House Bill 0249
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Florida House of Representatives - 1999 HB 249
By Representative Heyman
1 A bill to be entitled
2 An act relating to health care advance
3 directives; amending s. 765.101, F.S.; defining
4 the term "palliative care"; redefining the term
5 "terminal condition" to provide that such a
6 condition is not necessary for ensuring a right
7 to refuse treatment; amending s. 765.102, F.S.;
8 providing legislative intent; amending s.
9 765.302, F.S.; revising a provision relating to
10 the procedure for making a living will to
11 remove reference to a terminal condition;
12 amending s. 765.303, F.S.; revising the
13 suggested form of a living will; amending s.
14 765.304, F.S.; removing reference to a physical
15 condition which is terminal with respect to the
16 procedure for a living will; amending s.
17 765.305, F.S.; removing reference to a terminal
18 condition with respect to the procedure in the
19 absence of a living will; amending s. 765.306,
20 F.S.; removing reference to a terminal
21 condition with respect to the determination of
22 a patient's condition under the Life-Prolonging
23 Procedure Act of Florida; providing an
24 effective date.
25
26 Be It Enacted by the Legislature of the State of Florida:
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28 Section 1. Subsections (11), (12), (13), (14), (15),
29 and (16) of section 765.101, Florida Statutes, are renumbered
30 as subsections (12), (13), (14), (15), (16), and (17),
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1 respectively, a new subsection (11) is added to said section,
2 and subsection (15) is amended, to read:
3 765.101 Definitions.--As used in this chapter:
4 (11) "Palliative care" means efforts to eliminate or
5 reduce mental or physical pain, suffering, and discomfort.
6 (16)(15) "Terminal condition" means:
7 (a) A condition caused by injury, disease, or illness
8 from which there is no reasonable probability of recovery and
9 which, without treatment, can be expected to cause death; or
10 (b) A persistent vegetative state characterized by a
11 permanent and irreversible condition of unconsciousness in
12 which there is:
13 1. The absence of voluntary action or cognitive
14 behavior of any kind; and
15 2. An inability to communicate or interact
16 purposefully with the environment.
17
18 "Terminal condition" is not necessary for ensuring a right to
19 refuse treatment.
20 Section 2. Section 765.102, Florida Statutes, is
21 amended to read:
22 765.102 Legislative findings and intent.--
23 (1) The Legislature finds that every competent adult
24 has the fundamental right of self-determination regarding
25 decisions pertaining to his or her own health, including the
26 right to choose or refuse medical treatment. This right is
27 subject to certain interests of society, such as the
28 protection of human life and the preservation of ethical
29 standards in the medical profession. Furthermore, the
30 fundamental right of self-determination, including the right
31 to refuse treatment, provides for informed, competent, and
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1 uncoerced adults to refuse any medical treatment, including
2 life-sustaining treatment. Such a refusal may be set out in an
3 advance directive.
4 (2) The Legislature intends that nothing in this
5 chapter shall be construed to prevent or discourage the
6 provision of medically and pharmacologically appropriate pain
7 control or other forms of palliative care. In accordance with
8 standard and accepted medical and ethical principles, the use
9 of pharmacological substances with the intent of alleviating
10 or eliminating pain and other discomfort is encouraged. Such
11 use is not to be regarded as ethically or legally blameworthy,
12 even if appropriate pain control occurs during, and so
13 precedes the outcome of, the dying process.
14 (3)(2) To ensure that such right is not lost or
15 diminished by virtue of later physical or mental incapacity,
16 the Legislature intends that a procedure be established to
17 allow a person to plan for incapacity by designating another
18 person to direct the course of his or her medical treatment
19 upon his or her incapacity. Such procedure should be less
20 expensive and less restrictive than guardianship and permit a
21 previously incapacitated person to exercise his or her full
22 right to make health care decisions as soon as the capacity to
23 make such decisions has been regained.
24 (4)(3) The Legislature further finds that the
25 artificial prolongation of life for a person with a terminal
26 condition may secure for him or her only a precarious and
27 burdensome existence, while providing nothing medically
28 necessary or beneficial to the patient. In order that the
29 rights and intentions of a person with such a condition may be
30 respected even after he or she is no longer able to
31 participate actively in decisions concerning himself or
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1 herself, and to encourage communication among such patient,
2 his or her family, and his or her physician, the Legislature
3 declares that the laws of this state recognize the right of a
4 competent adult to make an advance directive instructing his
5 or her physician to provide, withhold, or withdraw
6 life-prolonging procedures, or to designate another to make
7 the treatment decision for him or her in the event that such
8 person should be found to be incompetent and suffering from a
9 terminal condition.
10 (5) The Legislature further recognizes that many
11 difficult ethical issues accompany actions and processes at
12 the end of life, and that reasonable people may disagree on
13 these issues. Therefore, the Legislature strongly urges
14 institutions that train health professionals to establish or
15 maintain educational programs to address ethical issues
16 pertaining to end-of-life care. These issues should include,
17 but not be limited to, withdrawing and withholding treatment,
18 palliative care (including pain control), surrogate
19 decisionmaking, valid refusal of treatment, and other issues
20 as appropriate and as stated in current law.
21 Section 3. Subsection (1) of section 765.302, Florida
22 Statutes, is amended to read:
23 765.302 Procedure for making a living will; notice to
24 physician.--
25 (1) Any informed, competent, and uncoerced adult may,
26 at any time, make a living will or written declaration
27 directing the providing, withholding, or withdrawal of
28 life-prolonging procedures in the event such person suffers
29 from a terminal condition. A living will must be signed by
30 the principal in the presence of two subscribing witnesses,
31 one of whom is neither a spouse nor a blood relative of the
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1 principal. If the principal is physically unable to sign the
2 living will, one of the witnesses must subscribe the
3 principal's signature in the principal's presence and at the
4 principal's direction.
5 Section 4. Subsection (1) of section 765.303, Florida
6 Statutes, is amended to read:
7 765.303 Suggested form of a living will.--
8 (1) A living will may, BUT NEED NOT, be in the
9 following form:
10 Living Will
11 Declaration made this .... day of ...., 19 .... I,
12 ........, willfully and voluntarily make known my desire that
13 my dying not be artificially prolonged under the circumstances
14 set forth below, and I do hereby declare:
15 If at any time I have a terminal condition as
16 determined by my attending physician and if my attending or
17 treating physician and another consulting physician have
18 determined that there is no medical probability of my recovery
19 from such condition, I direct that life-prolonging procedures
20 be withheld or withdrawn when the application of such
21 procedures would serve only to prolong artificially the
22 process of dying, and that I be permitted to die naturally
23 with only the administration of medication or the performance
24 of any medical procedure deemed necessary to provide me with
25 comfort care or to alleviate pain.
26 It is my intention that this declaration be honored by
27 my family and physician as the final expression of my legal
28 right to refuse medical or surgical treatment and to accept
29 the consequences for such refusal.
30 In the event that I have been determined to be unable
31 to provide express and informed consent regarding the
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1 withholding, withdrawal, or continuation of life-prolonging
2 procedures, I wish to designate, as my surrogate to carry out
3 the provisions of this declaration:
4
5 Name:.........................................................
6 Address:......................................................
7 .................................................. Zip Code:...
8 Phone:................
9 I understand the full import of this declaration, and I
10 am emotionally and mentally competent to make this
11 declaration.
12 Additional Instructions (optional):
13 ..............................................................
14 ..............................................................
15 ..............................................................
16 ....(Signed)....
17 ....Witness....
18 ....Address....
19 ....Phone....
20 ....Witness....
21 ....Address....
22 ....Phone....
23
24 Section 5. Subsection (2) of section 765.304, Florida
25 Statutes, is amended to read:
26 765.304 Procedure for living will.--
27 (2) Before proceeding in accordance with the
28 principal's living will, it must be determined that:
29 (a) The principal does not have a reasonable
30 probability of recovering competency so that the right could
31 be exercised directly by the principal.
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1 (b) The principal's physical condition is terminal.
2 (b)(c) Any limitations or conditions expressed orally
3 or in a written declaration have been carefully considered and
4 satisfied.
5 Section 6. Subsection (2) of section 765.305, Florida
6 Statutes, is amended to read:
7 765.305 Procedure in absence of a living will.--
8 (2) Before exercising the incompetent patient's right
9 to forego treatment, the surrogate must be satisfied that:
10 (a) the patient does not have a reasonable probability
11 of recovering competency so that the right could be exercised
12 by the patient.
13 (b) The patient's physical condition is terminal.
14 Section 7. Section 765.306, Florida Statutes, is
15 amended to read:
16 765.306 Determination of patient condition.--In
17 determining whether the patient has a terminal condition or
18 may recover capacity, or whether a medical condition or
19 limitation referred to in an advance directive exists, the
20 patient's attending or treating physician and at least one
21 other consulting physician must separately examine the
22 patient. The findings of each such examination must be
23 documented in the patient's medical record and signed by the
24 each examining physician before life-prolonging procedures may
25 be withheld or withdrawn.
26 Section 8. This act shall take effect October 1, 1999.
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2 HOUSE SUMMARY
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Revises provisions with respect to health care advance
4 directives to provide that a terminal condition is not
necessary for ensuring a right to refuse treatment.
5 Provides Legislative intent with respect to health care
advance directives.
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7 Revises the Life-Prolonging Procedure Act of Florida to
remove reference to terminal condition.
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9 See bill for details.
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