SB-0784, As Passed Senate, June 12, 2018

 

 

 

 

 

 

 

 

 

 

 

SUBSTITUTE FOR

 

SENATE BILL NO. 784

 

 

 

 

 

 

 

 

 

 

 

      A bill to amend 1996 PA 193, entitled

 

"Michigan do-not-resuscitate procedure act,"

 

by amending sections 2, 3a, 4, 8, 9, 10, and 11 (MCL 333.1052,

 

333.1053a, 333.1054, 333.1058, 333.1059, 333.1060, and 333.1061),

 

sections 2 and 11 as amended by 2017 PA 157 and section 3a as

 

added and sections 4, 8, 9, and 10 as amended by 2013 PA 155, and

 

by adding section 3b.

 

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 

 1        Sec. 2. As used in this act:

 

 2        (a) "Actual notice" includes the physical presentation of an

 

 3  order, a revocation of an order, or another written document

 

 4  authorized under this act from or on behalf of a declarant.

 

 5        (b) "Advanced illness" means a medical or surgical condition

 

 6  with significant functional impairment that is not reversible by

 


 1  curative therapies and that is anticipated to progress toward

 

 2  death despite attempts at curative therapies or modulation.

 

 3        (c) (b) "Attending physician" means the physician who has

 

 4  primary responsibility for the treatment and care of a declarant.

 

 5        (d) (c) "Declarant" means an individual who has executed a

 

 6  do-not-resuscitate order on his or her own behalf or on whose

 

 7  behalf a do-not-resuscitate order has been executed as provided

 

 8  in this act.

 

 9        (e) (d) "Delegatee" means an individual to whom a physician

 

10  has delegated the authority to perform 1 or more selected acts,

 

11  tasks, or functions under section 16215 of the public health

 

12  code, MCL 333.16215.

 

13        (f) (e) "Do-not-resuscitate identification bracelet" or

 

14  "identification bracelet" means a wrist bracelet that meets the

 

15  requirements of section 7 and that is worn by a declarant while a

 

16  do-not-resuscitate order is in effect.

 

17        (g) (f) "Do-not-resuscitate order" or "order" means a

 

18  document executed under this act directing that, if an individual

 

19  suffers cessation of both spontaneous respiration and circulation

 

20  in a setting outside of a hospital, resuscitation will not be

 

21  initiated.

 

22        (h) (g) "Emergency medical technician" means that term as

 

23  defined in section 20904 of the public health code, MCL

 

24  333.20904.

 

25        (i) (h) "Emergency medical technician specialist" means that

 

26  term as defined in section 20904 of the public health code, MCL

 

27  333.20904.

 


 1        (j) (i) "Guardian" means that term as defined in section

 

 2  1104 of the estates and protected individuals code, 1998 PA 386,

 

 3  MCL 700.1104.

 

 4        (k) (j) "Hospital" means that term as defined in section

 

 5  20106 of the public health code, MCL 333.20106.

 

 6        (l) (k) "Medical first responder" means that term as defined

 

 7  in section 20906 of the public health code, MCL 333.20906.

 

 8        (m) "Minor child" means an individual who is less than 18

 

 9  years of age, has been diagnosed by an attending physician as

 

10  having an advanced illness, and is not emancipated by operation

 

11  of law as provided in section 4 of 1968 PA 293, MCL 722.4.

 

12        (n) (l) "Nurse" means an individual who is licensed or

 

13  otherwise authorized to engage in the practice of nursing or

 

14  practice of nursing as a licensed practical nurse under part 172

 

15  of the public health code, MCL 333.17201 to 333.17242.

 

16        (o) (m) "Organization" means a company, corporation, firm,

 

17  partnership, association, trust, or other business entity or a

 

18  governmental agency.

 

19        (p) (n) "Paramedic" means that term as defined in section

 

20  20908 of the public health code, MCL 333.20908.

 

21        (q) "Parent" means the natural or adoptive parent of a minor

 

22  child who possesses legal decision-making authority as to the

 

23  important decisions affecting the welfare of the minor child.

 

24        (r) (o) "Patient advocate" means an individual who is

 

25  designated to make medical treatment decisions for a patient

 

26  under sections 5506 to 5515 of the estates and protected

 

27  individuals code, 1998 PA 386, MCL 700.5506 to 700.5515.

 


 1        (s) (p) "Physician" means an individual who is licensed or

 

 2  otherwise authorized to engage in the practice of medicine or the

 

 3  practice of osteopathic medicine and surgery under article 15 of

 

 4  the public health code, MCL 333.16101 to 333.18838.

 

 5        (t) (q) "Physician's assistant" means an individual who is

 

 6  licensed as a physician's assistant under part 170 or part 175 of

 

 7  the public health code, MCL 333.17001 to 333.17084 and 333.17501

 

 8  to 333.17556.

 

 9        (u) (r) "Public health code" means the public health code,

 

10  1978 PA 368, MCL 333.1101 to 333.25211.

 

11        (v) Except as otherwise provided in subdivision (w),

 

12  "resuscitate" means perform cardiopulmonary resuscitation or a

 

13  component of cardiopulmonary resuscitation, including, but not

 

14  limited to, any of the following:

 

15        (i) Cardiac compression.

 

16        (ii) Endotracheal intubation or other advanced airway

 

17  management.

 

18        (iii) Artificial ventilation.

 

19        (iv) Defibrillation.

 

20        (v) The administration of a cardiac resuscitation

 

21  medication.

 

22        (vi) Another related procedure.

 

23        (w) "Resuscitate" does not include the Heimlich maneuver or

 

24  a similar procedure used to expel an obstruction from an

 

25  individual's throat.

 

26        (x) "School" means a nonpublic school or a public school as

 

27  those terms are defined in section 5 of the revised school code,

 


 1  1976 PA 451, MCL 380.5.

 

 2        (y) (s) "Vital sign" means a pulse or evidence of

 

 3  respiration.

 

 4        (z) (t) "Ward" means that term as defined in section 1108 of

 

 5  the estates and protected individuals code, 1998 PA 386, MCL

 

 6  700.1108.

 

 7        Sec. 3a. (1) A guardian with the power to execute a do-not-

 

 8  resuscitate order under section 5314 of the estates and protected

 

 9  individuals code, 1998 PA 386, MCL 700.5314, may execute a do-

 

10  not-resuscitate order on behalf of a ward who is not a minor

 

11  child after complying with section 5314 of the estates and

 

12  protected individuals code, 1998 PA 386, MCL 700.5314. A guardian

 

13  of a ward who is a minor child may execute a do-not-resuscitate

 

14  order on behalf of the ward.

 

15        (2) An order executed under this section shall must be on a

 

16  form described in section 4. The order shall must be dated, and

 

17  executed voluntarily, and signed by each of the following

 

18  individuals:

 

19        (a) The guardian.

 

20        (b) The ward's attending physician.

 

21        (c) Two witnesses 18 years of age or older, at least 1 each

 

22  of whom is not the ward's spouse, parent, child, grandchild,

 

23  sibling, or presumptive heir.

 

24        (3) The names of all signatories shall must be printed or

 

25  typed below the corresponding signatures. A witness shall not

 

26  sign an order unless the guardian appears to the witness to be of

 

27  sound mind and under no duress, fraud, or undue influence.

 


 1        (4) At any time after an order is signed and witnessed, the

 

 2  guardian, the attending physician or his or her delegatee, or an

 

 3  individual designated by the guardian may apply an identification

 

 4  bracelet to the ward's wrist.

 

 5        (5) A guardian who executes an order under this section

 

 6  shall maintain do all of the following:

 

 7        (a) Maintain possession of the order. and shall have

 

 8        (b) Have the order accessible within the ward's place of

 

 9  residence or other setting outside of a hospital. or, if

 

10        (c) If applicable, provide a copy of the order to the

 

11  administrator of the following:

 

12        (i) The administrator of the ward's school or to the

 

13  administrator's designee.

 

14        (ii) The administrator of a facility in which the ward is a

 

15  patient or resident or to the administrator's designee.

 

16        Sec. 3b. (1) A parent may execute a do-not-resuscitate order

 

17  on behalf of his or her minor child. If the parent shares with

 

18  another parent legal decision-making authority as to the

 

19  important decisions affecting the welfare of the minor child,

 

20  both parents of the minor child must execute the order.

 

21        (2) An order executed under this section must be on a form

 

22  described in section 4. The order must be dated, executed

 

23  voluntarily, and signed by each of the following individuals:

 

24        (a) The parent or, if required under subsection (1), both

 

25  parents of the minor child.

 

26        (b) The minor child's attending physician.

 

27        (c) Two witnesses 18 years of age or older, each of whom is

 


 1  not the minor child's parent, child, grandchild, sibling, or

 

 2  presumptive heir.

 

 3        (3) The names of all signatories must be printed or typed

 

 4  below the corresponding signatures. A witness shall not sign an

 

 5  order unless the parent appears or, if required under subsection

 

 6  (1), both parents of the minor child appear, to the witness to be

 

 7  of sound mind and under no duress, fraud, or undue influence.

 

 8        (4) At any time after an order is signed and witnessed, the

 

 9  parent, the attending physician or his or her delegatee, or an

 

10  individual designated by the parent may apply an identification

 

11  bracelet to the minor child's wrist.

 

12        (5) A parent who executes an order under this section shall

 

13  do all of the following:

 

14        (a) Maintain possession of the order.

 

15        (b) Have the order accessible within the minor child's place

 

16  of residence or other setting outside of a hospital.

 

17        (c) If applicable, provide a copy of the order to the

 

18  following:

 

19        (i) The administrator of the minor child's school or to the

 

20  administrator's designee.

 

21        (ii) The administrator of a facility in which the minor child

 

22  is a patient or resident or to the administrator's designee.

 

23        Sec. 4. A do-not-resuscitate order executed under section 3,

 

24  or 3a, shall or 3b must include, but is not limited to, the

 

25  following language, and shall must be in substantially the

 

26  following form:

 

 


1

                     "DO-NOT-RESUSCITATE ORDER

2

This do-not-resuscitate order is issued by

3

_______________________________________, attending physician for

4

_________________________________________.

5

(Type or print declarant's, or ward's, or minor child's name)

6

Use the appropriate consent section below:

7

A. DECLARANT CONSENT

8

   I have discussed my health status with my physician named

9

above. I request that in the event my heart and breathing should

10

stop, no person shall attempt to resuscitate me.

11

   This order will remain in effect until it is revoked as

12

provided by law.

13

   Being of sound mind, I voluntarily execute this order, and

14

I understand its full import.

15

_______________________________________          _______________

16

        (Declarant's signature)                      (Date)

17

_______________________________________          _______________

18

  (Signature of person who signed for                (Date)

19

       declarant, if applicable)

20

_______________________________________

21

       (Type or print full name)

22

B. PATIENT ADVOCATE CONSENT

23

   I authorize that in the event the declarant's heart and

24

breathing should stop, no person shall attempt to resuscitate

25

the declarant. I understand the full import of this order and

26

assume responsibility for its execution. This order will remain

27

in effect until it is revoked as provided by law.

28

_______________________________________          _______________

29

     (Patient advocate's signature)                  (Date)

30

_______________________________________

31

(Type or print patient advocate's name)

32

C. PARENT CONSENT


1

     I authorize that in the event the minor child's heart and

2

breathing should stop, no person shall attempt to resuscitate

3

the minor child. I understand the full import of this order and

4

assume responsibility for its execution. This order will remain

5

in effect until it is revoked as provided by law.

6

_______________________________________          _______________

7

         (Parent's signature)                        (Date)

8

_______________________________________         

9

      (Type or print parent's name)

10

_______________________________________          _______________

11

         (Parent's signature)                        (Date)

12

_______________________________________         

13

      (Type or print parent's name)

14

D. C. GUARDIAN CONSENT

15

   I authorize that in the event the ward's heart and breathing

16

should stop, no person shall attempt to resuscitate the ward.

17

I understand the full import of this order and assume

18

responsibility for its execution. This order will remain in

19

effect until it is revoked as provided by law.

20

_______________________________________          _______________

21

        (Guardian's signature)                       (Date)

22

_______________________________________

23

    (Type or print guardian's name)

24

_______________________________________          _______________

25

        (Physician's signature)                      (Date)

26

_______________________________________

27

 (Type or print physician's full name)

28

29

                      ATTESTATION OF WITNESSES

30

   The individual who has executed this order appears to be of

31

sound mind, and under no duress, fraud, or undue influence.

32

Upon executing this order, the declarant has (has not)received


1

an identification bracelet.

2

______________________________    ______________________________

3

 (Witness signature)   (Date)      (Witness signature)   (Date)

4

______________________________    ______________________________

5

(Type or print witness's name)    (Type or print witness's name)

6

7

  THIS FORM WAS PREPARED PURSUANT TO, AND IS IN COMPLIANCE WITH,

8

          THE MICHIGAN DO-NOT-RESUSCITATE PROCEDURE ACT.".

 

 

 9        Sec. 8. An attending physician who signs a declarant's do-

 

10  not-resuscitate order under section 3, or 3a, or 3b shall

 

11  immediately obtain a copy or a duplicate of the executed order

 

12  and make that copy or duplicate part of the declarant's permanent

 

13  medical record.

 

14        Sec. 9. If a person interested in the welfare of the

 

15  declarant has reason to believe that an order has been executed

 

16  contrary to the wishes of the declarant or, if the declarant is a

 

17  ward including a ward who is a minor child, contrary to the

 

18  wishes or best interests of the ward, the person may petition the

 

19  probate court to have the order and the conditions of its

 

20  execution reviewed. If the probate court finds that an order has

 

21  been executed contrary to the wishes of the declarant or, if the

 

22  declarant is a ward including a ward who is a minor child,

 

23  contrary to the wishes or best interests of the ward, the probate

 

24  court shall issue an injunction voiding the effectiveness of the

 

25  order and prohibiting compliance with the order.

 

26        Sec. 10. (1) A declarant may revoke an order executed by

 

27  himself or herself or executed on his or her behalf at any time

 

28  and in any manner by which he or she is able to communicate his


 

 1  or her intent to revoke the order. If the declarant's revocation

 

 2  is not in writing, an individual who observes the declarant's

 

 3  revocation of the order shall describe the circumstances of the

 

 4  revocation in writing, sign the writing, and deliver the writing

 

 5  to the declarant's attending physician or his or her delegatee

 

 6  and, if the declarant is a patient or resident of a facility or a

 

 7  pupil of a school, to the administrator of the facility or school

 

 8  or the administrator's designee. A patient advocate, parent, or

 

 9  guardian may revoke an order on behalf of a declarant at any time

 

10  by issuing the revocation in writing and provide actual notice of

 

11  the revocation by delivering the written revocation to the

 

12  declarant's attending physician or his or her delegatee and, if

 

13  the declarant is a patient or resident of a facility or a pupil

 

14  of a school, to the administrator of the facility or school or

 

15  the administrator's designee. Upon revocation, the declarant,

 

16  patient advocate, parent, guardian, or attending physician or his

 

17  or her delegatee who has actual notice of a revocation of an

 

18  order under this section shall do all of the following:

 

19        (a) Write "void" on all pages of the order.

 

20        (b) If applicable, remove the declarant's do-not-resuscitate

 

21  identification bracelet.

 

22        (2) A physician or his or her delegatee who receives actual

 

23  notice of a revocation of an order shall immediately make the

 

24  revocation, including, if available, the written description of

 

25  the circumstances of the revocation required by subsection (1),

 

26  part of the declarant's permanent medical record. The

 

27  administrator of a facility or his or her designee who receives


 

 1  actual notice of a revocation of an order of a declarant who is a

 

 2  patient or resident of the facility shall immediately make the

 

 3  revocation part of the patient's or resident's permanent medical

 

 4  record. The administrator of a school or his or her designee who

 

 5  receives actual notice of a revocation of an order of a declarant

 

 6  who is a pupil of the school shall immediately make the

 

 7  revocation part of the pupil's school file and place the

 

 8  revocation in the file created under section 1180(1)(a) of the

 

 9  revised school code, 1976 PA 451, MCL 380.1180.

 

10        (3) A revocation of an order under this section is binding

 

11  upon another person at the time that other person receives actual

 

12  notice of the revocation.

 

13        Sec. 11. (1) One or more of the following health

 

14  professionals who arrive at a declarant's location outside of a

 

15  hospital shall determine if the declarant has 1 or more vital

 

16  signs, whether or not the health professional views or has actual

 

17  notice of an order that is alleged to have been executed by the

 

18  declarant or other person authorized to execute an order on the

 

19  declarant's behalf:

 

20        (a) A paramedic.

 

21        (b) An emergency medical technician.

 

22        (c) An emergency medical technician specialist.

 

23        (d) A physician.

 

24        (e) A nurse.

 

25        (f) A medical first responder.

 

26        (g) A respiratory therapist.

 

27        (h) A physician's assistant.


 

 1        (2) If the health professional determines under subsection

 

 2  (1) that the declarant has no vital signs, and if the health

 

 3  professional determines that the declarant is wearing a do-not-

 

 4  resuscitate identification bracelet or has actual notice of a do-

 

 5  not-resuscitate order for the declarant, subject to section 11a,

 

 6  the health professional shall not attempt to resuscitate the

 

 7  declarant.

 

 8        (3) If the declarant is a minor child who is enrolled and

 

 9  located at a school, an individual who determines that the

 

10  declarant is wearing a do-not-resuscitate identification bracelet

 

11  or has actual notice of a do-not-resuscitate order for the

 

12  declarant shall not attempt to resuscitate the declarant before a

 

13  health professional described in subsection (1) arrives at the

 

14  declarant's location.

 

15        Enacting section 1. This amendatory act takes effect 90 days

 

16  after the date it is enacted into law.

 

17        Enacting section 2. This amendatory act does not take effect

 

18  unless Senate Bill No. 827 of the 99th Legislature is enacted

 

19  into law.