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S.B. 54
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DIRECTIVES FOR MEDICAL SERVICES
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2000 GENERAL SESSION
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STATE OF UTAH
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Sponsor: Karen Hale
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AN ACT RELATING TO HEALTH; REQUIRING THE DEPARTMENT OF HEALTH TO
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PREPARE STANDARDIZED FORMS FOR MEDICAL DIRECTIVES; REQUIRING HEALTH
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CARE FACILITIES TO PROVIDE INFORMATION REGARDING MEDICAL DIRECTIVES;
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AND CLARIFYING THE LEGAL STATUS AND USE OF FORMS THAT ARE PREPARED
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OR APPROVED BY THE DEPARTMENT.
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This act affects sections of Utah Code Annotated 1953 as follows:
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AMENDS:
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26-21-6, as last amended by Chapter 169, Laws of Utah 1998
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75-2-1104, as last amended by Chapter 129, Laws of Utah 1993
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75-2-1105, as last amended by Chapter 129, Laws of Utah 1993
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ENACTS:
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26-21-23, Utah Code Annotated 1953
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Be it enacted by the Legislature of the state of Utah:
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Section 1.
Section
26-21-6
is amended to read:
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26-21-6. Duties of department.
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(1) The department shall:
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(a) enforce rules established pursuant to this chapter;
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(b) authorize an agent of the department to conduct inspections of health-care facilities
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pursuant to this chapter;
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(c) collect information authorized by the committee that may be necessary to ensure that
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adequate health-care facilities are available to the public;
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(d) collect and credit fees for licenses as free revenue;
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(e) collect and credit fees for conducting plan reviews as dedicated credits;
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(f) designate an executive secretary from within the department to assist the committee in
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carrying out its powers and responsibilities;
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(g) establish reasonable standards for criminal background checks by public and private
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entities;
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(h) recognize those public and private entities which meet the standards established in
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Subsection (1)(g); [and]
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(i) prepare standardized forms for medical directives in accordance with Section
26-21-23
;
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and
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[(i)] (j) provide necessary administrative and staff support to the committee.
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(2) The department may:
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(a) exercise all incidental powers necessary to carry out the purposes of this chapter;
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(b) review architectural plans and specifications of proposed health-care facilities or
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renovations of health-care facilities to ensure that the plans and specifications conform to rules
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established by the committee; and
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(c) make rules as necessary to implement the provisions of this chapter, except as authority
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is specifically delegated to the committee.
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Section 2.
Section
26-21-23
is enacted to read:
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26-21-23. Medical directives on department-prepared forms.
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(1) In an effort to create a single set of medical directive forms to be used in and
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transferred among health care facilities, the department shall, in consultation with the committee,
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prepare the following standard forms:
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(a) a directive for medical services that is consistent with the requirements of Subsections
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75-2-1104
(2) and (3);
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(b) a directive for medical services after injury or illness has occurred that is consistent
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with the requirements of Subsections
75-2-1105
(2), (3), (4)(b), and (4)(c); and
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(c) a standard medical worksheet to assist individuals and their families in identifying the
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desired outcome of medical services in view of the individual's health condition.
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(2) The department may, in consultation with the committee, approve other directives for
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medical services that are consistent with the requirements of Subsection
75-2-1104
(2) and (3) or
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Subsections
75-2-1105
(2), (3), (4)(b), and (4)(c).
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(3) At the time of admission:
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(a) a hospital shall:
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(i) ask whether the individual has a directive for medical services; and
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(ii) if the individual does not have a directive for medical services:
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(A) offer to provide the individual with information about forms that are prepared or
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approved by the department; and
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(B) provide any department prepared or approved form requested by the individual; and
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(b) a nursing care facility shall:
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(i) ask whether the individual has a directive for medical services; and
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(ii) if the individual does not have a directive for medical services:
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(A) provide to the individual:
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(I) a medical outcome work sheet prepared in accordance with Subsection (2); and
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(II) the appropriate medical directive form prepared in accordance with Subsection (1);
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(B) explain the nature of the forms; and
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(C) request that the forms be completed and a copy submitted to the nursing care facility
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at the earliest convenience of the individual.
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(4) Forms that are prepared or approved by the department and properly completed shall
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be fully transferrable within the health care system.
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(5) Medical directives completed on department prepared or approved forms shall have
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the same legal status as any other medical directive prepared in accordance with, and governed by,
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Title 75, Chapter 2, Part 11, Personal Choice and Living Will Act.
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Section 3.
Section
75-2-1104
is amended to read:
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75-2-1104. Directive for medical services.
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(1) A person 18 years of age or older may execute a directive under this part. The directive
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is binding upon attending physicians and all other providers of medical services.
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(2) The directive shall be:
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(a) in writing;
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(b) signed by the declarant or by another person in the declarant's presence and by the
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declarant's expressed direction;
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(c) dated; and
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(d) signed in the presence of two or more witnesses 18 years of age or older.
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(3) Neither of the witnesses may be:
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(a) the person who signed the directive on behalf of the declarant;
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(b) related to the declarant by blood or marriage;
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(c) entitled to any portion of the estate of the declarant according to the laws of intestate
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succession of this state or under any will or codicil of the declarant;
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(d) directly financially responsible for the declarant's medical care; or
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(e) any agent of any health care facility in which the declarant is a patient at the time the
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directive is executed.
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(4) The directive shall be on a form prepared or approved by the Department of Health
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pursuant to Section
26-21-23
, in substantially the following form, or in a form substantially similar
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to the form approved by prior Utah law:
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DIRECTIVE TO PHYSICIANS AND PROVIDERS OF MEDICAL SERVICES
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(Pursuant to Section
75-2-1104
, UCA)
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This directive is made this _____ day of __________, ______.
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1. I, __________, being of sound mind, willfully and voluntarily make known my desire
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that my life not be artificially prolonged by life-sustaining procedures except as I may otherwise
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provide in this directive.
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2. I declare that if at any time I should have an injury, disease, or illness, which is certified
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in writing to be a terminal condition or persistent vegetative state by two physicians who have
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personally examined me, and in the opinion of those physicians the application of life-sustaining
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procedures would serve only to unnaturally prolong the moment of my death and to unnaturally
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postpone or prolong the dying process, I direct that these procedures be withheld or withdrawn and
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my death be permitted to occur naturally.
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3. I expressly intend this directive to be a final expression of my legal right to refuse
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medical or surgical treatment and to accept the consequences from this refusal which shall remain
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in effect notwithstanding my future inability to give current medical directions to treating
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physicians and other providers of medical services.
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4. I understand that the term "life-sustaining procedure" includes artificial nutrition and
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hydration and any other procedures that I specify below to be considered life-sustaining but does
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not include the administration of medication or the performance of any medical procedure which
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is intended to provide comfort care or to alleviate pain:
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____________________________________________________________________________
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5. I reserve the right to give current medical directions to physicians and other providers
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of medical services so long as I am able, even though these directions may conflict with the above
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written directive that life-sustaining procedures be withheld or withdrawn.
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6. I understand the full import of this directive and declare that I am emotionally and
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mentally competent to make this directive.
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____________________________________
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Declarant's signature
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____________________________________
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City, County, and State of Residence
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We witnesses certify that each of us is 18 years of age or older and each personally
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witnessed the declarant sign or direct the signing of this directive; that we are acquainted with the
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declarant and believe him to be of sound mind; that the declarant's desires are as expressed above;
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that neither of us is a person who signed the above directive on behalf of the declarant; that we are
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not related to the declarant by blood or marriage nor are we entitled to any portion of declarant's
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estate according to the laws of intestate succession of this state or under any will or codicil of
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declarant; that we are not directly financially responsible for declarant's medical care; and that we
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are not agents of any health care facility in which the declarant may be a patient at the time of
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signing this directive.
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_____________________________________________________
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Signature of Witness Signature of Witness
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_____________________________________________________
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Address of Witness Address of Witness
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Section 4.
Section
75-2-1105
is amended to read:
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75-2-1105. Directive for medical services after injury or illness is incurred.
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(1) (a) A person 18 years of age or older may, after incurring an injury, disease, or illness,
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direct his care by means of a directive made under this section, which is binding upon attending
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physicians and other providers of medical services.
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(b) When a declarant has executed a directive under Section
75-2-1104
and is in a terminal
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condition or a persistent vegetative state, that directive takes precedence over a nonconflicting
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directive executed under this section. A directive executed by an attorney-in-fact appointed under
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Section
75-2-1106
takes precedence over all earlier signed directives.
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(2) A directive made under this section shall be:
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(a) in writing;
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(b) signed by the declarant or by another person in the declarant's presence and by the
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declarant's expressed direction, or if the declarant does not have the ability to give current
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directions concerning his care and treatment, by the following persons, as proxy, in the following
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order of priority if no person in a prior class is available, willing, and competent to act:
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(i) an attorney-in-fact appointed under Section
75-2-1106
;
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(ii) any previously appointed legal guardian of the declarant;
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(iii) the person's spouse if not legally separated;
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(iv) the parents or surviving parent;
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(v) the person's child 18 years of age or older, or if the person has more than one child, by
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a majority of the children 18 years of age or older who are reasonably available for consultation
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upon good faith efforts to secure participation of all those children;
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(vi) by the declarant's nearest reasonably available living relative 18 years of age or older
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if the declarant has no parent or child living; or
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(vii) by a legal guardian appointed for the purposes of this section;
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(c) dated;
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(d) signed, completed, and certified by the declarant's attending physician; and
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(e) signed pursuant to Subsection (2)(b) above in the presence of two or more witnesses
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18 years of age or older.
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(3) Neither of the witnesses may be:
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(a) the person who signed the directive on behalf of the declarant;
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(b) related to the declarant by blood or marriage;
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(c) entitled to any portion of the declarant's estate according to the laws of intestate
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succession of this state or under any will or codicil of the declarant;
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(d) directly financially responsible for declarant's medical care; or
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(e) an agent of any health care facility in which the declarant is a patient or resident at the
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time of executing the directive.
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(4) A directive executed under this section shall:
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(a) be on a form prepared or approved by the Department of Health pursuant to Section
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26-21-23
, in substantially the following form, or in a form substantially similar to the form
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approved by prior Utah law; and [shall]
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(b) contain a description by the attending physician of the declarant's injury, disease, or
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illness[. It shall]; and
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(c) include specific directions for care and treatment or withholding of treatment.
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DIRECTIVE TO PHYSICIANS AND PROVIDERS OF MEDICAL SERVICES
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(Pursuant to Section
75-2-1105
, UCA)
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I, _______________, certify that I am serving as the attending physician for
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____________________ of __________, who has been under my care since the ____ day of
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__________, ______.
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1. This declarant, _______________________________, is currently suffering from the
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following injury, disease, or illness:
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____________________________________________________________________________
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____________________________________________________________________________
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____________________________________________________________________________
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2. I certify that I have explained to the declarant to the extent he is able to understand, and
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to the available persons acting as proxy, the reasonable available alternatives for his care and
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treatment.
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3. I certify that the care and treatment alternatives directed below are:
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______ (a) directed by the declarant; or
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______ (b) that the declarant has a physical or mental condition which renders him unable
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to give personal directions for care and treatment and that the care and treatment alternatives
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directed below are in my opinion, and in the opinion of the declarant's proxy, what the declarant
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would probably decide if able to give current directions concerning his care and treatment.
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Date: _______________________________________________
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Signature of attending physician
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The following care and treatment or withholding of treatment is directed with respect to
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the declarant:
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____________________________________________________________________________
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____________________________________________________________________________
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____________________________________________________________________________
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_________________________________________________________
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Relationship to declarantSignature of declarant or person
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of person signing onauthorized by law to sign
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declarant's behalf,directive as a proxy on
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if applicable.behalf of declarant
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________________________________
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Address of Signer
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________________________________
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City, County, and State of
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residence of Signer
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We witnesses certify that each of us is 18 years of age or older; that we personally
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witnessed the declarant or a proxy sign this directive; that we are acquainted with the declarant and
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believe that care and treatment alternatives directed above are what the declarant has decided for
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himself concerning his care and treatment, or, if the foregoing was signed by a proxy, that we are
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acquainted with the proxy and believe that the proxy sincerely believes that the care and treatment
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alternatives directed above are what the declarant would probably decide for himself if he were
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able to give current directions concerning his care and treatment; that neither of us signed the
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above directive for or on behalf of declarant; that we are not related to the declarant by blood or
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marriage nor are we entitled to any portion of declarant's estate according to the laws of intestate
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succession of this state or under any will or codicil of the declarant; that we are not directly
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financially responsible for declarant's medical care; and that we are not agents of any health care
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facility in which declarant may be a patient at the time of signing this directive.
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_____________________________________________________
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Signature of Witness Signature of Witness
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_____________________________________________________
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Address of Witness Address of Witness
Legislative Review Note
as of 1-27-00 11:04 AM
A limited legal review of this legislation raises no obvious constitutional or statutory concerns.