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Key: (1) language to be deleted (2) new language

  

                         Laws of Minnesota 1989 

                          CHAPTER 3-S.F.No. 28 
           An act relating to probate; providing for adult health 
          care decisions; imposing penalties; proposing coding 
          for new law as Minnesota Statutes, chapter 145B. 
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
    Section 1.  [145B.01] [CITATION.] 
    This chapter may be cited as the "adult health care 
decisions act." 
    Sec. 2.  [145B.02] [DEFINITIONS.] 
    Subdivision 1.  [APPLICABILITY.] The definitions in this 
section apply to this chapter. 
    Subd. 2.  [DECLARATION.] "Declaration" means a writing made 
according to section 3. 
    Subd. 3.  [HEALTH CARE.] "Health care" means care, 
treatment, services, or procedures to maintain, diagnose, or 
treat an individual's physical condition when the individual is 
in a terminal condition. 
    Subd. 4.  [HEALTH CARE DECISION.] "Health care decision" 
means a decision to begin, continue, increase, limit, 
discontinue, or not begin any health care. 
    Subd. 5.  [HEALTH CARE FACILITY.] "Health care facility" 
means a hospital or other entity licensed under sections 144.50 
to 144.58; a nursing home licensed to serve adults under section 
144A.02; or a home care provider licensed under sections 144A.43 
to 144A.49. 
    Subd. 6.  [HEALTH CARE PROVIDER.] "Health care provider" 
means a person, health care facility, organization, or 
corporation licensed, certified, or otherwise authorized or 
permitted by the laws of this state to administer health care 
directly or through an arrangement with other health care 
providers. 
    Subd. 7.  [HMO.] "HMO" means an organization licensed under 
sections 62D.01 to 62D.30. 
     Subd. 8.  [TERMINAL CONDITION.] "Terminal condition" means 
an incurable or irreversible condition for which the 
administration of medical treatment will serve only to prolong 
the dying process. 
    Sec. 3.  [145B.03] [DECLARATION.] 
    Subdivision 1.  [SCOPE.] A competent adult may make a 
declaration of preferences or instructions regarding health care.
These preferences or instructions may include, but are not 
limited to, consent to or refusal of any health care, treatment, 
service, procedure, or placement.  A declaration may include 
preferences or instructions regarding health care, the 
designation of a proxy to make health care decisions on behalf 
of the declarant, or both. 
    Subd. 2.  [REQUIREMENTS FOR EXECUTING A DECLARATION.] (a) A 
declaration is effective only if it is signed by the declarant 
and two witnesses or a notary public. 
     (b) A declaration must state: 
    (1) the declarant's preferences regarding whether the 
declarant wishes to receive or not receive artificial 
administration of nutrition and hydration; or 
    (2) that the declarant wishes the proxy, if any, to make 
decisions regarding the administering of artificially 
administered nutrition and hydration for the declarant 
if the declarant is unable to make health care decisions and the 
declaration becomes operative.  If the declaration does not 
state the declarant's preferences regarding artificial 
administration of nutrition and hydration, the declaration shall 
be enforceable as to all other preferences or instructions 
regarding health care, and a decision to administer, withhold, 
or withdraw nutrition and hydration artificially shall be made 
pursuant to section 13.  However, the mere existence of a 
declaration or appointment of a proxy does not, by itself, 
create a presumption that the declarant wanted the withholding 
or withdrawing of artificially administered nutrition or 
hydration. 
    (c) The declaration may be communicated to and then 
transcribed by one of the witnesses.  If the declarant is 
physically unable to sign the document, one of the witnesses 
shall sign the document at the declarant's direction. 
    (d) Neither of the witnesses can be someone who is entitled 
to any part of the estate of the declarant under a will then 
existing or by operation of law.  Neither of the witnesses nor 
the notary may be named as a proxy in the declaration.  Each 
witness shall substantially make the following declaration on 
the document: 
    "I certify that the declarant voluntarily signed this 
declaration in my presence and that the declarant is personally 
known to me.  I am not named as a proxy by the declaration." 
    Subd. 3.  [GUARDIAN OR CONSERVATOR.] Except as otherwise 
provided in the declaration, designation of a proxy is 
considered a nomination of a guardian or conservator of the 
person for purposes of section 525.544. 
    Sec. 4.  [145B.04] [SUGGESTED FORM.] 
    A declaration executed after August 1, 1989, under this 
chapter must be substantially in the form in this section.  
Forms printed for public distribution must be substantially in 
the form in this section. 
 "Health Care Declaration
Notice: 
    This is an important legal document.  Before signing this 
document, you should know these important facts: 
    (a) This document gives your health care providers or your 
designated proxy the power and guidance to make health care 
decisions according to your wishes when you are in a terminal 
condition and cannot do so.  This document may include what kind 
of treatment you want or do not want and under what 
circumstances you want these decisions to be made.  You may 
state where you want or do not want to receive any treatment. 
    (b) If you name a proxy in this document and that person 
agrees to serve as your proxy, that person has a duty to act 
consistently with your wishes.  If the proxy does not know your 
wishes, the proxy has the duty to act in your best interests.  
If you do not name a proxy, your health care providers have a 
duty to act consistently with your instructions or tell you that 
they are unwilling to do so. 
    (c) This document will remain valid and in effect until and 
unless you amend or revoke it.  Review this document 
periodically to make sure it continues to reflect your 
preferences.  You may amend or revoke the declaration at any 
time by notifying your health care providers. 
    (d) Your named proxy has the same right as you have to 
examine your medical records and to consent to their disclosure 
for purposes related to your health care or insurance unless you 
limit this right in this document. 
    (e) If there is anything in this document that you do not 
understand, you should ask for professional help to have it 
explained to you. 
TO MY FAMILY, DOCTORS, AND ALL THOSE CONCERNED WITH MY CARE: 
    I, .........................., being an adult of sound 
mind, willfully and voluntarily make this statement as a 
directive to be followed if I am in a terminal condition and 
become unable to participate in decisions regarding my health 
care.  I understand that my health care providers are legally 
bound to act consistently with my wishes, within the limits of 
reasonable medical practice and other applicable law.  I also 
understand that I have the right to make medical and health care 
decisions for myself as long as I am able to do so and to revoke 
this declaration at any time. 
    (1) The following are my feelings and wishes regarding my 
health care (you may state the circumstances under which this 
declaration applies): 
................................................................ 
................................................................ 
................................................................ 
................................................................ 
    (2) I particularly want to have all appropriate health care 
that will help in the following ways (you may give instructions 
for care you do want): 
.................................................................
.................................................................
.................................................................
.................................................................
    (3) I particularly do not want the following (you may list 
specific treatment you do not want in certain circumstances): 
.................................................................
.................................................................
    (4) I particularly want to have the following kinds of 
life-sustaining treatment if I am diagnosed to have a terminal 
condition (you may list the specific types of life-sustaining 
treatment that you do want if you have a terminal condition): 
............................................................... 
............................................................... 
............................................................... 
............................................................... 
    (5) I particularly do not want the following kinds of 
life-sustaining treatment if I am diagnosed to have a terminal 
condition (you may list the specific types of life-sustaining 
treatment that you do not want if you have a terminal condition):
............................................................... 
............................................................... 
............................................................... 
............................................................... 
    (6) I recognize that if I reject artificially administered 
sustenance, then I may die of dehydration or malnutrition rather 
than from my illness or injury.  The following are my feelings 
and wishes regarding artificially administered sustenance should 
I have a terminal condition (you may indicate whether you wish 
to receive food and fluids given to you in some other way than 
by mouth if you have a terminal condition): 
............................................................... 
............................................................... 
............................................................... 
............................................................... 
    (7) Thoughts I feel are relevant to my instructions.  (You 
may, but need not, give your religious beliefs, philosophy, or 
other personal values that you feel are important.  You may also 
state preferences concerning the location of your care.) 
............................................................... 
............................................................... 
............................................................... 
............................................................... 
    (8) Proxy Designation.  (If you wish, you may name someone 
to see that your wishes are carried out, but you do not have to 
do this.  You may also name a proxy without including specific 
instructions regarding your care.  If you name a proxy, you 
should discuss your wishes with that person.) 
    If I become unable to communicate my instructions, I 
designate the following person(s) to act on my behalf 
consistently with my instructions, if any, as stated in this 
document.  Unless I write instructions that limit my proxy's 
authority, my proxy has full power and authority to make health 
care decisions for me.  If a guardian or conservator of the 
person is to be appointed for me, I nominate my proxy named in 
this document to act as guardian or conservator of my person. 
    Name:  ................................................. 
    Address:  .............................................. 
    Phone Number:  ......................................... 
    Relationship:  (If any) ................................ 
    If the person I have named above refuses or is unable or 
unavailable to act on my behalf, or if I revoke that person's 
authority to act as my proxy, I authorize the following person 
to do so: 
    Name:  .....................................................
    Address:  ..................................................
    Phone Number:  .............................................
    Relationship:  (If any) ....................................
    I understand that I have the right to revoke the 
appointment of the persons named above to act on my behalf at 
any time by communicating that decision to the proxy or my 
health care provider. 
    DATE:  .....................................................
    SIGNED: ....................................................
     STATE OF .........................  
    ................................... 
    COUNTY OF ........................ 
    Subscribed, sworn to, and acknowledged before me by 
.......... on this ..... day of ............, 19... 
    ......................................... 
    NOTARY PUBLIC] 
    OR 
    (Sign and date here in the presence of two adult witnesses, 
neither of whom is entitled to any part of your estate under a 
will or by operation of law, and neither of whom is your proxy.) 
    I certify that the declarant voluntarily signed this 
declaration in my presence and that the declarant is personally 
known to me.  I am not named as a proxy by the declaration, and 
to the best of my knowledge, I am not entitled to any part of 
the estate of the declarant under a will or by operation of law. 
Witness ....................  Address ..................... 
Witness ....................  Address ..................... 
Reminder:  Keep the signed original with your personal papers. 
Give signed copies to your doctors, family, and proxy." 
    Sec. 5.  [145B.05] [WHEN OPERATIVE.] 
    A declaration becomes operative when it is delivered to the 
declarant's physician or other health care provider.  The 
physician or provider must comply with it to the fullest extent 
possible, consistent with reasonable medical practice and other 
applicable law, or comply with the notice and transfer 
provisions of sections 6 and 7.  The physician or health care 
provider shall continue to obtain the declarant's informed 
consent to all health care decisions if the declarant is capable 
of informed consent. 
     Sec. 6.  [145B.06] [COMPLIANCE WITH DECLARATION.] 
     Subdivision 1.  [BY HEALTH CARE PROVIDER.] (a) A physician 
or other health care provider shall make the declaration a part 
of the declarant's medical record.  If the physician or other 
health care provider is unwilling at any time to comply with the 
declaration, the physician or health care provider must promptly 
notify the declarant and document the notification in the 
declarant's medical record.  After notification, if a competent 
declarant fails to transfer to a different physician or 
provider, the physician or provider has no duty to transfer the 
patient. 
    (b) If a physician or other health care provider receives a 
declaration from a competent declarant and does not advise the 
declarant of unwillingness to comply, and if the declarant then 
becomes incompetent or otherwise unable to seek transfer to a 
different physician or provider, the physician or other health 
care provider who is unwilling to comply with the declaration 
shall promptly take all reasonable steps to transfer care of the 
declarant to a physician or other health care provider who is 
willing to comply with the declaration. 
    Subd. 2.  [BY PROXY.] A proxy designated to make health 
care decisions and who agrees to serve as proxy may make health 
care decisions on behalf of a declarant to the same extent that 
the declarant could make the decision, subject to limitations or 
conditions stated in the declaration.  In exercising this 
authority, the proxy shall act consistently with any desires the 
declarant expresses in the declaration or otherwise makes known 
to the proxy.  If the declarant's desires are unknown, the proxy 
shall act in the best interests of the declarant. 
    Sec. 7.  [145B.07] [TRANSFER OF CARE.] 
    If a declaration is delivered to a physician or other 
health care provider who transfers care of patients to other 
health care providers, or if a declaration is delivered to a 
health care provider, including a health care facility or HMO 
that delivers patient care through an arrangement with 
individual providers, the physician or other health care 
provider receiving a declaration shall make reasonable efforts: 
    (1) to ensure that an agreement with the patient to comply 
with the declaration will be honored by others who provide 
health care to that patient; or 
    (2) to identify and deliver the declaration to the 
individual providers and facilitate the declarant's discussion 
with those individuals whose agreement to comply with the 
declaration is required. 
    Sec. 8.  [145B.08] [ACCESS TO MEDICAL INFORMATION BY 
PROXY.] 
    Unless a declaration under this chapter provides otherwise, 
a proxy has the same rights as the declarant to receive 
information regarding proposed health care, to receive and 
review medical records, and to consent to the disclosure of 
medical records for purposes related to the declarant's health 
care or insurance. 
    Sec. 9.  [145B.09] [REVOCATION.] 
    Subdivision 1.  [GENERAL.] A declaration under this chapter 
may be revoked in whole or in part at any time and in any manner 
by the declarant, without regard to the declarant's physical or 
mental condition.  A revocation is effective when the declarant 
communicates it to the attending physician or other health care 
provider.  The attending physician or other health care provider 
shall note the revocation as part of the declarant's medical 
record. 
    Subd. 2.  [EFFECT OF MARRIAGE DISSOLUTION OR ANNULMENT ON 
DESIGNATION OF PROXY.] Unless a declaration under this chapter 
expressly provides otherwise, if after executing a declaration 
the declarant's marriage is dissolved or annulled, the 
dissolution or annulment revokes any designation of the former 
spouse as a proxy to make health care decisions for the 
declarant. 
    Sec. 10.  [145B.10] [PENALTIES.] 
    Subdivision 1.  [CONCEALING OR CHANGING DECLARATION.] An 
individual who willfully conceals, cancels, defaces, or 
obliterates a declaration of another under this chapter without 
the declarant's consent or who falsifies or forges a revocation 
of the declaration of another is guilty of a gross misdemeanor.  
    Subd. 2.  [FORGING DECLARATION.] An individual who 
falsifies or forges the declaration of another under this 
chapter, or who willfully conceals or withholds personal 
knowledge of a revocation, is guilty of aggravated forgery under 
section 609.625, subdivision 1. 
    Subd. 3.  [FORCED EXECUTION OF A DECLARATION.] A person who 
coerces or fraudulently induces another to execute a declaration 
under this chapter is guilty of a felony. 
    Subd. 4.  [REQUIRED OR PROHIBITED EXECUTION.] A person who 
requires or prohibits the execution of a declaration under this 
chapter as a condition for being insured for or receiving all or 
some health care services is guilty of a misdemeanor. 
    Subd. 5.  [OTHER SANCTIONS PRESERVED.] The sanctions 
provided in this section do not displace any sanction applicable 
under other law. 
    Sec. 11.  [145B.11] [EFFECT ON INSURANCE.] 
    The making or effectuation of a declaration under this 
chapter does not affect the sale, procurement, issuance, or 
validity of a policy of life insurance or annuity, nor does it 
affect, impair, or modify the terms of an existing policy of 
life insurance or annuity or the liability of the party issuing 
the policy or annuity contract. 
    Sec. 12.  [145B.12] [NO PRESUMPTION CREATED.] 
    Subdivision 1.  If an individual has not executed or has 
revoked a declaration under this chapter, a presumption is not 
created with respect to: 
    (1) the individual's intentions concerning the provision of 
health care; or 
    (2) the appropriate health care to be provided. 
      Subd. 2.  Nothing in this chapter shall be construed to 
authorize or justify the withholding or withdrawal of 
artificially administered nutrition or hydration from any person 
who has not issued a declaration or designated a proxy under 
this chapter. 
    Sec. 13.  [145B.13] [REASONABLE MEDICAL PRACTICE REQUIRED.] 
    In reliance on a patient's declaration, a decision to 
administer, withhold, or withdraw medical treatment after the 
patient has been diagnosed by the attending physician to be in a 
terminal condition must always be based on reasonable medical 
practice, including: 
    (1) continuation of appropriate care to maintain the 
patient's comfort, hygiene, and human dignity and to alleviate 
pain; 
    (2) oral administration of food or water to a patient who 
accepts it, except for clearly documented medical reasons; and 
    (3) in the case of a declaration of a patient that the 
attending physician knows is pregnant, the declaration must not 
be given effect as long as it is possible that the fetus could 
develop to the point of live birth with continued application of 
life-sustaining treatment. 
    Sec. 14.  [145B.14] [CERTAIN PRACTICES NOT CONDONED.] 
    Nothing in this chapter may be construed to condone, 
authorize, or approve mercy killing, euthanasia, suicide, or 
assisted suicide. 
    Sec. 15.  [145B.15] [RECOGNITION OF PREVIOUSLY EXECUTED 
DECLARATION.] 
    A declaration that substantially complies with section 3, 
but is made before the effective date of this chapter, is an 
effective declaration under this chapter.  
    Sec. 16.  [145B.16] [RECOGNITION OF DOCUMENT EXECUTED IN 
ANOTHER STATE.] 
    A declaration executed in another state is effective if it 
substantially complies with this chapter. 
    Sec. 17.  [145B.17] [EXISTING RIGHTS.] 
    Nothing in this chapter impairs or supersedes the existing 
rights of any patient or any other legal right or legal 
responsibility a person may have to begin, continue, withhold, 
or withdraw health care.  Nothing in this chapter prohibits 
lawful treatment by spiritual means through prayer in lieu of 
medical or surgical treatment when treatment by spiritual means 
has been authorized by the declarant. 
    Presented to the governor February 28, 1989 
    Signed by the governor March 3, 1989, 11:36 a.m.