CSHB 392(HSS): "An Act relating to advanced practice registered nurses and physician assistants; and relating to death certificates, do not resuscitate orders, and life sustaining treatment."
00 CS FOR HOUSE BILL NO. 392(HSS) 01 "An Act relating to advanced practice registered nurses and physician assistants; and 02 relating to death 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, an attending advanced practice 08 registered nurse, or an attending physician assistant has documented in the 09 person's medical or clinical record that the person's death is anticipated due to illness, 10 infirmity, or disease; this prognosis is valid for purposes of this section for not [NO] 11 more than 120 days from the date of the documentation; 12 (2) at the time of documentation under (1) of this subsection, the 13 physician, the advanced practice registered nurse, or the physician assistant 14 authorized in writing a specific registered nurse or nurses to make a determination and
01 pronouncement of the person's death; however, if the person is in a health care facility 02 and the health care facility has complied with (d) of this section, the physician, the 03 advanced practice registered nurse, or the physician assistant may authorize all 04 nurses employed by the facility to make a determination and pronouncement of the 05 person's death. 06 * Sec. 2. AS 08.68.700(b) is amended to read: 07 (b) A registered nurse who has determined and pronounced death under this 08 section shall document the clinical criteria for the determination and pronouncement in 09 the person's medical or clinical record and notify the physician, the advanced 10 practice registered nurse, or the physician assistant who determined that the 11 prognosis for the patient was for an anticipated death. The registered nurse shall sign 12 the death certificate, which must include the 13 (1) name of the deceased; 14 (2) presence of a contagious disease, if known; and 15 (3) date and time of death. 16 * Sec. 3. AS 08.68.700(c) is amended to read: 17 (c) Except as otherwise provided under AS 18.50.230, a physician or 18 physician assistant licensed under AS 08.64 or an advanced practice registered 19 nurse licensed under this chapter shall certify a death determined under (b) of this 20 section within 24 hours after the pronouncement by the registered nurse. 21 * Sec. 4. AS 08.68.700(d) is amended to read: 22 (d) In a health care facility in which a physician, an advanced practice 23 registered nurse, or a physician assistant chooses to proceed under (a) of this 24 section, written policies and procedures shall be adopted that provide for the 25 determination and pronouncement of death by a registered nurse authorized by a 26 physician, an advanced practice registered nurse, or a physician assistant under 27 this section. A registered nurse employed by a health care facility and authorized by 28 a physician, an advanced practice registered nurse, or a physician assistant to 29 make a determination and pronouncement of death under this section may not 30 make the [A] determination or pronouncement [OF DEATH UNDER THIS 31 SECTION] unless the facility has written policies and procedures implementing and
01 ensuring compliance with this section. 02 * Sec. 5. AS 13.52.065(a) is amended to read: 03 (a) A physician, an advanced practice registered nurse, or a physician 04 assistant may issue a do not resuscitate order for a patient of the physician, the 05 advanced practice registered nurse, or the physician assistant. The physician, the 06 advanced practice registered nurse, or the physician assistant shall document the 07 grounds for the order in the patient's medical file. 08 * Sec. 6. AS 13.52.065(c) is amended to read: 09 (c) The department shall develop standardized designs and symbols for do not 10 resuscitate identification cards, forms, necklaces, and bracelets that signify, when 11 carried or worn, that the carrier or wearer is an individual for whom a physician, an 12 advanced practice registered nurse, or a physician assistant has issued a do not 13 resuscitate order. 14 * Sec. 7. AS 13.52.065(d) is amended to read: 15 (d) A health care provider other than a physician, an advanced practice 16 registered nurse, or a physician assistant shall comply with the protocol adopted 17 under (b) of this section for do not resuscitate orders when the health care provider is 18 presented with a do not resuscitate identification, an oral do not resuscitate order 19 issued directly by a physician, an advanced practice registered nurse, or a 20 physician assistant if the applicable hospital allows oral do not resuscitate orders, or a 21 written do not resuscitate order entered on and as required by a form prescribed by the 22 department. 23 * Sec. 8. AS 13.52.065(f) is amended to read: 24 (f) A do not resuscitate order may not be made ineffective unless a physician, 25 an advanced practice registered nurse, or a physician assistant revokes the do not 26 resuscitate order, a patient for whom the order is written and who has capacity 27 requests that the do not resuscitate order be revoked, or the patient for whom the order 28 is written is under 18 years of age and the parent or guardian of the patient requests 29 that the do not resuscitate order be revoked. Any physician, advanced practice 30 registered nurse, or physician assistant of a patient for whom a do not resuscitate 31 order is written may revoke the do not resuscitate order if the person for whom the
01 order is written requests that the physician, the advanced practice registered nurse, 02 or the physician assistant revoke the do not resuscitate order. 03 * Sec. 9. AS 13.52.080(a) is amended to read: 04 (a) A health care provider or health care institution that acts in good faith and 05 in accordance with generally accepted health care standards applicable to the health 06 care provider or institution is not subject to civil or criminal liability or to discipline 07 for unprofessional conduct for 08 (1) providing health care information in good faith under 09 AS 13.52.070; 10 (2) complying with a health care decision of a person based on a good 11 faith belief that the person has authority to make a health care decision for a patient, 12 including a decision to withhold or withdraw health care; 13 (3) declining to comply with a health care decision of a person based 14 on a good faith belief that the person then lacked authority; 15 (4) complying with an advance health care directive and assuming in 16 good faith that the directive was valid when made and has not been revoked or 17 terminated; 18 (5) participating in the withholding or withdrawal of cardiopulmonary 19 resuscitation under the direction or with the authorization of a physician, an advanced 20 practice registered nurse, or a physician assistant or upon discovery of do not 21 resuscitate identification upon an individual; 22 (6) causing or participating in providing cardiopulmonary resuscitation 23 or other life-sustaining procedures 24 (A) under AS 13.52.065(e) when an individual has made an 25 anatomical gift; 26 (B) because an individual has made a do not resuscitate order 27 ineffective under AS 13.52.065(f) or another provision of this chapter; or 28 (C) because the patient is a woman of childbearing age and 29 AS 13.52.055 applies; or 30 (7) acting in good faith under the terms of this chapter or the law of 31 another state relating to anatomical gifts.
01 * Sec. 10. AS 13.52.100(c) is amended to read: 02 (c) An individual who is a qualified patient, including an individual for whom 03 a physician, an advanced practice registered nurse, or a physician assistant has 04 issued a do not resuscitate order, has the right to make a decision regarding the use of 05 cardiopulmonary resuscitation and other life-sustaining procedures as long as the 06 individual is able to make the decision. If an individual who is a qualified patient, 07 including an individual for whom a physician, advanced practice registered nurse, 08 or physician assistant has issued a do not resuscitate order, is not able to make the 09 decision, the protocol adopted under AS 13.52.065 for do not resuscitate orders 10 governs a decision regarding the use of cardiopulmonary resuscitation and other life- 11 sustaining procedures. 12 * Sec. 11. AS 13.52.300 is amended to read: 13 Sec. 13.52.300. Optional form. The following sample form may be used to 14 create an advance health care directive. The other sections of this chapter govern the 15 effect of this or any other writing used to create an advance health care directive. This 16 form may be duplicated. This form may be modified to suit the needs of the person, or 17 a different form that complies with this chapter may be used, including the mandatory 18 witnessing requirements: 19 ADVANCE HEALTH CARE DIRECTIVE 20 Explanation 21 You have the right to give instructions about your own health 22 care to the extent allowed by law. You also have the right to name 23 someone else to make health care decisions for you to the extent 24 allowed by law. This form lets you do either or both of these things. It 25 also lets you express your wishes regarding the designation of your 26 health care provider. If you use this form, you may complete or modify 27 all or any part of it. You are free to use a different form if the form 28 complies with the requirements of AS 13.52. 29 Part 1 of this form is a durable power of attorney for health 30 care. A "durable power of attorney for health care" means the 31 designation of an agent to make health care decisions for you. Part 1
01 lets you name another individual as an agent to make health care 02 decisions for you if you do not have the capacity to make your own 03 decisions or if you want someone else to make those decisions for you 04 now even though you still have the capacity to make those decisions. 05 You may name an alternate agent to act for you if your first choice is 06 not willing, able, or reasonably available to make decisions for you. 07 Unless related to you, your agent may not be an owner, operator, or 08 employee of a health care institution where you are receiving care. 09 Unless the form you sign limits the authority of your agent, 10 your agent may make all health care decisions for you that you could 11 legally make for yourself. This form has a place for you to limit the 12 authority of your agent. You do not have to limit the authority of your 13 agent if you wish to rely on your agent for all health care decisions that 14 may have to be made. If you choose not to limit the authority of your 15 agent, your agent will have the right, to the extent allowed by law, to 16 (a) consent or refuse consent to any care, treatment, service, or 17 procedure to maintain, diagnose, or otherwise affect a physical or 18 mental condition, including the administration or discontinuation of 19 psychotropic medication; 20 (b) select or discharge health care providers and institutions; 21 (c) approve or disapprove proposed diagnostic tests, surgical 22 procedures, and programs of medication; 23 (d) direct the provision, withholding, or withdrawal of artificial 24 nutrition and hydration and all other forms of health care; and 25 (e) make an anatomical gift following your death. 26 Part 2 of this form lets you give specific instructions for any 27 aspect of your health care to the extent allowed by law, except you may 28 not authorize mercy killing, assisted suicide, or euthanasia. Choices are 29 provided for you to express your wishes regarding the provision, 30 withholding, or withdrawal of treatment to keep you alive, including 31 the provision of artificial nutrition and hydration, as well as the
01 provision of pain relief medication. Space is provided for you to add to 02 the choices you have made or for you to write out any additional 03 wishes. 04 Part 3 of this form lets you express an intention to make an 05 anatomical gift following your death. 06 Part 4 of this form lets you make decisions in advance about 07 certain types of mental health treatment. 08 Part 5 of this form lets you designate a physician to have 09 primary responsibility for your health care. 10 After completing this form, sign and date the form at the end 11 and have the form witnessed by one of the two alternative methods 12 listed below. Give a copy of the signed and completed form to your 13 physician, to any other health care providers you may have, to any 14 health care institution at which you are receiving care, and to any health 15 care agents you have named. You should talk to the person you have 16 named as your agent to make sure that the person understands your 17 wishes and is willing to take the responsibility. 18 You have the right to revoke this advance health care directive 19 or replace this form at any time, except that you may not revoke this 20 declaration when you are determined not to be competent by a court, by 21 two physicians, at least one of whom shall be a psychiatrist, or by both 22 a physician and a professional mental health clinician. In this advance 23 health care directive, "competent" means that you have the capacity 24 (1) to assimilate relevant facts and to appreciate and 25 understand your situation with regard to those facts; and 26 (2) to participate in treatment decisions by means of a 27 rational thought process. 28 PART 1 29 DURABLE POWER OF ATTORNEY FOR 30 HEALTH CARE DECISIONS 31 (1) DESIGNATION OF AGENT. I designate the
01 following individual as my agent to make health care decisions for me: 02 _________________________________________________________ 03 (name of individual you choose as agent) 04 _________________________________________________________ 05 (address) (city) (state) (zip code) 06 _________________________________________________________ 07 (home telephone) (work telephone) 08 OPTIONAL: If I revoke my agent's authority or if my agent is 09 not willing, able, or reasonably available to make a health care decision 10 for me, I designate as my first alternate agent 11 _________________________________________________________ 12 (name of individual you choose as first alternate agent) 13 _________________________________________________________ 14 (address) (city) (state) (zip code) 15 _________________________________________________________ 16 (home telephone) (work telephone) 17 OPTIONAL: If I revoke the authority of my agent and first 18 alternate agent or if neither is willing, able, or reasonably available to 19 make a health care decision for me, I designate as my second alternate 20 agent 21 _________________________________________________________ 22 (name of individual you choose as second alternate agent) 23 _________________________________________________________ 24 (address) (city) (state) (zip code) 25 _________________________________________________________ 26 (home telephone) (work telephone) 27 (2) AGENT'S AUTHORITY. My agent is authorized 28 and directed to follow my individual instructions and my other wishes 29 to the extent known to the agent in making all health care decisions for 30 me. If these are not known, my agent is authorized to make these 31 decisions in accordance with my best interest, including decisions to
01 provide, withhold, or withdraw artificial hydration and nutrition and 02 other forms of health care to keep me alive, except as I state here: 03 _________________________________________________________ 04 _________________________________________________________ 05 _________________________________________________________ 06 (Add additional sheets if needed.) 07 Under this authority, "best interest" means that the benefits to you 08 resulting from a treatment outweigh the burdens to you resulting from 09 that treatment after assessing 10 (A) the effect of the treatment on your physical, 11 emotional, and cognitive functions; 12 (B) the degree of physical pain or discomfort 13 caused to you by the treatment or the withholding or withdrawal 14 of the treatment; 15 (C) the degree to which your medical condition, 16 the treatment, or the withholding or withdrawal of treatment, 17 results in a severe and continuing impairment; 18 (D) the effect of the treatment on your life 19 expectancy; 20 (E) your prognosis for recovery, with and 21 without the treatment; 22 (F) the risks, side effects, and benefits of the 23 treatment or the withholding of treatment; and 24 (G) your religious beliefs and basic values, to 25 the extent that these may assist in determining benefits and 26 burdens. 27 (3) WHEN AGENT'S AUTHORITY BECOMES 28 EFFECTIVE. Except in the case of mental illness, my agent's authority 29 becomes effective when my primary physician determines that I am 30 unable to make my own health care decisions unless I mark the 31 following box. In the case of mental illness, unless I mark the
01 following box, my agent's authority becomes effective when a court 02 determines I am unable to make my own decisions, or, in an 03 emergency, if my primary physician or another health care provider 04 determines I am unable to make my own decisions. If I mark this box [ 05 ], my agent's authority to make health care decisions for me takes effect 06 immediately. 07 (4) AGENT'S OBLIGATION. My agent shall make 08 health care decisions for me in accordance with this durable power of 09 attorney for health care, any instructions I give in Part 2 of this form, 10 and my other wishes to the extent known to my agent. To the extent 11 my wishes are unknown, my agent shall make health care decisions for 12 me in accordance with what my agent determines to be in my best 13 interest. In determining my best interest, my agent shall consider my 14 personal values to the extent known to my agent. 15 (5) NOMINATION OF GUARDIAN. If a guardian of 16 my person needs to be appointed for me by a court, I nominate the 17 agent designated in this form. If that agent is not willing, able, or 18 reasonably available to act as guardian, I nominate the alternate agents 19 whom I have named under (1) above, in the order designated. 20 PART 2 21 INSTRUCTIONS FOR HEALTH CARE 22 If you are satisfied to allow your agent to determine what is best 23 for you in making health care decisions, you do not need to fill out this 24 part of the form. If you do fill out this part of the form, you may strike 25 any wording you do not want. There is a state protocol that governs the 26 use of do not resuscitate orders by physicians, advanced practice 27 registered nurses, physician assistants, and other health care 28 providers. You may obtain a copy of the protocol from the Alaska 29 Department of Health and Social Services. A "do not resuscitate order" 30 means a directive from a licensed physician, advanced practice 31 registered nurse, or physician assistant that emergency
01 cardiopulmonary resuscitation should not be administered to you. 02 (6) END-OF-LIFE DECISIONS. Except to the extent 03 prohibited by law, I direct that my health care providers and others 04 involved in my care provide, withhold, or withdraw treatment in 05 accordance with the choice I have marked below: (Check only one 06 box.) 07 [ ] (A) Choice To Prolong Life 08 I want my life to be prolonged as long as 09 possible within the limits of generally accepted health care 10 standards; OR 11 [ ] (B) Choice Not To Prolong Life 12 I want comfort care only and I do not want my 13 life to be prolonged with medical treatment if, in the judgment 14 of my physician, I have (check all choices that represent your 15 wishes) 16 [ ] (i) a condition of permanent 17 unconsciousness: a condition that, to a high degree of 18 medical certainty, will last permanently without 19 improvement; in which, to a high degree of medical 20 certainty, thought, sensation, purposeful action, social 21 interaction, and awareness of myself and the 22 environment are absent; and for which, to a high degree 23 of medical certainty, initiating or continuing life- 24 sustaining procedures for me, in light of my medical 25 outcome, will provide only minimal medical benefit for 26 me; or 27 [ ] (ii) a terminal condition: an 28 incurable or irreversible illness or injury that without the 29 administration of life-sustaining procedures will result in 30 my death in a short period of time, for which there is no 31 reasonable prospect of cure or recovery, that imposes
01 severe pain or otherwise imposes an inhumane burden 02 on me, and for which, in light of my medical condition, 03 initiating or continuing life-sustaining procedures will 04 provide only minimal medical benefit; 05 [ ] Additional instructions: ________________ 06 ___________________________________________________ 07 (C) Artificial Nutrition and Hydration. If I am 08 unable to safely take nutrition, fluids, or nutrition and fluids 09 (check your choices or write your instructions), 10 [ ] I wish to receive artificial nutrition and 11 hydration indefinitely; 12 [ ] I wish to receive artificial nutrition and 13 hydration indefinitely, unless it clearly increases my suffering 14 and is no longer in my best interest; 15 [ ] I wish to receive artificial nutrition and 16 hydration on a limited trial basis to see if I can improve; 17 [ ] In accordance with my choices in (6)(B) 18 above, I do not wish to receive artificial nutrition and hydration. 19 [ ] Other instructions:_____________________ 20 ___________________________________________________ 21 (D) Relief from Pain. 22 [ ] I direct that adequate treatment be 23 provided at all times for the sole purpose of the 24 alleviation of pain or discomfort; or 25 [ ] I give these instructions: 26 _____________________________________________ 27 _____________________________________________ 28 (E) Should I become unconscious and I 29 am pregnant, I direct that ________________________ 30 _____________________________________________ 31 _____________________________________________
01 (7) OTHER WISHES. (If you do not agree with any of 02 the optional choices above and wish to write your own, or if you wish 03 to add to the instructions you have given above, you may do so here.) I 04 direct that 05 _________________________________________________________ 06 _________________________________________________________ 07 Conditions or limitations: ______________________________ 08 _________________________________________________________. 09 (Add additional sheets if needed.) 10 PART 3 11 ANATOMICAL GIFT AT DEATH 12 (OPTIONAL) 13 If you are satisfied to allow your agent to determine whether to 14 make an anatomical gift at your death, you do not need to fill out this 15 part of the form. 16 (8) Upon my death: (mark applicable box) 17 [ ] (A) I give any needed organs, tissues, or 18 other body parts, OR 19 [ ] (B) I give the following organs, tissues, or 20 other body parts only ________________________________ 21 __________________________________________________ 22 [ ] (C) My gift is for the following purposes 23 (mark any of the following you want): 24 [ ] (i) transplant; 25 [ ] (ii) therapy; 26 [ ] (iii) research; 27 [ ] (iv) education. 28 [ ] (D) I refuse to make an anatomical gift. 29 PART 4 30 MENTAL HEALTH TREATMENT 31 This part of the declaration allows you to make decisions in
01 advance about mental health treatment. The instructions that you 02 include in this declaration will be followed only if a court, two 03 physicians that include a psychiatrist, or a physician and a professional 04 mental health clinician believe that you are not competent and cannot 05 make treatment decisions. Otherwise, you will be considered to be 06 competent and to have the capacity to give or withhold consent for the 07 treatments. 08 If you are satisfied to allow your agent to determine what is best 09 for you in making these mental health decisions, you do not need to fill 10 out this part of the form. If you do fill out this part of the form, you 11 may strike any wording you do not want. 12 (9) PSYCHOTROPIC MEDICATIONS. If I do not 13 have the capacity to give or withhold informed consent for mental 14 health treatment, my wishes regarding psychotropic medications are as 15 follows: 16 ________ I consent to the administration of the following 17 medications: ______________________________________________ 18 ________ I do not consent to the administration of the 19 following medications: ______________________________________ 20 Conditions or limitations:_______________________________ 21 _________________________________________________________. 22 (10) ELECTROCONVULSIVE TREATMENT. If I do 23 not have the capacity to give or withhold informed consent for mental 24 health treatment, my wishes regarding electroconvulsive treatment are 25 as follows: 26 ________ I consent to the administration of electroconvulsive 27 treatment. 28 ________ I do not consent to the administration of 29 electroconvulsive treatment. 30 Conditions or limitations: ______________________________ 31 _________________________________________________________.
01 (11) ADMISSION TO AND RETENTION IN 02 FACILITY. If I do not have the capacity to give or withhold informed 03 consent for mental health treatment, my wishes regarding admission to 04 and retention in a mental health facility for mental health treatment are 05 as follows: 06 ________ I consent to being admitted to a mental health facility 07 for mental health treatment for up to ________ days. (The number of 08 days not to exceed 17.) 09 ________ I do not consent to being admitted to a mental health 10 facility for mental health treatment. 11 Conditions or limitations: ______________________________ 12 _________________________________________________________. 13 OTHER WISHES OR INSTRUCTIONS 14 _________________________________________________________ 15 _________________________________________________________ 16 _________________________________________________________ 17 Conditions or limitations: ______________________________ 18 _________________________________________________________. 19 PART 5 20 PRIMARY PHYSICIAN 21 (OPTIONAL) 22 (12) I designate the following physician as my primary 23 physician: 24 _________________________________________________________ 25 (name of physician) 26 _________________________________________________________ 27 (address) (city) (state) (zip code) 28 _________________________________________________________ 29 (telephone) 30 OPTIONAL: If the physician I have designated above is 31 not willing, able, or reasonably available to act as my primary
01 physician, I designate the following physician as my primary physician: 02 _________________________________________________________ 03 (name of physician) 04 _________________________________________________________ 05 (address) (city) (state) (zip code) 06 _________________________________________________________ 07 (telephone) 08 (13) EFFECT OF COPY. A copy of this form has the 09 same effect as the original. 10 (14) SIGNATURES. Sign and date the form here: 11 _________________________________________________________ 12 (date) (sign your name) 13 _________________________________________________________ 14 (print your name) 15 _________________________________________________________ 16 (address) (city) (state) (zip code) 17 (15) WITNESSES. This advance care health directive 18 will not be valid for making health care decisions unless it is 19 (A) signed by two qualified adult witnesses who 20 are personally known to you and who are present when you sign 21 or acknowledge your signature; the witnesses may not be a 22 health care provider employed at the health care institution or 23 health care facility where you are receiving health care, an 24 employee of the health care provider who is providing health 25 care to you, an employee of the health care institution or health 26 care facility where you are receiving health care, or the person 27 appointed as your agent by this document; at least one of the 28 two witnesses may not be related to you by blood, marriage, or 29 adoption or entitled to a portion of your estate upon your death 30 under your will or codicil; or 31 (B) acknowledged before a notary public in the
01 state. 02 ALTERNATIVE NO. 1 03 Witness Who is Not Related to or a Devisee of the Principal 04 I swear under penalty of perjury under AS 11.56.200 05 that the principal is personally known to me, that the principal signed or 06 acknowledged this durable power of attorney for health care in my 07 presence, that the principal appears to be of sound mind and under no 08 duress, fraud, or undue influence, and that I am not 09 (1) a health care provider employed at the health care 10 institution or health care facility where the principal is receiving health 11 care; 12 (2) an employee of the health care provider providing 13 health care to the principal; 14 (3) an employee of the health care institution or health 15 care facility where the principal is receiving health care; 16 (4) the person appointed as agent by this document; 17 (5) related to the principal by blood, marriage, or 18 adoption; or 19 (6) entitled to a portion of the principal's estate upon the 20 principal's death under a will or codicil. 21 ________________________________________________________ 22 (date) (signature of witness) 23 ________________________________________________________ 24 (printed name of witness) 25 ________________________________________________________ 26 (address) (city) (state) (zip code) 27 Witness Who May be 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 who is 06 providing 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; or 09 (4) the person appointed as agent by this document. 10 _______________________________________________________ 11 (date) (signature of witness) 12 _______________________________________________________ 13 (printed name of witness) 14 _______________________________________________________ 15 (address) (city) (state) (zip code) 16 ALTERNATIVE NO. 2 17 State of Alaska 18 ________________ Judicial District 19 On this ____ day of ___________________, in the year 20 ______________, before me, _______________________________ 21 (insert name of notary public) appeared 22 _______________________________, personally known to me (or 23 proved to me on the basis of satisfactory evidence) to be the person 24 whose name is subscribed to this instrument, and acknowledged that 25 the person executed it. 26 Notary Seal 27 ___________________________ 28 (signature of notary public) 29 * Sec. 12. AS 13.52.390(12) is amended to read: 30 (12) "do not resuscitate order" means a directive from a licensed 31 physician, advanced practice registered nurse, or physician assistant that
01 emergency cardiopulmonary resuscitation should not be administered to a qualified 02 patient; 03 * Sec. 13. AS 13.52.390(23) is amended to read: 04 (23) "life-sustaining procedures" means any medical treatment, 05 procedure, or intervention that, in the judgment of the primary physician, advanced 06 practice registered nurse, or physician assistant, when applied to a patient with a 07 qualifying condition, would not be effective to remove the qualifying condition, would 08 serve only to prolong the dying process, or, when administered to a patient with a 09 condition of permanent unconsciousness, may keep the patient alive but is not 10 expected to restore consciousness; in this paragraph, "medical treatment, procedure, or 11 intervention" includes assisted ventilation, renal dialysis, surgical procedures, blood 12 transfusions, and the administration of drugs, including antibiotics, or artificial 13 nutrition and hydration; 14 * Sec. 14. AS 13.52.390 is amended by adding new paragraphs to read: 15 (38) "advanced practice registered nurse" has the meaning given in 16 AS 08.68.850; 17 (39) "physician assistant" means an individual licensed under 18 AS 08.64.107. 19 * Sec. 15. AS 18.50.230(c) is amended to read: 20 (c) The medical certification shall be completed and signed within 24 hours 21 after death by the physician, the advanced practice registered nurse, or the 22 physician assistant in charge of the patient's care for the illness or condition that 23 resulted in death except when an official inquiry or inquest is required and except as 24 provided by regulation in special problem cases.