Passed by the Senate March 10, 2003 YEAS 48   ________________________________________ President of the Senate Passed by the House April 14, 2003 YEAS 92   ________________________________________ Speaker of the House of Representatives | I, Milton H. Doumit, Jr., Secretary of the Senate of the State of Washington, do hereby certify that the attached is ENGROSSED SUBSTITUTE SENATE BILL 5223 as passed by the Senate and the House of Representatives on the dates hereon set forth. ________________________________________ Secretary | |
Approved ________________________________________ Governor of the State of Washington | Secretary of State State of Washington |
State of Washington | 58th Legislature | 2003 Regular Session |
READ FIRST TIME 02/19/03.
AN ACT Relating to mental health advance directives; amending RCW 11.94.010 and 7.70.065; reenacting and amending RCW 9.94A.515 and 9.94A.515; adding a new section to chapter 11.94 RCW; adding a new section to chapter 7.70 RCW; adding a new section to chapter 9A.60 RCW; adding a new chapter to Title 71 RCW; creating a new section; prescribing penalties; providing an effective date; and providing an expiration date.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
NEW SECTION. Sec. 1 (1) The legislature declares that an
individual with capacity has the ability to control decisions relating
to his or her own mental health care. The legislature finds that:
(a) Some mental illnesses cause individuals to fluctuate between
capacity and incapacity;
(b) During periods when an individual's capacity is unclear, the
individual may be unable to access needed treatment because the
individual may be unable to give informed consent;
(c) Early treatment may prevent an individual from becoming so ill
that involuntary treatment is necessary; and
(d) Mentally ill individuals need some method of expressing their
instructions and preferences for treatment and providing advance
consent to or refusal of treatment.
The legislature recognizes that a mental health advance directive
can be an essential tool for an individual to express his or her
choices at a time when the effects of mental illness have not deprived
him or her of the power to express his or her instructions or
preferences.
(2) The legislature further finds that:
(a) A mental health advance directive must provide the individual
with a full range of choices;
(b) Mentally ill individuals have varying perspectives on whether
they want to be able to revoke a directive during periods of
incapacity;
(c) For a mental health advance directive to be an effective tool,
individuals must be able to choose how they want their directives
treated during periods of incapacity; and
(d) There must be clear standards so that treatment providers can
readily discern an individual's treatment choices.
Consequently, the legislature affirms that, pursuant to other
provisions of law, a validly executed mental health advance directive
is to be respected by agents, guardians, and other surrogate decision
makers, health care providers, professional persons, and health care
facilities.
NEW SECTION. Sec. 2 The definitions in this section apply
throughout this chapter unless the context clearly requires otherwise.
(1) "Adult" means any individual who has attained the age of
majority or is an emancipated minor.
(2) "Agent" has the same meaning as an attorney-in-fact or agent as
provided in chapter 11.94 RCW.
(3) "Capacity" means that an adult has not been found to be
incapacitated pursuant to this chapter or RCW 11.88.010(1)(e).
(4) "Court" means a superior court under chapter 2.08 RCW.
(5) "Health care facility" means a hospital, as defined in RCW
70.41.020; an institution, as defined in RCW 71.12.455; a state
hospital, as defined in RCW 72.23.010; a nursing home, as defined in
RCW 18.51.010; or a clinic that is part of a community mental health
service delivery system, as defined in RCW 71.24.025.
(6) "Health care provider" means an osteopathic physician or
osteopathic physician's assistant licensed under chapter 18.57 or
18.57A RCW, a physician or physician's assistant licensed under chapter
18.71 or 18.71A RCW, or an advanced registered nurse practitioner
licensed under RCW 18.79.050.
(7) "Incapacitated" means an adult who: (a) Is unable to
understand the nature, character, and anticipated results of proposed
treatment or alternatives; understand the recognized serious possible
risks, complications, and anticipated benefits in treatments and
alternatives, including nontreatment; or communicate his or her
understanding or treatment decisions; or (b) has been found to be
incompetent pursuant to RCW 11.88.010(1)(e).
(8) "Informed consent" means consent that is given after the
person: (a) Is provided with a description of the nature, character,
and anticipated results of proposed treatments and alternatives, and
the recognized serious possible risks, complications, and anticipated
benefits in the treatments and alternatives, including nontreatment, in
language that the person can reasonably be expected to understand; or
(b) elects not to be given the information included in (a) of this
subsection.
(9) "Long-term care facility" has the same meaning as defined in
RCW 43.190.020.
(10) "Mental disorder" means any organic, mental, or emotional
impairment which has substantial adverse effects on an individual's
cognitive or volitional functions.
(11) "Mental health advance directive" or "directive" means a
written document in which the principal makes a declaration of
instructions or preferences or appoints an agent to make decisions on
behalf of the principal regarding the principal's mental health
treatment, or both, and that is consistent with the provisions of this
chapter.
(12) "Mental health professional" means a psychiatrist,
psychologist, psychiatric nurse, or social worker, and such other
mental health professionals as may be defined by rules adopted by the
secretary pursuant to the provisions of chapter 71.05 RCW.
(13) "Principal" means an adult who has executed a mental health
advance directive.
(14) "Professional person" means a mental health professional and
shall also mean a physician, registered nurse, and such others as may
be defined by rules adopted by the secretary pursuant to the provisions
of chapter 71.05 RCW.
NEW SECTION. Sec. 3 (1) The definition of informed consent is to
be construed to be consistent with that term as it is used in chapter
7.70 RCW.
(2) The definitions of mental disorder, mental health professional,
and professional person are to be construed to be consistent with those
terms as they are defined in RCW 71.05.020.
NEW SECTION. Sec. 4 For the purposes of this chapter, an adult
is presumed to have capacity.
NEW SECTION. Sec. 5 (1) An adult with capacity may execute a
mental health advance directive.
(2) A directive executed in accordance with this chapter is
presumed to be valid. The inability to honor one or more provisions of
a directive does not affect the validity of the remaining provisions.
(3) A directive may include any provision relating to mental health
treatment or the care of the principal or the principal's personal
affairs. Without limitation, a directive may include:
(a) The principal's preferences and instructions for mental health
treatment;
(b) Consent to specific types of mental health treatment;
(c) Refusal to consent to specific types of mental health
treatment;
(d) Consent to admission to and retention in a facility for mental
health treatment for up to fourteen days;
(e) Descriptions of situations that may cause the principal to
experience a mental health crisis;
(f) Suggested alternative responses that may supplement or be in
lieu of direct mental health treatment, such as treatment approaches
from other providers;
(g) Appointment of an agent pursuant to chapter 11.94 RCW to make
mental health treatment decisions on the principal's behalf, including
authorizing the agent to provide consent on the principal's behalf to
voluntary admission to inpatient mental health treatment; and
(h) The principal's nomination of a guardian or limited guardian as
provided in RCW 11.94.010 for consideration by the court if
guardianship proceedings are commenced.
(4) A directive may be combined with or be independent of a
nomination of a guardian or other durable power of attorney under
chapter 11.94 RCW, so long as the processes for each are executed in
accordance with its own statutes.
NEW SECTION. Sec. 6 (1) A directive shall:
(a) Be in writing;
(b) Contain language that clearly indicates that the principal
intends to create a directive;
(c) Be dated and signed by the principal or at the principal's
direction in the principal's presence if the principal is unable to
sign;
(d) Designate whether the principal wishes to be able to revoke the
directive during any period of incapacity or wishes to be unable to
revoke the directive during any period of incapacity; and
(e) Be witnessed in writing by at least two adults, each of whom
shall declare that he or she personally knows the principal, was
present when the principal dated and signed the directive, and that the
principal did not appear to be incapacitated or acting under fraud,
undue influence, or duress.
(2) A directive that includes the appointment of an agent under
chapter 11.94 RCW shall contain the words "This power of attorney shall
not be affected by the incapacity of the principal," or "This power of
attorney shall become effective upon the incapacity of the principal,"
or similar words showing the principal's intent that the authority
conferred shall be exercisable notwithstanding the principal's
incapacity.
(3) A directive is valid upon execution, but all or part of the
directive may take effect at a later time as designated by the
principal in the directive.
(4) A directive may:
(a) Be revoked, in whole or in part, pursuant to the provisions of
section 8 of this act; or
(b) Expire under its own terms.
NEW SECTION. Sec. 7 A directive may not:
(1) Create an entitlement to mental health or medical treatment or
supersede a determination of medical necessity;
(2) Obligate any health care provider, professional person, or
health care facility to pay the costs associated with the treatment
requested;
(3) Obligate any health care provider, professional person, or
health care facility to be responsible for the nontreatment personal
care of the principal or the principal's personal affairs outside the
scope of services the facility normally provides;
(4) Replace or supersede the provisions of any will or testamentary
document or supersede the provisions of intestate succession;
(5) Be revoked by an incapacitated principal unless that principal
selected the option to permit revocation while incapacitated at the
time his or her directive was executed; or
(6) Be used as the authority for inpatient admission for more than
fourteen days in any twenty-one day period.
NEW SECTION. Sec. 8 (1)(a) A principal with capacity may, by
written statement by the principal or at the principal's direction in
the principal's presence, revoke a directive in whole or in part.
(b) An incapacitated principal may revoke a directive only if he or
she elected at the time of executing the directive to be able to revoke
when incapacitated.
(2) The revocation need not follow any specific form so long as it
is written and the intent of the principal can be discerned.
(3) The principal shall provide a copy of his or her written
statement of revocation to his or her agent, if any, and to each health
care provider, professional person, or health care facility that
received a copy of the directive from the principal.
(4) The written statement of revocation is effective:
(a) As to a health care provider, professional person, or health
care facility, upon receipt. The professional person, health care
provider, or health care facility, or persons acting under their
direction shall make the statement of revocation part of the
principal's medical record; and
(b) As to the principal's agent, upon receipt. The principal's
agent shall notify the principal's health care provider, professional
person, or health care facility of the revocation and provide them with
a copy of the written statement of revocation.
(5) A directive also may:
(a) Be revoked, in whole or in part, expressly or to the extent of
any inconsistency, by a subsequent directive; or
(b) Be superseded or revoked by a court order, including any order
entered in a criminal matter. A directive may be superseded by a court
order regardless of whether the order contains an explicit reference to
the directive. To the extent a directive is not in conflict with a
court order, the directive remains effective, subject to the provisions
of section 15 of this act. A directive shall not be interpreted in a
manner that interferes with: (i) Incarceration or detention by the
department of corrections, in a city or county jail, or by the
department of social and health services; or (ii) treatment of a
principal who is subject to involuntary treatment pursuant to chapter
10.77, 70.96A, 71.05, 71.09, or 71.34 RCW.
(6) A directive that would have otherwise expired but is effective
because the principal is incapacitated remains effective until the
principal is no longer incapacitated unless the principal has elected
to be able to revoke while incapacitated and has revoked the directive.
(7) When a principal with capacity consents to treatment that
differs from, or refuses treatment consented to in, the provisions of
his or her directive, the consent or refusal constitutes a waiver of
that provision and does not constitute a revocation of the provision or
directive unless the principal also revokes the directive or provision.
NEW SECTION. Sec. 9 A witness may not be any of the following:
(1) A person designated to make health care decisions on the
principal's behalf;
(2) A health care provider or professional person directly involved
with the provision of care to the principal at the time the directive
is executed;
(3) An owner, operator, employee, or relative of an owner or
operator of a health care facility or long-term care facility in which
the principal is a patient or resident;
(4) A person who is related by blood, marriage, or adoption to the
person or with whom the principal has a dating relationship, as defined
in RCW 26.50.010;
(5) A person who is declared to be an incapacitated person; or
(6) A person who would benefit financially if the principal making
the directive undergoes mental health treatment.
NEW SECTION. Sec. 10 (1) If a directive authorizes the
appointment of an agent, the provisions of chapter 11.94 RCW and RCW
7.70.065 shall apply unless otherwise stated in this chapter.
(2) The principal who appoints an agent must notify the agent in
writing of the appointment.
(3) An agent must act in good faith.
(4) An agent may make decisions on behalf of the principal. Unless
the principal has revoked the directive, the decisions must be
consistent with the instructions and preferences the principal has
expressed in the directive, or if not expressed, as otherwise known to
the agent. If the principal's instructions or preferences are not
known, the agent shall make a decision he or she determines is in the
best interest of the principal.
(5) Except to the extent the right is limited by the appointment or
any federal or state law, the agent has the same right as the principal
to receive, review, and authorize the use and disclosure of the
principal's health care information when the agent is acting on behalf
of the principal and to the extent required for the agent to carry out
his or her duties. This subsection shall be construed to be consistent
with chapters 70.02, 70.24, 70.96A, 71.05, and 71.34 RCW, and with
federal law regarding health care information.
(6) Unless otherwise provided in the appointment and agreed to in
writing by the agent, the agent is not, as a result of acting in the
capacity of agent, personally liable for the cost of treatment provided
to the principal.
(7) An agent may resign or withdraw at any time by giving written
notice to the principal. The agent must also give written notice to
any health care provider, professional person, or health care facility
providing treatment to the principal. The resignation or withdrawal is
effective upon receipt unless otherwise specified in the resignation or
withdrawal.
(8) If the directive gives the agent authority to act while the
principal has capacity, the decisions of the principal supersede those
of the agent at any time the principal has capacity.
(9) Unless otherwise provided in the durable power of attorney, the
principal may revoke the agent's appointment as provided under other
state law.
NEW SECTION. Sec. 11 (1) For the purposes of this chapter, a
principal, agent, professional person, or health care provider may seek
a determination whether the principal is incapacitated or has regained
capacity.
(2)(a) For the purposes of this chapter, no adult may be declared
an incapacitated person except by:
(i) A court, if the request is made by the principal or the
principal's agent;
(ii) One mental health professional and one health care provider;
or
(iii) Two health care providers.
(b) One of the persons making the determination under (a)(ii) or
(iii) of this subsection must be a psychiatrist, psychologist, or a
psychiatric advanced registered nurse practitioner.
(3) When a professional person or health care provider requests a
capacity determination, he or she shall promptly inform the principal
that:
(a) A request for capacity determination has been made; and
(b) The principal may request that the determination be made by a
court.
(4) At least one mental health professional or health care provider
must personally examine the principal prior to making a capacity
determination.
(5)(a) When a court makes a determination whether a principal has
capacity, the court shall, at a minimum, be informed by the testimony
of one mental health professional familiar with the principal and
shall, except for good cause, give the principal an opportunity to
appear in court prior to the court making its determination.
(b) To the extent that local court rules permit, any party or
witness may testify telephonically.
(6) When a court has made a determination regarding a principal's
capacity and there is a subsequent change in the principal's condition,
subsequent determinations whether the principal is incapacitated may be
made in accordance with any of the provisions of subsection (2) of this
section.
NEW SECTION. Sec. 12 A principal may bring an action to contest
the validity of his or her directive. If an action under this section
is commenced while an action to determine the principal's capacity is
pending, the court shall consolidate the actions and decide the issues
simultaneously.
NEW SECTION. Sec. 13 (1) An initial determination of capacity
must be completed within forty-eight hours of a request made by a
person authorized in section 11 of this act. During the period between
the request for an initial determination of the principal's capacity
and completion of that determination, the principal may not be treated
unless he or she consents at the time or treatment is otherwise
authorized by state or federal law.
(2)(a)(i) When an incapacitated principal is admitted to inpatient
treatment pursuant to the provisions of his or her directive, his or
her capacity must be reevaluated within seventy-two hours or when there
has been a change in the principal's condition that indicates that he
or she appears to have regained capacity, whichever occurs first.
(ii) When an incapacitated principal has been admitted to and
remains in inpatient treatment for more than seventy-two hours pursuant
to the provisions of his or her directive, the principal's capacity
must be reevaluated when there has been a change in his or her
condition that indicates that he or she appears to have regained
capacity.
(iii) When a principal who is being treated on an inpatient basis
and has been determined to be incapacitated requests, or his or her
agent requests, a redetermination of the principal's capacity the
redetermination must be made within seventy-two hours.
(b) When a principal who has been determined to be incapacitated is
being treated on an outpatient basis and there is a request for a
redetermination of his or her capacity, the redetermination must be
made within five days of the first request following a determination.
(3)(a) When a principal who has appointed an agent for mental
health treatment decisions requests a determination or redetermination
of capacity, the agent must make reasonable efforts to obtain the
determination or redetermination.
(b) When a principal who does not have an agent for mental health
treatment decisions is being treated in an inpatient facility and
requests a determination or redetermination of capacity, the mental
health professional or health care provider must complete the
determination or, if the principal is seeking a determination from a
court, must make reasonable efforts to notify the person authorized to
make decisions for the principal under RCW 7.70.065 of the principal's
request.
(c) When a principal who does not have an agent for mental health
treatment decisions is being treated on an outpatient basis, the person
requesting a capacity determination must arrange for the determination.
(4) If no determination has been made within the time frames
established in subsection (1) or (2) of this section, the principal
shall be considered to have capacity.
(5) When an incapacitated principal is being treated pursuant to
his or her directive, a request for a redetermination of capacity does
not prevent treatment.
NEW SECTION. Sec. 14 (1) A principal who:
(a) Chose not to be able to revoke his or her directive during any
period of incapacity;
(b) Consented to voluntary admission to inpatient mental health
treatment, or authorized an agent to consent on the principal's behalf;
and
(c) At the time of admission to inpatient treatment, refuses to be
admitted,
may only be admitted into inpatient mental health treatment under
subsection (2) of this section.
(2) A principal may only be admitted to inpatient mental health
treatment under his or her directive if, prior to admission, a
physician member of the treating facility's professional staff:
(a) Evaluates the principal's mental condition, including a review
of reasonably available psychiatric and psychological history,
diagnosis, and treatment needs, and determines, in conjunction with
another health care provider or mental health professional, that the
principal is incapacitated;
(b) Obtains the informed consent of the agent, if any, designated
in the directive;
(c) Makes a written determination that the principal needs an
inpatient evaluation or is in need of inpatient treatment and that the
evaluation or treatment cannot be accomplished in a less restrictive
setting; and
(d) Documents in the principal's medical record a summary of the
physician's findings and recommendations for treatment or evaluation.
(3) In the event the admitting physician is not a psychiatrist, the
principal shall receive a complete psychological assessment by a mental
health professional within twenty-four hours of admission to determine
the continued need for inpatient evaluation or treatment.
(4)(a) If it is determined that the principal has capacity, then
the principal may only be admitted to, or remain in, inpatient
treatment if he or she consents at the time or is detained under the
involuntary treatment provisions of chapter 70.96A, 71.05, or 71.34
RCW.
(b) If a principal who is determined by two health care providers
or one mental health professional and one health care provider to be
incapacitated continues to refuse inpatient treatment, the principal
may immediately seek injunctive relief for release from the facility.
(5) If, at the end of the period of time that the principal or the
principal's agent, if any, has consented to voluntary inpatient
treatment, but no more than fourteen days after admission, the
principal has not regained capacity or has regained capacity but
refuses to consent to remain for additional treatment, the principal
must be released during reasonable daylight hours, unless detained
under chapter 70.96A, 71.05, or 71.34 RCW.
(6)(a) Except as provided in (b) of this subsection, any principal
who is voluntarily admitted to inpatient mental health treatment under
this chapter shall have all the rights provided to individuals who are
voluntarily admitted to inpatient treatment under chapter 71.05, 71.34,
or 72.23 RCW.
(b) Notwithstanding RCW 71.05.050 regarding consent to inpatient
treatment for a specified length of time, the choices an incapacitated
principal expressed in his or her directive shall control, provided,
however, that a principal who takes action demonstrating a desire to be
discharged, in addition to making statements requesting to be
discharged, shall be discharged, and no principal shall be restrained
in any way in order to prevent his or her discharge.
(7) Consent to inpatient admission in a directive is effective only
while the professional person, health care provider, and health care
facility are in substantial compliance with the material provisions of
the directive related to inpatient treatment.
NEW SECTION. Sec. 15 (1) Upon receiving a directive, a health
care provider, professional person, or health care facility providing
treatment to the principal, or persons acting under the direction of
the health care provider, professional person, or health care facility,
shall make the directive a part of the principal's medical record and
shall be deemed to have actual knowledge of the directive's contents.
(2) When acting under authority of a directive, a health care
provider, professional person, or health care facility shall act in
accordance with the provisions of the directive to the fullest extent
possible, unless in the determination of the health care provider,
professional person, or health care facility:
(a) Compliance with the provision would violate the accepted
standard of care established in RCW 7.70.040;
(b) The requested treatment is not available;
(c) Compliance with the provision would violate applicable law; or
(d) It is an emergency situation and compliance would endanger any
person's life or health.
(3)(a) In the case of a principal committed or detained under the
involuntary treatment provisions of chapter 10.77, 70.96A, 71.05,
71.09, or 71.34 RCW, those provisions of a principal's directive that,
in the determination of the health care provider, professional person,
or health care facility, are inconsistent with the purpose of the
commitment or with any order of the court relating to the commitment
are invalid during the commitment.
(b) Remaining provisions of a principal's directive are advisory
while the principal is committed or detained.
The treatment provider is encouraged to follow the remaining
provisions of the directive, except as provided in (a) of this
subsection or subsection (2) of this section.
(4) In the case of a principal who is incarcerated or committed in
a state or local correctional facility, provisions of the principal's
directive that are inconsistent with reasonable penological objectives
or administrative hearings regarding involuntary medication are invalid
during the period of incarceration or commitment. In addition,
treatment may be given despite refusal of the principal or the
provisions of the directive: (a) For any reason under subsection (2)
of this section; or (b) if, without the benefit of the specific
treatment measure, there is a significant possibility that the person
will harm self or others before an improvement of the person's
condition occurs.
(5)(a) If the health care provider, professional person, or health
care facility is, at the time of receiving the directive, unable or
unwilling to comply with any part or parts of the directive for any
reason, the health care provider, professional person, or health care
facility shall promptly notify the principal and, if applicable, his or
her agent and shall document the reason in the principal's medical
record.
(b) If the health care provider, professional person, or health
care facility is acting under authority of a directive and is unable to
comply with any part or parts of the directive for the reasons listed
in subsection (2) or (3) of this section, the health care provider,
professional person, or health care facility shall promptly notify the
principal and if applicable, his or her agent, and shall document the
reason in the principal's medical record.
(6) In the event that one or more parts of the directive are not
followed because of one or more of the reasons set forth in subsection
(2) or (4) of this section, all other parts of the directive shall be
followed.
(7) If no provider-patient relationship has previously been
established, nothing in this chapter requires the establishment of a
provider-patient relationship.
NEW SECTION. Sec. 16 Where a principal consents in a directive
to electroconvulsive therapy, the health care provider, professional
person, or health care facility, or persons acting under the direction
of the health care provider, professional person, or health care
facility, shall document the therapy and the reason it was used in the
principal's medical record.
NEW SECTION. Sec. 17 (1) For the purposes of this section,
"provider" means a private or public agency, government entity, health
care provider, professional person, health care facility, or person
acting under the direction of a health care provider or professional
person, health care facility, or long-term care facility.
(2) A provider is not subject to civil liability or sanctions for
unprofessional conduct under the uniform disciplinary act, chapter
18.130 RCW, when in good faith and without negligence:
(a) The provider provides treatment to a principal in the absence
of actual knowledge of the existence of a directive, or provides
treatment pursuant to a directive in the absence of actual knowledge of
the revocation of the directive;
(b) A health care provider or mental health professional determines
that the principal is or is not incapacitated for the purpose of
deciding whether to proceed according to a directive, and acts upon
that determination;
(c) The provider administers or does not administer mental health
treatment according to the principal's directive in good faith reliance
upon the validity of the directive and the directive is subsequently
found to be invalid;
(d) The provider does not provide treatment according to the
directive for one of the reasons authorized under section 15 of this
act; or
(e) The provider provides treatment according to the principal's
directive.
NEW SECTION. Sec. 18 (1) Where an incapacitated principal has
executed more than one valid directive and has not revoked any of the
directives:
(a) The directive most recently created shall be treated as the
principal's mental health treatment preferences and instructions as to
any inconsistent or conflicting provisions, unless provided otherwise
in either document.
(b) Where a directive executed under this chapter is inconsistent
with a directive executed under any other chapter, the most recently
created directive controls as to the inconsistent provisions.
(2) Where an incapacitated principal has appointed more than one
agent under chapter ll.94 RCW with authority to make mental health
treatment decisions, RCW 11.94.010 controls.
(3) The treatment provider shall inquire of a principal whether the
principal is subject to any court orders that would affect the
implementation of his or her directive.
NEW SECTION. Sec. 19 (1) Directives validly executed before the
effective date of this section shall be given full force and effect
until revoked, superseded, or expired.
(2) A directive validly executed in another political jurisdiction
is valid to the extent permitted by Washington state law.
NEW SECTION. Sec. 20 Any person with reasonable cause to believe
that a directive has been created or revoked under circumstances
amounting to fraud, duress, or undue influence may petition the court
for appointment of a guardian for the person or to review the actions
of the agent or person alleged to be involved in improper conduct under
RCW 11.94.090 or 74.34.110.
NEW SECTION. Sec. 21 The fact that
a person has executed a
directive does not constitute an indication of mental disorder or that
the person is not capable of providing informed consent.
NEW SECTION. Sec. 22 A person shall not be required to execute
or to refrain from executing a directive, nor shall the existence of a
directive be used as a criterion for insurance, as a condition for
receiving mental or physical health services, or as a condition of
admission to or discharge from a health care facility or long-term care
facility.
NEW SECTION. Sec. 23 No person or health care facility may use
or threaten abuse, neglect, financial exploitation, or abandonment of
the principal, as those terms are defined in RCW 74.34.020, to carry
out the directive.
NEW SECTION. Sec. 24 A directive does not limit any authority
otherwise provided in Title 10, 70, or 71 RCW, or any other applicable
state or federal laws to detain a person, take a person into custody,
or to admit, retain, or treat a person in a health care facility.
NEW SECTION. Sec. 25 (1) If a principal who is a resident of a
long-term care facility is admitted to inpatient mental health
treatment pursuant to his or her directive, the principal shall be
allowed to be readmitted to the same long-term care facility as if his
or her inpatient admission had been for a physical condition on the
same basis that the principal would be readmitted under state or
federal statute or rule when:
(a) The treating facility's professional staff determine that
inpatient mental health treatment is no longer medically necessary for
the resident. The determination shall be made in writing by a
psychiatrist or by a mental health professional and a physician; or
(b) The person's consent to admission in his or her directive has
expired.
(2)(a) If the long-term care facility does not have a bed available
at the time of discharge, the treating facility may discharge the
resident, in consultation with the resident and agent if any, and in
accordance with a medically appropriate discharge plan, to another
long-term care facility.
(b) This section shall apply to inpatient mental health treatment
admission of long-term care facility residents, regardless of whether
the admission is directly from a facility, hospital emergency room, or
other location.
(c) This section does not restrict the right of the resident to an
earlier release from the inpatient treatment facility. This section
does not restrict the right of a long-term care facility to initiate
transfer or discharge of a resident who is readmitted pursuant to this
section, provided that the facility has complied with the laws
governing the transfer or discharge of a resident.
(3) The joint legislative audit and review committee shall conduct
an evaluation of the operation and impact of this section. The
committee shall report its findings to the appropriate committees of
the legislature by December 1, 2004.
NEW SECTION. Sec. 26 The directive shall be in substantially the
following form:
Mental Health Advance Directive | |
NOTICE TO PERSONS CREATING A MENTAL HEALTH ADVANCE DIRECTIVE | |
This is an important legal document. It creates an advance directive for mental health treatment. Before signing this document you should know these important facts: | |
YOU DO NOT HAVE TO FILL OUT OR SIGN THIS FORM. IF YOU DO NOT SIGN THIS FORM, IT WILL NOT TAKE EFFECT. | |
If you choose to complete and sign this document, you may still decide to leave some items blank. | |
YOU MAY NOT REVOKE THIS DIRECTIVE WHEN YOU HAVE BEEN FOUND TO BE INCAPACITATED UNLESS YOU HAVE SPECIFICALLY STATED IN THIS DIRECTIVE THAT YOU WANT IT TO BE REVOCABLE WHEN YOU ARE INCAPACITATED. | |
PART I. STATEMENT OF INTENT TO CREATE A MENTAL HEALTH ADVANCE DIRECTIVE | |
I, . . . . . . . . . . being a person with capacity, willfully and voluntarily execute this mental health advance directive so that my choices regarding my mental health care will be carried out in circumstances when I am unable to express my instructions and preferences regarding my mental health care. If a guardian is appointed by a court to make mental health decisions for me, I intend this document to take precedence over all other means of ascertaining my intent. | |
The fact that I may have left blanks in this directive does not affect its validity in any way. I intend that all completed sections be followed. If I have not expressed a choice, my agent should make the decision that he or she determines is in my best interest. I intend this directive to take precedence over any other directives I have previously executed, to the extent that they are inconsistent with this document, or unless I expressly state otherwise in either document. | |
I understand that I may revoke this directive in whole or in part if I am a person with capacity. I understand that I cannot revoke this directive if a court, two health care providers, or one mental health professional and one health care provider find that I am an incapacitated person, unless, when I executed this directive, I chose to be able to revoke this directive while incapacitated. | |
I understand that, except as otherwise provided in law, revocation must be in writing. I understand that nothing in this directive, or in my refusal of treatment to which I consent in this directive, authorizes any health care provider, professional person, health care facility, or agent appointed in this directive to use or threaten to use abuse, neglect, financial exploitation, or abandonment to carry out my directive. | |
I understand that there are some circumstances where my provider may not have to follow my directive. | |
PART II. WHEN THIS DIRECTIVE IS EFFECTIVE | |
YOU MUST COMPLETE THIS PART FOR YOUR DIRECTIVE TO BE VALID. | |
I intend that this directive become effective (YOU MUST CHOOSE ONLY ONE): | |
. . . . . . Immediately upon my signing of this directive. | |
. . . . . . If I become incapacitated. | |
. . . . . . When the following circumstances, symptoms, or behaviors occur: . . . . . . . . . . . . | |
. . . . . . . . . . . . | |
. . . . . . . . . . . . | |
PART III. DURATION OF THIS DIRECTIVE | |
YOU MUST COMPLETE THIS PART FOR YOUR DIRECTIVE TO BE VALID. | |
I want this directive to (YOU MUST CHOOSE ONLY ONE): | |
. . . . . . Remain valid and in effect for an indefinite period of time. | |
. . . . . . Automatically expire . . . . . . years from the date it was created. | |
PART IV. WHEN I MAY REVOKE THIS DIRECTIVE | |
YOU MUST COMPLETE THIS PART FOR THIS DIRECTIVE TO BE VALID. | |
I intend that I be able to revoke this directive (YOU MUST CHOOSE ONLY ONE): | |
. . . . . . Only when I have capacity. | |
. . . . . . Even if I am incapacitated. | |
PART V. PREFERENCES AND INSTRUCTIONS ABOUT TREATMENT, FACILITIES, AND PHYSICIANS | |
A. Preferences and Instructions About Physician(s) to be Involved in My Treatment | |
I would like the physician(s) named below to be involved in my treatment decisions: Dr. . . . . . . . . . . . . . . . . Contact information: . . . . . . . . . . . . Dr. . . . . . . . . . . . . . . . . Contact information: . . . . . . . . . . . . | |
I do not wish to be treated by Dr. . . . . . . . . . . . . | |
B. Preferences and Instructions About Other Providers | |
I am receiving other treatment or care from providers who I feel have an impact on my mental health care. I would like the following treatment provider(s) to be contacted when this directive is effective: | |
Name . . . . . . . . . . . . . . . . . . . . Profession . . . . . . . . . . . . . . . . . . . . Contact information . . . . . . . . . . . . | |
Name . . . . . . . . . . . . . . . . . . . . Profession . . . . . . . . . . . . . . . . . . . . Contact information . . . . . . . . . . . . | |
C. Preferences and Instructions About Medications for Psychiatric Treatment (initial and complete all that apply) | |
. . . . . . I consent, and authorize my agent (if appointed) to consent, to the following medications: . . . . . . . . . . . . | |
. . . . . . I do not consent, and I do not authorize my agent (if appointed) to consent, to the administration of the following medications: . . . . . . . . . . . . | |
. . . . . . I am willing to take the medications excluded above if my only reason for excluding them is the side effects
which include . . . . . . . . . . . . and these side effects can be eliminated by dosage adjustment or other means | |
. . . . . . I am willing to try any other medication the hospital doctor recommends | |
. . . . . . I am willing to try any other medications my outpatient doctor recommends | |
. . . . . . I do not want to try any other medications. | |
Medication Allergies | |
I have allergies to, or severe side effects from, the following: . . . . . . . . . . . . . . . . . . . . . . . . | |
Other Medication Preferences or Instructions | |
. . . . . . I have the following other preferences or instructions about medications . . . . . . . . . . . . . . . . . . . . . . . . | |
D. Preferences and Instructions About Hospitalization and Alternatives (initial all that apply and, if desired, rank "1" for first choice, "2" for second choice, and so on) | |
. . . . . . In the event my psychiatric condition is serious enough to require 24-hour care and I have no physical conditions that require immediate access to emergency medical care, I prefer to receive this care in programs/facilities designed as alternatives to psychiatric hospitalizations. | |
. . . . . . I would also like the interventions below to be tried before hospitalization is considered: | |
. . . . . . Calling someone or having someone call me when needed. | |
Name: . . . . . . . . . . . . | Telephone: . . . . . . . . . . . . |
. . . . . . Staying overnight with someone | |
Name: . . . . . . . . . . . . | Telephone: . . . . . . . . . . . . |
. . . . . . Having a mental health service provider come to see me | |
. . . . . . Going to a crisis triage center or emergency room | |
. . . . . . Staying overnight at a crisis respite (temporary) bed | |
. . . . . . Seeing a service provider for help with psychiatric medications | |
. . . . . . Other, specify: . . . . . . . . . . . . | |
Authority to Consent to Inpatient Treatment | |
I consent, and authorize my agent (if appointed) to consent, to voluntary admission to inpatient mental health treatment for . . . . . . days (not to exceed 14 days) | |
(Sign one): | |
. . . . . . If deemed appropriate by my agent (if appointed) and treating physician | |
. . . . . . . . . . . . (Signature) | |
or | |
. . . . . . Under the following circumstances (specify symptoms, behaviors, or circumstances that indicate the need for hospitalization) . . . . . . . . . . . . | |
. . . . . . . . . . . . (Signature) | |
. . . . . . I do not consent, or authorize my agent (if appointed) to consent, to inpatient treatment | |
. . . . . . . . . . . . (Signature) | |
Hospital Preferences and Instructions | |
If hospitalization is required, I prefer the following hospitals: . . . . . . . . . . . . | |
I do not consent to be admitted to the following hospitals: . . . . . . . . . . . . | |
E. Preferences and Instructions About Preemergency | |
I would like the interventions below to be tried before use of seclusion or restraint is considered (initial all that apply): | |
. . . . . . "Talk me down" one-on-one | |
. . . . . . More medication | |
. . . . . . Time out/privacy | |
. . . . . . Show of authority/force | |
. . . . . . Shift my attention to something else | |
. . . . . . Set firm limits on my behavior | |
. . . . . . Help me to discuss/vent feelings | |
. . . . . . Decrease stimulation | |
. . . . . . Offer to have neutral person settle dispute | |
. . . . . . Other, specify . . . . . . . . . . . . | |
F. Preferences and Instructions About Seclusion, Restraint, and Emergency Medications | |
If it is determined that I am engaging in behavior that requires seclusion, physical restraint, and/or emergency use of medication, I prefer these interventions in the order I have chosen (choose "1" for first choice, "2" for second choice, and so on): | |
. . . . . . Seclusion | |
. . . . . . Seclusion and physical restraint (combined) | |
. . . . . . Medication by injection | |
. . . . . . Medication in pill or liquid form | |
In the event that my attending physician decides to use medication in response to an emergency situation after due consideration of my preferences and instructions for emergency treatments stated above, I expect the choice of medication to reflect any preferences and instructions I have expressed in Part III C of this form. The preferences and instructions I express in this section regarding medication in emergency situations do not constitute consent to use of the medication for nonemergency treatment. | |
G. Preferences and Instructions About Electroconvulsive Therapy (ECT or Shock Therapy) | |
My wishes regarding electroconvulsive therapy are (sign one): | |
. . . . . . I do not consent, nor authorize my agent (if appointed) to consent, to the administration of electroconvulsive therapy | |
. . . . . . . . . . . . (Signature) | |
. . . . . . I consent, and authorize my agent (if appointed) to consent, to the administration of electroconvulsive therapy | |
. . . . . . . . . . . . (Signature) | |
. . . . . . I consent, and authorize my agent (if appointed) to consent, to the administration of electroconvulsive therapy, but only under the following conditions: . . . . . . . . . . . . | |
. . . . . . . . . . . . | |
. . . . . . . . . . . . (Signature) | |
H. Preferences and Instructions About Who is Permitted to Visit | |
If I have been admitted to a mental health treatment facility, the following people are not permitted to visit me there: | |
Name: . . . . . . . . . . . . | |
Name: . . . . . . . . . . . . | |
Name: . . . . . . . . . . . . | |
I understand that persons not listed above may be permitted to visit me. | |
I. Additional Instructions About My Mental Health Care | |
Other instructions about my mental health care: . . . . . . . . . . . . | |
. . . . . . . . . . . . | |
In case of emergency, please contact: | |
Name: . . . . . . . . . . . . | Address: . . . . . . . . . . . . |
Work telephone: . . . . . . . . . . . . | Home telephone: . . . . . . . . . . . . |
Physician: . . . . . . . . . . . . | Address: . . . . . . . . . . . . |
Telephone: . . . . . . . . . . . . | |
The following may help me to avoid a hospitalization: . . . . . . . . . . . . | |
. . . . . . . . . . . . | |
I generally react to being hospitalized as follows: . . . . . . . . . . . . | |
. . . . . . . . . . . . | |
Staff of the hospital or crisis unit can help me by doing the following: . . . . . . . . . . . . | |
. . . . . . . . . . . . | |
. . . . . . . . . . . . | |
J. Refusal of Treatment | |
I do not consent to any mental health treatment. | |
. . . . . . . . . . . . (Signature) | |
PART VI. DURABLE POWER OF ATTORNEY (APPOINTMENT OF MY AGENT) | |
(Fill out this part only if you wish to appoint an agent or nominate a guardian.) | |
I authorize an agent to make mental health treatment decisions on my behalf. The authority granted to my agent includes the right to consent, refuse consent, or withdraw consent to any mental health care, treatment, service, or procedure, consistent with any instructions and/or limitations I have set forth in this directive. I intend that those decisions should be made in accordance with my expressed wishes as set forth in this document. If I have not expressed a choice in this document and my agent does not otherwise know my wishes, I authorize my agent to make the decision that my agent determines is in my best interest. This agency shall not be affected by my incapacity. Unless I state otherwise in this durable power of attorney, I may revoke it unless prohibited by other state law. | |
A. Designation of an Agent | |
I appoint the following person as my agent to make mental health treatment decisions for me as authorized in this document and request that this person be notified immediately when this directive becomes effective: | |
Name: . . . . . . . . . . . . | Address: . . . . . . . . . . . . |
Work telephone: . . . . . . . . . . . . | Home telephone: . . . . . . . . . . . . |
Relationship: . . . . . . . . . . . . | |
B. Designation of Alternate Agent | |
If the person named above is unavailable, unable, or refuses to serve as my agent, or I revoke that person's authority to serve as my agent, I hereby appoint the following person as my alternate agent and request that this person be notified immediately when this directive becomes effective or when my original agent is no longer my agent: | |
Name: . . . . . . . . . . . . | Address: . . . . . . . . . . . . |
Work telephone: . . . . . . . . . . . . | Home telephone: . . . . . . . . . . . . |
Relationship: . . . . . . . . . . . . | |
C. When My Spouse is My Agent (initial if desired) | |
. . . . . . If my spouse is my agent, that person shall remain my agent even if we become legally separated or our marriage is dissolved, unless there is a court order to the contrary or I have remarried. | |
D. Limitations on My Agent's Authority | |
I do not grant my agent the authority to consent on my behalf to the following: | |
. . . . . . . . . . . . | |
. . . . . . . . . . . . | |
E. Limitations on My Ability to Revoke this Durable Power of Attorney | |
I choose to limit my ability to revoke this durable power of attorney as follows: | |
. . . . . . . . . . . . | |
. . . . . . . . . . . . | |
F. Preference as to Court-Appointed Guardian | |
In the event a court appoints a guardian who will make decisions regarding my mental health treatment, I nominate the following person as my guardian: | |
Name: . . . . . . . . . . . . | Address: . . . . . . . . . . . . |
Work telephone: . . . . . . . . . . . . | Home telephone: . . . . . . . . . . . . |
Relationship: . . . . . . . . . . . . | |
The appointment of a guardian of my estate or my person or any other decision maker shall not give the guardian or decision maker the power to revoke, suspend, or terminate this directive or the powers of my agent, except as authorized by law. | |
. . . . . . . . . . . . (Signature required if nomination is made) | |
PART VII. OTHER DOCUMENTS | |
(Initial all that apply) | |
I have executed the following documents that include the power to make decisions regarding health care services for myself: | |
. . . . . . Health care power of attorney (chapter 11.94 RCW) | |
. . . . . . "Living will" (Health care directive; chapter 70.122 RCW) | |
. . . . . . I have appointed more than one agent. I understand that the most recently appointed agent controls except as stated below: | |
. . . . . . . . . . . . | |
PART VIII. NOTIFICATION OF OTHERS AND CARE OF PERSONAL AFFAIRS | |
(Fill out this part only if you wish to provide nontreatment instructions.) | |
I understand the preferences and instructions in this part are NOT the responsibility of my treatment provider and that no treatment provider is required to act on them. | |
A. Who Should Be Notified | |
I desire my agent to notify the following individuals as soon as possible when this directive becomes effective: | |
Name: . . . . . . . . . . . . | Address: . . . . . . . . . . . . |
Day telephone: . . . . . . . . . . . . | Evening telephone: . . . . . . . . . . . . |
Name: . . . . . . . . . . . . | Address: . . . . . . . . . . . . |
Day telephone: . . . . . . . . . . . . | Evening telephone: . . . . . . . . . . . . |
B. Preferences or Instructions About Personal Affairs | |
I have the following preferences or instructions about my personal affairs (e.g., care of dependents, pets, household) if I am admitted to a mental health treatment facility: | |
. . . . . . . . . . . . | |
. . . . . . . . . . . . | |
C. Additional Preferences and Instructions: | |
. . . . . . . . . . . . | |
. . . . . . . . . . . . | |
. . . . . . . . . . . . | |
. . . . . . . . . . . . | |
PART IX. SIGNATURE | |
By signing here, I indicate that I understand the purpose and effect of this document and that I am giving my informed consent to the treatments and/or admission to which I have consented or authorized my agent to consent in this directive. I intend that my consent in this directive be construed as being consistent with the elements of informed consent under chapter 7.70 RCW. | |
Signature: . . . . . . . . . . . . | Date: . . . . . . . . . . . . |
Printed Name: . . . . . . . . . . . . | |
This directive was signed and declared by the "Principal," to be his or her directive, in our presence who, at his or her request, have signed our names below as witnesses. We declare that, at the time of the creation of this instrument, the Principal is personally known to us, and, according to our best knowledge and belief, has capacity at this time and does not appear to be acting under duress, undue influence, or fraud. We further declare that none of us is: | |
(A) A person designated to make medical decisions on the principal's behalf; | |
(B) A health care provider or professional person directly involved with the provision of care to the principal at the time the directive is executed; | |
(C) An owner, operator, employee, or relative of an owner or operator of a health care facility or long-term care facility in which the principal is a patient or resident; | |
(D) A person who is related by blood, marriage, or adoption to the person, or with whom the principal has a dating relationship as defined in RCW 26.50.010; | |
(E) An incapacitated person; | |
(F) A person who would benefit financially if the principal undergoes mental health treatment; or | |
(G) A minor. | |
Witness 1: Signature: . . . . . . . . . . . . | Date: . . . . . . . . . . . . |
Printed Name: . . . . . . . . . . . . | |
Telephone: . . . . . . . . . . . . | Address: . . . . . . . . . . . . |
Witness 2: Signature: . . . . . . . . . . . . | Date: . . . . . . . . . . . . |
Printed Name: . . . . . . . . . . . . | |
Telephone: . . . . . . . . . . . . | Address: . . . . . . . . . . . . |
PART X. RECORD OF DIRECTIVE | |
I have given a copy of this directive to the following persons: . . . . . . . . . . . . | |
. . . . . . . . . . . . | |
DO NOT FILL OUT PART XI UNLESS YOU INTEND TO REVOKE THIS DIRECTIVE IN PART OR IN WHOLE | |
PART XI. REVOCATION OF THIS DIRECTIVE | |
(Initial any that apply): | |
. . . . . . I am revoking the following part(s) of this directive (specify): . . . . . . . . . . . . | |
. . . . . . . . . . . . | |
. . . . . . I am revoking all of this directive. | |
By signing here, I indicate that I understand the purpose and effect of my revocation and that no person is bound by any revoked provision(s). I intend this revocation to be interpreted as if I had never completed the revoked provision(s). | |
Signature: . . . . . . . . . . . . | Date: . . . . . . . . . . . . |
Printed Name: . . . . . . . . . . . . | |
DO NOT SIGN THIS PART UNLESS YOU INTEND TO REVOKE THIS DIRECTIVE IN PART OR IN WHOLE |
Sec. 27 RCW 11.94.010 and 1995 c 297 s 9 are each amended to read
as follows:
(1) Whenever a principal designates another as his or her attorney
in fact or agent, by a power of attorney in writing, and the writing
contains the words "This power of attorney shall not be affected by
disability of the principal," or "This power of attorney shall become
effective upon the disability of the principal," or similar words
showing the intent of the principal that the authority conferred shall
be exercisable notwithstanding the principal's disability, the
authority of the attorney in fact or agent is exercisable on behalf of
the principal as provided notwithstanding later disability or
incapacity of the principal at law or later uncertainty as to whether
the principal is dead or alive. All acts done by the attorney in fact
or agent pursuant to the power during any period of disability or
incompetence or uncertainty as to whether the principal is dead or
alive have the same effect and inure to the benefit of and bind the
principal or the principal's guardian or heirs, devisees, and personal
representative as if the principal were alive, competent, and not
disabled. A principal may nominate, by a durable power of attorney,
the guardian or limited guardian of his or her estate or person for
consideration by the court if protective proceedings for the
principal's person or estate are thereafter commenced. The court shall
make its appointment in accordance with the principal's most recent
nomination in a durable power of attorney except for good cause or
disqualification. If a guardian thereafter is appointed for the
principal, the attorney in fact or agent, during the continuance of the
appointment, shall account to the guardian rather than the principal.
The guardian has the same power the principal would have had if the
principal were not disabled or incompetent, to revoke, suspend or
terminate all or any part of the power of attorney or agency.
(2) Persons shall place reasonable reliance on any determination of
disability or incompetence as provided in the instrument that specifies
the time and the circumstances under which the power of attorney
document becomes effective.
(3)(a) A principal may authorize his or her attorney-in-fact to
provide informed consent for health care decisions on the principal's
behalf. If a principal has appointed more than one agent with
authority to make mental health treatment decisions in accordance with
a directive under chapter 71.-- RCW (sections 1 through 26 of this
act), to the extent of any conflict, the most recently appointed agent
shall be treated as the principal's agent for mental health treatment
decisions unless provided otherwise in either appointment.
(b) Unless he or she is the spouse, or adult child or brother or
sister of the principal, none of the following persons may act as the
attorney-in-fact for the principal: Any of the principal's physicians,
the physicians' employees, or the owners, administrators, or employees
of the health care facility or long-term care facility as defined in
RCW 43.190.020 where the principal resides or receives care. Except
when the principal has consented in a mental health advance directive
executed under chapter 71.-- RCW (sections 1 through 26 of this act) to
inpatient admission or electroconvulsive therapy, this authorization is
subject to the same limitations as those that apply to a guardian under
RCW 11.92.043(5) (a) through (c).
NEW SECTION. Sec. 28 A new section is added to chapter 11.94 RCW
to read as follows:
No person appointed by a principal as an agent to make mental
health treatment decisions pursuant to a mental health advance
directive under chapter 71.-- RCW (sections 1 through 26 of this act)
shall be compensated for the performance of his or her duties as an
agent to make mental health treatment decisions. This section does not
prohibit an agent from receiving reimbursement for reasonable expenses
incurred in the performance of his or her duties under chapter 71.--
RCW (sections 1 through 26 of this act).
Sec. 29 RCW 7.70.065 and 1987 c 162 s 1 are each amended to read
as follows:
(1) Informed consent for health care for a patient who is not
competent, as defined in RCW 11.88.010(1)(((b))) (e), to consent may be
obtained from a person authorized to consent on behalf of such patient.
Persons authorized to provide informed consent to health care on behalf
of a patient who is not competent to consent shall be a member of one
of the following classes of persons in the following order of priority:
(a) The appointed guardian of the patient, if any;
(b) The individual, if any, to whom the patient has given a durable
power of attorney that encompasses the authority to make health care
decisions;
(c) The patient's spouse;
(d) Children of the patient who are at least eighteen years of age;
(e) Parents of the patient; and
(f) Adult brothers and sisters of the patient.
(2) If the physician seeking informed consent for proposed health
care of the patient who is not competent to consent makes reasonable
efforts to locate and secure authorization from a competent person in
the first or succeeding class and finds no such person available,
authorization may be given by any person in the next class in the order
of descending priority. However, no person under this section may
provide informed consent to health care:
(a) If a person of higher priority under this section has refused
to give such authorization; or
(b) If there are two or more individuals in the same class and the
decision is not unanimous among all available members of that class.
(3) Before any person authorized to provide informed consent on
behalf of a patient not competent to consent exercises that authority,
the person must first determine in good faith that that patient, if
competent, would consent to the proposed health care. If such a
determination cannot be made, the decision to consent to the proposed
health care may be made only after determining that the proposed health
care is in the patient's best interests.
NEW SECTION. Sec. 30 A new section is added to chapter 7.70 RCW
to read as follows:
Consent to treatment or admission contained in a validly executed
mental health advance directive constitutes informed consent for
purposes of this chapter.
NEW SECTION. Sec. 31 A new section is added to chapter 9A.60 RCW
to read as follows:
(1) For purposes of this section "mental health advance directive"
means a written document that is a "mental health advance directive" as
defined in section 2 of this act.
(2) A person is guilty of fraudulent creation or revocation of a
mental health advance directive if he or she knowingly:
(a) Makes, completes, alters, or revokes the mental health advance
directive of another without the principal's consent;
(b) Utters, offers, or puts off as true a mental health advance
directive that he or she knows to be forged; or
(c) Obtains or prevents the signature of a principal or witness to
a mental health advance directive by deception or duress.
(3) Fraudulent creation or revocation of a mental health advance
directive is a class C felony.
Sec. 32 RCW 9.94A.515 and 2002 c 340 s 2, 2002 c 324 s 2, 2002 c
290 s 2, 2002 c 253 s 4, 2002 c 229 s 2, 2002 c 134 s 2, and 2002 c 133
s 4 are each reenacted and amended to read as follows:
TABLE 2 | ||
CRIMES INCLUDED WITHIN EACH SERIOUSNESS LEVEL | ||
XVI | ||
XV | ||
XIV | ||
XIII | ||
XII | ||
XI | ||
X | ||
IX | ||
VIII | ||
VII | ||
VI | ||
V | ||
IV | ||
III | ||
II | ||
I | ||
Sec. 33 RCW 9.94A.515 and 2002 c 340 s 2, 2002 c 324 s 2, 2002 c
290 s 7, 2002 c 253 s 4, 2002 c 229 s 2, 2002 c 134 s 2, and 2002 c 133
s 4 are each reenacted and amended to read as follows:
TABLE 2 | ||
CRIMES INCLUDED WITHIN EACH SERIOUSNESS LEVEL | ||
XVI | ||
XV | ||
XIV | ||
XIII | ||
XII | ||
XI | ||
X | ||
IX | ||
VIII | ||
VII | ||
VI | ||
V | ||
IV | ||
III | ||
Escape 2 (RCW 9A.76.120) | ||
II | ||
I | ||
NEW SECTION. Sec. 34 Sections 1 through 26 of this act
constitute a new chapter in Title 71 RCW.
NEW SECTION. Sec. 35 If any provision of this act or its
application to any person or circumstance is held invalid, the
remainder of the act or the application of the provision to other
persons or circumstances is not affected.
NEW SECTION. Sec. 36 Section 32 of this act expires July 1,
2004.
NEW SECTION. Sec. 37 Section 33 of this act takes effect July 1,
2004.
NEW SECTION. Sec. 38 Part headings used in this act are not any
part of the law.