As Introduced

127th General Assembly Regular Session 2007-2008

H. B. No. 601

Representative Wachtmann 

Cosponsors: Representatives Goodwin, Newcomb, Fessler, Yuko, Combs, Collier, Huffman, Mallory 

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A BILL

To amend sections 2133.21, 2133.22, 2133.23, 2133.24,

1

and 2133.26, to enact sections 2133.212 and

2

2133.30 to 2133.48, and to repeal section 2133.25

3

of the Revised Code to require the Director of

4

Health to prescribe a form to document medical

5

orders for life-sustaining treatment and to make

6

changes to the law governing DNR identification

7

and orders.

8

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

Section 1. That sections 2133.21, 2133.22, 2133.23, 2133.24,	9
and 2133.26 be amended and sections 2133.212, 2133.30, 2133.31,	10
2133.32, 2133.33, 2133.34, 2133.35, 2133.36, 2133.37, 2133.38,	11
2133.39, 2133.40, 2133.41, 2133.42, 2133.43, 2133.44, 2133.45,	12
2133.46, 2133.47, and 2133.48 of the Revised Code be enacted to	13
read as follows:	14

Sec. 2133.21.  As used in this section and sections 2133.21	15
to2133.211, 2133.22, 2133.24, and 2133.26 of the Revised Code,	16
unless the context clearly requires otherwise:	17

(A) "Attending physician" means the physician to whom a	18
person, or the family of a person, has assigned primary	19
responsibility for the treatment or care of the person or, if the	20
person or the person's family has not assigned that	21
responsibility, the physician who has accepted that	22
responsibility.	23

(B) "CPR" means cardiopulmonary resuscitation or a component	24
of cardiopulmonary resuscitation, but it does not include clearing	25
a person's airway for a purpose other than as a component of CPR.	26

(C) "Declaration," "health care facility," "life-sustaining	27
treatment," "physician," "professional disciplinary action," and	28
"tort action" have the same meanings as in section 2133.01 of the	29
Revised Codemeans a document executed in accordance with section	30
2133.02 of the Revised Code that includes a specific authorization	31
for the use or continuation, or the withholding or withdrawal, of	32
CPR.	33

(C)(D) "DNR identification" means a standardized	34
identification card, form, necklace, or bracelet that is of	35
uniform size and design, that has been approved by the department	36
of health pursuant to section 2133.25 of the Revised Code, and	37
that signifies eitherone of the following:	38

(1) That the person who is named on and possesses the card,	39
form, necklace, or bracelet has executed a declaration that	40
authorizes the withholding or withdrawal of CPR and that has not	41
been revoked pursuant to section 2133.04 of the Revised Code;	42

(2) That the attending physician of the person who is named	43
on and possesses the card, form, necklace, or bracelet has issued	44
a current do-not-resuscitate order, in accordance with the	45
do-not-resuscitate protocol adopted by the department of health	46
pursuant to section 2133.25 of the Revised Code, for that person	47
and has documented the grounds for the order in that person's	48
medical record.;	49

(3) That an issuing practitioner has completed a MOLST form	50
that has not been superseded as described in section 2133.41 of	51
the Revised Code or revoked as described in section 2133.39 of the	52
Revised Code.	53

(D)(E) "Do-not-resuscitate order" means a directive, other	54
than a hospital do-not-resuscitate order, issued by a physician	55
prior to the effective date of this amendment that identifies a	56
person and specifies that CPR should not be administered to the	57
person so identified.	58

(E) "Do-not-resuscitate protocol" means the standardized	59
method of procedure for the withholding of CPR by physicians,	60
emergency medical service personnel, and health care facilities	61
that is adopted in the rules of the department of health pursuant	62
to section 2133.25 of the Revised Code.	63

(F) "Emergency medical services personnel" means paid or	64
volunteer firefighters, law enforcement officers, first	65
responders, emergency medical technicians-basic, emergency medical	66
technicians-intermediate, emergency medical technicians-paramedic,	67
medical technicians, or other emergency services personnel acting	68
within the ordinary course of their profession.	69

(G) "CPR" means cardiopulmonary resuscitation or a component	70
of cardiopulmonary resuscitation, but it does not include clearing	71
a person's airway for a purpose other than as a component of CPR	72
"Health care facility," "life-sustaining treatment," "physician,"	73
"professional disciplinary action," and "tort action" have the	74
same meanings as in section 2133.01 of the Revised Code.	75

(H) "Hospital do-not-resuscitate order" means a directive	76
issued by a physician pursuant to section 2133.212 of the Revised	77
Code.	78

(I) "Issuing practitioner" has the same meaning as in section	79
2133.30 of the Revised Code.	80

(J) "MOLST form" means a form completed pursuant to division	81
(A) of section 2133.33 of the Revised Code that includes a	82
specific authorization for the use or continuation, or the	83
withholding or withdrawal, of CPR.	84

Sec. 2133.212. A physician may issue a directive for a person	85
admitted to a hospital that identifies the person and specifies	86
that CPR should not be administered to the person during the	87
relevant hospital stay. A directive issued under this section is	88
valid only for the single hospital stay during which it is made	89
and expires at the time of the patient's discharge from the	90
hospital.	91

At the time of discharge, the patient's physician or an	92
employee or agent of the hospital shall destroy the directive,	93
inform the patient or the patient's representative of such	94
destruction, and explain that a physician, physician assistant, or	95
advanced practice nurse is permitted under section 2133.33 of the	96
Revised Code to issue medical orders for life-sustaining treatment	97
for the patient by completing a MOLST form.	98

Sec. 2133.22.  (A)(1) None of the following are subject to	99
criminal prosecution, to liability in damages in a tort or other	100
civil action for injury, death, or loss to person or property, or	101
to professional disciplinary action arising out of or relating to	102
the withholding or withdrawal of CPR from a person who has	103
executed a declaration, for whom a do-not-resuscitate order or	104
hospital do-not-resuscitate order has been issued or MOLST form	105
has been completed, or after DNR identification is discovered in	106
the person's possession and reasonable efforts have been made to	107
determine that the person in possession of the DNR identification	108
is the person named on the DNR identification:	109

(a) A physician who causes the withholding or withdrawal of	110
CPR from the person possessingwho has executed a declaration, for	111
whom a do-not-resuscitate order or hospital do-not-resuscitate	112
order has been issued or MOLST form has been completed, or who	113
possesses the DNR identification;	114

(b) A person who participates under the direction of or with	115
the authorization of a physician in the withholding or withdrawal	116
of CPR from the person possessingwho has executed a declaration,	117
for whom a do-not-resuscitate order or hospital do-not-resuscitate	118
order has been issued or MOLST form has been completed, or who	119
possesses the DNR identification;	120

(c) Any emergency medical services personnel who cause or	121
participate in the withholding or withdrawal of CPR from the	122
person possessingwho has executed a declaration, for whom a	123
do-not-resuscitate order or hospital do-not-resuscitate order has	124
been issued or MOLST form has been completed, or who possesses the	125
DNR identification.	126

(2) None of the following are subject to criminal	127
prosecution, to liability in damages in a tort or other civil	128
action for injury, death, or loss to person or property, or to	129
professional disciplinary action arising out of or relating to the	130
withholding or withdrawal of CPR from a person in a health care	131
facility who has executed a declaration, for whom a	132
do-not-resuscitate order or hospital do-not-resuscitate order has	133
been issued or MOLST form has been completed, or after DNR	134
identification is discovered in the person's possession and	135
reasonable efforts have been made to determine that the person in	136
possession of the DNR identification is the person named on the	137
DNR identification or a do-not-resuscitate order is issued for the	138
person:	139

(a) The health care facility or the administrator of the	140
health care facility;	141

(b) A physician who causes the withholding or withdrawal of	142
CPR from the person possessingwho has executed a declaration, for	143
whom a do-not-resuscitate order or hospital do-not-resuscitate	144
order has been issued or MOLST form has been completed, or who	145
possesses the DNR identification or for whom the	146
do-not-resuscitate order has been issued;	147

(c) Any person who works for the health care facility as an	148
employee, contractor, or volunteer and who participates under the	149
direction of or with the authorization of a physician in the	150
withholding or withdrawal of CPR from the person possessingwho	151
has executed a declaration, for whom a do-not-resuscitate order or	152
hospital do-not-resuscitate order has been issued or MOLST form	153
has been completed, or who possesses the DNR identification;	154

(d) Any person who works for the health care facility as an	155
employee, contractor, or volunteer and who participates under the	156
direction of or with the authorization of a physician in the	157
withholding or withdrawal of CPR from the person for whom the	158
do-not-resuscitate order has been issued.	159

(3) If, after DNR identification is discovered in the	160
possession of a person, the person makes an oral or written	161
request to receive CPR, any person who provides CPR pursuant to	162
the request, any health care facility in which CPR is provided,	163
and the administrator of any health care facility in which CPR is	164
provided are not subject to criminal prosecution as a result of	165
the provision of the CPR, are not liable in damages in a tort or	166
other civil action for injury, death, or loss to person or	167
property that arises out of or is related to the provision of the	168
CPR, and are not subject to professional disciplinary action as a	169
result of the provision of the CPR.	170

(B) Divisions (A)(1), (A)(2), and (C) of this section do not	171
apply when CPR is withheld or withdrawn from a person who has	172
executed a declaration, for whom a do-not-resuscitate order or	173
hospital do-not-resuscitate order has been issued or MOLST form	174
has been completed, or who possesses DNR identification or for	175
whom a do-not-resuscitate order has been issued unless the	176
withholding or withdrawal is in accordance with the	177
do-not-resuscitate protocolinstructions regarding the withholding	178
or withdrawal of CPR in the declaration, do-not-resuscitate order	179
or hospital do-not-resuscitate order, or MOLST form.	180

(C) Any emergency medical services personnel who comply with	181
a do-not-resuscitate order issued by a physician and any	182
individuals who work for a health care facility as employees,	183
contractors, or volunteers and who comply with a	184
do-not-resuscitate order issued by a physician are not subject to	185
liability in damages in a civil action for injury, death, or loss	186
to person or property that arises out of or is related to	187
compliance with the order, are not subject to criminal prosecution	188
as a result of compliance with the order, and are not subject to	189
professional disciplinary action as a result of compliance with	190
the order.	191

In an emergency situation, emergency medical services	192
personnel and emergency department personnel are not required to	193
search a person to determine if the person possesses DNR	194
identification. If a person possesses DNR identification, if	195
emergency medical services personnel or emergency department	196
personnel provide CPR to the person in an emergency situation, and	197
if, at that time, the personnel do not know and do not have	198
reasonable cause to believe that the person possesses DNR	199
identification, the emergency medical services personnel and	200
emergency department personnel are not subject to criminal	201
prosecution as a result of the provision of the CPR, are not	202
liable in damages in a tort or other civil action for injury,	203
death, or loss to person or property that arises out of or is	204
related to the provision of the CPR, and are not subject to	205
professional disciplinary action as a result of the provision of	206
the CPR.	207

(D) Nothing in sections 2133.21 to 2133.26 of the Revised	208
Code or the do-not-resuscitate protocol grants immunity to a	209
physician for issuing a do-not-resuscitate order or hospital	210
do-not-resuscitate order that is contrary to reasonable medical	211
standards or that the physician knows or has reason to know is	212
contrary to the wishes of the patient or of a person who is	213
lawfully authorized to make informed medical decisions on the	214
patient's behalf.	215

Sec. 2133.23.  (A) If emergency medical services personnel,	216
other than physicians, are presented with DNR identification	217
possessed by a person or are presented with a written	218
do-not-resuscitate order for a person or if a physician directly	219
issues to emergency medical services personnel, other than	220
physicians, an oral do-not-resuscitate order for a personany of	221
the following, the emergency medical services personnel shall	222
comply with the do-not-resuscitate protocol for the person. If an	223
oral do-not-resuscitate order is issued by a physician who is not	224
present at the scene, the emergency medical services personnel	225
shall verify the physician's identityinstructions regarding the	226
withholding or withdrawal of CPR in the relevant document:	227

(1) A declaration executed by the person;

228

(2) A written do-not-resuscitate order or hospital	229
do-not-resuscitate order that has been issued for the person;	230

(3) A MOLST form that has been completed for the person.

231

(B) If a person possesses DNR identification and if the	232
person's attending physician or the health care facility in which	233
the person is located is unwilling or unable to comply with the	234
do-not-resuscitate protocol for the personinstructions regarding	235
the withholding or withdrawal of CPR in a declaration executed by	236
the person, a written do-not-resuscitate order or hospital	237
do-not-resuscitate order that has been issued for the person, or a	238
MOLST form that has been completed for the person, the attending	239
physician or the health care facility shall not prevent or attempt	240
to prevent, or unreasonably delay or attempt to delay, the	241
transfer of the person to a different physician who will follow	242
the protocolinstructions or to a different health care facility	243
in which the protocolinstructions will be followed.	244

(C) If a person who possesses DNR identification or for whom	245
a currentwho has executed a declaration or for whom a written	246
do-not-resuscitate order has been issued or MOLST form has been	247
completed is being transferred from one health care facility to	248
another, before or at the time of the transfer, the transferring	249
health care facility shall notify the receiving health care	250
facility and the persons transporting the person of the existence	251
of the DNR identification or the order, declaration, written	252
do-not-resuscitate order, or MOLST form. If a current	253
do-not-resuscitate order was issued orally, it shall be reduced to	254
writing before the time of the transfer. The DNR identification or	255
the order, declaration, written do-not-resuscitate order, or MOLST	256
form shall accompany the person to the receiving health care	257
facility and shall remain in effect unless it is revoked or	258
unless, in the case of a do-not-resuscitate order, the order no	259
longer is currentany of the following circumstances apply:	260

(1) In the case of a DNR identification, it has been revoked.

261

(2) In the case of a declaration, it has been revoked as	262
described in section 2133.04 of the Revised Code.	263

(3) In the case of a written do-not-resuscitate order, it is	264
no longer current.	265

(4) In the case of a MOLST form, it has been superseded as	266
described in section 2133.41 of the Revised Code, revoked as	267
described in section 2133.39 of the Revised Code, or when a	268
condition in division (A) or (B) of section 2133.43 of the Revised	269
Code applies.	270

Sec. 2133.24.  (A) The death of a person resulting from the	271
withholding or withdrawal of CPR for the person pursuant to the	272
do-not-resuscitate protocolinstructions regarding the withholding	273
or withdrawal of CPR in a declaration executed by the person, a	274
written do-not-resuscitate order or hospital do-not-resuscitate	275
order that has been issued for the person, or a MOLST form that	276
has been completed for the person and in the circumstances	277
described in section 2133.22 of the Revised Code or in accordance	278
with division (A) of section 2133.23 of the Revised Code does not	279
constitute for any purpose a suicide, aggravated murder, murder,	280
or any other homicide.	281

(B)(1) If a person has executed a declaration, or a written	282
do-not-resuscitate order or hospital do-not-resuscitate order has	283
been issued or a MOLST form completed for the person, or the	284
person possesses DNR identification or if a current	285
do-not-resuscitate order has been issued for a person, the	286
existence of the declaration, written do-not-resuscitate order or	287
hospital do-not-resuscitate order, MOLST form, or possession or	288
orderof the DNR identification shall not do either of the	289
following:	290

(a) Affect in any manner the sale, procurement, issuance, or	291
renewal of a policy of life insurance or annuity, notwithstanding	292
any term of a policy or annuity to the contrary;	293

(b) Be deemed to modify in any manner or invalidate the terms	294
of any policy of life insurance or annuity that is in effect on	295
the effective date of this section.	296

(2) Notwithstanding any term of a policy of life insurance or	297
annuity to the contrary, the withholding or withdrawal of CPR from	298
a person who is insured or covered under the policy or annuity and	299
who possesses DNR identification or for whom a current	300
do-not-resuscitate order has been issued, in accordance with	301
sections 2133.21 to 2133.26 of the Revised Code, who has executed	302
a declaration, or for whom a written do-not-resuscitate order or	303
hospital do-not-resuscitate order has been issued or MOLST form	304
has been completed shall not impair or invalidate any policy of	305
life insurance or annuity.	306

(3) Notwithstanding any term of a policy or plan to the	307
contrary, neither of the following shall impair or invalidate any	308
policy of health insurance or other health care benefit plan:	309

(a) The withholding or withdrawal in accordance with sections	310
2133.21 to 2133.26 of the Revised Code of CPR from a person who is	311
insured or covered under the policy or plan and who possesses DNR	312
identification or for whom a current do-not-resuscitate order has	313
been issued, who has executed a declaration, or for whom a written	314
do-not-resuscitate order or hospital do-not-resuscitate order has	315
been issued or MOLST form has been completed;	316

(b) The provision in accordance with sections 2133.21 to	317
2133.26 of the Revised Code of CPR to a person of the nature	318
described in division (B)(3)(a) of this section.	319

(4) No physician, health care facility, other health care	320
provider, person authorized to engage in the business of insurance	321
in this state under Title XXXIX of the Revised Code, health	322
insuring corporation, other health care benefit plan, legal entity	323
that is self-insured and provides benefits to its employees or	324
members, or other person shall require an individual to possess	325
DNR identification, execute a declaration, or have a written	326
do-not-resuscitate order or hospital do-not-resuscitate order	327
issued or MOLST form completed, or shall require an individual to	328
revoke or refrain from possessing DNR identification, as a	329
condition of being insured or of receiving health care benefits or	330
services.	331

(C)(1) Sections 2133.21 to 2133.26 of the Revised Code do not	332
create any presumption concerning the intent of an individual who	333
does not possess DNR identification with respect to the use,	334
withholding, or withdrawal of CPR.	335

(2) Sections 2133.21 to 2133.26 of the Revised Code do not	336
affect the right of a person to make informed decisions regarding	337
the use, withholding, or withdrawal of CPR for the person as long	338
as the person is able to make those decisions.	339

(3) Sections 2133.21 to 2133.26 of the Revised Code are in	340
addition to and independent of, and do not limit, impair, or	341
supersede, any right or responsibility that a person has to effect	342
the withholding or withdrawal of life-sustaining treatment to	343
another pursuant to sections 2133.01 to 2133.15 or sections	344
2133.30 to 2133.48 of the Revised Code or in any other lawful	345
manner.	346

(D) Nothing in sections 2133.21 to 2133.26 of the Revised	347
Code condones, authorizes, or approves of mercy killing, assisted	348
suicide, or euthanasia.	349

Sec. 2133.26.  (A)(1) No physician shall purposely prevent or	350
attempt to prevent, or delay or unreasonably attempt to delay, the	351
transfer of a patient in violation of division (B) of section	352
2133.23 of the Revised Code.	353

(2) No person shall purposely conceal, cancel, deface, or	354
obliterate the DNR identification of another person without the	355
consent of the other person.	356

(3) No person shall purposely falsify or forge a revocation	357
of a declaration or MOLST form that is the basis of the DNR	358
identification of another person or purposely falsify or forge an	359
order of a physician or a MOLST form that purports to supersede a	360
do-not-resuscitate order or hospital do-not-resuscitate order	361
issued, or MOLST form completed, for another person.	362

(4) No person shall purposely falsify or forge the DNR	363
identification of another person with the intent to cause the use,	364
withholding, or withdrawal of CPR for the other person.	365

(5) No person who has personal knowledge that another person	366
has revoked a declaration that is the basis of the other person's	367
DNR identification or personal knowledge that a physician has	368
issued an order that supersedes a do-not-resuscitate order that	369
the physician issued for another personNone of the following	370
shall purposely conceal or withhold that personal knowledge with	371
the intent to cause the use, withholding, or withdrawal of CPR for	372
the other person:	373

(a) A person who has personal knowledge that another person	374
has revoked a declaration that is the basis of the other person's	375
DNR identification;	376

(b) A person who has personal knowledge that a physician has	377
issued an order that supersedes a do-not-resuscitate order or	378
hospital do-not-resuscitate order that the physician issued for	379
another person;	380

(c) A person who has personal knowledge that another person	381
has revoked or superseded a MOLST form that is the basis of the	382
other person's DNR identification.	383

(B)(1) Whoever violates division (A)(1) or (5) of this	384
section is guilty of a misdemeanor of the third degree.	385

(2) Whoever violates division (A)(2), (3), or (4) of this	386
section is guilty of a misdemeanor of the first degree.	387

Sec. 2133.30. As used in this section and sections 2133.31	388
to 2133.48 of the Revised Code:	389

(A) "Advanced practice nurse" means a registered nurse who	390
holds a valid certificate that authorizes the practice of nursing	391
as a certified nurse practitioner or a clinical nurse specialist	392
in accordance with section 4723.43 of the Revised Code.	393

(B) "Attending physician" means the physician to whom a	394
patient or patient's family has assigned primary responsibility	395
for the medical treatment or care of the patient or, if the	396
responsibility has not been assigned, the physician who has	397
accepted that responsibility.	398

(C) "Comfort care" means any of the following:

399

(1) Nutrition when administered to diminish pain or	400
discomfort, but not to postpone death;	401

(2) Hydration when administered to diminish pain or	402
discomfort, but not to postpone death;	403

(3) Any other medical or nursing procedure, treatment,	404
intervention, or other measure that is taken to diminish pain or	405
discomfort, but not to postpone death.	406

(D) "CPR" has the same meaning as in section 2133.21 of the	407
Revised Code.	408

(E) "Declaration" means a document executed in accordance	409
with section 2133.02 of the Revised Code.	410

(F) "DNR identification," "do-not-resuscitate order," and	411
"hospital do-not-resuscitate order" have the same meanings as in	412
section 2133.21 of the Revised Code.	413

(G) "Durable power of attorney for health care" means a	414
document created pursuant to sections 1337.11 to 1337.17 of the	415
Revised Code.	416

(H) "Emergency medical services worker" means a paid or	417
volunteer firefighter, law enforcement officer, first responder,	418
emergency medical technician-basic, emergency medical	419
technician-intermediate, emergency medical technician-paramedic,	420
medical technician, or other emergency services worker acting	421
within the ordinary course of the emergency services profession.	422

(I) "Form preparer" means the issuing practitioner who	423
completes a medical orders for life-sustaining treatment form or	424
the individual who completes the form pursuant to the	425
practitioner's delegation.	426

(J) "Health care facility" has the same meaning as in section	427
1337.11 of the Revised Code.	428

(K) "Issuing practitioner" means a physician, physician	429
assistant, or advanced practice nurse who issues medical orders	430
for life-sustaining treatment for a patient by signing as the	431
issuing practitioner the medical orders for life-sustaining	432
treatment form for the patient.	433

(L) "Life-sustaining treatment" means any medical procedure,	434
treatment, intervention, or other measure that, when administered	435
to a patient, is intended to serve principally to prolong the	436
process of dying.	437

(M) "Medical orders for life-sustaining treatment" means	438
instructions, issued by a physician, physician assistant, or	439
advanced practice nurse, regarding how a patient should be treated	440
with respect to hospitalization, administration or withdrawal of	441
life-sustaining treatment and comfort care, and other treatment	442
the director of health has specified in rules adopted under	443
section 2133.31 of the Revised Code.	444

(N) "Medical orders for life-sustaining treatment form,"	445
"MOLST form," or "form" means the form prescribed by the director	446
of health pursuant to rules adopted under section 2133.31 of the	447
Revised Code that when completed documents an issuing	448
practitioner's medical orders for life-sustaining treatment.	449

(O) "Nutrition" means sustenance that is artificially or	450
technologically administered.	451

(P) "Patient" means an individual eighteen years of age or	452
older who is the subject of a MOLST form.	453

(Q) "Physician" means an individual authorized under Chapter	454
4731. of the Revised Code to practice medicine and surgery or	455
osteopathic medicine and surgery.	456

(R) "Physician assistant" means an individual who holds a	457
valid certificate to practice as a physician assistant issued	458
under Chapter 4730. of the Revised Code.	459

Sec. 2133.31. (A) Subject to division (D) of this section,	460
the director of health shall adopt rules in accordance with	461
Chapter 119. of the Revised Code to do all of the following:	462

(1) Specify the treatment, in addition to hospitalization,	463
administration or withdrawal of life-sustaining treatment and	464
comfort care, and administration of CPR that may be included in	465
instructions that constitute medical orders for life-sustaining	466
treatment under section 2133.30 of the Revised Code;	467

(2) Subject to divisions (B) and (C) of this section,	468
prescribe a medical orders for life-sustaining treatment (MOLST)	469
form;	470

(3) Specify procedures for a MOLST form to be amended or	471
revoked;	472

(4) Specify what constitutes full treatment for purposes of	473
section 2133.42 of the Revised Code;	474

(5) Specify the requirements an individual must meet to be	475
authorized to complete a MOLST form when this responsibility is	476
delegated by an issuing practitioner;	477

(6) Specify the extent to which medical orders for	478
life-sustaining treatment forms, physician orders for	479
life-sustaining treatment forms, or physician orders for scope of	480
treatment forms executed under the laws or regulations of other	481
states are valid for purposes of sections 2133.31 to 2133.48 of	482
the Revised Code;	483

(7) Specify the individual or class of individuals who must	484
sign and date a MOLST form if all of the individuals or classes	485
of individuals in divisions (B)(1) to (7) of section 2133.34 of	486
the Revised Code are incapacitated or are not willing to	487
participate or are not available within a reasonable period of	488
time to participate in the completion of a MOLST form;	489

(8) Address any other matters necessary or appropriate to	490
implement or clarify sections 2133.31 to 2133.48 of the Revised	491
Code.	492

(B) The rules the director adopts under division (A)(2) of	493
this section must, at minimum, address all of the following:	494

(1) The color the MOLST form must be if it is on paper;

495

(2) The logo that identifies a form, whether in paper or	496
electronic format, as an official MOLST form;	497

(3) The inclusion of a space designated for the patient's	498
name;	499

(4) The inclusion of spaces designated for the names,	500
telephone numbers, signatures, and dates of signature of all of	501
the following:	502

(a) The issuing practitioner;

503

(b) The form preparer;

504

(c) The patient or individual or class of individuals	505
specified in division (B) of section 2133.34 of the Revised Code	506
who participate in the form's completion.	507

(5) The inclusion of boxes for the form preparer to indicate	508
whether a physician or advanced practice nurse issued a	509
do-not-resuscitate order for the patient prior to the effective	510
date of this section and whether the patient has executed a	511
declaration or a durable power of attorney for health care.	512

(6) The inclusion of boxes corresponding to a range of	513
preferences the patient or individual or class of individuals	514
specified in division (B) of section 2133.34 of the Revised Code	515
who participate in a form's completion can select regarding	516
various medical treatments and when such treatments should be	517
administered, including, but not limited to, CPR, antibiotics,	518
artificially or technologically administered nutrition and	519
hydration, and other medical interventions and the inclusion of	520
spaces next to the boxes for the name of the patient, individual,	521
or individuals who make the selections;	522

(7) The inclusion of a space where the form preparer can	523
indicate whether the patient authorizes another individual to do	524
both of the following:	525

(a) Make all medical decisions on the patient's behalf,	526
including those regarding the administration of CPR and other	527
life-sustaining treatment;	528

(b) Revoke the form at any time in accordance with the	529
procedure prescribed in rules adopted under section 2133.31 of the	530
Revised Code and complete a new form.	531

(8) The inclusion of a space for the form preparer to list	532
the name and contact information for the attorney in fact under	533
the patient's durable power of attorney for health care or, if the	534
patient has not executed a durable power of attorney for health	535
care or the form preparer is not told who the attorney in fact is,	536
the patient's next of kin.	537

(9) The inclusion of a space designated for the signature of	538
a patient's attorney in fact under a durable power of attorney for	539
health care, to be signed by the attorney in fact if the attorney	540
in fact is present when the form is completed;	541

(10) The inclusion of a space for the form preparer to	542
indicate the date that the form was completed and signed in	543
accordance with sections 2133.34 and 2133.35 of the Revised Code;	544

(11) The inclusion of spaces designated for the names of	545
individuals who review the form after it is completed, the dates	546
on which reviews are completed, and the reviewer to indicate the	547
review's outcome;	548

(12) The inclusion of the following advisory statements, in	549
boldface type:	550

(a) "There is no requirement that a patient or patient's	551
representative execute a MOLST form. You are not required to sign	552
this form for the patient to receive treatment."	553

This statement shall appear in the space immediately above	554
the space designated for the signature of the patient or	555
individual or class of individuals specified in division (B) of	556
section 2133.34 of the Revised Code who participate in a form's	557
completion.	558

(b) "Use of this form is permitted for persons who are at	559
least eighteen years old and have advanced chronic progressive	560
illness, might die within the next year, or desire to define their	561
preferences for medical care."	562

(c) "The instructions in this form may supersede an	563
inconsistent instruction in a declaration (living will), durable	564
power of attorney for health care, or a DNR identification as	565
described in section 2133.41 of the Ohio Revised Code."	566

(d) "This form may be revoked in accordance with section	567
2133.39 of the Ohio Revised Code."	568

(C) When prescribing a medical orders for life-sustaining	569
treatment form pursuant to division (A)(2) of this section, the	570
director shall consider the design and content of forms used in	571
other states to document medical or physician orders for	572
life-sustaining treatment.	573

(D) The director shall adopt the initial rules required by	574
this section not later than six months after the effective date of	575
this section.	576

Sec. 2133.32.  The MOLST form prescribed in rules adopted	577
under section 2133.31 of the Revised Code shall be made available	578
on the department of health's web site in a format that can be	579
downloaded free of charge and reproduced.	580

Sec. 2133.33.  (A) Except as provided in division (C) of this	581
section, a physician, physician assistant, or advanced practice	582
nurse may at any time issue medical orders for life-sustaining	583
treatment for a patient by completing a MOLST form. Once completed	584
and signed in accordance with sections 2133.34 and 2133.35 of the	585
Revised Code, the MOLST form is valid and, except as provided in	586
division (B) of this section, the instructions in it become	587
operative and govern how the patient who is the subject of the	588
form is to be treated with respect to hospitalization,	589
administration or withdrawal of life-sustaining treatment and	590
comfort care, administration of CPR, and other treatment the	591
director of health has specified in rules adopted under section	592
2133.31 of the Revised Code.	593

(B) The instructions in a MOLST form are not operative and do	594
not govern how a patient is to be treated when the form is	595
superseded as described in section 2133.41 of the Revised Code,	596
revoked as described in section 2133.39 of the Revised Code, or	597
when a condition in division (A) or (B) of section 2133.43 of the	598
Revised Code applies.	599

(C) A physician, physician assistant, or advanced practice	600
nurse shall not have a MOLST form completed for a patient if,	601
subject to division (D) of this section, the patient, or if the	602
patient is incapacitated the individual or class of individuals	603
determined according to the order of priority in division (B) of	604
section 2133.34 of the Revised Code, makes known to the	605
physician, physician assistant, or advanced practice nurse that	606
completion of a MOLST form is not desired.	607

(D) Any disagreement within a class of individuals as to	608
whether a MOLST form should be completed shall be resolved in	609
accordance with section 2133.36 of the Revised Code.	610

Sec. 2133.34.  (A) All of the following must participate in	611
the completion of a MOLST form for the form to be valid:	612

(1) The issuing practitioner, who must sign and date the form	613
in the space designated for the practitioner's signature and who	614
may complete the form or delegate the responsibility of the form's	615
completion to an individual who meets the requirements established	616
in rules adopted under section 2133.31 of the Revised Code;	617

(2) If the issuing practitioner is not the form preparer, the	618
form preparer, who must sign and date the form in the space	619
designated for the form preparer's signature;	620

(3) Except as provided in division (B) of this section, the	621
patient, who must sign and date the form in the space designated	622
for the patient's signature.	623

(B) If the patient is incapacitated, the individual or class	624
of individuals determined in the following descending order of	625
priority and subject to divisions (D) and (E) of this section and	626
section 2133.36 of the Revised Code must sign and date the form in	627
the space designated for such signature or signatures and must	628
indicate the relationship to the patient:	629

(1) The patient's attorney in fact under the patient's	630
durable power of attorney for health care;	631

(2) The patient's guardian;

632

(3) The patient's spouse;

633

(4) An adult child of the patient or, if there is more than	634
one adult child, all of the patient's adult children;	635

(5) The patient's parents;

636

(6) An adult sibling of the patient or, if there is more than	637
one adult sibling, all of the adult's siblings;	638

(7) The adult not described in divisions (B)(1) to (6) of	639
this section who is most closely related to the patient by blood	640
or adoption;	641

(8) The individual or class of individuals designated by the	642
director of health in rules adopted under section 2133.31 of the	643
Revised Code.	644

(C) Division (B)(2) of this section shall not be construed as	645
permitting or requiring the appointment of a guardian for the	646
patient.	647

(D) If an appropriate individual entitled to participate	648
under division (B) of this section in a MOLST form's completion is	649
not available within a reasonable period of time to participate in	650
the form's completion, is incapacitated, or declines to	651
participate, the next priority individual or class of individuals	652
specified in that division is authorized to participate.	653

(E) If at least one individual in a class of individuals	654
entitled to participate under division (B) of this section in a	655
MOLST form's completion is incapacitated, is not willing to	656
participate, or is not available within a reasonable period of	657
time, participation shall be limited to the individual or	658
individuals in the class who are not incapacitated and are	659
willing to participate and available within a reasonable period	660
of time.	661

Sec. 2133.35. (A) When completing a MOLST form, the form	662
preparer shall discuss the instructions in the form with the	663
patient or, if the patient is incapacitated, the appropriate	664
individual or class of individuals determined in accordance with	665
division (B) of section 2133.34 of the Revised Code. The	666
instructions the form preparer lists on the form shall reflect	667
the desires of the patient or, subject to division (C) of this	668
section, the appropriate individual or class of individuals as	669
expressed during the discussion. A declaration or durable power	670
of attorney for health care, or both, if a copy of one or both	671
documents is furnished to the form preparer, may guide the	672
discussion between the form preparer and the patient or	673
appropriate individual or class of individuals.	674

(B) If a patient participates in the form's completion, the	675
patient may instruct the form preparer to document in the	676
appropriate space on the form that the patient authorizes another	677
individual to do both of the following:	678

(1) Make all medical decisions on the patient's behalf,	679
including those regarding the administration of CPR and other	680
life-sustaining treatment;	681

(2) Revoke the form at any time in accordance with the	682
procedure prescribed in rules adopted under section 2133.31 of the	683
Revised Code and complete a new form.	684

(C) Consistent with division (F) of section 1337.13 of the	685
Revised Code, an attorney in fact under a durable power of	686
attorney for health care or another individual or class of	687
individuals determined in accordance with division (B) of section	688
2133.34 of the Revised Code does not have the authority to advise	689
that the form preparer make an instruction in a MOLST form	690
inconsistent with an instruction in a declaration or durable power	691
of attorney for health care unless the issuing practitioner and at	692
least one physician who has reviewed the patient's medical record	693
determine that at least one of the following applies:	694

(1) A change in the physical condition of the patient has	695
significantly decreased the benefit of that instruction to the	696
patient.	697

(2) The instruction is not, or is no longer, significantly	698
effective in achieving the purpose for which the patient consented	699
to it.	700

Sec. 2133.36.  (A) Subject to division (B) of this section,	701
if individuals in a class of individuals determined in accordance	702
with division (B) of section 2133.34 of the Revised Code disagree	703
on any decision that must be made with regard to the completion of	704
the form, the opinion of the majority of individuals who are not	705
incapacitated and are available within a reasonable period of	706
time and willing to participate shall prevail.	707

(B) If a majority of individuals cannot reach a decision	708
under division (A) of this section, a physician who is not the	709
issuing practitioner but who has reviewed the patient's medical	710
record shall make the decision that the physician believes is most	711
consistent with reasonable medical standards.	712

Sec. 2133.37.  A completed MOLST form shall be placed in a	713
conspicuous location in the paper or electronic medical record of	714
the patient to whom it pertains. Whether maintained as part of a	715
paper or electronic medical record, the form must be readily	716
available and retrievable.	717

Sec. 2133.38.  If a patient with a MOLST form is transferred	718
from one health care facility to another, the health care facility	719
initiating the transfer shall communicate the existence of, and	720
send a copy of, the form to the receiving facility prior to the	721
transfer. The copy may be sent via regular mail or by facsimile or	722
other electronic means, but if maintained in paper format, must be	723
placed on the color of paper specified in rules adopted under	724
section 2133.31 of the Revised Code on receipt by the receiving	725
facility. A copy of the form is the same as the original.	726

Consistent with section 2133.37 of the Revised Code, the copy	727
of the MOLST form shall be placed in a conspicuous location in the	728
patient medical record immediately on receipt by the receiving	729
facility. After admission, the attending physician shall review	730
the MOLST form and discuss with the patient or appropriate	731
individual or class of individuals determined in accordance with	732
division (B) of section 2133.34 of the Revised Code whether the	733
form should be amended or revoked and whether a new form should be	734
issued.	735

If a decision is made to amend the form, the attending	736
physician shall proceed with the amendment consistent with the	737
amendment procedure prescribed in rules adopted under section	738
2133.31 of the Revised Code. If a decision is made to revoke the	739
form, whether or not there is an intention to issue a new form,	740
the revocation shall be done in accordance with section 2133.39 of	741
the Revised Code.	742

Sec. 2133.39.  (A) A patient may revoke a MOLST form at any	743
time in accordance with the procedure specified in rules adopted	744
under section 2133.31 of the Revised Code.	745

(B) If a patient is incapacitated, the individual or class of	746
individuals determined in accordance with division (B) of section	747
2133.34 of the Revised Code may revoke a form in accordance with	748
the procedure specified in rules adopted under section 2133.31 of	749
the Revised Code if the attending physician determines that at	750
least one of the following is true:	751

(1) There has been a change in the physical condition of the	752
patient that significantly decreases the benefit of the	753
instructions in the MOLST form to the patient.	754

(2) The instructions in the MOLST form are no longer	755
significantly effective in achieving the purposes for which the	756
patient, or individual or class of individuals determined in	757
accordance with division (B) of section 2133.34 of the Revised	758
Code, consented to their use.	759

Sec. 2133.40.  Unless revoked in accordance with section	760
2133.39 of the Revised Code, a MOLST form does not expire.	761

Sec. 2133.41.  (A) An instruction in a MOLST form that is	762
inconsistent with an instruction in a do-not-resuscitate order	763
always supersedes the inconsistent instruction in the	764
do-not-resuscitate order.	765

(B) An instruction in a MOLST form that is inconsistent with	766
an instruction in a general consent to treatment form signed by	767
or on behalf of the patient, a declaration, a durable power of	768
attorney for health care, or a hospital do-not-resuscitate order	769
supersedes the inconsistent instruction in any of those documents	770
unless both of the following are true:	771

(1) The document was executed after the MOLST form, as	772
evidenced by the date on the document.	773

(2) The attending physician is made aware of the document and	774
furnished a copy of it.	775

Sec. 2133.42.  If a section of a MOLST form has not been	776
completed, the attending physician may proceed with the	777
understanding that full treatment relative to treatment covered by	778
that section of the form is to be considered unless the form	779
indicates that the patient has authorized another individual to	780
make all medical decisions on the patient's behalf as described in	781
division (B) of section 2133.35 of the Revised Code.	782

Sec. 2133.43.  An attending physician may render treatment or	783
take a course of action that is contrary to, or in conflict with,	784
an instruction in a MOLST form if at least one of the following	785
conditions applies:	786

(A) The patient communicates to the attending physician that	787
the patient desires to be treated in a manner that is contrary to,	788
or in conflict with, an instruction in a MOLST form.	789

(B) An individual or class of individuals described in	790
division (B) of section 2133.34 of the Revised Code participated	791
in the completion of the MOLST form on behalf of the patient, and	792
the attending physician and another physician who has reviewed the	793
patient's medical record believe, to a reasonable degree of	794
medical certainty and in accordance with reasonable medical	795
standards, that either of the following is true:	796

(1) A change in the physical condition of the patient has	797
significantly decreased the benefit of the instruction to the	798
patient.	799

(2) The instruction is not, or is no longer, significantly	800
effective in achieving the purpose for which the individual or	801
class of individuals consented to its use.	802

Sec. 2133.44. (A) Subject to division (B) of this section, no	803
health care facility, health care professional, or emergency	804
services worker shall be subject to criminal prosecution, liable	805
in damages in tort or other civil action, or subject to	806
professional disciplinary action for acting in accordance with, or	807
otherwise being in compliance with, a valid MOLST form or sections	808
2133.31 to 2133.48 of the Revised Code.	809

(B) Division (A) of this section does not grant an immunity	810
from criminal or civil liability or from professional disciplinary	811
action to health care personnel for actions that are outside their	812
scope of authority.	813

Sec. 2133.45.  The death of an individual that occurs as a	814
result of actions taken consistent with instructions in a MOLST	815
form does not constitute for any purpose a suicide, aggravated	816
murder, murder, or any other homicide.	817

Sec. 2133.46.  The issuance of a MOLST form shall not do any	818
of the following:	819

(A) Affect in any manner the sale, procurement, issuance, or	820
renewal of a policy of life insurance or annuity, notwithstanding	821
any term of a policy or annuity to the contrary;	822

(B) Modify in any manner or invalidate the terms of a policy	823
of life insurance or annuity that is in effect on the effective	824
date of this section;	825

(C) Impair or invalidate a policy of life insurance or	826
annuity or any health benefit plan.	827

Sec. 2133.47.  No physician, health care facility, other	828
health care provider, person authorized to engage in the business	829
of insurance in this state under Title XXXIX of the Revised Code,	830
health insuring corporation, other health care benefit plan, legal	831
entity that is self-insured and provides benefits to its employees	832
or members, governmental entity, or other person shall require	833
that an individual be the subject of a MOLST form, or require an	834
individual to revoke or refrain from being the subject of a MOLST	835
form, as a condition of being insured or of receiving health care	836
benefits or services.	837

Sec. 2133.48.  In the absence of actual knowledge to the	838
contrary and if acting in good faith, an attending physician,	839
other health care professional, emergency services worker, or	840
health care facility may assume that a MOLST form complies with	841
sections 2133.31 to 2133.47 of the Revised Code and is valid.	842

Section 2. That existing sections 2133.21, 2133.22, 2133.23,	843
2133.24, and 2133.26 and section 2133.25 of the Revised Code are	844
hereby repealed.	845

Section 3. (A) There is hereby created the Medical Orders For	846
Life-Sustaining Treatment Advisory Council. The Council shall	847
consist of the following twenty-nine members:	848

(1) An employee of the Department of Aging, appointed by the	849
Director of Aging;	850

(2) An employee of the Department of Mental Health, appointed	851
by the Director of Mental Health;	852

(3) An employee of the Department of Mental Retardation and	853
Developmental Disabilities, appointed by the Director of Mental	854
Retardation and Developmental Disabilities;	855

(4) The Executive Director of the Ohio Medical Transportation	856
Board;	857

(5) The Executive Director of the State Board of Emergency	858
Medical Services;	859

(6) One representative from each of the following	860
organizations, appointed by the president or chief administrative	861
officer of the organization:	862

(a) The Ohio Hospital Association;

863

(b) The Ohio State Medical Association;

864

(c) The Ohio Chapter of the American College of Emergency	865
Physicians;	866

(d) The Ohio Hospice and Palliative Care Organization;

867

(e) The Ohio Health Care Association;

868

(f) The Ohio Ambulance and Medical Transportation	869
Association;	870

(g) The Ohio Medical Directors Association;

871

(h) The Ohio Association of Emergency Medical Services;

872

(i) The Bioethics Network of Ohio;

873

(j) The Ohio Nurses Association;

874

(k) The Ohio Academy of Nursing Homes;

875

(l) The Ohio Association of Professional Firefighters;

876

(m) The Ohio Osteopathic Association;

877

(n) The Association of Ohio Philanthropic Homes, Housing and	878
Services for the Aging;	879

(o) The Catholic Conference of Ohio;

880

(p) The Ohio Private Residential Association;

881

(q) The Northern Ohio Fire Fighters Association;

882

(r) The Ohio Assisted Living Association;

883

(s) The Ohio Council for Home Care;

884

(t) Lifeline of Ohio;

885

(u) The Ohio State Bar Association;

886

(v) The Ohio Association of Advanced Practice Nurses;

887

(w) The Ohio Fire Chiefs Association;

888

(x) The Ohio State Firefighters Association.

889

(B) The Council shall meet at the call of the Director of	890
Health. The Department of Health shall provide meeting space,	891
staff services, and technical assistance required by the Council	892
in carrying out its duties.	893

(C) The Council shall advise the Director of Health regarding	894
the rules the Director must adopt under section 2133.31 of the	895
Revised Code. Each member of the Council has one vote. A majority	896
of the members present at a meeting constitutes a quorum, and the	897
affirmative vote of a majority of the members present is necessary	898
for the Council to make an official recommendation to the Director	899
on a particular rule.	900

The Director may assign other duties to the Council, as the	901
Director considers appropriate.	902

(D) Members of the Council shall serve without compensation,	903
but shall be reimbursed for their actual and necessary expenses	904
incurred in attending meetings of the Council or performing	905
assignments for the Council.	906

(E) The Council shall cease to exist on the Director's	907
adoption of initial rules pursuant to section 2133.31 of the	908
Revised Code.	909