HB 197: "An Act relating to directives for personal health care services and for medical treatment."
00 HOUSE BILL NO. 197 01 "An Act relating to directives for personal health care services and for medical 02 treatment." 03 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 04 * Section 1. AS 13.26.332 is amended to read: 05 Sec. 13.26.332. Statutory form power of attorney. A person who wishes to 06 designate another as attorney-in-fact or agent by a power of attorney may execute a 07 statutory power of attorney set out in substantially the following form: 08 GENERAL POWER OF ATTORNEY 09 THE POWERS GRANTED FROM THE PRINCIPAL TO THE 10 AGENT OR AGENTS IN THE FOLLOWING DOCUMENT ARE 11 VERY BROAD. THEY MAY INCLUDE THE POWER TO 12 DISPOSE, SELL, CONVEY, AND ENCUMBER YOUR REAL AND 13 PERSONAL PROPERTY, AND THE POWER TO MAKE YOUR 14 HEALTH CARE DECISIONS. ACCORDINGLY, THE
01 FOLLOWING DOCUMENT SHOULD ONLY BE USED AFTER 02 CAREFUL CONSIDERATION. IF YOU HAVE ANY QUESTIONS 03 ABOUT THIS DOCUMENT, YOU SHOULD SEEK COMPETENT 04 ADVICE. 05 YOU MAY REVOKE THIS POWER OF ATTORNEY AT ANY 06 TIME. 07 Pursuant to AS 13.26.338 - 13.26.353, I, (Name of 08 principal) , of (Address of principal) , do hereby 09 appoint (Name and address of agent or agents) , my 10 attorney(s)-in-fact to act as I have checked below in my name, place, 11 and stead in any way which I myself could do, if I were personally 12 present, with respect to the following matters, as each of them is 13 defined in AS 13.26.344, to the full extent that I am permitted by law to 14 act through an agent: 15 THE AGENT OR AGENTS YOU HAVE APPOINTED WILL 16 HAVE ALL THE POWERS LISTED BELOW UNLESS YOU 17 DRAW A LINE THROUGH A CATEGORY; AND 18 INITIAL THE BOX OPPOSITE THAT CATEGORY 19 (A) real estate transactions ( ) 20 (B) transactions involving tangible personal property, 21 chattels, and goods ( ) 22 (C) bonds, shares, and commodities transactions ( ) 23 (D) banking transactions ( ) 24 (E) business operating transactions ( ) 25 (F) insurance transactions ( ) 26 (G) estate transactions ( ) 27 (H) gift transactions ( ) 28 (I) claims and litigation ( ) 29 (J) personal relationships and affairs ( ) 30 (K) benefits from government programs and military 31 service ( )
01 (L) [HEALTH CARE SERVICES ( ) 02 (M)] records, reports, and statements ( ) 03 (M) [(N)] delegation ( ) 04 (N) [(O)] all other matters, including those specified 05 as follows: ( ) 06 _________________________________________________________ 07 _________________________________________________________ 08 _________________________________________________________ 09 IF YOU HAVE APPOINTED MORE THAN ONE AGENT, 10 CHECK ONE OF THE FOLLOWING: 11 ( ) Each agent may exercise the powers conferred separately, without 12 the consent of any other agent. 13 ( ) All agents shall exercise the powers conferred jointly, with the 14 consent of all other agents. 15 TO INDICATE WHEN THIS DOCUMENT SHALL BECOME 16 EFFECTIVE, CHECK ONE OF THE FOLLOWING: 17 ( ) This document shall become effective upon the date of my 18 signature. 19 ( ) This document shall become effective upon the date of my 20 disability and shall not otherwise be affected by my disability. 21 IF YOU HAVE INDICATED THAT THIS DOCUMENT SHALL 22 BECOME EFFECTIVE ON THE DATE OF YOUR SIGNATURE, 23 CHECK ONE OF THE FOLLOWING: 24 ( ) This document shall not be affected by my subsequent disability. 25 ( ) This document shall be revoked by my subsequent disability. 26 IF YOU HAVE INDICATED THAT THIS DOCUMENT SHALL 27 BECOME EFFECTIVE UPON THE DATE OF YOUR SIGNATURE 28 AND WANT TO LIMIT THE TERM OF THIS DOCUMENT, 29 COMPLETE THE FOLLOWING: 30 This document shall only continue in effect for ________ ( ) 31 years from the date of my signature.
01 NOTICE OF REVOCATION OF THE POWERS GRANTED IN 02 THIS DOCUMENT 03 You may revoke one or more of the powers granted in this 04 document. Unless otherwise provided in this document, you may 05 revoke a specific power granted in this power of attorney by 06 completing a special power of attorney that includes the specific power 07 in this document that you want to revoke. Unless otherwise provided in 08 this document, you may revoke all the powers granted in this power of 09 attorney by completing a subsequent power of attorney. 10 NOTICE TO THIRD PARTIES 11 A third party who relies on the reasonable representations of an 12 attorney-in-fact as to a matter relating to a power granted by a properly 13 executed statutory power of attorney does not incur any liability to the 14 principal or to the principal's heirs, assigns, or estate as a result of 15 permitting the attorney-in-fact to exercise the authority granted by the 16 power of attorney. A third party who fails to honor a properly executed 17 statutory form power of attorney may be liable to the principal, the 18 attorney-in-fact, the principal's heirs, assigns, or estate for a civil 19 penalty, plus damages, costs, and fees associated with the failure to 20 comply with the statutory form power of attorney. If the power of 21 attorney is one which becomes effective upon the disability of the 22 principal, the disability of the principal is established by an affidavit, as 23 required by law. 24 IN WITNESS WHEREOF, I have hereunto signed my name this 25 ____ day of ________________, _________. 26 _________________________________ 27 Signature of Principal 28 Acknowledged before me at ______________________________ 29 __________________________ on ____________________________. 30 _________________________________ 31 Signature of Officer or Notary
01 * Sec. 2. AS 18.12.100 is amended to read: 02 Sec. 18.12.100. Definitions. In AS 18.12.010 - 18.12.100 [THIS CHAPTER], 03 (1) "anatomical gift" means an anatomical gift under AS 13.50; 04 (2) "attending physician" means the physician selected by, or assigned 05 to, the patient who has primary responsibility for the treatment and care of the patient; 06 (3) "cardiopulmonary resuscitation" means cardiopulmonary 07 resuscitation or a component of cardiopulmonary resuscitation; 08 (4) "declaration" means a document executed in accordance with the 09 requirements of AS 18.12.010; 10 (5) "DNR identification" means identification substantially similar to 11 that approved under AS 18.12.037; 12 (6) "do not resuscitate order" means a directive from a licensed 13 physician that emergency cardiopulmonary resuscitation should not be administered to 14 a particular person; 15 (7) "do not resuscitate protocol" means the protocol developed under 16 AS 18.12.035(b); 17 (8) "health care provider" means a person who is licensed, certified, or 18 otherwise authorized by the law of this state to administer health care in the ordinary 19 course of business or practice of a profession; 20 (9) "life-sustaining procedure" means a medical procedure or 21 intervention that, when administered to a qualified patient, will serve only to prolong 22 the dying process; 23 (10) "physician" means a person licensed to practice medicine in this 24 state or an officer in the regular medical service of the armed services of the United 25 States or the United States Public Health Service while in the discharge of their 26 official duties, or while volunteering services without pay or other remuneration to a 27 hospital, clinic, medical office, or other medical facility in the state; 28 (11) "qualified patient" means a patient who has executed a declaration 29 in accordance with AS 18.12.010 - 18.12.100 [THIS CHAPTER] and who has been 30 determined by the attending physician to be in a terminal condition; 31 (12) "terminal condition" means a progressive incurable or irreversible
01 condition that, without the administration of life-sustaining procedures, will, in the 02 opinion of two physicians, when available, who have personally examined the patient, 03 one of whom must be the attending physician, result in death within a relatively short 04 time. 05 * Sec. 3. AS 18.12 is amended by adding new sections to read: 06 Article 2. Health Care Services Directives. 07 Sec. 18.12.110. Statutory form power of attorney for health care services. 08 A person who wishes to designate another as attorney-in-fact or agent by a power of 09 attorney for purposes of the provision of health care services may execute a statutory 10 power of attorney to indicate the identity of the person who is to serve as attorney or 11 agent. The following sets out a model of a power of attorney that may be used for that 12 purpose: 13 POWER OF ATTORNEY FOR HEALTH CARE SERVICES 14 If I am no longer able to make my own health care decisions, this 15 form names the person I choose to make these choices for me. This 16 person will be my Health Care Agent. 17 This person will make my health care choices if both of these 18 things happen: 19 My attending or treating doctor finds that I am no longer able to 20 make health care choices; and 21 Another health care professional agrees that this is true. 22 The person I choose as my Health Care Agent is: 23 _________________________________________________________ 24 Name 25 _________________________________________________________ 26 Phone number 27 _________________________________________________________ 28 Address 29 _________________________________________________________ 30 City, state, zip code 31 If this person
01 is not able or willing to make these choices for me; 02 is divorced or legally separated from me; or 03 has died, 04 then these people are my next choices: 05 _________________________________________________________ 06 Second choice name 07 _________________________________________________________ 08 Phone number 09 _________________________________________________________ 10 Address 11 _________________________________________________________ 12 City, state, zip code 13 _________________________________________________________ 14 Third choice name 15 _________________________________________________________ 16 Phone number 17 _________________________________________________________ 18 Address 19 _________________________________________________________ 20 City, state, zip code 21 I understand that my Health Care Agent can make health care 22 decisions for me. I want my agent to be able to do the following things 23 in the list below except the things I have drawn a line through or 24 crossed out and have initialed or signed: 25 Make choices for me about my medical care or services, 26 such as tests, medicine, or surgery. This care or service could 27 be to find out what my health problem is, or how to treat it. It 28 can also include care to keep me alive. If the treatment or care 29 has already started, my Health Care Agent can keep it going or 30 have it stopped. 31 Interpret any instructions I have given in this form or given
01 in other discussions, according to my Health Care Agent's 02 understanding of my wishes and values. 03 Arrange for admission to a hospital, hospice, or nursing 04 home for me. My Health Care Agent can hire any kind of 05 health care worker I may need to help me or take care of me. 06 My agent may also fire a health care worker, if needed. 07 Make the decision to request, take away, or not give 08 medical treatments, including artificially provided food and 09 water, and any other treatments to keep me alive. 10 See and approve release of my medical records and 11 personal files. If I need to sign my name to get any of these 12 files, my Health Care Agent can sign for me. 13 Move me to another state to carry out my wishes. My 14 Health Care Agent can also move me to another state for other 15 reasons. 16 Take any legal action needed to carry out my wishes as set 17 out in this section. Apply for Medicare, Medicaid, or other 18 programs or insurance benefits for me. My Health Care Agent 19 can see my personal files, such as bank records, to find out what 20 is needed to fill out these forms. 21 Listed below are any changes, additions, or other 22 limitations on my Health Care Agent's powers: 23 ___________________________________________________ 24 ___________________________________________________ 25 ___________________________________________________ 26 ___________________________________________________ 27 ___________________________________________________ 28 ___________________________________________________ 29 ___________________________________________________ 30 ___________________________________________________ 31 ___________________________________________________
01 ___________________________________________________ 02 ___________________________________________________ 03 ___________________________________________________ 04 ___________________________________________________ 05 ___________________________________________________ 06 ___________________________________________________ 07 ___________________________________________________ 08 If I change my mind about having a Health Care Agent, I will do 09 the following: 10 Destroy all copies of this power of attorney; or 11 Write the word "Revoked" in large letters across the name of 12 each agent whose authority I want to cancel and sign my 13 name on that page; or 14 Tell someone, such as my doctor or family, that I want to cancel 15 or change my Health Care Agent. 16 IN WITNESS WHEREOF, I have signed my name this ____ day of 17 ____________________, _____. 18 ___________________________ 19 Signature 20 Acknowledged before me at _______________________________ on 21 ____________________, _____. 22 ___________________________ 23 Notary Public in and for Alaska 24 or 25 Signatures of witnesses: 26 _________________________ ___________________________ 27 Printed names of witnesses: 28 _________________________ ___________________________ 29 Addresses of witnesses: 30 _________________________ ___________________________ 31 _________________________ ___________________________
01 Phone numbers of witnesses: 02 _________________________ ___________________________ 03 Sec. 18.12.120. Statutory form power of attorney for medical treatment. 04 (a) A person who wishes to indicate to the person's health care agent how medical 05 treatment is to be provided to the person may execute a statutory power of attorney to 06 so indicate. The following sets out a model of a power of attorney that may be used 07 for that purpose: 08 POWER OF ATTORNEY TO 09 DESCRIBE MEDICAL TREATMENT 10 I believe that my life is precious and I deserve to be treated with 11 dignity. When the time comes that I am very sick and am not able to 12 speak for myself, I want the following wishes and any other 13 instructions I have given to my Health Care Agent to be respected and 14 followed. 15 The instructions that I am including in this section are to let my 16 family, my doctors and other health care providers, my friends, and all 17 others know the kind of medical treatment that I want or do not want. 18 (1) General Instructions 19 I do not want to be in pain. I want my doctor to give me 20 enough medicine to relieve my pain even if that means that I 21 will be drowsy or sleep more than I would otherwise. 22 I do not want anything done or omitted by my doctors or 23 nurses with the intention of taking my life. 24 I want to be offered food and fluids by mouth, and kept 25 clean and warm. 26 (2) Meaning of "Life-Support Treatment" 27 Life-support treatment means any medical procedure, 28 device, or medication to keep me alive. Life-support treatment 29 includes medical devices put in me to help me breathe, food and 30 water supplied artificially by medical device (tube feeding), 31 cardiopulmonary resuscitation (CPR), major surgery, blood
01 transfusions, dialysis, and antibiotics. 02 Because I wish to limit the meaning of life-support 03 treatment, I have set out this limitation in the space below: 04 ___________________________________________________ 05 ___________________________________________________ 06 ___________________________________________________ 07 ___________________________________________________ 08 ___________________________________________________ 09 ___________________________________________________ 10 (3) If I am close to death: 11 If my doctor and another health care professional both 12 decide that I am likely to die within a short period of time and 13 life-support treatment would only postpone the moment of my 14 death, I am choosing one of the following: 15 [ ] I want to have life-support treatment; 16 [ ] I want to have life-support treatment if my doctor 17 believes it could help, but I want my doctor to stop 18 giving me life-support treatment if it is not helping my 19 health condition or symptoms; or 20 [ ] I do not want life-support treatment; if it has been 21 started, I want it stopped. 22 (4) If I am in a coma and I am not expected to wake up or recover: 23 If my doctor and another health care professional both 24 decide that I am in a coma from which I am not expected to 25 wake up or recover and I have brain damage and life-support 26 treatment would only postpone the moment of my death, I have 27 chosen one of the following: 28 [ ] I want to have life-support treatment; 29 [ ] I want to have life-support treatment if my doctor 30 believes it could be helpful, but I want my doctor to stop 31 giving me life-support treatment if it is not helping my
01 health condition or symptoms; or 02 [ ] I do not want life-support treatment; if it has been 03 started, I want it stopped. 04 (5) If I have permanent and severe brain damage and I am not 05 expected to recover: 06 If my doctor and another health care professional both 07 decide that I have permanent and severe brain damage (for 08 example, I can open my eyes, I cannot speak or understand) and 09 I am not expected to recover and life-support treatment would 10 only postpone the moment of my death, I have chosen one of 11 the following: 12 [ ] I want to have life-support treatment; 13 [ ] I want to have life-support treatment if my doctor 14 believes it could help, but I want my doctor to stop 15 giving me life-support treatment if it is not helping my 16 health condition or symptoms; or 17 [ ] I do not want life-support treatment; if it has been 18 started, I want it stopped. 19 (6) If I am in another condition under which I do not wish to be 20 kept alive: 21 There are other conditions under which I do not wish to 22 have life-support treatment that I describe below. In this 23 condition, I believe that the costs and burdens of life-support 24 treatment are too much and not worth the benefits to me. 25 Therefore, in this condition, I do not want life-support 26 treatment: 27 ___________________________________________________ 28 ___________________________________________________ 29 ___________________________________________________ 30 ___________________________________________________ 31 ___________________________________________________
01 ___________________________________________________ 02 IN WITNESS WHEREOF, I have signed my name this _____ day 03 of ________________________, ______. 04 ___________________________ 05 Signature 06 Acknowledged before me at ____________________________ on 07 ________________________, ______. 08 ___________________________ 09 Notary Public in and for Alaska 10 or 11 Signatures of witnesses: 12 _________________________ ___________________________ 13 Printed names of witnesses: 14 _________________________ ___________________________ 15 Addresses of witnesses: 16 _________________________ ___________________________ 17 _________________________ ___________________________ 18 Phone numbers of witnesses: 19 _________________________ ___________________________ 20 (b) A person executing the form described in (a) of this section may also 21 express or relate one or more of the following: 22 (1) A wish for how comfortable the person wants to be, including 23 one of the following that the person has not crossed out: 24 I do not want to be in pain. I want my doctor to give me 25 enough medicine to relieve my pain, even if that means that I 26 will be drowsy or sleep more than I would otherwise. 27 If I show signs of depression, nausea, shortness of breath, 28 or hallucinations, I want my caregivers to do whatever they can 29 to help me. 30 I wish to have a cool moist cloth put on my head if I have a 31 fever.
01 I want my lips and mouth kept moist to stop dryness. 02 I wish to have warm baths often. I wish to be kept fresh 03 and clean at all times. 04 I wish to be massaged with warm oils as often as I can be. 05 I wish to have my favorite music played when possible 06 until my time of death. 07 I wish to have personal care like shaving, nail clipping, hair 08 brushing, and teeth brushing as long as they do not cause me 09 pain or discomfort. 10 I wish to have religious readings and well loved poems read 11 aloud when I am near death. 12 (2) A wish for how the person wishes to be treated by others, 13 including all of the following that the person has not crossed 14 out: 15 I wish to have people with me when possible. I want 16 someone to be with me when it seems that death may come at 17 any time. 18 I wish to have my hand held and to be talked to when 19 possible, even if I don't seem to respond to the voice or touch of 20 others. 21 I wish to have others by my side praying for me when 22 possible. 23 I wish to have the members of my church or synagogue 24 told that I am sick and asked to pray for me and visit me. 25 I wish to be cared for with kindness and cheerfulness, and 26 not sadness. 27 I wish to have pictures of my loved ones in my room, near 28 my bed. 29 If I am not able to control my bowel or bladder functions, I 30 wish for my clothes and bed linens to be kept clean and for 31 them to be changed as soon as they can be if they have been
01 soiled. 02 I want to die in my home if that can be done. 03 and 04 (3) A wish for what the person wants loved ones to know, including 05 all of the following: 06 I wish to have my family members and loved ones know 07 that I love them. 08 I wish to be forgiven for the times I have hurt my family, 09 friends, and others. 10 I wish to have my family members and friends know that I 11 forgive them for what they may have done to me in my life. 12 I wish for my family members and loved ones to know that, 13 because of the faith I have, I do not fear death itself. I think it is 14 not the end, but a new beginning for me. 15 I wish for all of my family members to make peace with 16 each other before my death if they can. 17 I wish for my family and friends to think about what I was 18 like before I had a terminal illness. I want them to remember 19 me in this way after my death. 20 I wish for my family and friends to look at my dying as a 21 time of personal growth for everyone, including me. This will 22 help me live a meaningful life in my final days. 23 I wish for my family and friends to get counseling if they 24 have trouble with my death. I want memories of my life to give 25 them joy and not sorrow. 26 If anyone asks how I want to be remembered, please say the 27 following about me: 28 _________________________________________________________ 29 _________________________________________________________ 30 _________________________________________________________ 31 _________________________________________________________
01 The following person knows my funeral wishes: ______________ 02 _________________________________________________________ 03 If there is to be a memorial service for me, I wish for this service to 04 include the following (list music, songs, readings or other specific 05 requests that you have): 06 _________________________________________________________ 07 _________________________________________________________ 08 _________________________________________________________ 09 _________________________________________________________ 10 (c) In addition to the preceding, a person may set out the following further 11 instructions: 12 I want to be treated with dignity near the end of my life. To be 13 treated with dignity means that I would like people to do the things 14 written in (a) and (b) of this section when it can be done. I understand 15 that my family, my doctors, and other health care providers, my friends, 16 and others may not be able to do the things or are not required by law 17 to do the things written in this section. I do not expect my wishes in 18 this section to place new or added legal duties on my doctors or other 19 health care providers. I also do not expect the wishes expressed in (b) 20 of this section to excuse my doctor or other health care providers from 21 giving me the proper care asked for by law. 22 (d) The medical treatment form described in (a) of this section and the 23 additional expressions set out in (b) and (c) of this section may be combined with the 24 form described in AS 18.12.110. 25 Sec. 18.12.130 Euthanasia not authorized. The statutory form power of 26 attorney for health care services set out in AS 18.12.110 and the statutory form power 27 of attorney for medical treatment set out in AS 18.12.120 may not be used to authorize 28 or approve euthanasia or mercy killing. 29 * Sec. 4. AS 13.26.335(1) and 13.26.344(l) are repealed. 30 * Sec. 5. The uncodified law of the State of Alaska is amended by adding a new section to 31 read:
01 CONTINUING VALIDITY OF RESPONSIBILITY FOR HEALTH CARE 02 SERVICES UNDER FORMER STATUTORY FORM POWER OF ATTORNEY UNTIL 03 TERMINATION OR REVOCATION OF APPOINTMENT. Notwithstanding the repeal, in 04 sec. 1 of this Act, of the authority to use the statutory form power of attorney prescribed by 05 AS 13.26.332 for exercising powers relating to health care services and the repeal, in sec. 4 of 06 this Act, of AS 13.26.335(1) and 13.26.344(l), a person who, by a statutory form power of 07 attorney executed under AS 13.26.332 before the effective date of this Act, has been given 08 powers to make health care decisions under and consistent with authority set out in the 09 repealed provisions, may continue to exercise those powers under and consistent with the 10 authority set out in the repealed provisions until the appointment made by the statutory form 11 power of attorney with respect to health care services terminates or is revoked. 12 * Sec. 6. The uncodified law of the State of Alaska is amended by adding a new section to 13 read: 14 REVISOR'S INSTRUCTIONS. The revisor of statutes shall substitute "AS 18.12.010 15 - 18.12.100" for "this chapter" in 16 (1) AS 18.12.010(d); 17 (2) AS 18.12.035(d); 18 (3) AS 18.12.037; 19 (4) AS 18.12.040(b); 20 (5) AS 18.12.050(b); 21 (6) AS 18.12.060; 22 (7) AS 18.12.080(a), (d), (e), and (f); and 23 (8) AS 18.12.090.