71st OREGON LEGISLATIVE ASSEMBLY--2001 Regular Session
NOTE: Matter within { + braces and plus signs + } in an
amended section is new. Matter within { - braces and minus
signs - } is existing law to be omitted. New sections are within
{ + braces and plus signs + } .
LC 3849
House Bill 3443
Sponsored by Representative PATRIDGE (at the request of Don
Hildebrand)
SUMMARY
The following summary is not prepared by the sponsors of the
measure and is not a part of the body thereof subject to
consideration by the Legislative Assembly. It is an editor's
brief statement of the essential features of the measure as
introduced.
Makes Five Wishes publication acceptable form of advance
directive in Oregon.
A BILL FOR AN ACT
Relating to form of advance directives; amending ORS 127.531.
Be It Enacted by the People of the State of Oregon:
SECTION 1. ORS 127.531 is amended to read:
127.531. (1) The form of an advance directive executed by an
Oregon resident must be the same as the form set forth in this
section to be valid. In any place in the form that requires the
initials of the principal, any mark by the principal is effective
to indicate the principal's intent.
(2) An advance directive shall be in the following form:
_________________________________________________________________
ADVANCE DIRECTIVE
YOU DO NOT HAVE TO FILL OUT AND SIGN THIS FORM
PART A: IMPORTANT INFORMATION ABOUT THIS ADVANCE DIRECTIVE
This is an important legal document. It can control critical
decisions about your health care. Before signing, consider these
important facts:
Facts About Part B
(Appointing a Health Care Representative)
You have the right to name a person to direct your health care
when you cannot do so. This person is called your 'health care
representative.' You can do this by using Part B of this form.
Your representative must accept on Part E of this form.
You can write in this document any restrictions you want on how
your representative will make decisions for you. Your
representative must follow your desires as stated in this
document or otherwise made known. If your desires are unknown,
your representative must try to act in your best interest. Your
representative can resign at any time.
Facts About Part C
(Giving Health Care Instructions)
You also have the right to give instructions for health care
providers to follow if you become unable to direct your care. You
can do this by using Part C of this form.
Facts About Completing This Form
This form is valid only if you sign it voluntarily and when you
are of sound mind. If you do not want an advance directive, you
do not have to sign this form.
Unless you have limited the duration of this advance directive,
it will not expire. If you have set an expiration date, and you
become unable to direct your health care before that date, this
advance directive will not expire until you are able to make
those decisions again.
You may revoke this document at any time. To do so, notify your
representative and your health care provider of the revocation.
Despite this document, you have the right to decide your own
health care as long as you are able to do so.
If there is anything in this document that you do not
understand, ask a lawyer to explain it to you.
You may sign PART B, PART C, or both parts. You may cross out
words that don't express your wishes or add words that better
express your wishes. Witnesses must sign PART D.
Print your NAME, BIRTHDATE AND ADDRESS here:
__________________
(Name)
__________
(Birthdate)
__________________
__________________
(Address)
Unless revoked or suspended, this advance directive will
continue for:
INITIAL ONE:
_ My entire life
_ Other period (_ Years)
PART B: APPOINTMENT OF HEALTH CARE REPRESENTATIVE
I appoint __________ as my health care representative. My
representative's address is _____ and telephone number is _____.
I appoint __________ as my alternate health care
representative. My alternate's address is _____ and telephone
number is _____.
I authorize my representative (or alternate) to direct my
health care when I can't do so.
NOTE: You may not appoint your doctor, an employee of your
doctor, or an owner, operator or employee of your health care
facility, unless that person is related to you by blood, marriage
or adoption or that person was appointed before your admission
into the health care facility.
1. Limits.
Special Conditions or Instructions:
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
INITIAL IF THIS APPLIES:
_ I have executed a Health Care Instruction or Directive to
Physicians. My representative is to honor it.
2. Life Support.
' Life support' refers to any medical means for maintaining
life, including procedures, devices and medications. If you
refuse life support, you will still get routine measures to keep
you clean and comfortable.
INITIAL IF THIS APPLIES:
_ My representative MAY decide about life support for me. (If
you don't initial this space, then your representative MAY
NOT decide about life support.)
3. Tube Feeding.
One sort of life support is food and water supplied
artificially by medical device, known as tube feeding.
INITIAL IF THIS APPLIES:
_ My representative MAY decide about tube feeding for me. (If
you don't initial this space, then your representative MAY
NOT decide about tube feeding.)
_____
(Date)
SIGN HERE TO APPOINT A HEALTH CARE REPRESENTATIVE
__________________
(Signature of person making appointment)
PART C: HEALTH CARE INSTRUCTIONS
NOTE: In filling out these instructions, keep the following in
mind:
o The term 'as my physician recommends' means that you want
your physician to try life support if your physician believes
it could be helpful and then discontinue it if it is not
helping your health condition or symptoms.
o 'Life support' and 'tube feeding' are defined in Part B
above.
o If you refuse tube feeding, you should understand that
malnutrition, dehydration and death will probably result.
o You will get care for your comfort and cleanliness, no
matter what choices you make.
o You may either give specific instructions by filling out
Items 1 to 4 below, or you may use the general instruction
provided by Item 5.
Here are my desires about my health care if my doctor and
another knowledgeable doctor confirm that I am in a medical
condition described below:
1. Close to Death. If I am close to death and life support
would only postpone the moment of my death:
A. INITIAL ONE:
_ I want to receive tube feeding.
_ I want tube feeding only as my physician recommends.
_ I DO NOT WANT tube feeding.
B. INITIAL ONE:
_ I want any other life support that may apply.
_ I want life support only as my physician recommends.
_ I want NO life support.
2. Permanently Unconscious. If I am unconscious and it is very
unlikely that I will ever become conscious again:
A. INITIAL ONE:
_ I want to receive tube feeding.
_ I want tube feeding only as my physician recommends.
_ I DO NOT WANT tube feeding.
B. INITIAL ONE:
_ I want any other life support that may apply.
_ I want life support only as my physician recommends.
_ I want NO life support.
3. Advanced Progressive Illness. If I have a progressive
illness that will be fatal and is in an advanced stage, and I am
consistently and permanently unable to communicate by any means,
swallow food and water safely, care for myself and recognize my
family and other people, and it is very unlikely that my
condition will substantially improve:
A. INITIAL ONE:
_ I want to receive tube feeding.
_ I want tube feeding only as my physician recommends.
_ I DO NOT WANT tube feeding.
B. INITIAL ONE:
_ I want any other life support that may apply.
_ I want life support only as my physician recommends.
_ I want NO life support.
4. Extraordinary Suffering. If life support would not help my
medical condition and would make me suffer permanent and severe
pain:
A. INITIAL ONE:
_ I want to receive tube feeding.
_ I want tube feeding only as my physician recommends.
_ I DO NOT WANT tube feeding.
B. INITIAL ONE:
_ I want any other life support that may apply.
_ I want life support only as my physician recommends.
_ I want NO life support.
5. General Instruction.
INITIAL IF THIS APPLIES:
_ I do not want my life to be prolonged by life support. I
also do not want tube feeding as life support. I want my
doctors to allow me to die naturally if my doctor and another
knowledgeable doctor confirm I am in any of the medical
conditions listed in Items 1 to 4 above.
6. Additional Conditions or Instructions.
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
(Insert description of what you want done.)
7. Other Documents. A 'health care power of attorney' is any
document you may have signed to appoint a representative to make
health care decisions for you.
INITIAL ONE:
_ I have previously signed a health care power of attorney. I
want it to remain in effect unless I appointed a health care
representative after signing the health care power of
attorney.
_ I have a health care power of attorney, and I REVOKE IT.
_ I DO NOT have a health care power of attorney.
__________
(Date)
SIGN HERE TO GIVE INSTRUCTIONS
__________________
(Signature)
_________________________________________________________________
PART D: DECLARATION OF WITNESSES
We declare that the person signing this advance directive:
(a) Is personally known to us or has provided proof of
identity;
(b) Signed or acknowledged that person's signature on this
advance directive in our presence;
(c) Appears to be of sound mind and not under duress, fraud or
undue influence;
(d) Has not appointed either of us as health care
representative or alternative representative; and
(e) Is not a patient for whom either of us is attending
physician.
Witnessed By:
____NOTE_TO_GOPHER_CUSTOMERS:__________________________________
THE FOLLOWING TABULAR TEXT MAY BE IRREGULAR.
FOR COMPLETE INFORMATION PLEASE SEE THE PRINTED MEASURE.
_______________________________________________________________
_______
_______
(Signature of (Printed Name
Witness/Date) of Witness)
_______
_______
(Signature of (Printed Name
Witness/Date of Witness)
____________________________________________________________
END OF POSSIBLE IRREGULAR TABULAR TEXT
____________________________________________________________
NOTE: One witness must not be a relative (by blood, marriage or
adoption) of the person signing this advance directive. That
witness must also not be entitled to any portion of the person's
estate upon death. That witness must also not own, operate or be
employed at a health care facility where the person is a patient
or resident.
_________________________________________________________________
PART E: ACCEPTANCE BY HEALTH CARE REPRESENTATIVE
I accept this appointment and agree to serve as health care
representative. I understand I must act consistently with the
desires of the person I represent, as expressed in this advance
directive or otherwise made known to me. If I do not know the
desires of the person I represent, I have a duty to act in what I
believe in good faith to be that person's best interest. I
understand that this document allows me to decide about that
person's health care only while that person cannot do so. I
understand that the person who appointed me may revoke this
appointment. If I learn that this document has been suspended or
revoked, I will inform the person's current health care provider
if known to me.
__________________
(Signature of Health Care Representative/Date)
__________________
(Printed name)
__________________
(Signature of Alternate Health Care Representative/Date)
__________________
(Printed name)
_________________________________________________________________
{ +
(3) Notwithstanding subsections (1) and (2) of this section, an
advance directive executed by an Oregon resident may be in the
form of the Five Wishes publication, as copyrighted by the
Commission on Aging with Dignity on the effective date of this
2001 Act. + }
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