CHAPTER 4. LIVING WILLS AND LIFE PROLONGING PROCEDURES
IC 16-36-4
Chapter 4. Living Wills and Life Prolonging Procedures
IC 16-36-4-1
Life prolonging procedure defined
Sec. 1. (a) As used in this chapter, "life prolonging procedure"means any medical procedure, treatment, or intervention that doesthe following:
(1) Uses mechanical or other artificial means to sustain, restore,or supplant a vital function.
(2) Serves to prolong the dying process.
(b) The term does not include the performance or provision of anymedical procedure or medication necessary to provide comfort careor to alleviate pain.
As added by P.L.2-1993, SEC.19. Amended by P.L.99-1994, SEC.1.
IC 16-36-4-2
Life prolonging procedures will declarant defined
Sec. 2. As used in this chapter, "life prolonging procedures willdeclarant" means a person who has executed a life prolongingprocedures will declaration under section 11 of this chapter.
As added by P.L.2-1993, SEC.19.
IC 16-36-4-3
Living will declarant defined
Sec. 3. As used in this chapter, "living will declarant" means aperson who has executed a living will declaration under section 10of this chapter.
As added by P.L.2-1993, SEC.19.
IC 16-36-4-4
Qualified patient defined
Sec. 4. As used in this chapter, "qualified patient" means a patientwho has been certified as a qualified patient under section 13 of thischapter.
As added by P.L.2-1993, SEC.19.
IC 16-36-4-5
Terminal condition defined
Sec. 5. As used in this chapter, "terminal condition" means acondition caused by injury, disease, or illness from which, to areasonable degree of medical certainty:
(1) there can be no recovery; and
(2) death will occur from the terminal condition within a shortperiod of time without the provision of life prolongingprocedures.
As added by P.L.2-1993, SEC.19.
IC 16-36-4-6
Policy Sec. 6. A competent adult has the right to control the decisionsrelating to the competent adult's medical care, including the decisionto have medical or surgical means or procedures calculated toprolong the competent adult's life provided, withheld, or withdrawn.
As added by P.L.2-1993, SEC.19.
IC 16-36-4-7
Consent to medical treatment; immunity from liability for failureto treat patient after refusal of treatment
Sec. 7. (a) A competent person may consent to or refuse consentfor medical treatment, including life prolonging procedures.
(b) No health care provider is required to provide medicaltreatment to a patient who has refused medical treatment under thissection.
(c) No civil or criminal liability is imposed on a health careprovider for the failure to provide medical treatment to a patient whohas refused the treatment in accordance with this section.
As added by P.L.2-1993, SEC.19.
IC 16-36-4-8
Life prolonging procedures will declarations; living willdeclarations
Sec. 8. (a) A person who is of sound mind and is at least eighteen(18) years of age may execute a life prolonging procedures willdeclaration under section 11 of this chapter or a living willdeclaration under section 10 of this chapter.
(b) A declaration under section 10 or 11 of this chapter must meetthe following conditions:
(1) Be voluntary.
(2) Be in writing.
(3) Be signed by the person making the declaration or byanother person in the declarant's presence and at the declarant'sexpress direction.
(4) Be dated.
(5) Be signed in the presence of at least two (2) competentwitnesses who are at least eighteen (18) years of age.
(c) A witness to a living will declaration under subsection (b)(5)may not meet any of the following conditions:
(1) Be the person who signed the declaration on behalf of andat the direction of the declarant.
(2) Be a parent, spouse, or child of the declarant.
(3) Be entitled to any part of the declarant's estate whether thedeclarant dies testate or intestate, including whether the witnesscould take from the declarant's estate if the declarant's will isdeclared invalid.
(4) Be directly financially responsible for the declarant'smedical care.
For the purposes of subdivision (3), a person is not considered to beentitled to any part of the declarant's estate solely by virtue of beingnominated as a personal representative or as the attorney for the
estate in the declarant's will.
(d) The living will declaration of a person diagnosed as pregnantby the attending physician has no effect during the person'spregnancy.
(e) The life prolonging procedures will declarant or the living willdeclarant shall notify the declarant's attending physician of theexistence of the declaration. An attending physician who is notifiedshall make the declaration or a copy of the declaration a part of thedeclarant's medical records.
(f) A living will declaration under section 10 of this chapter:
(1) does not require the physician to use, withhold, or withdrawlife prolonging procedures but is presumptive evidence of thepatient's desires concerning the use, withholding, or withdrawalof life prolonging procedures under this chapter; and
(2) shall be given great weight by the physician in determiningthe intent of the patient who is mentally incompetent.
(g) A life prolonging procedures will declaration under section 11of this chapter does require the physician to use life prolongingprocedures as requested.
As added by P.L.2-1993, SEC.19.
IC 16-36-4-9
Forms of declaration; requisites
Sec. 9. A declaration must be substantially in the form set forth ineither section 10 or 11 of this chapter, but the declaration mayinclude additional, specific directions. The invalidity of anyadditional, specific directions does not affect the validity of thedeclaration.
As added by P.L.2-1993, SEC.19.
IC 16-36-4-10
Form of living will declaration
Sec. 10. The following is the living will declaration form:
LIVING WILL DECLARATION
Declaration made this _____ day of _______ (month, year). I,_________, being at least eighteen (18) years of age and of soundmind, willfully and voluntarily make known my desires that mydying shall not be artificially prolonged under the circumstances setforth below, and I declare:
If at any time my attending physician certifies in writing that: (1)I have an incurable injury, disease, or illness; (2) my death will occurwithin a short time; and (3) the use of life prolonging procedureswould serve only to artificially prolong the dying process, I directthat such procedures be withheld or withdrawn, and that I bepermitted to die naturally with only the performance or provision ofany medical procedure or medication necessary to provide me withcomfort care or to alleviate pain, and, if I have so indicated below,the provision of artificially supplied nutrition and hydration.(Indicate your choice by initialling or making your mark beforesigning this declaration): __________ I wish to receive artificially supplied nutrition andhydration, even if the effort to sustain life is futile orexcessively burdensome to me.
__________ I do not wish to receive artificially suppliednutrition and hydration, if the effort to sustain life is futile orexcessively burdensome to me.
__________ I intentionally make no decision concerningartificially supplied nutrition and hydration, leaving thedecision to my health care representative appointed underIC 16-36-1-7 or my attorney in fact with health care powersunder IC 30-5-5.
In the absence of my ability to give directions regarding the useof life prolonging procedures, it is my intention that this declarationbe honored by my family and physician as the final expression of mylegal right to refuse medical or surgical treatment and accept theconsequences of the refusal.
I understand the full import of this declaration.
Signed _________________________
_______________________________
City, County, and State of Residence
The declarant has been personally known to me, and I believe(him/her) to be of sound mind. I did not sign the declarant's signatureabove for or at the direction of the declarant. I am not a parent,spouse, or child of the declarant. I am not entitled to any part of thedeclarant's estate or directly financially responsible for thedeclarant's medical care. I am competent and at least eighteen (18)years of age.
Witness _______________ Date __________
Witness _______________ Date __________
As added by P.L.2-1993, SEC.19. Amended by P.L.99-1994, SEC.2.
IC 16-36-4-11
Form of life prolonging procedures will declaration
Sec. 11. The following is the life prolonging procedures willdeclaration form:
LIFE PROLONGING PROCEDURES DECLARATION
Declaration made this ______ day of ______ (month, year). I,____________, being at least eighteen (18) years of age and of soundmind, willfully and voluntarily make known my desire that if at anytime I have an incurable injury, disease, or illness determined to bea terminal condition I request the use of life prolonging proceduresthat would extend my life. This includes appropriate nutrition andhydration, the administration of medication, and the performance ofall other medical procedures necessary to extend my life, to providecomfort care, or to alleviate pain.
In the absence of my ability to give directions regarding the useof life prolonging procedures, it is my intention that this declarationbe honored by my family and physician as the final expression of mylegal right to request medical or surgical treatment and accept theconsequences of the request. I understand the full import of this declaration.
Signed ___________________
_______________________
City, County, and State of Residence
The declarant has been personally known to me, and I believe(him/her) to be of sound mind. I am competent and at least eighteen(18) years of age.
Witness ______________ Date ________
Witness ______________ Date ________
As added by P.L.2-1993, SEC.19.
IC 16-36-4-12
Revocation of living will declaration or life prolonging procedureswill declaration
Sec. 12. (a) A living will declaration or a life prolongingprocedures will declaration may be revoked at any time by thedeclarant by any of the following:
(1) A signed, dated writing.
(2) Physical cancellation or destruction of the declaration by thedeclarant or another in the declarant's presence and at thedeclarant's direction.
(3) An oral expression of intent to revoke.
(b) A revocation is effective when communicated to the attendingphysician.
(c) No civil or criminal liability is imposed upon a person forfailure to act upon a revocation unless the person had actualknowledge of the revocation.
(d) The revocation of a life prolonging procedures will declarationis not evidence that the declarant desires to have life prolongingprocedures withheld or withdrawn.
As added by P.L.2-1993, SEC.19.
IC 16-36-4-13
Certification of qualified patient; procedure where physicianrefuses to honor declaration
Sec. 13. (a) The attending physician shall immediately certify inwriting that a person is a qualified patient if the following conditionsare met:
(1) The attending physician has diagnosed the patient as havinga terminal condition.
(2) The patient has executed a living will declaration or a lifeprolonging procedures will declaration in accordance with thischapter and was of sound mind at the time of the execution.
(b) The attending physician shall include a copy of the certificatein the patient's medical records.
(c) It is lawful for the attending physician to withhold or withdrawlife prolonging procedures from a qualified patient if that patientproperly executed a living will declaration under this chapter.
(d) A health care provider or an employee under the direction ofa health care provider who: (1) in good faith; and
(2) in accordance with reasonable medical standards;
participates in the withholding or withdrawal of life prolongingprocedures from a qualified patient who has executed a living willdeclaration in accordance with this chapter is not subject to criminalor civil liability and may not be found to have committed an act ofunprofessional conduct.
(e) An attending physician who refuses to use, withhold, orwithdraw life prolonging procedures from a qualified patient shalltransfer the qualified patient to another physician who will honor thepatient's living will declaration or life prolonging procedures willdeclaration unless:
(1) the physician has reason to believe the declaration was notvalidly executed or there is evidence that the patient no longerintends the declaration to be enforced; and
(2) the patient is presently unable to validate the declaration.
(f) If the attending physician, after reasonable investigation, findsno other physician willing to honor the patient's declaration, theattending physician may refuse to withhold or withdraw lifeprolonging procedures.
(g) If the attending physician does not transfer a patient for thereason set forth in subsection (e), the physician shall attempt toascertain the patient's intention and attempt to determine the validityof the declaration by consulting with any of the following individualswho are reasonably available, willing, and competent to act:
(1) The judicially appointed guardian of the person of thepatient if one has been appointed. This subdivision does notrequire the appointment of a guardian so that a treatmentdecision can be made under this section.
(2) The person or persons designated by the patient in writingto make the treatment decision.
(3) The patient's spouse.
(4) An adult child of the patient or, if the patient has more thanone (1) adult child, by a majority of the children who arereasonably available for consultation.
(5) The parents of the patient.
(6) An adult sibling of the patient or, if the patient has morethan one (1) adult sibling, by a majority of the siblings who arereasonably available for consultation.
(7) The patient's clergy or others with firsthand knowledge ofthe patient's intention.
The individuals described in subdivisions (1) through (7) shall act inthe best interest of the patient and shall be guided by the patient'sexpress or implied intentions, if known.
(h) The physician shall list the names of the individuals describedin subsection (g) who were consulted and the information receivedin the patient's medical records.
(i) If the attending physician determines from the informationreceived under subsection (g) that the qualified patient intended toexecute a valid living will declaration, the physician may either: (1) withhold or withdraw life prolonging procedures, with theconcurrence of one (1) other physician, as documented in thepatient's medical records; or
(2) request a court of competent jurisdiction to appoint aguardian for the patient to make the consent decision on behalfof the patient.
As added by P.L.2-1993, SEC.19. Amended by P.L.99-1994, SEC.3.
IC 16-36-4-14
Presumptions
Sec. 14. If the qualified patient who executed a living willdeclaration is incompetent at the time of the decision to withhold orwithdraw life prolonging procedures, a living will declarationexecuted in accordance with this chapter is presumed to be valid. Forpurposes of this chapter, a health care provider may presume in theabsence of actual notice to the contrary that the declarant was ofsound mind when the living will declaration was executed. The factthat the declarant executed a declaration may not be considered as anindication of a declarant's mental incompetency.
As added by P.L.2-1993, SEC.19.
IC 16-36-4-15
Cancellation or destruction of declaration; falsification or forgeryof revocation of another's declaration; offense
Sec. 15. A person who knowingly or intentionally:
(1) physically cancels or destroys a living will declaration or alife prolonging procedures will declaration without thedeclarant's consent; or
(2) falsifies or forges a revocation of another person's livingwill declaration or life prolonging procedures will declaration;
commits a Class D felony.
As added by P.L.2-1993, SEC.19.
IC 16-36-4-16
Falsification or forgery of declaration; concealment or withholdingof revocation of declaration; offense
Sec. 16. A person who knowingly or intentionally:
(1) falsifies or forges the living will declaration of anotherperson with intent to cause withholding or withdrawal of lifeprolonging procedures; or
(2) conceals or withholds personal knowledge of the revocationof a living will declaration with intent to cause a withholding orwithdrawal of life prolonging procedures;
commits a Class C felony.
As added by P.L.2-1993, SEC.19.
IC 16-36-4-17
Effect of living will or life prolonging procedures will declaration;suicide; life insurance
Sec. 17. (a) A death caused by the withholding or withdrawal of
life prolonging procedures in accordance with this chapter does notconstitute a suicide.
(b) The execution of a living will declaration or a life prolongingprocedures will declaration under this chapter does not:
(1) affect the sale or issuance of any life insurance policy; or
(2) modify the terms of a policy in force when the declarationis executed.
(c) A policy of life insurance is not legally impaired or invalidatedby the withholding or withdrawal of life prolonging procedures froman insured qualified patient, notwithstanding any term of the policyto the contrary.
(d) A person may not require another person to execute a livingwill declaration or a life prolonging procedures will declaration as acondition for being insured for or receiving health care services.
(e) This chapter does not impair or supersede any legal right orlegal responsibility that any person may have to effect thewithholding or withdrawal of life prolonging procedures in anylawful manner.
(f) A person who has been found:
(1) guilty; or
(2) guilty but mentally ill;
of an offense described in section 16 of this chapter is subject toIC 29-1-2-12.1.
As added by P.L.2-1993, SEC.19.
IC 16-36-4-18
Presumption of intent to consent to withholding or withdrawal oflife prolonging procedures
Sec. 18. This chapter creates no presumption concerning theintention of a person who has not executed a living will declarationto consent to the withholding or withdrawal of life prolongingprocedures if a terminal condition exists.
As added by P.L.2-1993, SEC.19.
IC 16-36-4-19
Euthanasia distinguished
Sec. 19. This chapter does not authorize euthanasia or anyaffirmative or deliberate act or omission to end life other than topermit the natural process of dying, including the withholding orwithdrawing of life prolonging procedures under this chapter.
As added by P.L.2-1993, SEC.19.
IC 16-36-4-20
Intervening forces; proximate causation
Sec. 20. The act of withholding or withdrawing life prolongingprocedures, when done under:
(1) a living will declaration made under this chapter;
(2) a court order or decision of a court appointed guardian; or
(3) a good faith medical decision by the attending physician thatthe patient has a terminal condition;is not an intervening force and does not affect the chain of proximatecause between the conduct of any person that placed the patient in aterminal condition and the patient's death.
As added by P.L.2-1993, SEC.19.
IC 16-36-4-21
Chapter violations by physician; discipline
Sec. 21. A physician who knowingly violates this chapter issubject to disciplinary sanctions under IC 25-1-9 as if the physicianhad knowingly violated a rule adopted by the medical licensing boardunder IC 25-22.5-2-7.
As added by P.L.2-1993, SEC.19.