HOUSE BILL No. 5258


     October 17, 2001, Introduced by Reps. DeRossett, Howell, Julian, Richardville, Stewart, Woronchak, Basham, Shulman, Raczkowski, Patterson,
Vander Veen, Scranton, George, Ehardt, Jelinek, Voorhees, Plakas, Shackleton, Anderson, Vear, Hummel, Kuipers, Stamas, Pappageorge, Allen,
Middaugh, Meyer, Gilbert, Kowall, Van Woerkom, Cassis, Kooiman, DeVuyst, Pumford, Cameron Brown, Sanborn, Birkholz, Faunce and Neumann and
referred to the Committee on Health Policy.


        A bill to amend 1978 PA 368, entitled

   "Public health code,"

   by amending sections 5652, 5653, 5654, and 5655 (MCL 333.5652,

   333.5653, 333.5654, and 333.5655), sections 5652 and 5655 as

   added by 1996 PA 594 and sections 5653 and 5654 as amended by

   2000 PA 58.

               THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

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           Sec. 5652.  (1) The legislature finds all of the following:

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           (a) That patients face a unique set of circumstances and

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      decisions once they have been diagnosed as having a terminal OR

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      ADVANCED illness.

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           (b) That published studies indicate that  terminally ill

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      patients WITH REDUCED LIFE EXPECTANCY DUE TO ADVANCED ILLNESSES

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      fear that in end-of-life situations they could receive unwanted

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      aggressive medical treatment.


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           (c) That  terminally ill  patients WITH REDUCED LIFE

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      EXPECTANCY DUE TO ADVANCED ILLNESSES are often unaware of their

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      legal rights, particularly with regard to controlling end-of-life

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      decisions.

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           (d) That the free flow of information among health care pro-

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      viders, patients, and patients' families can give patients and

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      their families a sense of control over their lives, ease the

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      stress involved in coping with a  terminal  REDUCED LIFE

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      EXPECTANCY DUE TO ADVANCED illness, and provide needed guidance

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      to all involved in determining the appropriate variety and degree

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      of medical intervention to be used.

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           (E) THAT HEALTH CARE PROVIDERS SHOULD BE ENCOURAGED TO DIS-

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      CUSS MEDICAL DIRECTIVES DURING INITIAL CONSULTATIONS, ANNUAL

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      EXAMINATIONS, AND HOSPITALIZATIONS, AT DIAGNOSIS OF A CHRONIC

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      ILLNESS, AND WHEN A PATIENT TRANSFERS FROM 1 HEALTH CARE SETTING

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      TO ANOTHER.

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           (2) In affirmation of the tradition in this state recogniz-

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      ing the integrity of patients and their desire for a humane and

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      dignified death, the Michigan legislature enacts the "Michigan

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      dignified death act".  In doing so, the legislature recognizes

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      that a well-considered body of common law exists detailing the

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      relationship between health care providers and their patients.

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      This act is not intended to abrogate any part of that COMMON

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      law.  This act is intended to increase  terminally ill patients'

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      awareness of  their  THE right OF A PATIENT WHO HAS A REDUCED

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      LIFE EXPECTANCY DUE TO ADVANCED ILLNESS to make decisions to

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      receive, continue, discontinue, or refuse medical treatment.  It



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      is hoped that by doing so, the legislature will encourage better

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      communication between  terminally ill  patients WITH REDUCED LIFE

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      EXPECTANCY DUE TO ADVANCED ILLNESSES and health care providers to

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      ensure that  a terminally ill  THE patient's final days are mean-

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      ingful and dignified.

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           Sec. 5653.  (1) As used in this part:

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           (a) "Health facility" means a health facility or agency

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      licensed under article 17.

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           (b) "Hospice" means that term as defined in section 20106.

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           (c) "Medical treatment" means a treatment including, but not

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      limited to, palliative care treatment, or a procedure, medica-

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      tion, surgery, a diagnostic test, or a hospice plan of care that

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      may be ordered, provided, or withheld or withdrawn by a health

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      professional or a health facility under generally accepted stan-

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      dards of medical practice and that is not prohibited by law.

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           (d) "Patient" means an individual who is under the care of a

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      physician.

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           (e) "Patient advocate" means that term as described and used

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      in sections 5506 to 5512 of the estates and protected individuals

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      code, 1998 PA 386, MCL 700.5506 to 700.5512.

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           (f) "Patient surrogate" means the parent or legal guardian

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      of a patient who is a minor or a member of the immediate family,

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      the next of kin, or the legal guardian of a patient who has a

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      condition other than minority that prevents the patient from

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      giving consent to medical treatment.

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           (g) "Physician" means that term as defined in section 17001

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      or 17501.



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            (h) "Terminal illness" means a disease or condition due to

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      which, in the opinion of a physician, a patient's death is antic-

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      ipated within 6 months after the date of the physician's

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      opinion.

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           (2) Article 1 contains general definitions and principles of

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      construction applicable to all articles in this code.

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           Sec. 5654.  (1) A physician who HAS DIAGNOSED A PATIENT AS

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      HAVING A REDUCED LIFE EXPECTANCY DUE TO AN ADVANCED ILLNESS AND

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      is recommending medical treatment for  terminal illness to a  THE

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      patient  who has been diagnosed as having a terminal illness

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      shall do all of the following:

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           (a) Orally inform the patient, the patient's patient surro-

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      gate, or, if the patient has designated a patient advocate and is

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      unable to participate in medical treatment decisions, the patient

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      advocate acting on behalf of the patient in accordance with sec-

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      tions 5506 to 5512 of the estates and protected individuals code,

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      1998 PA 386, MCL 700.5506 to 700.5512, about  the recommended

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      medical treatment for the  terminal  REDUCED LIFE EXPECTANCY DUE

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      TO ADVANCED illness and about alternatives to  the recommended

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      medical treatment for the  terminal  REDUCED LIFE EXPECTANCY DUE

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      TO ADVANCED illness.

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           (b) Orally inform the patient, patient surrogate, or patient

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      advocate about the advantages, disadvantages, and risks of the

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       recommended  medical treatment and of each alternative medical

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      treatment described in subdivision (a) and about the procedures

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      involved.  in the recommended and each alternative medical

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      treatment.



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           (2) A physician's duty to inform a patient, patient

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      surrogate, or patient advocate under subsection (1) does not

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      require the disclosure of information beyond that required by the

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      applicable standard of practice.

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           (3) Subsection (1) does not limit or modify the information

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      required to be disclosed under sections 5133(2) and 17013(1).

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           Sec. 5655.  In addition to the requirements of section 5654,

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       beginning 120 days after the effective date of the amendatory

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      act that added this part,  a physician who HAS DIAGNOSED A

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      PATIENT AS HAVING A REDUCED LIFE EXPECTANCY DUE TO AN ADVANCED

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      ILLNESS AND is recommending medical treatment for  terminal ill-

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      ness to a  THE patient  who has been diagnosed as having a termi-

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      nal illness  shall, both orally and in writing, inform the

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      patient, the patient's patient surrogate, or, if the patient has

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      designated a patient advocate and is unable to participate in

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      medical treatment decisions, the patient advocate, of all of the

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      following:

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           (a) If the patient has not designated a patient advocate,

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      that the patient has the option of designating a patient advocate

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      to make medical treatment decisions for the patient in the event

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      the patient is not able to participate in his or her medical

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      treatment decisions because of his or her medical condition.

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           (b) That the patient, or the patient's patient surrogate or

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      patient advocate, acting on behalf of the patient, has the right

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      to make an informed decision regarding receiving, continuing,

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      discontinuing, and refusing medical treatment for the patient's

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       terminal  REDUCED LIFE EXPECTANCY DUE TO ADVANCED illness.



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           (c) That the patient, or the patient's patient surrogate or

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      patient advocate, acting on behalf of the patient, may choose

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      palliative care treatment including, but not limited to, hospice

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      care and pain management.

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           (D) THAT THE PATIENT OR THE PATIENT'S SURROGATE OR PATIENT

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      ADVOCATE ACTING ON BEHALF OF THE PATIENT MAY CHOOSE ADEQUATE AND

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      APPROPRIATE PAIN AND SYMPTOM MANAGEMENT AS A BASIC AND ESSENTIAL

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      ELEMENT OF MEDICAL TREATMENT.

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           Enacting section 1.  Sections 5654 and 5655 of the public

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      health code, 1978 PA 368, MCL 333.5654 and 333.5655, as amended

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      by this amendatory act, take effect March 1, 2002.

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           Enacting section 2.  This amendatory act does not take

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      effect unless Senate Bill No. _____ or House Bill No. 5257

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      (request no. 05503'01) of the 91st Legislature is enacted into

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      law.



























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