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| Home > Statutes > Usa-Missouri |
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USA Statutes : missouri
Title : TRUSTS AND ESTATES OF DECEDENTS AND PERSONS UNDER DISABILITY
Chapter : Chapter 459 Declarations, Life Support
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As used in sections 459.010 to 459.055, the following terms mean:
(1) "Attending physician", the physician selected by, or assigned to, the
patient who has primary responsibility for the treatment and care of the
patient;
(2) "Competent person", a person eighteen years of age or older of sound
mind who is able to receive and evaluate information and to communicate a
decision;
(3) "Death-prolonging procedure", any medical procedure or intervention
which, when applied to a patient, would serve only to prolong
artificially the dying process and where, in the judgment of the
attending physician pursuant to usual and customary medical standards,
death will occur within a short time whether or not such procedure or
intervention is utilized. Death-prolonging procedure shall not include
the administration of medication or the performance of medical procedure
deemed necessary to provide comfort, care or to alleviate pain nor the
performance of any procedure to provide nutrition or hydration;
(4) "Declaration", a document executed in accordance with the
requirements of section 459.015;
(5) "Physician", a person licensed to practice medicine and surgery by
the state board of registration for the healing arts;
(6) "Terminal condition", an incurable or irreversible condition which,
in the opinion of the attending physician, is such that death will occur
within a short time regardless of the application of medical procedures.
(L. 1985 S.B. 51 § 1)
(1988) A guardian may not order termination of nutrition and hydration
from incompetent ward who is neither dead nor terminally ill although
ward is in persistent vegetative state. Cruzan, by Cruzan v. Harmon, 760
S.W.2d 408 (Mo. banc).
(1990) United States Constitution does not prohibit Missouri from
requiring that evidence of an incompetent's wishes as to the withdrawal
of life-sustaining treatment be proven by clear and convincing evidence.
Cruzan v. Director, Mo. Dept. of Health, 110 S. Ct. 2841.
1. Any competent person may execute a declaration directing the
withholding or withdrawal of death-prolonging procedures. The declaration
made pursuant to sections 459.010 to 459.055 shall be:
(1) In writing;
(2) Signed by the person making the declaration, or by another person in
the declarant's presence and by the declarant's expressed direction;
(3) Dated; and
(4) If not wholly in the declarant's handwriting, signed in the presence
of two or more witnesses at least eighteen years of age neither of whom
shall be the person who signed the declaration on behalf of and at the
direction of the person making the declaration.
2. It shall be the responsibility of the declarant to provide for
notification to his attending physician of the existence of the
declaration. Upon the request of the patient, the declaration shall be
placed in the declarant's medical records as maintained by his attending
physician and the medical records of any health facility of which he is a
patient.
3. The declaration may be in the following form, but it shall not be
necessary to use this sample form. In addition, the declaration may
include other specific directions. Should any of the other specific
directions be held to be invalid, such invalidity shall not affect other
directions of the declaration which can be given effect without the
invalid declaration, and to this end the directions in the declaration
are severable.
DECLARATION
I have the primary right to make my own decisions concerning treatment
that might unduly prolong the dying process. By this declaration I
express to my physician, family and friends my intent. If I should have a
terminal condition it is my desire that my dying not be prolonged by
administration of death-prolonging procedures. If my condition is
terminal and I am unable to participate in decisions regarding my medical
treatment, I direct my attending physician to withhold or withdraw
medical procedures that merely prolong the dying process and are not
necessary to my comfort or to alleviate pain. It is not my intent to
authorize affirmative or deliberate acts or omissions to shorten my life
rather only to permit the natural process of dying.
Signed this ................... day of ...................., ............
.
Signature ................................... City, County and State of
residence ............................
............................
The declarant is known to me, is eighteen years of age or older, of sound
mind and voluntarily signed this document in my presence.
Witness .....................................
Address .....................................
Witness .....................................
Address .....................................
REVOCATION PROVISION
I hereby revoke the above declaration.
Signed ......................................
(Signature of Declarant)
Date ........................................ (L. 1985 S.B. 51 § 2)
1. A declaration may be revoked at any time and in any manner by
which the declarant is able to communicate his intent to revoke, without
regard to mental or physical condition.
2. The attending physician or health care provider shall make the
revocation a part of the declarant's medical record.
3. There shall be no criminal or civil liability on the part of any
person for failure to act upon a revocation made pursuant to this section
unless the revocation is in the patient's medical record or unless that
person has actual knowledge of the revocation. (L. 1985 S.B. 51 § 3)
The directions of a declarant able to make treatment decisions
shall at all times supersede the declaration. The declaration shall be
given operative effect only if the declarant's condition is determined to
be terminal and the declarant is not able to make treatment decisions.
Such determinations shall be recorded in the declarant's medical record.
A physician, health care professional or facility or other person shall
not act contrary to the declarant's expressed intent to withhold or
withdraw death-prolonging procedures without serious reason therefor
consistent with the best interest of the declarant. Such reason shall be
recorded in the declarant's medical record. The declaration to withdraw
or withhold treatment by a patient diagnosed as pregnant by the attending
physician shall have no effect during the course of the declarant's
pregnancy. (L. 1985 S.B. 51 § 4)
1. An attending physician who is unwilling to comply with the
requirements of section 459.025 or who is unwilling to comply with the
declaration of a patient in accordance with section 459.015 shall take
all reasonable steps to effect the transfer of the declarant to another
physician.
2. If the policies of a health care facility preclude compliance with the
declaration of a patient under sections 459.010 to 459.055, that facility
shall take all reasonable steps to effect the transfer of the declarant
to a facility in which the provisions of sections 459.010 to 459.055 can
be carried out. (L. 1985 S.B. 51 § 5)
For the purpose of sections 459.010 to 459.055, a physician or
medical care facility may presume in the absence of actual notice to the
contrary that an individual who executed a declaration was competent when
it was executed. The fact of an individual having executed a declaration
shall not be considered as an indication of a declarant's mental
incapacity. Advanced age of itself shall not be a bar to a determination
of capacity. (L. 1985 S.B. 51 § 6)
A physician, licensed health care professional, medical care
facility or employee thereof or other person who, in good faith and
pursuant to usual and customary medical standards, causes or participates
in the withholding or withdrawal of death-prolonging procedures, which
acts are not otherwise unlawful, from a patient pursuant to a declaration
made in accordance with sections 459.010 to 459.055 shall not, as a
result thereof, be subject to criminal or civil liability or be found to
have committed an act of unprofessional conduct. (L. 1985 S.B. 51 § 7)
1. It shall constitute unprofessional conduct if a physician or
other licensed health care professional or facility with actual knowledge
of a declaration acts, when the declarant is in a terminal condition and
unable to make treatment decisions, contrary to the expressed intention
of the declarant, as stated in his declaration, without serious reason
therefor consistent with the best interest of the declarant.
2. Any person with actual knowledge of a declaration who acts, when the
declarant is in a terminal condition and unable to make treatment
decisions, contrary to the expressed intention of the patient as stated
in his declaration, without serious reason therefor consistent with the
best interests of the patient, shall lose such rights of inheritance to
the extent such loss is provided for by the patient's last will and
testament.
3. Any person who willfully conceals, cancels, defaces, obliterates or
destroys the declaration of another without such declarant's consent or
who falsifies or forges a revocation of the declaration of another shall
be guilty of a class A misdemeanor.
4. Any person who falsifies or forges the declaration of another, or who
willfully conceals or withholds personal knowledge of the revocation of a
declaration, with the purpose of causing withholding or withdrawal of
medical procedures contrary to the wishes of the declarant, and thereby,
because of such act, directly causes medical procedures to be withheld or
withdrawn, causing death or causing death to be hastened, shall be guilty
of a class B felony. (L. 1985 S.B. 51 § 8)
1. The making of a declaration pursuant to sections 459.010 to
459.055 shall not affect in any manner the sale, procurement, or issuance
of any policy of life insurance, nor shall it be deemed to modify the
terms of an existing policy of life insurance. No policy of life
insurance shall be legally impaired or invalidated in any manner by the
withholding or withdrawal of death-prolonging procedures from an insured
declarant, notwithstanding any term of the policy to the contrary.
2. No person, corporation or governmental agency shall require or induce
any person to execute a declaration as a condition for a contract or for
the provision of any service or benefit whatsoever. (L. 1985 S.B. 51 § 9)
Sections 459.010 to 459.055 shall be interpreted consistent with
the following:
(1) Each person has the primary right to request or refuse medical
treatment subject to the state's interest in protecting innocent third
parties, preventing homicide and suicide and preserving good ethical
standards in the medical profession.
(2) Nothing in sections 459.010 to 459.055 shall be interpreted to
increase or decrease the right of a patient to make decisions regarding
use of medical procedures so long as the patient is able to do so, nor to
impair or supersede any right or responsibility that any person has to
effect the withholding or withdrawal of medical care in any lawful
manner. In that respect, the provisions of sections 459.010 to 459.055
are cumulative.
(3) Sections 459.010 to 459.055 shall create no presumption concerning
the intention of an individual who has not executed a declaration to
consent to the use or withholding of medical procedures.
(4) Communication regarding treatment decisions among patients, the
families and physicians is encouraged.
(5) Sections 459.010 to 459.055 do not condone, authorize or approve
mercy killing or euthanasia nor permit any affirmative or deliberate act
or omission to shorten or end life. (L. 1985 S.B. 51 § 10)
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