HB 392: "An Act relating to advanced practice registered nurses; and relating to death certificates, do not resuscitate orders, and life sustaining treatment."
00 HOUSE BILL NO. 392 01 "An Act relating to advanced practice registered nurses; and relating to death 02 certificates, do not resuscitate orders, and life sustaining treatment." 03 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 04 * Section 1. AS 08.68.700(a) is amended to read: 05 (a) A registered nurse licensed under this chapter may make a determination 06 and pronouncement of death of a person under the following circumstances: 07 (1) an attending physician or an attending advanced practice 08 registered nurse has documented in the person's medical or clinical record that the 09 person's death is anticipated due to illness, infirmity, or disease; this prognosis is valid 10 for purposes of this section for not [NO] more than 120 days from the date of the 11 documentation; 12 (2) at the time of documentation under (1) of this subsection, the 13 physician or the advanced practice registered nurse authorized in writing a specific 14 registered nurse or nurses to make a determination and pronouncement of the person's
01 death; however, if the person is in a health care facility and the health care facility has 02 complied with (d) of this section, the physician or the advanced practice registered 03 nurse may authorize all nurses employed by the facility to make a determination and 04 pronouncement of the person's death. 05 * Sec. 2. AS 08.68.700(b) is amended to read: 06 (b) A registered nurse who has determined and pronounced death under this 07 section shall document the clinical criteria for the determination and pronouncement in 08 the person's medical or clinical record and notify the physician or the advanced 09 practice registered nurse who determined that the prognosis for the patient was for 10 an anticipated death. The registered nurse shall sign the death certificate, which must 11 include the 12 (1) name of the deceased; 13 (2) presence of a contagious disease, if known; and 14 (3) date and time of death. 15 * Sec. 3. AS 08.68.700(c) is amended to read: 16 (c) Except as otherwise provided under AS 18.50.230, a physician licensed 17 under AS 08.64 or an advanced practice registered nurse licensed under this 18 chapter shall certify a death determined under (b) of this section within 24 hours after 19 the pronouncement by the registered nurse. 20 * Sec. 4. AS 08.68.700(d) is amended to read: 21 (d) In a health care facility in which a physician or an advanced practice 22 registered nurse chooses to proceed under (a) of this section, written policies and 23 procedures shall be adopted that provide for the determination and pronouncement of 24 death by a registered nurse authorized by a physician or advanced practice 25 registered nurse under this section. A registered nurse employed by a health care 26 facility and authorized by a physician or advanced practice registered nurse to 27 make a determination and pronouncement of death under this section may not 28 make the [A] determination or pronouncement [OF DEATH UNDER THIS 29 SECTION] unless the facility has written policies and procedures implementing and 30 ensuring compliance with this section. 31 * Sec. 5. AS 13.52.065(a) is amended to read:
01 (a) A physician or an advanced practice registered nurse may issue a do not 02 resuscitate order for a patient of the physician or the advanced practice registered 03 nurse. The physician or the advanced practice registered nurse shall document the 04 grounds for the order in the patient's medical file. 05 * Sec. 6. AS 13.52.065(c) is amended to read: 06 (c) The department shall develop standardized designs and symbols for do not 07 resuscitate identification cards, forms, necklaces, and bracelets that signify, when 08 carried or worn, that the carrier or wearer is an individual for whom a physician or an 09 advanced practice registered nurse has issued a do not resuscitate order. 10 * Sec. 7. AS 13.52.065(d) is amended to read: 11 (d) A health care provider other than a physician or an advanced practice 12 registered nurse shall comply with the protocol adopted under (b) of this section for 13 do not resuscitate orders when the health care provider is presented with a do not 14 resuscitate identification, an oral do not resuscitate order issued directly by a physician 15 or an advanced practice registered nurse if the applicable hospital allows oral do 16 not resuscitate orders, or a written do not resuscitate order entered on and as required 17 by a form prescribed by the department. 18 * Sec. 8. AS 13.52.065(f) is amended to read: 19 (f) A do not resuscitate order may not be made ineffective unless a physician 20 or an advanced practice registered nurse revokes the do not resuscitate order, a 21 patient for whom the order is written and who has capacity requests that the do not 22 resuscitate order be revoked, or the patient for whom the order is written is under 18 23 years of age and the parent or guardian of the patient requests that the do not 24 resuscitate order be revoked. Any physician or advanced practice registered nurse 25 of a patient for whom a do not resuscitate order is written may revoke the do not 26 resuscitate order if the person for whom the order is written requests that the physician 27 or the advanced practice registered nurse revoke the do not resuscitate order. 28 * Sec. 9. AS 13.52.080(a) is amended to read: 29 (a) A health care provider or health care institution that acts in good faith and 30 in accordance with generally accepted health care standards applicable to the health 31 care provider or institution is not subject to civil or criminal liability or to discipline
01 for unprofessional conduct for 02 (1) providing health care information in good faith under 03 AS 13.52.070; 04 (2) complying with a health care decision of a person based on a good 05 faith belief that the person has authority to make a health care decision for a patient, 06 including a decision to withhold or withdraw health care; 07 (3) declining to comply with a health care decision of a person based 08 on a good faith belief that the person then lacked authority; 09 (4) complying with an advance health care directive and assuming in 10 good faith that the directive was valid when made and has not been revoked or 11 terminated; 12 (5) participating in the withholding or withdrawal of cardiopulmonary 13 resuscitation under the direction or with the authorization of a physician or an 14 advanced practice registered nurse or upon discovery of do not resuscitate 15 identification upon an individual; 16 (6) causing or participating in providing cardiopulmonary resuscitation 17 or other life-sustaining procedures 18 (A) under AS 13.52.065(e) when an individual has made an 19 anatomical gift; 20 (B) because an individual has made a do not resuscitate order 21 ineffective under AS 13.52.065(f) or another provision of this chapter; or 22 (C) because the patient is a woman of childbearing age and 23 AS 13.52.055 applies; or 24 (7) acting in good faith under the terms of this chapter or the law of 25 another state relating to anatomical gifts. 26 * Sec. 10. AS 13.52.100(c) is amended to read: 27 (c) An individual who is a qualified patient, including an individual for whom 28 a physician or an advanced practice registered nurse has issued a do not resuscitate 29 order, has the right to make a decision regarding the use of cardiopulmonary 30 resuscitation and other life-sustaining procedures as long as the individual is able to 31 make the decision. If an individual who is a qualified patient, including an individual
01 for whom a physician or advanced practice registered nurse has issued a do not 02 resuscitate order, is not able to make the decision, the protocol adopted under 03 AS 13.52.065 for do not resuscitate orders governs a decision regarding the use of 04 cardiopulmonary resuscitation and other life-sustaining procedures. 05 * Sec. 11. AS 13.52.300 is amended to read: 06 Sec. 13.52.300. Optional form. The following sample form may be used to 07 create an advance health care directive. The other sections of this chapter govern the 08 effect of this or any other writing used to create an advance health care directive. This 09 form may be duplicated. This form may be modified to suit the needs of the person, or 10 a different form that complies with this chapter may be used, including the mandatory 11 witnessing requirements: 12 ADVANCE HEALTH CARE DIRECTIVE 13 Explanation 14 You have the right to give instructions about your own health 15 care to the extent allowed by law. You also have the right to name 16 someone else to make health care decisions for you to the extent 17 allowed by law. This form lets you do either or both of these things. It 18 also lets you express your wishes regarding the designation of your 19 health care provider. If you use this form, you may complete or modify 20 all or any part of it. You are free to use a different form if the form 21 complies with the requirements of AS 13.52. 22 Part 1 of this form is a durable power of attorney for health 23 care. A "durable power of attorney for health care" means the 24 designation of an agent to make health care decisions for you. Part 1 25 lets you name another individual as an agent to make health care 26 decisions for you if you do not have the capacity to make your own 27 decisions or if you want someone else to make those decisions for you 28 now even though you still have the capacity to make those decisions. 29 You may name an alternate agent to act for you if your first choice is 30 not willing, able, or reasonably available to make decisions for you. 31 Unless related to you, your agent may not be an owner, operator, or
01 employee of a health care institution where you are receiving care. 02 Unless the form you sign limits the authority of your agent, 03 your agent may make all health care decisions for you that you could 04 legally make for yourself. This form has a place for you to limit the 05 authority of your agent. You do not have to limit the authority of your 06 agent if you wish to rely on your agent for all health care decisions that 07 may have to be made. If you choose not to limit the authority of your 08 agent, your agent will have the right, to the extent allowed by law, to 09 (a) consent or refuse consent to any care, treatment, service, or 10 procedure to maintain, diagnose, or otherwise affect a physical or 11 mental condition, including the administration or discontinuation of 12 psychotropic medication; 13 (b) select or discharge health care providers and institutions; 14 (c) approve or disapprove proposed diagnostic tests, surgical 15 procedures, and programs of medication; 16 (d) direct the provision, withholding, or withdrawal of artificial 17 nutrition and hydration and all other forms of health care; and 18 (e) make an anatomical gift following your death. 19 Part 2 of this form lets you give specific instructions for any 20 aspect of your health care to the extent allowed by law, except you may 21 not authorize mercy killing, assisted suicide, or euthanasia. Choices are 22 provided for you to express your wishes regarding the provision, 23 withholding, or withdrawal of treatment to keep you alive, including 24 the provision of artificial nutrition and hydration, as well as the 25 provision of pain relief medication. Space is provided for you to add to 26 the choices you have made or for you to write out any additional 27 wishes. 28 Part 3 of this form lets you express an intention to make an 29 anatomical gift following your death. 30 Part 4 of this form lets you make decisions in advance about 31 certain types of mental health treatment.
01 Part 5 of this form lets you designate a physician to have 02 primary responsibility for your health care. 03 After completing this form, sign and date the form at the end 04 and have the form witnessed by one of the two alternative methods 05 listed below. Give a copy of the signed and completed form to your 06 physician, to any other health care providers you may have, to any 07 health care institution at which you are receiving care, and to any health 08 care agents you have named. You should talk to the person you have 09 named as your agent to make sure that the person understands your 10 wishes and is willing to take the responsibility. 11 You have the right to revoke this advance health care directive 12 or replace this form at any time, except that you may not revoke this 13 declaration when you are determined not to be competent by a court, by 14 two physicians, at least one of whom shall be a psychiatrist, or by both 15 a physician and a professional mental health clinician. In this advance 16 health care directive, "competent" means that you have the capacity 17 (1) to assimilate relevant facts and to appreciate and 18 understand your situation with regard to those facts; and 19 (2) to participate in treatment decisions by means of a 20 rational thought process. 21 PART 1 22 DURABLE POWER OF ATTORNEY FOR 23 HEALTH CARE DECISIONS 24 (1) DESIGNATION OF AGENT. I designate the 25 following individual as my agent to make health care decisions for me: 26 _________________________________________________________ 27 (name of individual you choose as agent) 28 _________________________________________________________ 29 (address) (city) (state) (zip code) 30 _________________________________________________________ 31 (home telephone) (work telephone)
01 OPTIONAL: If I revoke my agent's authority or if my agent is 02 not willing, able, or reasonably available to make a health care decision 03 for me, I designate as my first alternate agent 04 _________________________________________________________ 05 (name of individual you choose as first alternate agent) 06 _________________________________________________________ 07 (address) (city) (state) (zip code) 08 _________________________________________________________ 09 (home telephone) (work telephone) 10 OPTIONAL: If I revoke the authority of my agent and first 11 alternate agent or if neither is willing, able, or reasonably available to 12 make a health care decision for me, I designate as my second alternate 13 agent 14 _________________________________________________________ 15 (name of individual you choose as second alternate agent) 16 _________________________________________________________ 17 (address) (city) (state) (zip code) 18 _________________________________________________________ 19 (home telephone) (work telephone) 20 (2) AGENT'S AUTHORITY. My agent is authorized 21 and directed to follow my individual instructions and my other wishes 22 to the extent known to the agent in making all health care decisions for 23 me. If these are not known, my agent is authorized to make these 24 decisions in accordance with my best interest, including decisions to 25 provide, withhold, or withdraw artificial hydration and nutrition and 26 other forms of health care to keep me alive, except as I state here: 27 _________________________________________________________ 28 _________________________________________________________ 29 _________________________________________________________ 30 (Add additional sheets if needed.) 31 Under this authority, "best interest" means that the benefits to you
01 resulting from a treatment outweigh the burdens to you resulting from 02 that treatment after assessing 03 (A) the effect of the treatment on your physical, 04 emotional, and cognitive functions; 05 (B) the degree of physical pain or discomfort 06 caused to you by the treatment or the withholding or withdrawal 07 of the treatment; 08 (C) the degree to which your medical condition, 09 the treatment, or the withholding or withdrawal of treatment, 10 results in a severe and continuing impairment; 11 (D) the effect of the treatment on your life 12 expectancy; 13 (E) your prognosis for recovery, with and 14 without the treatment; 15 (F) the risks, side effects, and benefits of the 16 treatment or the withholding of treatment; and 17 (G) your religious beliefs and basic values, to 18 the extent that these may assist in determining benefits and 19 burdens. 20 (3) WHEN AGENT'S AUTHORITY BECOMES 21 EFFECTIVE. Except in the case of mental illness, my agent's authority 22 becomes effective when my primary physician determines that I am 23 unable to make my own health care decisions unless I mark the 24 following box. In the case of mental illness, unless I mark the 25 following box, my agent's authority becomes effective when a court 26 determines I am unable to make my own decisions, or, in an 27 emergency, if my primary physician or another health care provider 28 determines I am unable to make my own decisions. If I mark this box [ 29 ], my agent's authority to make health care decisions for me takes effect 30 immediately. 31 (4) AGENT'S OBLIGATION. My agent shall make
01 health care decisions for me in accordance with this durable power of 02 attorney for health care, any instructions I give in Part 2 of this form, 03 and my other wishes to the extent known to my agent. To the extent 04 my wishes are unknown, my agent shall make health care decisions for 05 me in accordance with what my agent determines to be in my best 06 interest. In determining my best interest, my agent shall consider my 07 personal values to the extent known to my agent. 08 (5) NOMINATION OF GUARDIAN. If a guardian of 09 my person needs to be appointed for me by a court, I nominate the 10 agent designated in this form. If that agent is not willing, able, or 11 reasonably available to act as guardian, I nominate the alternate agents 12 whom I have named under (1) above, in the order designated. 13 PART 2 14 INSTRUCTIONS FOR HEALTH CARE 15 If you are satisfied to allow your agent to determine what is best 16 for you in making health care decisions, you do not need to fill out this 17 part of the form. If you do fill out this part of the form, you may strike 18 any wording you do not want. There is a state protocol that governs the 19 use of do not resuscitate orders by physicians, advanced practice 20 registered nurses, and other health care providers. You may obtain a 21 copy of the protocol from the Alaska Department of Health and Social 22 Services. A "do not resuscitate order" means a directive from a 23 licensed physician or advanced practice registered nurse that 24 emergency cardiopulmonary resuscitation should not be administered 25 to you. 26 (6) END-OF-LIFE DECISIONS. Except to the extent 27 prohibited by law, I direct that my health care providers and others 28 involved in my care provide, withhold, or withdraw treatment in 29 accordance with the choice I have marked below: (Check only one 30 box.) 31 [ ] (A) Choice To Prolong Life
01 I want my life to be prolonged as long as 02 possible within the limits of generally accepted health care 03 standards; OR 04 [ ] (B) Choice Not To Prolong Life 05 I want comfort care only and I do not want my 06 life to be prolonged with medical treatment if, in the judgment 07 of my physician, I have (check all choices that represent your 08 wishes) 09 [ ] (i) a condition of permanent 10 unconsciousness: a condition that, to a high degree of 11 medical certainty, will last permanently without 12 improvement; in which, to a high degree of medical 13 certainty, thought, sensation, purposeful action, social 14 interaction, and awareness of myself and the 15 environment are absent; and for which, to a high degree 16 of medical certainty, initiating or continuing life- 17 sustaining procedures for me, in light of my medical 18 outcome, will provide only minimal medical benefit for 19 me; or 20 [ ] (ii) a terminal condition: an 21 incurable or irreversible illness or injury that without the 22 administration of life-sustaining procedures will result in 23 my death in a short period of time, for which there is no 24 reasonable prospect of cure or recovery, that imposes 25 severe pain or otherwise imposes an inhumane burden 26 on me, and for which, in light of my medical condition, 27 initiating or continuing life-sustaining procedures will 28 provide only minimal medical benefit; 29 [ ] Additional instructions: ________________ 30 ___________________________________________________ 31 (C) Artificial Nutrition and Hydration. If I am
01 unable to safely take nutrition, fluids, or nutrition and fluids 02 (check your choices or write your instructions), 03 [ ] I wish to receive artificial nutrition and 04 hydration indefinitely; 05 [ ] I wish to receive artificial nutrition and 06 hydration indefinitely, unless it clearly increases my suffering 07 and is no longer in my best interest; 08 [ ] I wish to receive artificial nutrition and 09 hydration on a limited trial basis to see if I can improve; 10 [ ] In accordance with my choices in (6)(B) 11 above, I do not wish to receive artificial nutrition and hydration. 12 [ ] Other instructions:_____________________ 13 ___________________________________________________ 14 (D) Relief from Pain. 15 [ ] I direct that adequate treatment be 16 provided at all times for the sole purpose of the 17 alleviation of pain or discomfort; or 18 [ ] I give these instructions: 19 _____________________________________________ 20 _____________________________________________ 21 (E) Should I become unconscious and I 22 am pregnant, I direct that ________________________ 23 _____________________________________________ 24 _____________________________________________ 25 (7) OTHER WISHES. (If you do not agree with any of 26 the optional choices above and wish to write your own, or if you wish 27 to add to the instructions you have given above, you may do so here.) I 28 direct that 29 _________________________________________________________ 30 _________________________________________________________ 31 Conditions or limitations: ______________________________
01 _________________________________________________________. 02 (Add additional sheets if needed.) 03 PART 3 04 ANATOMICAL GIFT AT DEATH 05 (OPTIONAL) 06 If you are satisfied to allow your agent to determine whether to 07 make an anatomical gift at your death, you do not need to fill out this 08 part of the form. 09 (8) Upon my death: (mark applicable box) 10 [ ] (A) I give any needed organs, tissues, or 11 other body parts, OR 12 [ ] (B) I give the following organs, tissues, or 13 other body parts only ________________________________ 14 __________________________________________________ 15 [ ] (C) My gift is for the following purposes 16 (mark any of the following you want): 17 [ ] (i) transplant; 18 [ ] (ii) therapy; 19 [ ] (iii) research; 20 [ ] (iv) education. 21 [ ] (D) I refuse to make an anatomical gift. 22 PART 4 23 MENTAL HEALTH TREATMENT 24 This part of the declaration allows you to make decisions in 25 advance about mental health treatment. The instructions that you 26 include in this declaration will be followed only if a court, two 27 physicians that include a psychiatrist, or a physician and a professional 28 mental health clinician believe that you are not competent and cannot 29 make treatment decisions. Otherwise, you will be considered to be 30 competent and to have the capacity to give or withhold consent for the 31 treatments.
01 If you are satisfied to allow your agent to determine what is best 02 for you in making these mental health decisions, you do not need to fill 03 out this part of the form. If you do fill out this part of the form, you 04 may strike any wording you do not want. 05 (9) PSYCHOTROPIC MEDICATIONS. If I do not 06 have the capacity to give or withhold informed consent for mental 07 health treatment, my wishes regarding psychotropic medications are as 08 follows: 09 ________ I consent to the administration of the following 10 medications: ______________________________________________ 11 ________ I do not consent to the administration of the 12 following medications: ______________________________________ 13 Conditions or limitations:_______________________________ 14 _________________________________________________________. 15 (10) ELECTROCONVULSIVE TREATMENT. If I do 16 not have the capacity to give or withhold informed consent for mental 17 health treatment, my wishes regarding electroconvulsive treatment are 18 as follows: 19 ________ I consent to the administration of electroconvulsive 20 treatment. 21 ________ I do not consent to the administration of 22 electroconvulsive treatment. 23 Conditions or limitations: ______________________________ 24 _________________________________________________________. 25 (11) ADMISSION TO AND RETENTION IN 26 FACILITY. If I do not have the capacity to give or withhold informed 27 consent for mental health treatment, my wishes regarding admission to 28 and retention in a mental health facility for mental health treatment are 29 as follows: 30 ________ I consent to being admitted to a mental health facility 31 for mental health treatment for up to ________ days. (The number of
01 days not to exceed 17.) 02 ________ I do not consent to being admitted to a mental health 03 facility for mental health treatment. 04 Conditions or limitations: ______________________________ 05 _________________________________________________________. 06 OTHER WISHES OR INSTRUCTIONS 07 _________________________________________________________ 08 _________________________________________________________ 09 _________________________________________________________ 10 Conditions or limitations: ______________________________ 11 _________________________________________________________. 12 PART 5 13 PRIMARY PHYSICIAN 14 (OPTIONAL) 15 (12) I designate the following physician as my primary 16 physician: 17 _________________________________________________________ 18 (name of physician) 19 _________________________________________________________ 20 (address) (city) (state) (zip code) 21 _________________________________________________________ 22 (telephone) 23 OPTIONAL: If the physician I have designated above is 24 not willing, able, or reasonably available to act as my primary 25 physician, I designate the following physician as my primary physician: 26 _________________________________________________________ 27 (name of physician) 28 _________________________________________________________ 29 (address) (city) (state) (zip code) 30 _________________________________________________________ 31 (telephone)
01 (13) EFFECT OF COPY. A copy of this form has the 02 same effect as the original. 03 (14) SIGNATURES. Sign and date the form here: 04 _________________________________________________________ 05 (date) (sign your name) 06 _________________________________________________________ 07 (print your name) 08 _________________________________________________________ 09 (address) (city) (state) (zip code) 10 (15) WITNESSES. This advance care health directive 11 will not be valid for making health care decisions unless it is 12 (A) signed by two qualified adult witnesses who 13 are personally known to you and who are present when you sign 14 or acknowledge your signature; the witnesses may not be a 15 health care provider employed at the health care institution or 16 health care facility where you are receiving health care, an 17 employee of the health care provider who is providing health 18 care to you, an employee of the health care institution or health 19 care facility where you are receiving health care, or the person 20 appointed as your agent by this document; at least one of the 21 two witnesses may not be related to you by blood, marriage, or 22 adoption or entitled to a portion of your estate upon your death 23 under your will or codicil; or 24 (B) acknowledged before a notary public in the 25 state. 26 ALTERNATIVE NO. 1 27 Witness Who is Not Related to or a Devisee of the Principal 28 I swear under penalty of perjury under AS 11.56.200 29 that the principal is personally known to me, that the principal signed or 30 acknowledged this durable power of attorney for health care in my 31 presence, that the principal appears to be of sound mind and under no
01 duress, fraud, or undue influence, and that I am not 02 (1) a health care provider employed at the health care 03 institution or health care facility where the principal is receiving health 04 care; 05 (2) an employee of the health care provider providing 06 health care to the principal; 07 (3) an employee of the health care institution or health 08 care facility where the principal is receiving health care; 09 (4) the person appointed as agent by this document; 10 (5) related to the principal by blood, marriage, or 11 adoption; or 12 (6) entitled to a portion of the principal's estate upon the 13 principal's death under a will or codicil. 14 ________________________________________________________ 15 (date) (signature of witness) 16 ________________________________________________________ 17 (printed name of witness) 18 ________________________________________________________ 19 (address) (city) (state) (zip code) 20 Witness Who May be Related to or a Devisee of the Principal 21 I swear under penalty of perjury under AS 11.56.200 22 that the principal is personally known to me, that the principal signed or 23 acknowledged this durable power of attorney for health care in my 24 presence, that the principal appears to be of sound mind and under no 25 duress, fraud, or undue influence, and that I am not 26 (1) a health care provider employed at the health care 27 institution or health care facility where the principal is receiving health 28 care; 29 (2) an employee of the health care provider who is 30 providing health care to the principal; 31 (3) an employee of the health care institution or health
01 care facility where the principal is receiving health care; or 02 (4) the person appointed as agent by this document. 03 _______________________________________________________ 04 (date) (signature of witness) 05 _______________________________________________________ 06 (printed name of witness) 07 _______________________________________________________ 08 (address) (city) (state) (zip code) 09 ALTERNATIVE NO. 2 10 State of Alaska 11 ________________ Judicial District 12 On this ____ day of ___________________, in the year 13 ______________, before me, _______________________________ 14 (insert name of notary public) appeared 15 _______________________________, personally known to me (or 16 proved to me on the basis of satisfactory evidence) to be the person 17 whose name is subscribed to this instrument, and acknowledged that 18 the person executed it. 19 Notary Seal 20 ___________________________ 21 (signature of notary public) 22 * Sec. 12. AS 13.52.390(12) is amended to read: 23 (12) "do not resuscitate order" means a directive from a licensed 24 physician or advanced practice registered nurse that emergency cardiopulmonary 25 resuscitation should not be administered to a qualified patient; 26 * Sec. 13. AS 13.52.390(23) is amended to read: 27 (23) "life-sustaining procedures" means any medical treatment, 28 procedure, or intervention that, in the judgment of the primary physician or advanced 29 practice registered nurse, when applied to a patient with a qualifying condition, 30 would not be effective to remove the qualifying condition, would serve only to 31 prolong the dying process, or, when administered to a patient with a condition of
01 permanent unconsciousness, may keep the patient alive but is not expected to restore 02 consciousness; in this paragraph, "medical treatment, procedure, or intervention" 03 includes assisted ventilation, renal dialysis, surgical procedures, blood transfusions, 04 and the administration of drugs, including antibiotics, or artificial nutrition and 05 hydration; 06 * Sec. 14. AS 13.52.390 is amended by adding a new paragraph to read: 07 (38) "advanced practice registered nurse" has the meaning given in 08 AS 08.68.850. 09 * Sec. 15. AS 18.50.230(c) is amended to read: 10 (c) The medical certification shall be completed and signed within 24 hours 11 after death by the physician or the advanced practice registered nurse in charge of 12 the patient's care for the illness or condition that resulted in death except when an 13 official inquiry or inquest is required and except as provided by regulation in special 14 problem cases.