1.1 	A bill for an act
1.2 	relating to health; providing for do not
1.3 	resuscitate/do not intubate orders; providing
1.4 	liability protection for certain health professionals;
1.5 	proposing coding for new law as Minnesota Statutes,
1.6 	chapter 145D.
1.7 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.8 	Section 1. [145D.01] DEFINITIONS.
1.9 		Subdivision 1.Scope. The definitions in this section
1.10 	apply to this chapter.
1.11 		Subd. 2.Attending physician. "Attending physician"
1.12 	means a physician selected by or assigned to the principal who
1.13 	has primary responsibility for treatment or care of the
1.14 	principal and who is licensed under chapter 147.  If more than
1.15 	one physician shares that responsibility, any of those
1.16 	physicians may act as the attending physician under the
1.17 	provisions of this chapter.
1.18 		Subd. 3.Cardiopulmonary resuscitation. "Cardiopulmonary
1.19 	resuscitation" means those measures used to restore or support
1.20 	cardiac or respiratory function in the event of a cardiac or
1.21 	respiratory arrest.
1.22 		Subd. 4.Commissioner. "Commissioner" means the
1.23 	commissioner of health.
1.24 		Subd. 5.Decision-making capacity. "Decision-making
1.25 	capacity" means the ability to understand the significant
1.26 	benefits, risks, and alternatives to proposed health care and to
2.1 	make and communicate a health care decision.
2.2 	Subd. 6.[DNR/DNI] "DNR/DNI" means do not resuscitate and
2.3 	do not intubate.
2.4 		Subd. 7.Dnr/dni identification. "DNR/DNI identification"
2.5 	means a standardized identification necklace, bracelet, or card,
2.6 	as provided under section 145D.11, that signifies that a DNR/DNI
2.7 	order has been issued for the possessor.
2.8 		Subd. 8.Dnr/dni order. "DNR/DNI order" means an order
2.9 	issued by an attending physician that cardiopulmonary
2.10 	resuscitation or intubation should not be administered to a
2.11 	principal.
2.12 		Subd. 9.Ems personnel. "EMS personnel" means emergency
2.13 	medical services personnel, including paid or volunteer
2.14 	firefighters, law-enforcement officers, emergency medical
2.15 	technicians, paramedics, first responders, or other emergency
2.16 	services personnel, providers, or entities acting within the
2.17 	usual course of their professions.
2.18 		Subd. 10.Health care decision. "Health care decision"
2.19 	means a decision to give, withhold, or withdraw informed consent
2.20 	to any type of health care, including, but not limited to,
2.21 	medical and surgical treatments, including life-prolonging
2.22 	interventions; nursing care; hospitalization; treatment in a
2.23 	nursing home or other extended care facility; home health care;
2.24 	and the gift or donation of a body organ or tissue.
2.25 		Subd. 11.Health care facility. "Health care facility"
2.26 	means a hospital or other entity licensed under sections 144.50
2.27 	to 144.58, a nursing home licensed to serve adults under section
2.28 	144A.02, a home care provider licensed under sections 144A.43 to
2.29 	144A.47, or a hospice provider licensed under sections 144A.75
2.30 	to 144A.755.
2.31 		Subd. 12.Health care provider. "Health care provider"
2.32 	means a person, health care facility, organization, or
2.33 	corporation licensed, certified, or otherwise authorized or
2.34 	permitted by the laws of this state to administer health care
2.35 	directly or through an arrangement with other health care
2.36 	providers, including health maintenance organizations licensed
3.1 	under chapter 62D.
3.2 		Subd. 13.Home. "Home" means any place of residence
3.3 	other than a health care facility and includes residential board
3.4 	and care homes and personal care homes.
3.5 		Subd. 14.Principal. "Principal" means an individual age
3.6 	18 or older who is the subject of a DNR/DNI order.
3.7 		Subd. 15.Qualified physician. "Qualified physician"
3.8 	means a physician licensed under chapter 147 who has personally
3.9 	examined the principal.
3.10 		Subd. 16.Health care agent or agent. "Health care agent"
3.11 	or "agent" means an individual age 18 or older who is appointed
3.12 	by a principal in a health care power of attorney to make health
3.13 	care decisions on behalf of the principal.
3.14 		Subd. 17.Trauma. "Trauma" means blunt or penetrating
3.15 	bodily injuries from impact that occur in situations, including,
3.16 	but not limited to, motor vehicle collisions, mass casualty
3.17 	incidents, and industrial accidents.

3.18 	Sec. 2. [145D.02] APPLICABILITY.
3.19 	This chapter applies to all persons regardless of whether
3.20 	they have completed a living will under chapter 145B, a health
3.21 	care directive under chapter 145C, or a health care power of
3.22 	attorney under chapter 145C.  For the purposes of direction to
3.23 	EMS personnel, a DNR/DNI order does not apply to treatment
3.24 	rendered at the site where trauma has occurred to a principal
3.25 	who experiences a cardiac or respiratory arrest as the result of
3.26 	severe trauma.

3.27 	Sec. 3. [145D.03] PRESUMED CONSENT TO CARDIOPULMONARY
3.28 	RESUSCITATION AND INTUBATION.
3.29 	(a) An individual is presumed to consent to the
3.30 	administration of cardiopulmonary resuscitation and intubation
3.31 	in the event of cardiac or respiratory arrest, unless one or
3.32 	more of the following conditions, of which the health care
3.33 	provider has actual knowledge, apply:
3.34 	(1) a DNR/DNI order has been issued for the individual
3.35 	according to this chapter;
3.36 	(2) a completed health care directive for the individual is
4.1 	in effect according to chapter 145C, or a completed living will
4.2 	for the individual is in effect according to chapter 145B, and
4.3 	the individual is in a terminal condition or a persistent
4.4 	vegetative state; or 
4.5 	(3) a completed health care power of attorney for the
4.6 	individual is in effect according to chapter 145C, in which the
4.7 	individual indicated that the individual does not wish to
4.8 	receive cardiopulmonary resuscitation or intubation or the
4.9 	individual's health care agent has determined that the
4.10 	individual would not wish to receive cardiopulmonary
4.11 	resuscitation or intubation.
4.12 	(b) Nothing in this section requires a nursing home,
4.13 	personal care home, hospice, or extended care facility operated
4.14 	in connection with hospitals to institute or maintain the
4.15 	ability to provide cardiopulmonary resuscitation or intubation
4.16 	or to expand its existing equipment, facilities, or personnel to
4.17 	provide cardiopulmonary resuscitation or intubation.  If a
4.18 	health care facility does not provide cardiopulmonary
4.19 	resuscitation or intubation, this policy must be communicated in
4.20 	writing to the principal or health care agent prior to admission.

4.21 	Sec. 4. [145D.04] ISSUANCE OF DNR/DNI ORDER.
4.22 		Subdivision 1.Issuance. An attending physician may
4.23 	issue a DNR/DNI order for a principal who is present in or
4.24 	residing at home or in a health care facility if the principal
4.25 	or health care agent has consented to the order.  A DNR/DNI
4.26 	order must be issued in writing in the form described in this
4.27 	section for a principal not present or residing in a health care
4.28 	facility.  For principals present in health care facilities, a
4.29 	DNR/DNI order must be issued according to the policies and
4.30 	procedures of the health care facility or according to this
4.31 	section.
4.32 		Subd. 2.Who may consent. (a) Principals may request
4.33 	their physicians to issue DNR/DNI orders for them.
4.34 	(b) A health care agent may consent to a DNR/DNI order for
4.35 	a principal who lacks decision-making capacity.  A DNR/DNI order
4.36 	written by a physician, with the consent of the health care
5.1 	agent, for a principal who lacks decision-making capacity is
5.2 	valid and must be respected by health care providers.
5.3 	(c) A parent or guardian may consent to a DNR/DNI order for
5.4 	a minor child, if a second physician who has examined the child
5.5 	concurs with the opinion of the attending physician that the
5.6 	provision of cardiopulmonary resuscitation or intubation would
5.7 	be contrary to accepted medical standards.  If the minor is
5.8 	between the ages of 16 and 18 and, in the opinion of the
5.9 	attending physician, is of sufficient maturity to understand the
5.10 	nature and effect of a DNR/DNI order, then the order must be
5.11 	signed by the minor and a parent or guardian of the minor.  In
5.12 	the event of a conflict between the wishes of the parents or
5.13 	guardians and the wishes of the mature minor, the wishes of the
5.14 	mature minor must take precedence.  For purposes of this
5.15 	section, a minor less than 16 years of age is not considered
5.16 	mature.  Nothing in this section shall be interpreted to
5.17 	conflict with the provisions of the federal Child Abuse
5.18 	Prevention and Treatment Act and implementing regulations under
5.19 	Code of Federal Regulations, title 45, section 1340.  In the
5.20 	event conflict is unavoidable, federal law and regulation
5.21 	governs.
5.22 		Subd. 3.Documentation. (a) For a principal not present
5.23 	or residing in a health care facility, the DNR/DNI order must be
5.24 	noted in the following form on a card suitable for carrying on
5.25 	the person:
5.26 	DNR/DNI ORDER 
5.27 	Physician Signature 
5.28 	Address 
5.29 	Principal Signature 
5.30 	Address 
5.31 	Health Care Agent Signature 
5.32 	Address 
5.33 	(b) For a principal residing in a health care facility, the
5.34 	DNR/DNI order must be preserved in at least one of the following
5.35 	forms:
5.36 	(1) forms required by the policies and procedures of the
6.1 	health care facility; or 
6.2 	(2) a DNR/DNI card according to paragraph (a).

6.3 	Sec. 5. [145D.05] COMPLIANCE.
6.4 	(a) Health care providers must comply with the DNR/DNI
6.5 	order when presented with one of the following:
6.6 	(1) a DNR/DNI order completed by a physician on a form as
6.7 	specified in section 145D.04;
6.8 	(2) a DNR/DNI identification as provided under section
6.9 	145D.11; or 
6.10 	(3) a DNR/DNI order for a principal present or residing in
6.11 	a health care facility issued according to the health care
6.12 	facility's policies and procedures.
6.13 	(b) Health care providers must respect DNR/DNI orders for a
6.14 	principal in health care facilities, ambulances, homes, and
6.15 	communities.

6.16 	Sec. 6. [145D.06] REVOCATION OF DNR/DNI ORDER.
6.17 	(a) At any time in a health care facility, a DNR/DNI order
6.18 	may be revoked by the principal by making either a written,
6.19 	oral, or other act of communication to a physician or other
6.20 	professional health staff of the health care facility.
6.21 	(b) At any time, a principal residing at home may revoke a
6.22 	DNR/DNI order by destroying the order and removing any DNR/DNI
6.23 	identification on the person.  The principal is responsible for
6.24 	notifying the principal's physician of the revocation.
6.25 	(c) At any time, a health care agent may revoke consent to
6.26 	a DNR/DNI order for a principal in a health care facility who
6.27 	lacks decision-making capacity by:
6.28 	(1) notifying a physician or other professional staff of
6.29 	the health care facility of the revocation of consent in
6.30 	writing; or 
6.31 	(2) by orally notifying the attending physician in the
6.32 	presence of a witness 18 years of age or older.
6.33 	(d) At any time, a health care agent may revoke the agent's
6.34 	consent to a DNR/DNI order for a principal residing at home who
6.35 	lacks decision-making capacity by destroying the order and
6.36 	removing the DNR/DNI identification from the principal.  The
7.1 	health care agent is responsible for notifying the principal's
7.2 	physician of the revocation.
7.3 	(e) The attending physician who is informed of, or provided
7.4 	with, a revocation of consent according to this section must
7.5 	immediately cancel the DNR/DNI order if the principal is in a
7.6 	health care facility and notify the professional health staff of
7.7 	the health care facility responsible for the principal's care of
7.8 	the revocation and cancellation.  Any professional health staff
7.9 	of the health care facility who is informed of or provided with
7.10 	a revocation of consent according to this section must
7.11 	immediately notify the attending physician of the revocation.
7.12 	(f) Only a licensed physician may cancel the issuance of a
7.13 	DNR/DNI order.

7.14 	Sec. 7. [145D.07] LIABILITY PROTECTION.
7.15 	(a) A health care provider, EMS personnel, health care
7.16 	facility, or individual employed by, acting as the agent of, or
7.17 	under contract with any of the foregoing is immune from criminal
7.18 	or civil liability for carrying out in good faith a DNR/DNI
7.19 	order authorized by this chapter on behalf of a principal as
7.20 	instructed by the principal or health care agent.
7.21 	(b) A health care provider, EMS personnel, health care
7.22 	facility, individual employed by, acting as agent of, or under
7.23 	contract with any of the foregoing, or other individual who
7.24 	witnesses a cardiac or respiratory arrest is immune from
7.25 	criminal or civil liability for providing cardiopulmonary
7.26 	resuscitation or intubation to a principal for whom a DNR/DNI
7.27 	order has been issued, if the health care provider or individual
7.28 	reasonably and in good faith:
7.29 	(1) was unaware of the issuance of a DNR/DNI order; or 
7.30 	(2) believed that consent to the DNR/DNI order had been
7.31 	revoked or canceled.
7.32 	(c) Any physician who refuses to issue a DNR/DNI order at a
7.33 	principal's request or to comply with a DNR/DNI order entered
7.34 	according to this chapter must take reasonable steps to promptly
7.35 	advise the principal or health care agent of the principal that
7.36 	the physician is unwilling to effectuate the order.  The
8.1 	attending physician must thereafter at the election of the
8.2 	principal or health care agent permit the principal or health
8.3 	care agent to obtain another physician.

8.4 	Sec. 8. [145D.08] INSURANCE.
8.5 	(a) No policy of life insurance is legally impaired,
8.6 	modified, or invalidated in any manner by the issuance of a
8.7 	DNR/DNI order, notwithstanding any term of the policy to the
8.8 	contrary.
8.9 	(b) A person may not prohibit or require the issuance of a
8.10 	DNR/DNI order for an individual as a condition of the individual
8.11 	being insured or receiving health care services.

8.12 	Sec. 9. [145D.09] INTERINSTITUTIONAL TRANSFERS.
8.13 	If a principal with a DNR/DNI order is transferred from one
8.14 	health care facility to another health care facility, the health
8.15 	care facility initiating the transfer must communicate the
8.16 	existence of a DNR/DNI order to the receiving facility prior to
8.17 	the transfer.  The written DNR/DNI order, or the DNR/DNI card
8.18 	described in section 145D.04, must accompany the principal to
8.19 	the health care facility receiving the principal and remains
8.20 	effective until a physician at the receiving facility issues
8.21 	admission orders.  The DNR/DNI card must be kept as the first
8.22 	page in the principal's transfer records.

8.23 	Sec. 10. [145D.10] PRESERVATION OF EXISTING RIGHTS.
8.24 	(a) Nothing in this chapter supersedes any legal right or
8.25 	legal responsibility that any person may have to effect the
8.26 	withholding of cardiopulmonary resuscitation or intubation in
8.27 	any lawful manner.  In this respect, the provisions of this
8.28 	chapter are cumulative.
8.29 	(b) Nothing in this chapter shall be construed to preclude
8.30 	a court of competent jurisdiction from approving the issuance of
8.31 	a DNR/DNI order under circumstances other than those under which
8.32 	such an order may be issued according to this chapter.

8.33 	Sec. 11. [145D.11] FORMAT; DISTRIBUTION.
8.34 	(a) The commissioner must implement the statewide
8.35 	distribution of standardized DNR/DNI forms as described in
8.36 	section 145D.04, subdivision 3.
9.1 	(b) DNR/DNI identification may consist of either a medical
9.2 	condition bracelet or necklace with an inscription of the
9.3 	patient's name, date of birth in numerical form, and "MN
9.4 	DNR/DNI."  The commissioner must issue the DNR/DNI
9.5 	identification only upon presentation of a properly executed
9.6 	DNR/DNI order form as described in section 145D.04, subdivision
9.7 	3, or a DNR/DNI order properly executed according to a health
9.8 	care facility's written policy and procedure.
9.9 	(c) The commissioner must establish a system for the
9.10 	distribution of DNR/DNI identification.  The commissioner must
9.11 	develop and implement a statewide educational effort to inform
9.12 	the public of the right to accept or refuse cardiopulmonary
9.13 	resuscitation or intubation and to request a physician to write
9.14 	a DNR/DNI order.

9.15 	Sec. 12. [145D.12] CERTAIN PRACTICES NOT CONDONED.
9.16 	Withholding cardiopulmonary resuscitation or intubation
9.17 	from a principal according to this chapter does not, for any
9.18 	purpose, constitute suicide or murder.  Withholding
9.19 	cardiopulmonary resuscitation from a principal according to this
9.20 	chapter, however, does not relieve an individual of
9.21 	responsibility for any criminal acts that may have caused the
9.22 	principal's condition.  Nothing in this chapter legalizes,
9.23 	condones, authorizes, or approves mercy killing or assisted
9.24 	suicide.