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hb920_00_IN
As Introduced
136th
General Assembly
Regular
Session
H. B. No. 920
2025-2026
Representative Baker
To
amend sections 1337.12, 2108.23, 2108.231, 2133.01, 2133.03, 2133.07,
2133.21, 2133.22, 2133.23, 2133.24, 2133.25, 2133.26, 4765.35,
4765.37, 4765.38, and 4765.39
and to enact section 2133.151
of the Revised Code
to
provide for a do-not-intubate order, protocol, and identification
separate from a do-not-resuscitate order, protocol, and
identification.
BE
IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section
1.
That
sections 1337.12, 2108.23, 2108.231, 2133.01, 2133.03, 2133.07,
2133.21, 2133.22, 2133.23, 2133.24, 2133.25, 2133.26, 4765.35,
4765.37, 4765.38, and 4765.39
be amended and section 2133.151
of the Revised Code be
enacted
to
read as follows:
Sec.
1337.12.
(A)(1)
An adult who is of sound mind voluntarily may create a valid durable
power of attorney for health care by executing a durable power of
attorney, in accordance with section 1337.24 of the Revised Code,
that authorizes an attorney in fact as described in division (A)(2)
of this section to make health care decisions for the principal at
any time that the attending physician of the principal determines
that the principal has lost the capacity to make informed health care
decisions for the principal. The durable power of attorney for health
care may authorize the attorney in fact, commencing immediately upon
the execution of the instrument or at any subsequent time and
regardless of whether the principal has lost the capacity to make
informed health care decisions, to obtain information concerning the
principal's health, including protected health information as defined
in 45 C.F.R. 160.103. Except as otherwise provided in divisions (B)
to (F) of section 1337.13 of the Revised Code, the authorization may
include the right to give informed consent, to refuse to give
informed consent, or to withdraw informed consent to any health care
that is being or could be provided to the principal. Additionally, to
be valid, a durable power of attorney for health care shall satisfy
both of the following:
(a)
It shall be signed at the end of the instrument by the principal and
shall state the date of its execution.
(b)
It shall be witnessed in accordance with division (B) of this section
or be acknowledged by the principal in accordance with division (C)
of this section.
(2)
Except as otherwise provided in this division, a durable power of
attorney for health care may designate any competent adult as the
attorney in fact. The attending physician of the principal and an
administrator of any nursing home in which the principal is receiving
care shall not be designated as an attorney in fact in, or act as an
attorney in fact pursuant to, a durable power of attorney for health
care. An employee or agent of the attending physician of the
principal and an employee or agent of any health care facility in
which the principal is being treated shall not be designated as an
attorney in fact in, or act as an attorney in fact pursuant to, a
durable power of attorney for health care, except that these
limitations do not preclude a principal from designating either type
of employee or agent as the principal's attorney in fact if the
individual is a competent adult and related to the principal by
blood, marriage, or adoption, or if the individual is a competent
adult and the principal and the individual are members of the same
religious order.
(3)
A durable power of attorney for health care shall not expire, unless
the principal specifies an expiration date in the instrument.
However, when a durable power of attorney contains an expiration
date, if the principal lacks the capacity to make informed health
care decisions for the principal on the expiration date, the
instrument shall continue in effect until the principal regains the
capacity to make informed health care decisions for the principal.
(B)
If witnessed for purposes of division (A)(1)(b) of this section, a
durable power of attorney for health care shall be witnessed by at
least two individuals who are adults and who are not ineligible to be
witnesses under this division. Any person who is related to the
principal by blood, marriage, or adoption, any person who is
designated as the attorney in fact or alternate attorney in fact in
the instrument, the attending physician of the principal, and the
administrator of any nursing home in which the principal is receiving
care are ineligible to be witnesses.
The
witnessing of a durable power of attorney for health care shall
involve the principal signing, or acknowledging the principal's
signature, at the end of the instrument in the presence of each
witness. Then, each witness shall subscribe the witness's signature
after the signature of the principal and, by doing so, attest to the
witness's belief that the principal appears to be of sound mind and
not under or subject to duress, fraud, or undue influence. The
signatures of the principal and the witnesses under this division are
not required to appear on the same page of the instrument.
(C)
If acknowledged for purposes of division (A)(1)(b) of this section, a
durable power of attorney for health care shall be acknowledged
before a notary public, who shall make the certification described in
section 147.53 of the Revised Code and also shall attest that the
principal appears to be of sound mind and not under or subject to
duress, fraud, or undue influence.
(D)(1)
If a principal has both a valid durable power of attorney for health
care and a valid declaration, division (B) of section 2133.03 of the
Revised Code applies. If a principal has both a valid durable power
of attorney for health care and a DNR identification
or
DNI identification
that
is based upon a valid declaration and if the declaration supersedes
the durable power of attorney for health care under division (B) of
section 2133.03 of the Revised Code, the DNR identification
or
DNI identification
supersedes
the durable power of attorney for health care to the extent of any
conflict between the two. A valid durable power of attorney for
health care supersedes any DNR identification
or
DNI identification
that
is based upon a do-not-resuscitate order
or
a do-not-intubate order
that
a physician issued for the principal which is inconsistent with the
durable power of attorney for health care or a valid decision by the
attorney in fact under a durable power of attorney.
(2)
As used in division (D) of this section:
(a)
"Declaration" has the same meaning as in section 2133.01 of
the Revised Code.
(b)
"Do-not-intubate
order,"
"
Do-not-resuscitate
do-not-resuscitate
order
,
"
"DNI
identification,"
and
"DNR identification" have the same meanings as in section
2133.21 of the Revised Code.
(E)(1)
In a durable power of attorney for health care, a principal may
nominate a guardian of the principal's person, estate, or both for
consideration by a court if proceedings for the appointment of a
guardian for the principal's person, estate, or both are commenced at
a later time. The principal may authorize the person nominated as the
guardian or the attorney in fact to nominate a successor guardian for
consideration by the court. The principal's nomination of a guardian
of the principal's person, estate, or both is revoked by the
principal's subsequent nomination of a guardian of the principal's
person, estate, or both, and, except for good cause shown or
disqualification, the court shall make its appointment in accordance
with the principal's most recent nomination.
(2)
The principal may direct that bond be waived for a person nominated
as guardian or successor guardian under division (E)(1) of this
section.
(3)
A durable power of attorney for health care that contains the
nomination of a person to be the guardian of the person, estate, or
both of the principal may be filed with the probate court for
safekeeping, and the probate court shall designate the nomination as
the nomination of a standby guardian.
(4)
If a guardian is appointed for the principal, a durable power of
attorney for health care is not terminated, and the authority of the
attorney in fact continues unless the court, pursuant to its
authority under section 2111.50 of the Revised Code, limits,
suspends, or terminates the power of attorney after notice to the
attorney in fact and upon a finding that the limitation, suspension,
or termination is in the best interest of the principal.
Sec.
2108.23.
(A)(1)
The bureau of motor vehicles shall develop and maintain a donor
registry that identifies each individual who has agreed to make an
anatomical gift at the time of application or renewal of a driver's
license, identification card, or motor vehicle registration as
provided in division (A)(1) or (2) of section 2108.05 of the Revised
Code. The registry shall be fully operational not later than July 1,
2002.
(2)
The registrar of motor vehicles or a deputy registrar shall ask
whether each of the following wishes to certify the applicant's
willingness to become a donor:
(a)
A person applying for or renewing a driver's license;
(b)
A person applying for or renewing an identification card;
(c)
A person applying for or renewing a motor vehicle registration.
(3)
The registrar or deputy registrar shall provide to any applicant who
wishes to certify the applicant's willingness to become a donor the
form set forth in division
(C)(2)
(B)(2)
of section 2133.07 of the Revised Code.
(4)
Any person who provides to the bureau the form set forth in division
(C)(2)
(B)(2)
of section 2133.07 of the Revised Code requesting to be included in
the donor registry shall be included.
(5)
Neither the registrar nor a deputy registrar shall ask a person, who
is already included in the donor registry, to be a donor.
(B)
The bureau shall maintain the registry in a manner that provides to
organ procurement organizations, tissue banks, and eye banks
immediate access to the information in the registry twenty-four hours
a day and seven days a week.
(C)(1)
The registrar of motor vehicles, in consultation with the director of
health and the second chance trust fund advisory committee created
under section 2108.35 of the Revised Code, shall formulate proposed
rules that specify all of the following:
(a)
The information to be included in the registry;
(b)
A process, in accordance with division (B) of section 2108.06 of the
Revised Code, for an individual to revoke the individual's intent to
make an anatomical gift and for updating information in the registry;
(c)
How the registry will be made available to organ procurement
organizations, tissue banks, and eye banks;
(d)
Limitations on the use of and access to the registry;
(e)
How information on organ, tissue, and eye donation will be developed
and disseminated to the public by the bureau and the department of
health;
(f)
The manner in which a person may request to be included in the
registry on a written application for a driver's license,
identification card, motor vehicle registration, or the renewal
thereof. The manner of the request may include either allowing the
requestor to provide the necessary information on the bureau
application or redirecting the requestor to another form specific to
the registry.
(g)
Anything else the registrar considers appropriate.
(2)
In adopting the proposed rules under this division, the registrar may
consult with any person or entity that expresses an interest in the
matters to be dealt with in the rules.
(3)
Following formulation of the proposed rules, the registrar shall
adopt rules in accordance with Chapter 119. of the Revised Code.
(D)
The costs of developing and initially implementing the registry shall
be paid from the second chance trust fund created in section 2108.34
of the Revised Code.
Sec.
2108.231.
(A)
As used in this section:
(1)
"Eligible person" means a person who is all of the
following:
(a)
A resident of this state;
(b)
Eligible to make an anatomical gift under division (A) of section
2108.04 of the Revised Code;
(c)
Not already included in the donor registry established under section
2108.23 of the Revised Code.
(2)
"Issuer" means the chief of the division of wildlife and
agents authorized under section 1533.13 of the Revised Code to issue
hunting and fishing licenses.
(B)(1)
Beginning on August 1, 2025, an issuer shall ask whether an eligible
person wishes to certify the person's willingness to become an
anatomical gift donor when the person is applying for a hunting or
fishing license in person.
(2)
If an eligible person indicates to the issuer the person's
willingness to become an anatomical gift donor, the issuer shall
register the eligible person in the donor registry maintained by the
bureau of motor vehicles under section 2108.23 of the Revised Code.
(C)
Beginning on August 1, 2025, the chief of the division of wildlife
shall provide the form set forth in division
(C)(2)
(B)(2)
of section 2133.07 of the Revised Code to a person applying for a
hunting or fishing license by mail. An eligible person who provides
the form to the bureau of motor vehicles requesting to be included in
the donor registry shall be included.
(D)
Beginning on August 1, 2025, the chief shall provide any person
applying online for a hunting or fishing license who is willing to
become an anatomical gift donor with an electronic hyperlink to the
donor registry. An eligible person who registers electronically with
the donor registry shall be included in the donor registry.
Sec.
2133.01.
Unless
the context otherwise requires, as used in sections 2133.01 to
2133.15 of the Revised Code:
(A)
"Adult" means an individual who is eighteen years of age or
older.
(B)
"Attending physician" means the physician to whom a
declarant or other patient, or the family of a declarant or other
patient, has assigned primary responsibility for the treatment or
care of the declarant or other patient, or, if the responsibility has
not been assigned, the physician who has accepted that
responsibility.
(C)
"Comfort care" means any of the following:
(1)
Nutrition when administered to diminish the pain or discomfort of a
declarant or other patient, but not to postpone the declarant's or
other patient's death;
(2)
Hydration when administered to diminish the pain or discomfort of a
declarant or other patient, but not to postpone the declarant's or
other patient's death;
(3)
Any other medical or nursing procedure, treatment, intervention, or
other measure that is taken to diminish the pain or discomfort of a
declarant or other patient, but not to postpone the declarant's or
other patient's death.
(D)
"Consulting physician" means a physician who, in
conjunction with the attending physician of a declarant or other
patient, makes one or more determinations that are required to be
made by the attending physician, or to be made by the attending
physician and one other physician, by an applicable provision of this
chapter, to a reasonable degree of medical certainty and in
accordance with reasonable medical standards.
(E)
"Declarant" means any adult who has executed a declaration
in accordance with section 2133.02 of the Revised Code.
(F)
"Declaration" means a written document executed in
accordance with section 2133.02 of the Revised Code.
(G)
"DNI
identification," "DNR identification,"
"do-not-intubate order," and "do-not-resuscitate
order" have the same meanings as in section 2133.21 of the
Revised Code.
(H)
"Durable
power of attorney for health care" means a document created
pursuant to sections 1337.11 to 1337.17 of the Revised Code.
(H)
(I)
"Guardian" means a person appointed by a probate court
pursuant to Chapter 2111. of the Revised Code to have the care and
management of the person of an incompetent.
(I)
(J)
"Health care facility" means any of the following:
(1)
A hospital;
(2)
A hospice care program, pediatric respite care program, or other
institution that specializes in comfort care of patients in a
terminal condition or in a permanently unconscious state;
(3)
A nursing home or residential care facility, as defined in section
3721.01 of the Revised Code;
(4)
A home health agency and any residential facility where a person is
receiving care under the direction of a home health agency;
(5)
An intermediate care facility for individuals with intellectual
disabilities.
(J)
(K)
"Health care personnel" means physicians, nurses, physician
assistants, emergency medical technicians-basic, emergency medical
technicians-intermediate, emergency medical technicians-paramedic,
medical technicians, dietitians, other authorized persons acting
under the direction of an attending physician, and administrators of
health care facilities.
(K)
(L)
"Home health agency" has the same meaning as in section
3740.01 of the Revised Code.
(L)
(M)
"Hospice care program" and "pediatric respite care
program" have the same meanings as in section 3712.01 of the
Revised Code.
(M)
(N)
"Hospital" has the same meanings as in sections 3701.01,
3727.01, and 5122.01 of the Revised Code.
(N)
(O)
"Hydration" means fluids that are artificially or
technologically administered.
(O)
(P)
"Incompetent" has the same meaning as in section 2111.01 of
the Revised Code.
(P)
(Q)
"Intermediate care facility for
the
individuals
with intellectual disabilities" has the same meaning as in
section 5124.01 of the Revised Code.
(Q)
(R)
"Life-sustaining treatment" means any medical procedure,
treatment, intervention, or other measure that, when administered to
a qualified patient or other patient, will serve principally to
prolong the process of dying.
(R)
(S)
"Nurse" means a person who is licensed to practice nursing
as a registered nurse or to practice practical nursing as a licensed
practical nurse pursuant to Chapter 4723. of the Revised Code.
(S)
(T)
"Nursing home" has the same meaning as in section 3721.01
of the Revised Code.
(T)
(U)
"Nutrition" means sustenance that is artificially or
technologically administered.
(U)
(V)
"Permanently unconscious state" means a state of permanent
unconsciousness in a declarant or other patient that, to a reasonable
degree of medical certainty as determined in accordance with
reasonable medical standards by the declarant's or other patient's
attending physician and one other physician who has examined the
declarant or other patient, is characterized by both of the
following:
(1)
Irreversible unawareness of one's being and environment.
(2)
Total loss of cerebral cortical functioning, resulting in the
declarant or other patient having no capacity to experience pain or
suffering.
(V)
(W)
"Person" has the same meaning as in section 1.59 of the
Revised Code and additionally includes political subdivisions and
governmental agencies, boards, commissions, departments,
institutions, offices, and other instrumentalities.
(W)
(X)
"Physician" means a person who is authorized under Chapter
4731. of the Revised Code to practice medicine and surgery or
osteopathic medicine and surgery.
(X)
(Y)
"Political subdivision" and "state" have the same
meanings as in section 2744.01 of the Revised Code.
(Y)
(Z)
"Professional disciplinary action" means action taken by
the board or other entity that regulates the professional conduct of
health care personnel, including the state medical board and the
board of nursing.
(Z)
(AA)
"Qualified patient" means an adult who has executed a
declaration and has been determined to be in a terminal condition or
in a permanently unconscious state.
(AA)
(BB)
"Terminal condition" means an irreversible, incurable, and
untreatable condition caused by disease, illness, or injury from
which, to a reasonable degree of medical certainty as determined in
accordance with reasonable medical standards by a declarant's or
other patient's attending physician and one other physician who has
examined the declarant or other patient, both of the following apply:
(1)
There can be no recovery.
(2)
Death is likely to occur within a relatively short time if
life-sustaining treatment is not administered.
(BB)
(CC)
"Tort action" means a civil action for damages for injury,
death, or loss to person or property, other than a civil action for
damages for breach of a contract or another agreement between
persons.
Sec.
2133.03.
(A)(1)
A declaration becomes operative when it is communicated to the
attending physician of the declarant, the attending physician and one
other physician who examines the declarant determine that the
declarant is in a terminal condition or in a permanently unconscious
state, whichever is addressed in the declaration, the applicable
requirements of divisions (A)(2) and (3) of this section are
satisfied, and the attending physician determines that the declarant
no longer is able to make informed decisions regarding the
administration of life-sustaining treatment. When the declaration
becomes operative, the attending physician and health care facilities
shall act in accordance with its provisions or comply with the
provisions of section 2133.10 of the Revised Code.
(2)
In order for a declaration to become operative in connection with a
declarant who is in a permanently unconscious state, the consulting
physician associated with the determination that the declarant is in
the permanently unconscious state shall be a physician who, by virtue
of advanced education or training, of a practice limited to
particular diseases, illnesses, injuries, therapies, or branches of
medicine or surgery or osteopathic medicine and surgery, of
certification as a specialist in a particular branch of medicine or
surgery or osteopathic medicine and surgery, or of experience
acquired in the practice of medicine or surgery or osteopathic
medicine and surgery, is qualified to determine whether the declarant
is in a permanently unconscious state.
(3)
In order for a declaration to become operative in connection with a
declarant who is in a terminal condition or in a permanently
unconscious state, the attending physician of the declarant shall
determine, in good faith, to a reasonable degree of medical
certainty, and in accordance with reasonable medical standards, that
there is no reasonable possibility that the declarant will regain the
capacity to make informed decisions regarding the administration of
life-sustaining treatment.
(B)(1)(a)
A declaration supersedes any general consent to treatment form signed
by or on behalf of the declarant prior to, upon, or after the
declarant's admission to a health care facility to the extent there
is a conflict between the declaration and the form, even if the form
is signed after the execution of the declaration. To the extent that
the provisions of a declaration and a general consent to treatment
form do not conflict, both documents shall govern the use or
continuation, or the withholding or withdrawal, of life-sustaining
treatment and other medical or nursing procedures, treatments,
interventions, or other measures in connection with the declarant.
Division (B)(1)(a) of this section does not apply if a declaration is
revoked pursuant to section 2133.04 of the Revised Code after the
signing of a general consent to treatment form.
(b)
A declaration supersedes a
DNI
identification or
DNR
identification
,
as defined in section 2133.21 of the Revised Code,
of the declarant that is based upon a prior, inconsistent declaration
of the declarant or that is based upon a
do-not-intubate
order or a
do-not-resuscitate
order
,
as defined in section 2133.21 of the Revised Code,
that a physician has issued for the declarant and that is
inconsistent with the declaration.
(2)
If a declarant has both a valid durable power of attorney for health
care and a valid declaration, the declaration supersedes the durable
power of attorney for health care to the extent that the provisions
of the documents would conflict if the declarant should be in a
terminal condition or in a permanently unconscious state. Division
(B)(2) of this section does not apply if the declarant revokes the
declaration pursuant to section 2133.04 of the Revised Code.
Sec.
2133.07.
(A)
As
used in this section, "DNR identification" has the same
meaning as in section 2133.21 of the Revised Code.
(B)
A
printed form of a declaration may be sold or otherwise distributed in
this state for use by adults who are not advised by an attorney. By
use of a printed form of that nature, a declarant may authorize the
use or continuation, or the withholding or withdrawal, of
life-sustaining treatment should the declarant be in a terminal
condition, a permanently unconscious state, or either a terminal
condition or a permanently unconscious state, may authorize the
withholding or withdrawal of nutrition or hydration should the
declarant be in a permanently unconscious state as described in
division (A)(3)(a) of section 2133.02 of the Revised Code, and may
designate one or more persons who are to be notified by the
declarant's attending physician at any time that life-sustaining
treatment would be withheld or withdrawn pursuant to the declaration.
The printed form shall not be used as an instrument for granting any
other type of authority or for making any other type of designation,
except that the printed form may be used as a
DNI
identification or
DNR
identification if the declarant specifies on the form that the
declarant wishes to use it as a
DNI
identification or
DNR
identification.
(C)(1)
(B)(1)
A printed form of a declaration under division
(B)
(A)
of this section shall include, as a separate page or as a portion of
a page that can be detached from the declaration, a donor registry
enrollment form that permits the donor to be included in the donor
registry created under section 2108.23 of the Revised Code.
(2)
The donor registry enrollment form may be in any form that complies
with the requirements of division (B) of section 2108.05 of the
Revised Code. On completion, the form shall be forwarded to the
bureau of motor vehicles.
Sec.
2133.151.
Any
do-not-resuscitate order that is executed not later than twelve
months after the effective date of this section in accordance with
former Chapter 2133. of the Revised Code as that chapter existed
prior to the effective date of this section is valid until revoked by
the individual.
Sec.
2133.21.
As
used in sections 2133.21 to 2133.26 of the Revised Code, unless the
context clearly requires otherwise:
(A)
"Attending physician" means the physician to whom a person,
or the family of a person, has assigned primary responsibility for
the treatment or care of the person or, if the person or the person's
family has not assigned that responsibility, the physician who has
accepted that responsibility.
(B)
"CPR"
means cardiopulmonary resuscitation or a component of cardiopulmonary
resuscitation, but it does not include clearing a person's airway for
a purpose other than as a component of CPR.
(C)
"Declaration,"
"health care facility," "life-sustaining treatment,"
"physician," "professional disciplinary action,"
and "tort action" have the same meanings as in section
2133.01 of the Revised Code.
(C)
(D)
"DNI identification" means a standardized identification
card, form, necklace, or bracelet that is of uniform size and design,
that has been approved by the department of health pursuant to
section 2133.25 of the Revised Code, and that signifies either of the
following:
(1)
That the person who is named on and possesses the card, form,
necklace, or bracelet has executed a declaration that authorizes the
withholding or withdrawal of intubation and that has not been revoked
pursuant to section 2133.04 of the Revised Code;
(2)
That the attending physician of the person who is named on and
possesses the card, form, necklace, or bracelet has issued a current
do-not-intubate order, in accordance with the do-not-intubate
protocol adopted by the department of health pursuant to section
2133.25 of the Revised Code, for that person and has documented the
grounds for the order in that person's medical record.
(E)
"DNR identification" means a standardized identification
card, form, necklace, or bracelet that is of uniform size and design,
that has been approved by the department of health pursuant to
section 2133.25 of the Revised Code, and that signifies either of the
following:
(1)
That the person who is named on and possesses the card, form,
necklace, or bracelet has executed a declaration that authorizes the
withholding or withdrawal of CPR and that has not been revoked
pursuant to section 2133.04 of the Revised Code;
(2)
That the attending physician of the person who is named on and
possesses the card, form, necklace, or bracelet has issued a current
do-not-resuscitate order, in accordance with the do-not-resuscitate
protocol adopted by the department of health pursuant to section
2133.25 of the Revised Code, for that person and has documented the
grounds for the order in that person's medical record.
(D)
(F)
"Do-not-intubate
order" means a directive issued by a physician that identifies a
person and specifies that the person so identified should not be
intubated.
(G)
"Do-not-intubate protocol" means the standardized method of
procedure for the withholding of intubation by physicians, emergency
medical service personnel, and health care facilities that is adopted
in the rules of the department of health pursuant to section 2133.25
of the Revised Code.
(H)
"Do-not-resuscitate
order" means a directive issued by a physician that identifies a
person and specifies that CPR should not be administered to the
person so identified.
(E)
(I)
"Do-not-resuscitate
protocol" means the standardized method of procedure for the
withholding of CPR by physicians, emergency medical service
personnel, and health care facilities that is adopted in the rules of
the department of health pursuant to section 2133.25 of the Revised
Code.
(F)
(J)
"Emergency medical services personnel" means paid or
volunteer firefighters, law enforcement officers, first responders,
emergency medical technicians-basic, emergency medical
technicians-intermediate, emergency medical technicians-paramedic,
medical technicians, or other emergency services personnel acting
within the ordinary course of their profession.
(G)
"CPR" means cardiopulmonary resuscitation or a component of
cardiopulmonary resuscitation, but it does not include clearing a
person's airway for a purpose other than as a component of CPR.
(K)
"Intubate" or "intubation" means the medical
procedure of inserting a tube into a person's trachea to maintain an
open airway and facilitate breathing. It also includes the use of a
supraglottic airway device.
Sec.
2133.22.
(A)(1)
None of the following are subject to criminal prosecution, to
liability in damages in a tort or other civil action for injury,
death, or loss to person or property, or to professional disciplinary
action arising out of or relating to
the
withholding or withdrawal of intubation or
the
withholding or withdrawal of CPR from a person after
DNI
identification or
DNR
identification
,
as applicable,
is discovered in the person's possession and reasonable efforts have
been made to determine that the person in possession of the
DNR
identification
is the person named on the
DNR
identification:
(a)
A physician who causes the withholding or withdrawal of CPR
or
the withholding or withdrawal of intubation
from
the person possessing the DNR
or
DNI
identification
,
as applicable
;
(b)
A person who participates under the direction of or with the
authorization of a physician in the withholding or withdrawal of CPR
or
the withholding or withdrawal of intubation
from
the person possessing the DNR
or DNI
identification
,
as applicable
;
(c)
Any emergency medical services personnel who cause or participate in
the withholding or withdrawal of CPR
or
the withholding or withdrawal of intubation
from
the person possessing the DNR
or DNI
identification
,
as applicable
.
(2)
None of the following are subject to criminal prosecution, to
liability in damages in a tort or other civil action for injury,
death, or loss to person or property, or to professional disciplinary
action arising out of or relating to the withholding or withdrawal of
CPR
or
the withholding or withdrawal of intubation
from
a person in a health care facility after DNR
or DNI
identification
,
as applicable,
is discovered in the person's possession and reasonable efforts have
been made to determine that the person in possession of the
DNR
identification
is the person named on the
DNR
identification
,
or a
do-not-intubate
order or
do-not-resuscitate
order is issued for the person:
(a)
The health care facility or the administrator of the health care
facility;
(b)
A physician who causes the withholding or withdrawal of CPR
or
the withholding or withdrawal of intubation
from
the person possessing the DNR identification
or DNI identification, as applicable,
or for whom the do-not-resuscitate order
or do-not-intubate order
has been issued;
(c)
Any person who works for the health care facility as an employee,
contractor, or volunteer and who participates under the direction of
or with the authorization of a physician in the withholding or
withdrawal of CPR
or
in the withholding or withdrawal of intubation
from
the person possessing the DNR
or DNI
identification
,
as applicable
;
(d)
Any person who works for the health care facility as an employee,
contractor, or volunteer and who participates under the direction of
or with the authorization of a physician in the withholding or
withdrawal of CPR
or in the withholding or withdrawal of intubation
from the person for whom the do-not-resuscitate order
or
do-not-intubate order
has
been issued.
(3)
If, after DNR identification
or
DNI identification
is
discovered in the possession of a person, the person makes an oral or
written request to receive CPR
or intubation, as applicable
,
any person who provides CPR
or
intubation
pursuant
to the request, any health care facility in which CPR
or
intubation
is
provided, and the administrator of any health care facility in which
CPR
or intubation
is provided are not subject to criminal prosecution as a result of
the provision of the CPR
or intubation
,
are not liable in damages in a tort or other civil action for injury,
death, or loss to person or property that arises out of or is related
to the provision of the CPR
or intubation
,
and are not subject to professional disciplinary action as a result
of the provision of the CPR
or intubation
.
(B)
Divisions (A)(1), (A)(2), and (C) of this section do not apply when
either:
(1)
CPR
is withheld or withdrawn from a person who possesses DNR
identification or for whom a do-not-resuscitate order has been issued
unless the withholding or withdrawal is in accordance with the
do-not-resuscitate protocol.
(2)
Intubation is withheld or withdrawn from a person who possesses DNI
identification or for whom a do-not-intubate order has been issued
unless the withholding or withdrawal is in accordance with the
do-not-intubate protocol.
(C)
Any emergency medical services personnel who comply with a
do-not-resuscitate order
or
do-not-intubate order
issued
by a physician and any individuals who work for a health care
facility as employees, contractors, or volunteers and who comply with
a do-not-resuscitate order
or do-not-intubate order
issued by a physician are not subject to liability in damages in a
civil action for injury, death, or loss to person or property that
arises out of or is related to compliance with the order, are not
subject to criminal prosecution as a result of compliance with the
order, and are not subject to professional disciplinary action as a
result of compliance with the order.
In
an emergency situation, emergency medical services personnel and
emergency department personnel are not required to search a person to
determine if the person possesses DNR identification
or DNI identification
.
If a person possesses DNR identification
or DNI identification
,
if emergency medical services personnel or emergency department
personnel provide CPR
or intubation
to the person in an emergency situation, and if, at that time, the
personnel do not know and do not have reasonable cause to believe
that the person possesses DNR identification
or DNI identification
,
the emergency medical services personnel and emergency department
personnel are not subject to criminal prosecution as a result of the
provision of the CPR
or intubation
,
are not liable in damages in a tort or other civil action for injury,
death, or loss to person or property that arises out of or is related
to the provision of the CPR
or intubation
,
and are not subject to professional disciplinary action as a result
of the provision of the CPR
or intubation
.
(D)
Nothing in sections 2133.21 to 2133.26 of the Revised Code
or
,
the
do-not-resuscitate protocol
,
or the do-not-intubate protocol
grants immunity to a physician for issuing a do-not-resuscitate order
or
do-not-intubate order
that
is contrary to reasonable medical standards or that the physician
knows or has reason to know is contrary to the wishes of the patient
or of a person who is lawfully authorized to make informed medical
decisions on the patient's behalf.
Sec.
2133.23.
(A)
If emergency medical services personnel, other than physicians, are
presented with
DNI
identification or
DNR
identification possessed by a person or are presented with a written
do-not-intubate
order or
do-not-resuscitate
order for a person or if a physician directly issues to emergency
medical services personnel, other than physicians, an oral
do-not-intubate
order or
do-not-resuscitate
order for a person, the emergency medical services personnel shall
comply with the
do-not-intubate
protocol or
do-not-resuscitate
protocol for the person. If an oral
do-not-intubate
order or
do-not-resuscitate
order is issued by a physician who is not present at the scene, the
emergency medical services personnel shall verify the physician's
identity.
(B)
If a person possesses
DNI
identification or
DNR
identification and if the person's attending physician or the health
care facility in which the person is located is unwilling or unable
to comply with the
do-not-intubate
protocol or
do-not-resuscitate
protocol for the person, the attending physician or the health care
facility shall not prevent or attempt to prevent, or unreasonably
delay or attempt to delay, the transfer of the person to a different
physician who will follow the protocol or to a different health care
facility in which the protocol will be followed.
(C)
If a person who possesses
DNI
identification or
DNR
identification or for whom a current
do-not-intubate
order or
do-not-resuscitate
order has been issued is being transferred from one health care
facility to another, before or at the time of the transfer, the
transferring health care facility shall notify the receiving health
care facility and the persons transporting the person of the
existence of the
DNI
identification or
DNR
identification or the order. If a current
do-not-intubate
order or
do-not-resuscitate
order was issued orally, it shall be reduced to writing before the
time of the transfer. The
DNI
identification or
DNR
identification or
the
order
shall accompany the person to the receiving health care facility and
shall remain in effect unless it is revoked or unless, in the case of
a
do-not-intubate
order or
do-not-resuscitate
order, the order no longer is current.
Sec.
2133.24.
(A)
The death of a person resulting from the withholding or withdrawal of
CPR
or
the withholding or withdrawal of intubation
for
the person pursuant to the
do-not-intubate
protocol or
do-not-resuscitate
protocol and in the circumstances described in section 2133.22 of the
Revised Code or in accordance with division (A) of section 2133.23 of
the Revised Code does not constitute for any purpose a suicide,
aggravated murder, murder, or any other homicide.
(B)(1)
If a person possesses
DNI
identification or
DNR
identification or if a current
do-not-intubate
order or
do-not-resuscitate
order has been issued for a person, the possession or order shall not
do either of the following:
(a)
Affect in any manner the sale, procurement, issuance, or renewal of a
policy of life insurance or annuity, notwithstanding any term of a
policy or annuity to the contrary;
(b)
Be deemed to modify in any manner or invalidate the terms of any
policy of life insurance or annuity that is in effect on the
effective date of this section.
(2)
Notwithstanding any term of a policy of life insurance or annuity to
the contrary, the withholding or withdrawal of CPR
or
the withholding or withdrawal of intubation, as applicable,
from
a person who is insured or covered under the policy or annuity and
who possesses DNR identification
or
DNI identification
or
for whom a current do-not-resuscitate order
or
do-not-intubate order
has
been issued, in accordance with sections 2133.21 to 2133.26 of the
Revised Code, shall not impair or invalidate any policy of life
insurance or annuity.
(3)
Notwithstanding any term of a policy or plan to the contrary, neither
of the following shall impair or invalidate any policy of health
insurance or other health care benefit plan:
(a)
The withholding or withdrawal in accordance with sections 2133.21 to
2133.26 of the Revised Code of CPR
or
intubation
from
a person who is insured or covered under the policy or plan and who
possesses DNR identification
or
DNI identification
or
for whom a current do-not-resuscitate order
or do-not-intubate order
has been issued;
(b)
The provision in accordance with sections 2133.21 to 2133.26 of the
Revised Code of CPR
or
intubation, as applicable,
to
a person of the nature described in division (B)(3)(a) of this
section.
(4)
No physician, health care facility, other health care provider,
person authorized to engage in the business of insurance in this
state under Title XXXIX of the Revised Code, health insuring
corporation, other health care benefit plan, legal entity that is
self-insured and provides benefits to its employees or members, or
other person shall require an individual to possess
DNI
identification or
DNR
identification, or shall require an individual to revoke or refrain
from possessing
DNI
identification or
DNR
identification, as a condition of being insured or of receiving
health care benefits or services.
(C)(1)
Sections 2133.21 to 2133.26 of the Revised Code do not create any
presumption concerning the intent of an individual who does not
possess DNR identification
or
DNI identification
with
respect to the use, withholding, or withdrawal of CPR
or intubation
.
(2)
Sections 2133.21 to 2133.26 of the Revised Code do not affect the
right of a person to make informed decisions regarding the use,
withholding, or withdrawal of CPR
or
intubation, as applicable,
for
the person as long as the person is able to make those decisions.
(3)
Sections 2133.21 to 2133.26 of the Revised Code are in addition to
and independent of, and do not limit, impair, or supersede, any right
or responsibility that a person has to effect the withholding or
withdrawal of life-sustaining treatment to another pursuant to
sections 2133.01 to 2133.15 of the Revised Code or in any other
lawful manner.
(D)
Nothing in sections 2133.21 to 2133.26 of the Revised Code condones,
authorizes, or approves of mercy killing, assisted suicide, or
euthanasia.
Sec.
2133.25.
(A)
The department of health, by rule adopted pursuant to Chapter 119. of
the Revised Code, shall adopt a standardized method of procedure for
the withholding of CPR
and
the withholding of intubation
by
physicians, certified nurse-midwives, clinical nurse specialists,
certified nurse practitioners, emergency medical services personnel,
and health care facilities in accordance with sections 2133.21 to
2133.26 of the Revised Code. The standardized
method
methods
shall
specify criteria for determining when a
do-not-intubate
order or
do-not-resuscitate
order is current. The standardized
method
methods
so
adopted shall be the
"do-not-intubate
protocol" and the
"do-not-resuscitate
protocol" for purposes of sections 2133.21 to 2133.26 of the
Revised Code. The department also shall approve one or more standard
forms of
DNI
identification and
DNR
identification to be used throughout this state.
(B)
The department of health shall adopt rules in accordance with Chapter
119. of the Revised Code for the administration of sections 2133.21
to 2133.26 of the Revised Code.
(C)
The department of health shall appoint an advisory committee to
advise the department in the development of rules under this section.
The advisory committee shall include, but shall not be limited to,
representatives of each of the following organizations:
(1)
The Ohio hospital association;
(2)
The Ohio state medical association;
(3)
The Ohio chapter of the American college of emergency physicians;
(4)
The Ohio hospice organization;
(5)
The Ohio council for home care and hospice;
(6)
The Ohio health care association;
(7)
The Ohio ambulance association;
(8)
The Ohio medical directors association;
(9)
The Ohio association of emergency medical services;
(10)
The bioethics network of Ohio;
(11)
The Ohio nurses association;
(12)
The Ohio academy of nursing homes;
(13)
The Ohio association of professional firefighters;
(14)
The department of developmental disabilities;
(15)
The Ohio osteopathic association;
(16)
The association of Ohio philanthropic homes and housing services for
the aging;
(17)
The catholic conference of Ohio;
(18)
The department of aging;
(19)
The department of
mental
health and addiction services
behavioral
health
;
(20)
The Ohio private residential association;
(21)
The northern Ohio fire fighters association;
(22)
The Ohio association of advanced practice nurses.
Sec.
2133.26.
(A)(1)
No physician shall purposely prevent or attempt to prevent, or delay
or unreasonably attempt to delay, the transfer of a patient in
violation of division (B) of section 2133.23 of the Revised Code.
(2)
No person shall purposely conceal, cancel, deface, or obliterate the
DNI
identification or
DNR
identification of another person without the consent of the other
person.
(3)
No person shall purposely falsify or forge a revocation of a
declaration that is the basis of the
DNI
identification or
DNR
identification of another person or purposely falsify or forge an
order of a physician that purports to supersede a
do-not-intubate
order or a
do-not-resuscitate
order issued for another person.
(4)
No person shall purposely falsify or forge the
DNI
identification or
DNR
identification of another person with the intent to cause the use,
withholding, or withdrawal of CPR
or intubation, as applicable,
for the other person.
(5)
No person who has personal knowledge that another person has revoked
a declaration that is the basis of the other person's
DNI
identification or
DNR
identification or personal knowledge that a physician has issued an
order that supersedes a
do-not-intubate
order or a
do-not-resuscitate
order that the physician issued for another person shall purposely
conceal or withhold that personal knowledge with the intent to cause
the use, withholding, or withdrawal of CPR
or
intubation, as applicable,
for
the other person.
(B)(1)
Whoever violates division (A)(1) or (5) of this section is guilty of
a misdemeanor of the third degree.
(2)
Whoever violates division (A)(2), (3), or (4) of this section is
guilty of a misdemeanor of the first degree.
Sec.
4765.35.
(A)
A first responder may perform any of the emergency medical services
specified for first responders in rules adopted under section 4765.11
of the Revised Code by the state board of emergency medical, fire,
and transportation services. A first responder shall perform the
emergency medical services in accordance with this chapter and any
rules adopted under it by the board.
(B)(1)
Except as provided in division (B)(2) of this section, the emergency
medical services provided by a first responder shall be performed
only pursuant to one of the following:
(a)
The written or verbal authorization of a physician or of the
cooperating physician advisory board;
(b)
An authorization transmitted through a direct communication device by
a physician, physician assistant designated by a physician, or
registered nurse designated by a physician;
(c)
Any applicable protocols adopted by the emergency medical service
organization with which the first responder is affiliated.
(2)
Division (B)(1) of this section does not prohibit a first responder
from complying with a
do-not-intubate
order or a
do-not-resuscitate
order issued by a physician assistant or advanced practice registered
nurse pursuant to section 2133.211 of the Revised Code.
Sec.
4765.37.
(A)
An emergency medical technician-basic may perform any of the
emergency medical services specified for EMTs-basic in rules adopted
under section 4765.11 of the Revised Code by the state board of
emergency medical, fire, and transportation services. An EMT-basic
shall perform the emergency medical services in accordance with this
chapter and any rules adopted under it by the board.
(B)(1)
Except as provided in division (B)(2) of this section, the emergency
medical services provided by an EMT-basic shall be performed only
pursuant to one of the following:
(a)
The written or verbal authorization of a physician or of the
cooperating physician advisory board;
(b)
An authorization transmitted through a direct communication device by
a physician, physician assistant designated by a physician, or
registered nurse designated by a physician;
(c)
Any applicable protocols adopted by the emergency medical service
organization with which the EMT-basic is affiliated.
(2)
Division (B)(1) of this section does not prohibit an EMT-basic from
complying with a
do-not-intubate
order or a
do-not-resuscitate
order issued by a physician assistant or advanced practice registered
nurse pursuant to section 2133.211 of the Revised Code.
Sec.
4765.38.
(A)
An emergency medical technician-intermediate may perform any of the
emergency medical services specified for EMTs-I in rules adopted
under section 4765.11 of the Revised Code by the state board of
emergency medical, fire, and transportation services. An EMT-I shall
perform emergency medical services in accordance with this chapter
and any rules adopted under it by the board.
(B)(1)
Except as provided in division (B)(2) of this section, the emergency
medical services provided by an EMT-I shall be performed only
pursuant to one of the following:
(a)
The written or verbal authorization of a physician or of the
cooperating physician advisory board;
(b)
An authorization transmitted through a direct communication device by
a physician, physician assistant designated by a physician, or
registered nurse designated by a physician;
(c)
Any applicable protocols adopted by the emergency medical service
organization with which the EMT-I is affiliated.
(2)
Division (B)(1) of this section does not prohibit an EMT-I from
complying with a
do-not-intubate
order or a
do-not-resuscitate
order issued by a physician assistant or advanced practice registered
nurse pursuant to section 2133.211 of the Revised Code.
(C)
In addition to, and in the course of, providing emergency medical
treatment, an EMT-I may withdraw blood as provided under sections
1547.11, 4506.17, and 4511.19 of the Revised Code. An EMT-I shall
withdraw blood in accordance with this chapter and any rules adopted
under it by the board.
Sec.
4765.39.
(A)
An emergency medical technician-paramedic may perform any of the
emergency medical services specified for paramedics in rules adopted
under section 4765.11 of the Revised Code by the state board of
emergency medical, fire, and transportation services. A paramedic
shall perform emergency medical services in accordance with this
chapter and any rules adopted under it by the state board of
emergency medical, fire, and transportation services.
(B)(1)
Except as provided in division (B)(2) of this section, the emergency
medical services provided by a paramedic shall be performed only
pursuant to one of the following:
(a)
The written or verbal authorization of a physician or of the
cooperating physician advisory board;
(b)
An authorization transmitted through a direct communication device by
a physician, physician assistant designated by a physician, or
registered nurse designated by a physician;
(c)
Any applicable protocols adopted by the emergency medical service
organization with which the paramedic is affiliated.
(2)
Division (B)(1) of this section does not prohibit a paramedic from
complying with a
do-not-intubate
order or a
do-not-resuscitate
order issued by a physician assistant or advanced practice registered
nurse pursuant to section 2133.211 of the Revised Code.
(C)
In addition to, and in the course of, providing emergency medical
treatment, a paramedic may withdraw blood as provided under sections
1547.11, 4506.17, and 4511.19 of the Revised Code. A paramedic shall
withdraw blood in accordance with this chapter and any rules adopted
under it by the board.
Section
2.
That
existing sections 1337.12, 2108.23, 2108.231, 2133.01, 2133.03,
2133.07, 2133.21, 2133.22, 2133.23, 2133.24, 2133.25, 2133.26,
4765.35, 4765.37, 4765.38, and 4765.39 of the Revised Code are hereby
repealed.