CHAPTER 4.13
HEALTH CARE DECISIONS ACT

(b) In order that the rights of patients may be respected even after they are no longer able to communicate their decisions and where a patient had failed to execute a valid durable power of attorney for health care or living will and in the absence of such documents this section hereby authorizes a surrogate decision maker to act on behalf of such patient who is unable to give informed consent for his or her medical treatment decisions to his or her physician(s) and/or health care facility. The surrogate decision maker shall be a member of the highest class set forth in sections 23-4.13-3, (a) and (b) and be familiar with the patient's activities, health and religious beliefs. The surrogate decision maker may execute documents on behalf of this patient authorizing the physician(s) and/or health care facility to provide medical treatment including withholding or withdrawing of life-sustaining procedures and to provide appropriate pain management treatment.

23-4.13-2. Definitions. -- (a) "Patient" shall mean a person who is receiving medical treatment and is unable to give informed consent either orally, in writing, or by gestures concerning his or her wishes for medical treatment and failed to execute a valid durable power of attorney for health care or living will.

(b) "Surrogate decision maker" shall mean the person who by this act is authorized to make decisions for the patient's medical treatment.

(c) "Significant other person" shall mean a person who maintains a durable relationship with the patient, resides with the patient and is familiar with the patient's activities, health, and religious beliefs.

(d) "Friend" shall mean any person who maintains such regular contact with the patient as to be familiar with his or her activities, health and religious beliefs.

(e) "Health care provider" shall mean a licensed physician, nurse or health care facility as defined within title 23.

(1) the guardian of the person, whose guardianship is in effect at the time the decision is necessary.

(2) the spouse of the patient; provided, no complaint for divorce, divorce from bed and board, legal separation or an annulment of the marriage has been filed by either spouse.

(3) the significant other person who maintains a durable relationship with the patient and resides with the patient;

(4) an adult son or daughter of the patient;

(5) either parent of the patient;

(6 an adult brother or sister of the patient;

(7) a grandparent of the patient;

(8) a niece or nephew of the patient;

(9) a friend of the patient.

(b) Surrogate decision making may not be made by a person listed in section 23-4.13-3(a), if;

(1) any judge in a court of competent jurisdiction has issued a restraining order, denial of visitation, no contact order or other edict restricting the flow of commerce between the patient and the proposed surrogate decision maker;

(2) any law enforcement or other investigating agency has instituted and found credible evidence of physical, mental, sexual or domestic abuse between the patient and the proposed surrogate decision maker; and

(3) no person in a prior class is available and willing to act as surrogate decision maker; and

(4) In the event that no one in the highest class of surrogate decision maker is available, then the health care provider may rely on a surrogate decision maker from the next class.

(c) Any person who seeks to be or is designated as a surrogate decision maker shall provide the health care provider with an affidavit setting forth the facts and circumstances upon which such claim is based and the willingness to follow the patient's medical treatment wishes, such affidavit shall be part of the patient's permanent medical record.

23-4.13-4. Authority of surrogate health care decision maker. -- A surrogate decision maker authorized under this section to act on behalf of the patient must execute a document authorizing medical treatment and pain management for the patient and may include directions to withhold or withdraw life-saving measures in the same requirements that a patient would execute a durable power of attorney for health care as set forth in sections 23-4.10-1 through 23-4.10-12 inclusive.

23-4.13-5. Withdrawal. -- A surrogate decision maker may withdraw at any time. A withdrawal is only effective as to the health care provider or emergency medical services personnel upon communication to that individual by the surrogate decision maker or by another who witnessed the withdrawal. Another surrogate decision maker may be nominated according to the classes set forth in section 23-4.13-3.

(b) A surrogate decision maker may revoke the authorization for treatment of the patient at any time and in any manner.

(1) A revocation is only effective as to the attending physician or any health care provider or emergency medical services personnel upon communication to that health care provider or emergency medical services personnel by the declarant or by another who witnessed the revocation.

(2) The physician or health care provider shall document the revocation in the patient's medical record.

(3) For emergency medical services personnel: the absence of reliable documentation shall constitute a revocation of a durable power of attorney for health care.

23-4.13-8. Treatment. -- (a) A patient has the right to make decisions including use of life sustaining procedures as long as the patient is able to do so. If a patient is unable to give informed consent, either orally, in writing, or by gestures concerning a medical treatment decision and failed to execute a valid durable power of attorney for health care or living will, a surrogate decision maker may make medical treatment decisions for the patient as if the patient were acting for himself.

(b) This chapter does not prohibit any action considered necessary by the health care provider or emergency medical services personnel for comfort, care, or alleviation of pain.

(c) The decision of the surrogate decision maker for a patient known to the health care provider to be pregnant shall be given no force or effect as long as it is probable that the fetus could develop to the point of live birth with continued application of a life sustaining procedures.

(1) a physician who acts pursuant to the instructions of the surrogate decision maker;

(2) a person who acts under the direction or with the authorization of a physician or health care provider;

(3) the health care provider owning or operating the facility in which the instructions of the surrogate decision maker are implemented;

(4) emergency medical services personnel who act pursuant to an advanced directive protocol;

(5) emergency medical services personnel who proceed to provide life-sustaining treatment to a patient pursuant to a revocation communicated to them;

(6) a surrogate decision maker acting in accordance with this chapter;

(7) a physician or health care provider is not subject to civil or criminal liability for actions under this chapter, which are in accordance with reasonable medical standards.

(b) The designation of a surrogate decision maker pursuant to this chapter does not affect in any manner the sale, procurement, or issuance of any policy of life insurance, nor does it modify the terms of an existing policy of life insurance. A policy of life insurance is not legally impaired or invalidated in any manner by the withholding or withdrawal of life-sustaining procedures from an insured qualified patient, not withstanding any term of the policy to the contrary.

(c) This chapter does not increase or decrease the right of a patient to make decisions regarding use of life-sustaining procedures so long as the patient is able to do so, or impair or supersede any right or responsibility that any person has to effect the withholding or withdrawal of medical care.

(d) This chapter does not condone, authorize, or approve mercy killing or euthanasia.

(1) the surrogate decision maker authorizes treatment or the lack thereof, or withholding or withdrawing treatment that is illegal;

(2) the surrogate decision maker acts contrary to the patient's known desires; or

(3) where the patient's desires are not known, the surrogate decision maker does anything that is clearly contrary to the patient's best interest.

(b) The proceeding shall have preference over all other cases in the court and shall be determined summarily upon the petition and such oral or written proof as may be offered by the parties.

23-4.13-12. Severability. -- Any provision of this chapter or its application to any person or circumstance is held invalid, the invalidity does not affect other provisions or applications of this chapter which can be given effect without the invalid provision or application and to this end the provisions of this chapter are severable.

(b) The director of the department of health is authorized to promulgate standards for assessment of pain.

(c) Every person or corporation who shall willfully and continually violate the provisions of section 23-17-54 will be subject to a fine up to one hundred dollars ($100) for the first violation and up to five hundred dollars ($500) for each subsequent violation thereof and any other remedy provided for in Rhode Island law.