by a person after a sufficient explanation and disclosure of the subject matter involved to enable that person to have a general understanding of the procedure and the medically acceptable alternative procedures and to make a knowing health care decision without coercion or undue influence.
(9) "Life-prolonging procedure" means any medical procedure, treatment, or intervention which:
(a) Utilizes mechanical or other artificial means to sustain, restore, or supplant a spontaneous vital function; and
(b) When applied to a patient in a terminal condition, serves only to prolong the process of dying.
The term "life-prolonging procedure" does not include the administration of medication or performance of medical procedure, when such medication or procedure is deemed necessary to provide comfort care or to alleviate pain.
(10) "Living will" or "declaration" means:
(a) A witnessed document in writing, voluntarily executed by the principal in accordance with s. 765.302; or
(b) A witnessed oral statement made by the principal expressing the principal's instructions concerning life-prolonging procedures.
(11) "Physician" means a person licensed pursuant to chapter 458 or chapter 459.
(12) "Principal" means a competent adult executing an advance directive and on whose behalf health care decisions are to be made.
(13) "Proxy" means a competent adult who has not been expressly designated to make health care decisions for a particular incapacitated individual, but who, nevertheless, is authorized pursuant to s. 765.401 to make health care decisions for such individual.
(14) "Surrogate" means any competent adult expressly designated by a principal to make health care decisions on behalf of the principal upon the principal's incapacity.
(15) "Terminal condition" means:
(a) A condition caused by injury, disease, or illness from which there is no reasonable probability of recovery and which, without treatment, can be expected to cause death; or
(b) A persistent vegetative state characterized by a permanent and irreversible condition of unconsciousness in which there is:
1. The absence of voluntary action or cognitive behavior of any kind; and
2. An inability to communicate or interact purposefully with the environment.
(16) "Treating physician" means the physician who has treated or is treating the patient for any condition directly related to the condition resulting in the patient's incapacity.
History.--s. 2, ch. 92-199; s. 3, ch. 94-183; s. 46, ch. 96-169.
765.102 Legislative findings and intent.--
(1) The Legislature finds that every competent adult has the fundamental right of self-determination regarding decisions pertaining to his or her own health, including the right to choose or refuse medical treatment. This right is subject to certain interests of society, such as the protection of human life and the preservation of ethical standards in the medical profession.
(2) To ensure that such right is not lost or diminished by virtue of later physical or mental incapacity, the Legislature intends that a procedure be established to allow a person to plan for incapacity by designating another person to direct the course of his or her medical treatment upon his or her incapacity. Such procedure should be less expensive and less restrictive than guardianship and permit a previously incapacitated person to exercise his or her full right to make health care decisions as soon as the capacity to make such decisions has been regained.
(3) The Legislature further finds that the artificial prolongation of life for a person with a terminal condition may secure for him or her only a precarious and burdensome existence, while providing nothing medically necessary or beneficial to the patient. In order that the rights and intentions of a person with such a condition may be respected even after he or she is no longer able to participate actively in decisions concerning himself or herself, and to encourage communication among such patient, his or her family, and his or her physician, the Legislature declares that the laws of this state recognize the right of a competent adult to make an advance directive instructing his or her physician to provide, withhold, or withdraw life-prolonging procedures, or to designate another to make the treatment decision for him or her in the event that such person should be found to be incompetent and suffering from a terminal condition.
History.--s. 2, ch. 92-199; s. 1144, ch. 97-102.
765.103 Existing advance directives.--Any advance directive made prior to April 10, 1992, shall be given effect as provided in this chapter provided such directive was legally effective when written.
History.--s. 2, ch. 92-199.
765.104 Revocation.--
(1) An advance directive or designation of a surrogate may be revoked at any time by a competent principal:
(a) By means of a signed, dated writing;
(b) By means of the physical cancellation or destruction of the advance directive by the principal or by another in the principal's presence and at the principal's direction;
(c) By means of an oral expression of intent to revoke; or
(d) By means of a subsequently executed advance directive that is materially different from a previously executed advance directive.
(2) Unless otherwise provided in the advance directive or in an order of dissolution or annulment of marriage, the dissolution or annulment of marriage of the principal revokes the designation of the principal's former spouse as a surrogate.
(3) Any such revocation will be effective when it is communicated to the surrogate, health care provider, or health care facility. No civil or criminal liability shall be imposed upon any person for a failure to act upon a revocation unless that person has actual knowledge of such revocation.
History.--s. 2, ch. 92-199; s. 47, ch. 96-169.
765.105 Review of surrogate or proxy's decision.--The patient's family, the health care facility, or the attending physician, or any other interested person who may reasonably be expected to be directly affected by the surrogate or proxy's decision concerning any health care decision may seek expedited judicial intervention pursuant to rule 5.900 of the Florida Probate Rules, if that person believes:
(1) The surrogate or proxy's decision is not in accord with the patient's known desires or the provisions of this chapter;
(2) The advance directive is ambiguous, or the patient has changed his or her mind after execution of the advance directive;
(3) The surrogate or proxy was improperly designated or appointed, or the designation of the surrogate is no longer effective or has been revoked;
(4) The surrogate or proxy has failed to discharge duties, or incapacity or illness renders the surrogate or proxy incapable of discharging duties;
(5) The surrogate or proxy has abused powers; or
(6) The patient has sufficient capacity to make his or her own health care decisions.
History.--s. 2, ch. 92-199; s. 4, ch. 94-183.
765.106 Preservation of existing rights.--The provisions of this chapter are cumulative to the existing law regarding an individual's right to consent, or refuse to consent, to medical treatment and do not impair any existing rights or responsibilities which a health care provider, a patient, including a minor, competent or incompetent person, or a patient's family may have under the common law, Federal Constitution, State Constitution, or statutes of this state.
History.--s. 2, ch. 92-199; s. 5, ch. 94-183.
765.107 Construction.--This chapter shall not be construed to repeal by implication any provision of s. 766.103, the Florida Medical Consent Law. For all purposes, the Florida Medical Consent Law shall be considered an alternative to provisions of this section.
History.--s. 2, ch. 92-199.
765.108 Effect with respect to insurance.--The making of an advance directive pursuant to the provisions of this chapter shall not affect the sale, procurement, or issuance of any policy of life insurance, nor shall such making of an advance directive be deemed to modify the terms of an existing policy of life insurance. No policy of life insurance will be legally impaired or invalidated by the withholding or withdrawal of life-prolonging procedures from an insured patient in accordance with the provisions of this chapter, nor by any other treatment decision made according to this chapter, notwithstanding any term of the policy to the contrary. A person shall not be required to make an advance directive as a condition for being insured for, or receiving, health care services.
History.--s. 2, ch. 92-199.
765.109 Immunity from liability; weight of proof; presumption.--
(1) A 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 liability, and will not be deemed to have engaged in unprofessional conduct, as a result of carrying out a health care decision made in accordance with the provisions of this chapter. The surrogate or proxy who makes a health care decision on a patient's behalf, pursuant to this chapter, is not subject to criminal prosecution or civil liability for such action.
(2) The provisions of this section shall apply unless it is shown by a preponderance of the evidence that the person authorizing or effectuating a health care decision did not, in good faith, comply with the provisions of this chapter.
History.--s. 2, ch. 92-199.
765.110 Health care facilities and providers; discipline.--
(1) A health care facility, pursuant to Pub. L. No. 101-508, ss. 4206 and 4751, shall provide to each patient written information concerning the individual's rights concerning advance directives and the health care facility's policies respecting the implementation of such rights, and shall document in the patient's medical records whether or not the individual has executed an advance directive.
(2) A health care provider or health care facility shall be subject to professional discipline and revocation of license or certification, and a fine of not more than $500 per incident, or both, if the health care provider or health care facility, as a condition of treatment or admission, requires an individual to execute or waive an advance directive.
(3) The 1Department of Health and Rehabilitative Services and the Agency for Health Care Administration shall adopt rules to implement the provisions of the section.
History.--s. 2, ch. 92-199; s. 6, ch. 94-183; s. 243, ch. 94-218; s. 48, ch. 96-169.
1Note.--The Department of Health and Rehabilitative Services was redesignated as the Department of Children and Family Services by s. 5, ch. 96-403, and the Department of Health was created by s. 8, ch. 96-403.
765.112 Recognition of advance directive executed in another state.--An advance directive executed in another state in compliance with the law of that state or of this state is validly executed for the purposes of this chapter.
History.--s. 2, ch. 92-199.
765.113 Restrictions on providing consent.--Unless the principal expressly delegates such authority to the surrogate in writing, or a surrogate or proxy has sought and received court approval pursuant to rule 5.900 of the Florida Probate Rules, a surrogate or proxy may not provide consent for:
(1) Abortion, sterilization, electroshock therapy, psychosurgery, experimental treatments that have not been approved by a federally approved institutional review board in accordance with 45 C.F.R. part 46 or 21 C.F.R. part 56, or voluntary admission to a mental health facility.
(2) Withholding or withdrawing life-prolonging procedures from a pregnant patient prior to viability as defined in 1s. 390.001(5).
History.--s. 2, ch. 92-199; s. 7, ch. 94-183.
1Note.--Transferred to s. 390.0111 by s. 2, ch. 97-151.
HEALTH CARE SURROGATE
765.201 Short title.
765.202 Designation of a health care surrogate.
765.203 Suggested form of designation.
765.204 Capacity of principal; procedure.
765.205 Responsibility of the surrogate.
765.201 Short title.--Sections 765.202-765.205 may be cited as the "Florida Health Care Surrogate Act."
History.--s. 3, ch. 92-199.
765.202 Designation of a health care surrogate.--
(1) A written document designating a surrogate to make health care decisions for a principal shall be signed by the principal in the presence of two subscribing adult witnesses. A principal unable to sign the instrument may, in the presence of witnesses, direct that another person sign the principal's name as required herein. An exact copy of the instrument shall be provided to the surrogate.
(2) The person designated as surrogate shall not act as witness to the execution of the document designating the health care surrogate. At least one person who acts as a witness shall be neither the principal's spouse nor blood relative.
(3) A document designating a health care surrogate may also designate an alternate surrogate provided the designation is explicit. The alternate surrogate may assume his or her duties as surrogate for the principal if the original surrogate is unwilling or unable to perform his or her duties. The principal's failure to designate an alternate surrogate shall not invalidate the designation.
(4) If neither the designated surrogate nor the designated alternate surrogate is able or willing to make health care decisions on behalf of the principal and in accordance with the principal's instructions, the health care facility may seek the appointment of a proxy pursuant to part IV.
(5) A principal may designate a separate surrogate to consent to mental health treatment in the event that the principal is determined by a court to be incompetent to consent to mental health treatment and a guardian advocate is appointed as provided under s. 394.4598. However, unless the document designating the health care surrogate expressly states otherwise, the court shall assume that the health care surrogate authorized to make health care decisions under this chapter is also the principal's choice to make decisions regarding mental health treatment.
(6) Unless the document states a time of termination, the designation shall remain in effect until revoked by the principal.
(7) A written designation of a health care surrogate executed pursuant to this section establishes a rebuttable presumption of clear and convincing evidence of the principal's designation of the surrogate.
History.--s. 3, ch. 92-199; s. 8, ch. 94-183; s. 49, ch. 96-169; s. 1797, ch. 97-102.
765.203 Suggested form of designation.--A written designation of a health care surrogate executed pursuant to this chapter may, but need not be, in the following form:
Name:_____(Last)_____(First)_____(Middle Initial)_____
In the event that I have been determined to be incapacitated to provide informed consent for medical treatment and surgical and diagnostic procedures, I wish to designate as my surrogate for health care decisions:
Name:
Address: