As Introduced

128th General Assembly Regular Session 2009-2010

H. B. No. 241

Representative Garland 

Cosponsors: Representatives Lundy, Sayre, Williams, B., Luckie, Hackett, Skindell, Okey, Newcomb, Yuko, Hagan, Boyd, Letson, Harris, Evans, Heard 

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A BILL

To amend sections 2133.02, 2133.21, 2133.211, 2133.22

1

to 2133.26, and 3795.03 and to enact sections

2

2133.27 and 2133.30 to 2133.49 of the Revised

3

Code to require the Director of Health to

4

prescribe a form to document medical orders for

5

life-sustaining treatment and to make changes to

6

the law governing DNR identification and

7

orders.

8

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

Section 1. That sections 2133.02, 2133.21, 2133.211, 2133.22,	9
2133.23, 2133.24, 2133.25, 2133.26, and 3795.03 be amended and	10
sections 2133.27, 2133.30, 2133.31, 2133.32, 2133.33, 2133.34,	11
2133.35, 2133.36, 2133.37, 2133.38, 2133.39, 2133.40, 2133.41,	12
2133.42, 2133.43, 2133.44, 2133.45, 2133.46, 2133.47, 2133.48,	13
and 2133.49 of the Revised Code be enacted to read as follows:	14

Sec. 2133.02.  (A)(1) An adult who is of sound mind	15
voluntarily may execute at any time a declaration governing the	16
use or continuation, or the withholding or withdrawal, of	17
life-sustaining treatment. The declaration shall be signed at the	18
end by the declarant or by another individual at the direction of	19
the declarant, state the date of its execution, and either be	20
witnessed as described in division (B)(1) of this section or be	21
acknowledged by the declarant in accordance with division (B)(2)	22
of this section. The declaration may include a designation by the	23
declarant of one or more persons who are to be notified by the	24
declarant's attending physician at any time that life-sustaining	25
treatment would be withheld or withdrawn pursuant to the	26
declaration. The declaration may include a specific authorization	27
for the use or continuation or the withholding or withdrawal of	28
CPR, but the failure to include a specific authorization for the	29
withholding or withdrawal of CPR does not preclude the withholding	30
or withdrawal of CPR in accordance with sections 2133.01 to	31
2133.15 or sections 2133.21 to 2133.262133.27 of the Revised	32
Code.	33

(2) Depending upon whether the declarant intends the	34
declaration to apply when the declarant is in a terminal	35
condition, in a permanently unconscious state, or in either a	36
terminal condition or a permanently unconscious state, the	37
declarant's declaration shall use either or both of the terms	38
"terminal condition" and "permanently unconscious state" and shall	39
define or otherwise explain those terms in a manner that is	40
substantially consistent with the provisions of section 2133.01 of	41
the Revised Code.	42

(3)(a) If a declarant who has authorized the withholding or	43
withdrawal of life-sustaining treatment intends that the	44
declarant's attending physician withhold or withdraw nutrition or	45
hydration when the declarant is in a permanently unconscious state	46
and when the nutrition and hydration will not or no longer will	47
serve to provide comfort to the declarant or alleviate the	48
declarant's pain, then the declarant shall authorize the	49
declarant's attending physician to withhold or withdraw nutrition	50
or hydration when the declarant is in the permanently unconscious	51
state by doing both of the following in the declaration:	52

(i) Including a statement in capital letters or other	53
conspicuous type, including, but not limited to, a different font,	54
bigger type, or boldface type, that the declarant's attending	55
physician may withhold or withdraw nutrition and hydration if the	56
declarant is in a permanently unconscious state and if the	57
declarant's attending physician and at least one other physician	58
who has examined the declarant determine, to a reasonable degree	59
of medical certainty and in accordance with reasonable medical	60
standards, that nutrition or hydration will not or no longer will	61
serve to provide comfort to the declarant or alleviate the	62
declarant's pain, or checking or otherwise marking a box or line	63
that is adjacent to a similar statement on a printed form of a	64
declaration;	65

(ii) Placing the declarant's initials or signature underneath	66
or adjacent to the statement, check, or other mark described in	67
division (A)(3)(a)(i) of this section.	68

(b) Division (A)(3)(a) of this section does not apply to the	69
extent that a declaration authorizes the withholding or withdrawal	70
of life-sustaining treatment when a declarant is in a terminal	71
condition. The provisions of division (E) of section 2133.12 of	72
the Revised Code pertaining to comfort care shall apply to a	73
declarant in a terminal condition.	74

(B)(1) If witnessed for purposes of division (A) of this	75
section, a declaration shall be witnessed by two individuals as	76
described in this division in whose presence the declarant, or	77
another individual at the direction of the declarant, signed the	78
declaration. The witnesses to a declaration shall be adults who	79
are not related to the declarant by blood, marriage, or adoption,	80
who are not the attending physician of the declarant, and who are	81
not the administrator of any nursing home in which the declarant	82
is receiving care. Each witness shall subscribe the witness'	83
signature after the signature of the declarant or other individual	84
at the direction of the declarant and, by doing so, attest to the	85
witness' belief that the declarant appears to be of sound mind and	86
not under or subject to duress, fraud, or undue influence. The	87
signatures of the declarant or other individual at the direction	88
of the declarant under division (A) of this section and of the	89
witnesses under this division are not required to appear on the	90
same page of the declaration.	91

(2) If acknowledged for purposes of division (A) of this	92
section, a declaration shall be acknowledged before a notary	93
public, who shall make the certification described in section	94
147.53 of the Revised Code and also shall attest that the	95
declarant appears to be of sound mind and not under or subject to	96
duress, fraud, or undue influence.	97

(C) An attending physician, or other health care personnel	98
acting under the direction of an attending physician, who is	99
furnished a copy of a declaration shall make it a part of the	100
declarant's medical record and, when section 2133.05 of the	101
Revised Code is applicable, also shall comply with that section.	102

(D)(1) Subject to division (D)(2) of this section, an	103
attending physician of a declarant or a health care facility in	104
which a declarant is confined may refuse to comply or allow	105
compliance with the declarant's declaration on the basis of a	106
matter of conscience or on another basis. An employee or agent of	107
an attending physician of a declarant or of a health care facility	108
in which a declarant is confined may refuse to comply with the	109
declarant's declaration on the basis of a matter of conscience.	110

(2) If an attending physician of a declarant or a health care	111
facility in which a declarant is confined is not willing or not	112
able to comply or allow compliance with the declarant's	113
declaration, the physician or facility promptly shall so advise	114
the declarant and comply with the provisions of section 2133.10 of	115
the Revised Code, or, if the declaration has become operative as	116
described in division (A) of section 2133.03 of the Revised Code,	117
shall comply with the provisions of section 2133.10 of the Revised	118
Code.	119

(E) As used in this section, "CPR" has the same meaning as in	120
section 2133.21 of the Revised Code.	121

Sec. 2133.21.  As used in this section and sections 2133.21	122
2133.211 to 2133.262133.27 of the Revised Code, unless the	123
context clearly requires otherwise:	124

(A) "Attending physician" means the physician to whom a	125
person, or the family of a person, has assigned primary	126
responsibility for the treatment or care of the person or, if the	127
person or the person's family has not assigned that	128
responsibility, the physician who has accepted that	129
responsibility.	130

(B) "CPR" means cardiopulmonary resuscitation or a component	131
of cardiopulmonary resuscitation, but it does not include clearing	132
a person's airway for a purpose other than as a component of CPR.	133

(C) "Declaration," "health care facility," "life-sustaining	134
treatment," "physician," "professional disciplinary action," and	135
"tort action" have the same meanings as in section 2133.01 of the	136
Revised Codemeans a document executed in accordance with section	137
2133.02 of the Revised Code that includes a specific authorization	138
for the withholding or withdrawal of CPR.	139

(C)(D) "DNR identification" means a standardized	140
identification card, form, necklace, or bracelet that is of	141
uniform size and design, that has been approved by the department	142
of health pursuant to section 2133.25 of the Revised Code, and	143
that signifies eitherone of the following:	144

(1) That the person who is named on and possesses the card,	145
form, necklace, or bracelet has executed a declaration that	146
authorizes the withholding or withdrawal of CPR and that has not	147
been revoked pursuant to section 2133.04 of the Revised Code;	148

(2) That the attending physician of the person who is named	149
on and possesses the card, form, necklace, or bracelet has issued	150
a current do-not-resuscitate order, in accordance with the	151
do-not-resuscitate protocol adopted by the department of health	152
pursuant to section 2133.25 of the Revised Code, for that person	153
and has documented the grounds for the order in that person's	154
medical record.;	155

(3) That an issuing practitioner has completed a MOLST form	156
that has not been revoked as described in section 2133.39 of the	157
Revised Code.	158

(D)(E) "Do-not-resuscitate order" means a directive issued by	159
a physician prior to the effective date of this amendment in	160
accordance with the do-not-resuscitate protocol that identifies a	161
person and specifies that CPR should not be administered to the	162
person so identified.	163

(E)(F) "Do-not-resuscitate protocol" means the standardized	164
method of procedure for the withholding of CPR by physicians,	165
emergency medical service personnel, and health care facilities	166
that iswas adopted in the rules of the department of health	167
pursuant to section 2133.25 of the Revised Code as that section	168
existed prior to the effective date of this amendment.	169

(F)(G) "Emergency medical services personnel" means paid or	170
volunteer firefighters, law enforcement officers, first	171
responders, emergency medical technicians-basic, emergency medical	172
technicians-intermediate, emergency medical technicians-paramedic,	173
medical technicians, or other emergency services personnel acting	174
within the ordinary course of their profession.	175

(G) "CPR" means cardiopulmonary resuscitation or a component	176
of cardiopulmonary resuscitation, but it does not include clearing	177
a person's airway for a purpose other than as a component of CPR.	178

(H) "Health care facility," "life-sustaining treatment,"	179
"physician," "professional disciplinary action," and "tort	180
action" have the same meanings as in section 2133.01 of the	181
Revised Code.	182

(I) "Issuing practitioner" has the same meaning as in section	183
2133.30 of the Revised Code.	184

(J) "MOLST form" means a form completed pursuant to division	185
(A) of section 2133.33 of the Revised Code that includes a	186
specific authorization for the withholding or withdrawal of CPR.	187

Sec. 2133.211.  A person who holds a certificate of authority	188
to practice as a certified nurse practitioner or clinical nurse	189
specialist issued under section 4723.42 of the Revised Code may	190
take any action that may be taken by an attending physician under	191
sections 2133.212133.22 to 2133.262133.27 of the Revised Code	192
and has the immunity provided by section 2133.22 of the Revised	193
Code if the action is taken pursuant to a standard care	194
arrangement with a collaborating physician.	195

Sec. 2133.22.  (A)(1)(a) None of the followingpersons listed	196
in division (A)(1)(b) of this section are subject to criminal	197
prosecution, to liability in damages in a tort or other civil	198
action for injury, death, or loss to person or property, or to	199
professional disciplinary action arising out of or relating to	200
the withholding or withdrawal of CPR from a person after DNR	201
identification is discovered in the person's possession and	202
reasonable efforts have been made to determine that the person in	203
possession of the DNR identification is the person named on the	204
DNR identificationany of the following:	205

(a)(i) An individual who has executed a declaration;

206

(ii) An individual for whom a do-not-resuscitate order has	207
been issued;	208

(iii) An individual for whom a MOLST form has been completed;

209

(iv) An individual who is in possession of DNR identification	210
if reasonable efforts have been made to determine that the	211
individual is the individual named on the DNR identification.	212

(b) Division (A)(1)(a) of this section applies only to the	213
following:	214

(i) A physician who causes the withholding or withdrawal of	215
CPR from the person possessing the DNR identificationan	216
individual described in division (A)(1)(a) of this section;	217

(b)(ii) A person who participates under the direction of or	218
with the authorization of a physician in the withholding or	219
withdrawal of CPR from the person possessing the DNR	220
identificationan individual described in division (A)(1)(a) of	221
this section;	222

(c)(iii) Any emergency medical services personnel who cause	223
or participate in the withholding or withdrawal of CPR from the	224
person possessing the DNR identificationan individual described	225
in division (A)(1)(a) of this section.	226

(2)(a) None of the followingpersons listed in division	227
(A)(2)(b) of this section are subject to criminal prosecution, to	228
liability in damages in a tort or other civil action for injury,	229
death, or loss to person or property, or to professional	230
disciplinary action arising out of or relating to the withholding	231
or withdrawal of CPR from a person in a health care facility	232
after DNR identification is discovered in the person's possession	233
and reasonable efforts have been made to determine that the	234
person in possession of the DNR identification is the person named	235
on the DNR identification or a do-not-resuscitate order is issued	236
for the personany of the following who is in a health care	237
facility:	238

(a)(i) An individual who has executed a declaration;

239

(ii) An individual for whom a do-not-resuscitate order has	240
been issued;	241

(iii) An individual for whom a MOLST form has been completed;

242

(iv) An individual who is in possession of DNR identification	243
if reasonable efforts have been made to determine that the	244
individual is the individual named on the DNR identification.	245

(b) Division (A)(2)(a) of this section applies only to the	246
following:	247

(i) The health care facility or the administrator of the	248
health care facility;	249

(b)(ii) A physician who causes the withholding or withdrawal	250
of CPR from the person possessing the DNR identification or for	251
whom the do-not-resuscitate order has been issuedan individual	252
described in division (A)(2)(a) of this section;	253

(c)(iii) Any person who works for the health care facility as	254
an employee, contractor, or volunteer and who participates under	255
the direction of or with the authorization of a physician in the	256
withholding or withdrawal of CPR from the person possessing the	257
DNR identification;	258

(d) Any person who works for the health care facility as an	259
employee, contractor, or volunteer and who participates under the	260
direction of or with the authorization of a physician in the	261
withholding or withdrawal of CPR from the person for whom the	262
do-not-resuscitate order has been issuedan individual described	263
in division (A)(2)(a) of this section;	264

(iv) Any emergency medical services personnel who cause or	265
participate in the withholding or withdrawal of CPR from an	266
individual described in division (A)(2)(a) of this section.	267

(3) If, after DNR identification is discovered in the	268
possession of a personit is determined that a person is an	269
individual described in division (A)(1)(a) or (2)(a) of this	270
section, the person makes an oral or written request to receive	271
CPR, any person who provides CPR pursuant to the request, any	272
health care facility in which CPR is provided, and the	273
administrator of any health care facility in which CPR is	274
provided are not subject to criminal prosecution as a result of	275
the provision of the CPR, are not liable in damages in a tort or	276
other civil action for injury, death, or loss to person or	277
property that arises out of or is related to the provision of the	278
CPR, and are not subject to professional disciplinary action as a	279
result of the provision of the CPR.	280

(B) Divisions (A)(1), (A)and (2), and (C) of this section do	281
not apply when CPR is withheld or withdrawn from a person who	282
possesses DNR identification or for whom a do-not-resuscitate	283
order has been issuedan individual described in division	284
(A)(1)(a) or (2)(a) of this section unless the withholding or	285
withdrawal is in accordance with the do-not-resuscitate protocol	286
instructions regarding the withholding or withdrawal of CPR in	287
the individual's declaration, a do-not-resuscitate order that	288
names the individual, the individual's MOLST form, or in	289
instructions in any of the foregoing that is the basis of the	290
individual's DNR identification.	291

(C) Any emergency medical services personnel who comply with	292
a do-not-resuscitate order issued by a physician and any	293
individuals who work for a health care facility as employees,	294
contractors, or volunteers and who comply with a	295
do-not-resuscitate order issued by a physician are not subject to	296
liability in damages in a civil action for injury, death, or loss	297
to person or property that arises out of or is related to	298
compliance with the order, are not subject to criminal prosecution	299
as a result of compliance with the order, and are not subject to	300
professional disciplinary action as a result of compliance with	301
the order.	302

In an emergency situation, emergency medical services	303
personnel and emergency department personnel are not required to	304
search a person to determine if the person possesses DNR	305
identificationis an individual described in division (A)(1)(a) or	306
(2)(a) of this section. If a person possesses DNR identification	307
is an individual described in division (A)(1)(a) or (2)(a) of this	308
section, if emergency medical services personnel or emergency	309
department personnel provide CPR to the person in an emergency	310
situation, and if, at that time, the personnel do not know and do	311
not have reasonable cause to believe that the person possesses	312
DNR identificationis an individual described in division	313
(A)(1)(a) or (2)(a) of this section, the emergency medical	314
services personnel and emergency department personnel are not	315
subject to criminal prosecution as a result of the provision of	316
the CPR, are not liable in damages in a tort or other civil	317
action for injury, death, or loss to person or property that	318
arises out of or is related to the provision of the CPR, and are	319
not subject to professional disciplinary action as a result of	320
the provision of the CPR.	321

(D) Nothing in sections 2133.21 to 2133.262133.27 of the	322
Revised Code or the do-not-resuscitate protocol grants immunity to	323
a physician for issuing a do-not-resuscitate order that is	324
contrary to reasonable medical standards or that the physician	325
knows or has reason to know is contrary to the wishes of the	326
patient or of a person who is lawfully authorized to make	327
informed medical decisions on the patient's behalf.	328

Sec. 2133.23.  (A) If emergency medical services personnel,	329
other than physicians, are presented with DNR identification	330
possessed by a person or are presented with a written	331
do-not-resuscitate order for a person or if a physician directly	332
issues to emergency medical services personnel, other than	333
physicians, an oral do-not-resuscitate order for a persona	334
written do-not-resuscitate order that has been issued for the	335
person or a MOLST form that has been completed for the person, the	336
emergency medical services personnel shall comply with the	337
do-not-resuscitate protocol for the person. If an oral	338
do-not-resuscitate order is issued by a physician who is not	339
present at the scene, the emergency medical services personnel	340
shall verify the physician's identityinstructions regarding the	341
withholding or withdrawal of CPR in the relevant document or as	342
signified by the DNR identification.	343

(B) If a person possesses DNR identification and if the	344
person's attending physician or the health care facility in which	345
the person is located is unwilling or unable to comply with the	346
do-not-resuscitate protocol for the personinstructions regarding	347
the withholding or withdrawal of CPR in the person's declaration,	348
the written do-not-resuscitate order that has been issued for the	349
person, or the MOLST form that has been completed for the	350
person, any of which is the basis of the person's DNR	351
identification, the attending physician or the health care	352
facility shall not prevent or attempt to prevent, or unreasonably	353
delay or attempt to delay, the transfer of the person to a	354
different physician who will follow the protocolinstructions or	355
to a different health care facility in which the protocol	356
instructions will be followed.	357

(C) If a person whobeing transferred from one health care	358
facility to another possesses DNR identification or for whom a	359
current, has executed a declaration, is the subject of a written	360
do-not-resuscitate order that has been issued is being transferred	361
from one health care facility to another, before or at the time	362
of the transfer, or is the subject of a MOLST form that has been	363
completed, the transferring health care facility shall notify	364
the receiving health care facility and the persons transporting	365
the person of the existence of the DNR identification or the	366
order, declaration, do-not-resuscitate order, or MOLST form. The	367
notice shall be given before or at the time of the transfer. If a	368
current do-not-resuscitate order was issued orally, it shall be	369
reduced to writing before the time of the transfer. The DNR	370
identification or the order, declaration, do-not-resuscitate	371
order, or MOLST form shall accompany the person to the receiving	372
health care facility and shall, subject to section 2133.41 of	373
the Revised Code, remain in effect unless it is revoked or	374
unless, in the case of a do-not-resuscitate order, the order no	375
longer is currentany of the following circumstances apply:	376

(1) In the case of a DNR identification, it has been revoked	377
in accordance with rules adopted by the department of health	378
pursuant to section 2133.25 of the Revised Code.	379

(2) In the case of a declaration, it has been revoked as	380
described in section 2133.04 of the Revised Code.	381

(3) In the case of a written do-not-resuscitate order, it is	382
no longer current.	383

(4) In the case of a MOLST form, it has been revoked as	384
described in section 2133.39 of the Revised Code.	385

Sec. 2133.24.  (A) The death of a person resulting from the	386
withholding or withdrawal of CPR for the person pursuant to the	387
do-not-resuscitate protocolinstructions regarding the withholding	388
or withdrawal of CPR in a declaration executed by the person, a	389
written do-not-resuscitate order that has been issued for the	390
person, a MOLST form that has been completed for the person or	391
pursuant to instructions in any of the foregoing that is the basis	392
of the person's DNR identification and in the circumstances	393
described in section 2133.22 of the Revised Code or in accordance	394
with division (A) of section 2133.23 of the Revised Code does not	395
constitute for any purpose a suicide, aggravated murder, murder,	396
or any other homicide.	397

(B)(1) If a person has executed a declaration, a written	398
do-not-resuscitate order has been issued for the person, a MOLST	399
form has been completed for the person, or the person possesses	400
DNR identification or if a current do-not-resuscitate order has	401
been issued for a person, the existence of the declaration,	402
written do-not-resuscitate order, or MOLST form, or the	403
possession or orderof the DNR identification, shall not do	404
either of the following:	405

(a) Affect in any manner the sale, procurement, issuance, or	406
renewal of a policy of life insurance or annuity, notwithstanding	407
any term of a policy or annuity to the contrary;	408

(b) Be deemed to modify in any manner or invalidate the terms	409
of any policy of life insurance or annuity that is in effect on	410
the effective date of this section.	411

(2) Notwithstanding any term of a policy of life insurance	412
or annuity to the contrary, the withholding or withdrawal of CPR	413
from a person who is insured or covered under the policy or	414
annuity and who possesses DNR identification or for whom a	415
current do-not-resuscitate order has been issued, in accordance	416
with sections 2133.21 to 2133.26 of the Revised Code, who has	417
executed a declaration, for whom a written do-not-resuscitate	418
order has been issued, or for whom a MOLST form has been	419
completed shall not impair or invalidate any policy of life	420
insurance or annuity.	421

(3) Notwithstanding any term of a policy or plan to the	422
contrary, neither of the following shall impair or invalidate any	423
policy of health insurance or other health care benefit plan:	424

(a) The withholding or withdrawal in accordance with sections	425
2133.21 to 2133.262133.27 of the Revised Code of CPR from a	426
person who is insured or covered under the policy or plan and who	427
possesses DNR identification or for whom a current	428
do-not-resuscitate order has been issued, who has executed a	429
declaration, for whom a written do-not-resuscitate order has	430
been issued, or for whom a MOLST form has been completed;	431

(b) The provision in accordance with sections 2133.21 to	432
2133.262133.27 of the Revised Code of CPR to a person of the	433
nature described in division (B)(3)(a) of this section.	434

(4) No physician, health care facility, other health care	435
provider, person authorized to engage in the business of insurance	436
in this state under Title XXXIX of the Revised Code, health	437
insuring corporation, other health care benefit plan, legal entity	438
that is self-insured and provides benefits to its employees or	439
members, or other person shall require an individual to possess	440
DNR identification, execute a declaration, or have a written	441
do-not-resuscitate order issued, or have a MOLST form completed,	442
or shall require an individual to revoke or refrain from	443
possessing DNR identification, as a condition of being insured or	444
of receiving health care benefits or services.	445

(C)(1) Sections 2133.21 to 2133.262133.27 of the Revised	446
Code do not create any presumption concerning the intent of an	447
individual who does not possess DNR identification with respect	448
to the use, withholding, or withdrawal of CPR.	449

(2) Sections 2133.21 to 2133.262133.27 of the Revised Code	450
do not affect the right of a person to make informed decisions	451
regarding the use, withholding, or withdrawal of CPR for the	452
person as long as the person is able to make those decisions.	453

(3) Sections 2133.21 to 2133.262133.27 of the Revised Code	454
are in addition to and independent of, and do not limit, impair,	455
or supersede, any right or responsibility that a person has to	456
effect the withholding or withdrawal of life-sustaining treatment	457
to another pursuant to sections 2133.01 to 2133.15 or sections	458
2133.30 to 2133.47 of the Revised Code or in any other lawful	459
manner.	460

(D) Nothing in sections 2133.21 to 2133.262133.27 of the	461
Revised Code condones, authorizes, or approves of mercy killing,	462
assisted suicide, or euthanasia.	463

Sec. 2133.25.  (A) The department of health, by rule adopted	464
pursuant to Chapter 119. of the Revised Code, shall adopt a	465
standardized method of procedure for the withholding of CPR by	466
physicians, emergency medical services personnel, and health care	467
facilities in accordance with sections 2133.21 to 2133.26 of the	468
Revised Code. The standardized method shall specify criteria for	469
determining when a do-not-resuscitate order issued by a physician	470
is current. The standardized method so adopted shall be the	471
"do-not-resuscitate protocol" for purposes of sections 2133.21 to	472
2133.26 of the Revised Code. The department alsoof health, by	473
rule adopted pursuant to Chapter 119. of the Revised Code, shall	474
approve one or more standard forms of DNR identification to be	475
used throughout this state and shall specify one or more	476
procedures for revoking the forms of identification.	477

(B) The department of health shall adopt rules in accordance	478
with Chapter 119. of the Revised Code for the administration of	479
sections 2133.21 to 2133.26 of the Revised CodeThe	480
do-not-resuscitate protocol adopted by the department of health in	481
rules adopted pursuant to this section as this section existed	482
prior to the effective date of this amendment and the standard	483
forms of DNR identification approved by the department pursuant	484
to this section as this section existed prior to the effective	485
date of this amendment are effective only for do-not-resuscitate	486
orders issued before the effective date of this amendment. The	487
criteria for determining when a do-not-resuscitate order is	488
current apply only to orders issued before that date.	489

(C) The department of health shall appoint an advisory	490
committee to advise the department in the development of rules	491
under this section. The advisory committee shall include, but	492
shall not be limited to, representatives of each of the following	493
organizations:	494

(1) The association for hospitals and health systems (OHA);

495

(2) The Ohio state medical association;

496

(3) The Ohio chapter of the American college of emergency	497
physicians;	498

(4) The Ohio hospice organization;

499

(5) The Ohio council for home care;

500

(6) The Ohio health care association;

501

(7) The Ohio ambulance association;

502

(8) The Ohio medical directors association;

503

(9) The Ohio association of emergency medical services;

504

(10) The bioethics network of Ohio;

505

(11) The Ohio nurses association;

506

(12) The Ohio academy of nursing homes;

507

(13) The Ohio association of professional firefighters;

508

(14) The department of mental retardation and developmental	509
disabilities;	510

(15) The Ohio osteopathic association;

511

(16) The association of Ohio philanthropic homes, housing and	512
services for the aging;	513

(17) The catholic conference of Ohio;

514

(18) The department of aging;

515

(19) The department of mental health;

516

(20) The Ohio private residential association;

517

(21) The northern Ohio fire fighters association.

518

Sec. 2133.26.  (A)(1) No physician shall purposely prevent or	519
attempt to prevent, or delay or unreasonably attempt to delay, the	520
transfer of a patient in violation of division (B) of section	521
2133.23 of the Revised Code.	522

(2) No person shall purposely conceal, cancel, deface, or	523
obliterate the DNR identification of another person without the	524
consent of the other person.	525

(3) No person shall purposely falsify or forge a revocation	526
of a declaration or MOLST form that is the basis of the DNR	527
identification of another person or purposely falsify or forge an	528
order of a physician or an instruction in a MOLST form that	529
purports to supersede a do-not-resuscitate order issued, or an	530
instruction in a MOLST form completed, for another person.	531

(4) No person shall purposely falsify or forge the DNR	532
identification of another person with the intent to cause the use,	533
withholding, or withdrawal of CPR for the other person.	534

(5) No person who has personal knowledge that another person	535
has revoked a declaration that is the basis of the other person's	536
DNR identification or personal knowledge that a physician has	537
issued an order that supersedes a do-not-resuscitate order that	538
the physician issued for another personNone of the following	539
shall purposely conceal or withhold that personal knowledge with	540
the intent to cause the use, withholding, or withdrawal of CPR for	541
the other person:	542

(a) A person who has personal knowledge that another person	543
has revoked a declaration that is the basis of the other person's	544
DNR identification;	545

(b) A person who has personal knowledge that a physician has	546
issued an order that supersedes a do-not-resuscitate order that	547
the physician issued for another person;	548

(c) A person who has personal knowledge that another person	549
has revoked a MOLST form or superseded an instruction in a MOLST	550
form that is the basis of the other person's DNR identification.	551

(B)(1) Whoever violates division (A)(1) or (5) of this	552
section is guilty of a misdemeanor of the third degree.	553

(2) Whoever violates division (A)(2), (3), or (4) of this	554
section is guilty of a misdemeanor of the first degree.	555

Sec. 2133.27. Nothing in sections 2133.21 to 2133.26 of the	556
Revised Code prohibits a physician from issuing a directive on or	557
after the effective date of this section that identifies a person	558
and specifies that CPR should not be administered to the person so	559
identified but any such directive shall be issued in accordance	560
with reasonable and prevailing standards of care.	561

Sec. 2133.30. As used in this section and sections 2133.31	562
to 2133.47 of the Revised Code:	563

(A) "Advanced practice nurse" means a registered nurse who	564
holds a valid certificate that authorizes the practice of nursing	565
as a certified nurse practitioner or a clinical nurse specialist	566
in accordance with section 4723.43 of the Revised Code.	567

(B) "Attending physician" means the physician to whom a	568
patient or patient's family has assigned primary responsibility	569
for the medical treatment or care of the patient or, if the	570
responsibility has not been assigned, the physician who has	571
accepted that responsibility.	572

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

573

(1) Nutrition when administered to diminish pain or	574
discomfort, but not to postpone death;	575

(2) Hydration when administered to diminish pain or	576
discomfort, but not to postpone death;	577

(3) Any other medical or nursing procedure, treatment,	578
intervention, or other measure that is taken to diminish pain or	579
discomfort, but not to postpone death.	580

(D) "CPR" has the same meaning as in section 2133.21 of the	581
Revised Code.	582

(E) "Declaration" means a document executed in accordance	583
with section 2133.02 of the Revised Code.	584

(F) "DNR identification" and "do-not-resuscitate order" have	585
the same meanings as in section 2133.21 of the Revised Code.	586

(G) "Durable power of attorney for health care" means a	587
document created pursuant to sections 1337.11 to 1337.17 of the	588
Revised Code.	589

(H) "Emergency medical services worker" means a paid or	590
volunteer firefighter, law enforcement officer, first responder,	591
emergency medical technician-basic, emergency medical	592
technician-intermediate, emergency medical technician-paramedic,	593
medical technician, or other emergency services worker acting	594
within the ordinary course of the emergency services profession.	595

(I) "Form preparer" means the issuing practitioner who	596
completes a medical orders for life-sustaining treatment form or	597
the individual who completes the form pursuant to the	598
practitioner's delegation.	599

(J) "Health care facility" has the same meaning as in section	600
1337.11 of the Revised Code.	601

(K) "Issuing practitioner" means a physician, physician	602
assistant, or advanced practice nurse who issues medical orders	603
for life-sustaining treatment for a patient by signing as the	604
issuing practitioner the medical orders for life-sustaining	605
treatment form for the patient.	606

(L) "Life-sustaining treatment" means any medical procedure,	607
treatment, intervention, or other measure that, when administered	608
to a patient, is intended to serve principally to prolong the	609
process of dying.	610

(M) "Medical orders for life-sustaining treatment" means	611
instructions, issued by a physician, physician assistant, or	612
advanced practice nurse, regarding how a patient should be treated	613
with respect to hospitalization, administration or withdrawal of	614
life-sustaining treatment and comfort care, administration of CPR,	615
and other treatment the director of health has specified in rules	616
adopted under section 2133.31 of the Revised Code.	617

(N) "Medical orders for life-sustaining treatment form,"	618
"MOLST form," or "form" means the form prescribed by the director	619
of health pursuant to rules adopted under section 2133.31 of the	620
Revised Code that when completed documents an issuing	621
practitioner's medical orders for life-sustaining treatment.	622

(O) "Nutrition" means sustenance that is artificially or	623
technologically administered.	624

(P) "Physician" means an individual authorized under Chapter	625
4731. of the Revised Code to practice medicine and surgery or	626
osteopathic medicine and surgery.	627

(Q) "Physician assistant" means an individual who holds a	628
valid certificate to practice as a physician assistant issued	629
under Chapter 4730. of the Revised Code.	630

Sec. 2133.31. (A) Subject to division (D) of this section,	631
the director of health shall adopt rules in accordance with	632
Chapter 119. of the Revised Code to do all of the following:	633

(1) Specify the treatment, in addition to hospitalization,	634
administration or withdrawal of life-sustaining treatment and	635
comfort care, and administration of CPR, that may be included in	636
instructions that constitute medical orders for life-sustaining	637
treatment under section 2133.30 of the Revised Code;	638

(2) Subject to divisions (B) and (C) of this section,	639
prescribe a medical orders for life-sustaining treatment (MOLST)	640
form;	641

(3) Specify procedures for a MOLST form to be amended or	642
revoked;	643

(4) Specify what constitutes full treatment relative to	644
treatment covered by each section of a MOLST form, for purposes of	645
section 2133.42 of the Revised Code;	646

(5) Specify the requirements an individual must meet to be	647
authorized to complete a MOLST form when this responsibility is	648
delegated by an issuing practitioner;	649

(6) Specify the extent to which MOLST forms, physician orders	650
for life-sustaining treatment forms, or physician orders for	651
scope of treatment forms executed under the laws or regulations	652
of other states are valid for purposes of sections 2133.31 to	653
2133.48 of the Revised Code;	654

(7) Specify the individual or class of individuals who are	655
authorized to sign and date a MOLST form if all of the individuals	656
or classes of individuals in divisions (B)(2)(a) to (f) of	657
section 2133.34 of the Revised Code are incapacitated, are not	658
willing to participate, or are not available within a reasonable	659
period of time to participate in the completion of a MOLST form;	660

(8) Address any other matters necessary or appropriate to	661
implement or clarify sections 2133.31 to 2133.48 of the Revised	662
Code.	663

(B) The rules the director adopts under division (A)(2) of	664
this section shall, at minimum, address all of the following:	665

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

666

(2) The logo that identifies a form, whether in paper or	667
electronic format, as an official MOLST form;	668

(3) The inclusion of a space designated for the patient's	669
name;	670

(4) The inclusion of spaces designated for the names,	671
telephone numbers, signatures, and dates of signature of all of	672
the following:	673

(a) The issuing practitioner;

674

(b) The form preparer;

675

(c) The patient, the patient's attorney in fact under the	676
patient's durable power of attorney for health care, the	677
individual or class of individuals specified in division (B)(2)	678
of section 2133.34 of the Revised Code who participate in the	679
form's completion, or the individual authorized pursuant to	680
division (D) of section 2133.35 of the Revised Code to complete a	681
new form;	682

(d) The parent, guardian, or custodian of the patient, to be	683
used only if the patient is under eighteen years of age.	684

(5) The inclusion of boxes for the form preparer to indicate	685
whether a physician or advanced practice nurse has issued a	686
do-not-resuscitate order for the patient and whether the patient	687
has executed a declaration or a durable power of attorney for	688
health care.	689

(6) The inclusion of boxes corresponding to a range of	690
preferences the patient, the patient's parent, guardian, or legal	691
custodian, or any other individual or class of individuals	692
described in division (B)(4)(c) of this section who participate	693
in a form's completion can select regarding various medical	694
treatments and when such treatments should be administered,	695
including, but not limited to, CPR, antibiotics, artificially or	696
technologically administered nutrition and hydration, and other	697
medical interventions and the inclusion of spaces next to the	698
boxes for the names of the patient, individual, or individuals	699
who make the selections;	700

(7) The inclusion of a box for the form preparer to indicate	701
whether the patient, the patient's parent, guardian, or legal	702
custodian, or the other individual or class of individuals	703
described in division (B)(4)(c) of this section who participate in	704
the form's completion authorize the temporary administration of	705
medical treatments that may be contrary to the selections made	706
under division (B)(6) of this section if the patient has an	707
advanced chronic progressive illness and the medical treatment	708
would be administered for a different injury or illness.	709

(8) The inclusion of a space where the form preparer can	710
indicate the name and telephone number of an individual the	711
patient has authorized pursuant to division (D) of section 2133.35	712
of the Revised Code to do both of the following:	713

(a) Make all medical decisions on the patient's behalf,	714
including those regarding the administration of CPR and other	715
life-sustaining treatment;	716

(b) Revoke the form at any time in accordance with the	717
procedure prescribed in rules adopted under section 2133.31 of the	718
Revised Code and complete a new form on the patient's behalf.	719

(9) The inclusion of a space for the form preparer to list	720
the name and contact information for the patient's next of kin if	721
the patient does not have a legally effective durable power of	722
attorney for health care.	723

(10) The inclusion of a space for the form preparer to	724
indicate the date that the form was completed and signed in	725
accordance with sections 2133.34 and 2133.35 of the Revised Code;	726

(11) The inclusion of spaces designated for the names of	727
individuals who review the form after it is completed, the dates	728
on which reviews are completed, and the reviewer to indicate the	729
review's outcome;	730

(12) The inclusion of the following advisory statements, in	731
boldface type:	732

(a) "There is no requirement that a patient, a patient's	733
parent, guardian, or legal custodian, or a patient's	734
representative execute a MOLST form. You are not required to sign	735
this form for the patient to receive treatment."	736

This statement shall appear in the space immediately above	737
the space designated for the signature of the patient, the	738
patient's attorney in fact under the patient's durable power of	739
attorney for health care, or any of the other individuals or class	740
of individuals described in division (B)(4)(c) of this section who	741
participate in a form's completion.	742

(b) "The instructions in this form may supersede an	743
inconsistent instruction in a declaration (living will), durable	744
power of attorney for health care, general consent to treatment	745
form, or a DNR order as described in section 2133.41 of the Ohio	746
Revised Code."	747

(c) "This form may be revoked in accordance with section	748
2133.39 of the Ohio Revised Code."	749

(C) When prescribing a medical orders for life-sustaining	750
treatment form pursuant to division (A)(2) of this section, the	751
director shall consider the design and content of forms used in	752
other states to document medical or physician orders for	753
life-sustaining treatment.	754

(D) The director shall adopt the initial rules required by	755
this section not later than twelve months after the effective date	756
of this section. In adopting the rules, the director shall	757
consider the physician orders for life-sustaining treatment	758
(POLST) paradigm program requirements established by the national	759
POLST paradigm initiative task force.	760

Sec. 2133.32.  The MOLST form prescribed in rules adopted	761
under section 2133.31 of the Revised Code shall be made available	762
on the department of health's web site in a format that can be	763
downloaded free of charge and reproduced.	764

Sec. 2133.33.  (A) Except as provided in division (C) of this	765
section, a physician, physician assistant, or advanced practice	766
nurse may at any time issue medical orders for life-sustaining	767
treatment for a patient by completing a MOLST form. Once completed	768
and signed in accordance with sections 2133.34 and 2133.35 of the	769
Revised Code, the MOLST form is valid and, except as provided in	770
division (B) of this section, the instructions in it become	771
operative and govern how the patient who is the subject of the	772
form is to be treated with respect to hospitalization,	773
administration or withdrawal of life-sustaining treatment and	774
comfort care, administration of CPR, and other treatment the	775
director of health has specified in rules adopted under section	776
2133.31 of the Revised Code.	777

(B) The instructions in a MOLST form are not operative and do	778
not govern how a patient is to be treated when the instructions	779
are superseded as described in section 2133.41 or 2133.43 of the	780
Revised Code or the form is revoked as described in section	781
2133.39 of the Revised Code.	782

(C) A physician, physician assistant, or advanced practice	783
nurse shall not have a MOLST form completed for a patient if,	784
subject to division (D) of this section, any of the following	785
makes known to the physician, physician assistant, or advanced	786
practice nurse that completion of a MOLST form is not desired:	787

(1) If the patient is at least eighteen years of age and not	788
incapacitated, the patient;	789

(2) If the patient is not at least eighteen years of age, the	790
patient's parent, guardian, or legal custodian;	791

(3) If the patient is at least eighteen years of age,	792
incapacitated, has a legally effective durable power of attorney	793
for health care, and the circumstances in division (E) of this	794
section do not apply, the patient's attorney in fact under the	795
durable power of attorney for health care;	796

(4) If the patient is at least eighteen years of age,	797
incapacitated, does not have a legally effective durable power of	798
attorney for health care, and the circumstances in division (E) of	799
this section do not apply, the individual or class of individuals	800
determined according to the order of priority in division (B)(2)	801
of section 2133.34 of the Revised Code.	802

(D) Any disagreement within a class of individuals determined	803
according to the order of priority in division (B)(2) of section	804
2133.34 of the Revised Code as to whether a MOLST form should be	805
completed shall be resolved in accordance with section 2133.36 of	806
the Revised Code.	807

(E) If the patient, pursuant to division (D) of section	808
2133.35 of the Revised Code, authorized another individual to make	809
all medical decisions and to revoke a MOLST form on the patient's	810
behalf, that individual may make known to the physician, physician	811
assistant, or advanced practice nurse that completion of a new	812
MOLST form is not desired.	813

Sec. 2133.34.  (A) A MOLST form is valid only if all of the	814
following participate in completion of the form:	815

(1) The issuing practitioner, who shall sign and date the	816
form in the space designated for the practitioner's signature and	817
who may complete the form or delegate the responsibility of the	818
form's completion to an individual who meets the requirements	819
established in rules adopted under section 2133.31 of the Revised	820
Code;	821

(2) If the issuing practitioner is not the form preparer, the	822
form preparer, who shall sign and date the form in the space	823
designated for the form preparer's signature;	824

(3) Except as provided in division (B) of this section or	825
when the patient has, pursuant to division (D) of section 2133.35	826
of the Revised Code, authorized another individual to make all	827
medical decisions and to revoke a MOLST form and complete a new	828
form on the patient's behalf, the patient, who shall sign and	829
date the form in the space designated for the patient's	830
signature.	831

(B)(1) If the patient is at least eighteen years of age,	832
incapacitated, has a legally effective durable power of attorney	833
for health care, and is not already the subject of a valid MOLST	834
form, the patient's attorney in fact under the patient's durable	835
power of attorney for health care shall sign and date the form in	836
the space designated for such signature and indicate the person's	837
status as the patient's attorney in fact.	838

(2) If the patient is at least eighteen years of age,	839
incapacitated, does not have a legally effective durable power of	840
attorney for health care, and is not the subject of a valid MOLST	841
form, the individual or class of individuals determined in the	842
following order of priority and subject to divisions (D) and (E)	843
of this section and section 2133.36 of the Revised Code shall sign	844
and date the form in the space designated for such signature or	845
signatures and indicate the relationship to the patient:	846

(a) The patient's guardian;

847

(b) The patient's spouse;

848

(c) An adult child of the patient or, if there is more than	849
one adult child, all of the patient's adult children;	850

(d) The patient's parents;

851

(e) An adult sibling of the patient or, if there is more than	852
one adult sibling, all of the adult siblings;	853

(f) The adult not described in divisions (B)(2)(a) to (e) of	854
this section who is most closely related to the patient by blood	855
or adoption;	856

(g) The individual or class of individuals specified by the	857
director of health in rules adopted under section 2133.31 of the	858
Revised Code.	859

(3) If the patient is under eighteen years of age, the	860
parent, guardian, or legal custodian of the patient shall sign and	861
date the form in the space designated for such signature and	862
indicate the relationship to the patient.	863

(C) Division (B)(2)(a) of this section shall not be construed	864
as permitting or requiring the appointment of a guardian for the	865
patient.	866

(D) If an appropriate individual entitled to participate	867
under (B)(2) of this section in a MOLST form's completion is not	868
available within a reasonable period of time to participate in the	869
form's completion, is incapacitated, or declines to participate,	870
the next priority individual or class of individuals specified in	871
that division is authorized to participate.	872

(E) If at least one individual in a class of individuals	873
entitled to participate under division (B)(2) of this section in a	874
MOLST form's completion is incapacitated, is not willing to	875
participate, or is not available within a reasonable period of	876
time, participation shall be limited to the individual or	877
individuals in the class who are not incapacitated and are willing	878
to participate and available within a reasonable period of time.	879

Sec. 2133.35. (A)(1) When completing a MOLST form, the form	880
preparer shall, except as provided in division (A)(2) of this	881
section, discuss the instructions in the form with one of the	882
following:	883

(a) If the patient is at least eighteen years of age and not	884
incapacitated, the patient;	885

(b) If the patient is not at least eighteen years of age, the	886
patient's parent, guardian, or legal custodian;	887

(c) If the patient is at least eighteen years of age,	888
incapacitated, and has a legally effective durable power of	889
attorney for health care, the patient's attorney in fact under the	890
durable power of attorney for health care;	891

(d) If the patient is at least eighteen years of age,	892
incapacitated, and does not have a legally effective durable power	893
of attorney for health care, the individual or class of	894
individuals determined according to the order of priority in	895
division (B)(2) of section 2133.34 of the Revised Code.	896

(2) If the MOLST form is a new form completed by an	897
individual authorized pursuant to division (D) of this section to	898
make all medical decisions and to complete a new form on the	899
patient's behalf, the form preparer shall discuss the instructions	900
in the form with that individual.	901

(B) The instructions the form preparer lists on the form	902
shall reflect the desires of the appropriate person or persons	903
determined in accordance with division (A) of this section as	904
expressed during the discussion.	905

(C) A declaration or durable power of attorney for health	906
care, or both, if a copy of one or both documents is furnished to	907
the form preparer, may guide the discussion between the form	908
preparer and the appropriate person or persons determined in	909
accordance with division (A) of this section.	910

(D) If a patient participates in the form's completion, the	911
patient may instruct the form preparer to document in the	912
appropriate space on the form that the patient authorizes another	913
individual to do both of the following:	914

(1) Make all medical decisions on the patient's behalf,	915
including those regarding the administration of CPR and other	916
life-sustaining treatment;	917

(2) Revoke the form at any time in accordance with the	918
procedure prescribed in rules adopted under section 2133.31 of the	919
Revised Code and, if desired, complete a new form on the patient's	920
behalf.	921

Sec. 2133.36.  (A) Subject to division (B) of this section,	922
if individuals in a class of individuals determined in accordance	923
with division (B)(2) of section 2133.34 of the Revised Code	924
disagree on any decision that must be made with regard to the	925
completion of the form, the opinion of the majority of	926
individuals who are not incapacitated and are available within a	927
reasonable period of time and willing to participate shall	928
prevail.	929

(B) If a majority of individuals cannot reach a decision	930
under division (A) of this section, a physician who is not the	931
issuing practitioner but who has reviewed the patient's medical	932
record shall make the decision that the physician believes is most	933
consistent with reasonable and prevailing medical standards.	934

Sec. 2133.37.  A completed MOLST form shall be placed in a	935
conspicuous location in the paper or electronic medical record of	936
the patient to whom it pertains. Whether maintained as part of a	937
paper or electronic medical record, the form shall be readily	938
available and retrievable.	939

Sec. 2133.38. (A) If a patient with a MOLST form is	940
transferred from one health care facility to another, the health	941
care facility initiating the transfer shall communicate the	942
existence of, and send a copy of, the form to the receiving	943
facility prior to the transfer. The copy may be sent via regular	944
mail or by facsimile or other electronic means, but if maintained	945
in paper format, shall be placed on the color of paper	946
specified in rules adopted under section 2133.31 of the Revised	947
Code on receipt by the receiving facility. A copy of the form is	948
the same as the original.	949

(B)(1) Consistent with section 2133.37 of the Revised Code,	950
the copy of the MOLST form shall be placed in a conspicuous	951
location in the patient medical record immediately on receipt by	952
the receiving facility. After admission, the attending physician	953
shall review the MOLST form and, except as provided in division	954
(B)(2) of this section, discuss with one of the following whether	955
the form should be amended or revoked and whether a new form	956
should be issued:	957

(a) If the patient is at least eighteen years of age and not	958
incapacitated, the patient;	959

(b) If the patient is not at least eighteen years of age, the	960
patient's parent, guardian, or legal custodian;	961

(c) If the patient is at least eighteen years of age,	962
incapacitated, and has a legally effective durable power of	963
attorney for health care, the patient's attorney in fact under the	964
durable power of attorney for health care;	965

(d) If the patient is at least eighteen years of age,	966
incapacitated, and does not have a legally effective durable power	967
of attorney for health care, the individual or class of	968
individuals determined according to the order of priority in	969
division (B)(2) of section 2133.34 of the Revised Code.	970

(2) If the patient has authorized, pursuant to division (D)	971
of section 2133.35 of the Revised Code, another individual to make	972
all medical decisions and to revoke a MOLST form on the patient's	973
behalf, the attending physician, after the physician's review of	974
the form, shall discuss with that individual whether the form	975
should be amended or revoked and whether a new form should be	976
issued.	977

(C) If a decision is made to amend the form, the attending	978
physician shall proceed with the amendment consistent with the	979
amendment procedure prescribed in rules adopted under section	980
2133.31 of the Revised Code. If a decision is made to revoke the	981
form, whether or not there is an intention to issue a new form,	982
the revocation shall be done in accordance with section 2133.39 of	983
the Revised Code.	984

Sec. 2133.39.  (A) A patient, an individual the patient has	985
authorized pursuant to division (D) of section 2133.35 of the	986
Revised Code to make all medical decisions and to revoke a MOLST	987
form on the patient's behalf, or, if the patient is under	988
eighteen years of age, the patient's parent, guardian, or legal	989
custodian, may revoke a MOLST form at any time in accordance with	990
the procedure specified in rules adopted under section 2133.31 of	991
the Revised Code.	992

(B) If a patient is at least eighteen years of age,	993
incapacitated, and has not authorized an individual pursuant to	994
division (D) of section 2133.35 of the Revised Code to make all	995
medical decisions and to revoke the patient's MOLST form, the	996
patient's attorney in fact under a durable power of attorney for	997
health care or, if the patient does not have a legally effective	998
durable power of attorney for health care, the individual or	999
class of individuals determined in accordance with division	1000
(B)(2) of section 2133.34 of the Revised Code, may revoke a	1001
form in accordance with the procedure specified in rules	1002
adopted under section 2133.31 of the Revised Code if the	1003
attending physician determines that at least one of the	1004
following is the case:	1005

(1) There has been a change in the physical condition of the	1006
patient that significantly decreases the benefit of the	1007
instructions in the MOLST form to the patient.	1008

(2) The instructions in the MOLST form are no longer	1009
significantly effective in achieving the purposes for which	1010
consent to their use was given by the patient, the patient's	1011
attorney in fact under a durable power of attorney for health	1012
care, or the individual or class of individuals determined in	1013
accordance with division (B)(2) of section 2133.34 of the Revised	1014
Code.	1015

Sec. 2133.40.  Unless revoked in accordance with section	1016
2133.39 of the Revised Code, a MOLST form does not expire.	1017

Sec. 2133.41.  Except as provided in section 2133.43 of the	1018
Revised Code, both of the following apply with respect to	1019
determining which instruction supersedes when an instruction is	1020
inconsistent in different documents:	1021

(A) An instruction in a MOLST form that is inconsistent with	1022
an instruction in a do-not-resuscitate order always supersedes	1023
the inconsistent instruction in the do-not-resuscitate order.	1024

(B) An instruction in a MOLST form that is inconsistent with	1025
an instruction in a general consent to treatment form signed by	1026
or on behalf of the patient, a declaration, or a durable power of	1027
attorney for health care supersedes the inconsistent instruction	1028
in any of those documents unless both of the following conditions	1029
are met:	1030

(1) The document was executed after the MOLST form, as	1031
evidenced by the date on the document.	1032

(2) The attending physician is made aware of the document and	1033
furnished a copy of it.	1034

Sec. 2133.42.  Except as provided in section 2133.43 of the	1035
Revised Code, if a section of a MOLST form has not been	1036
completed, a health care professional may proceed with the	1037
understanding that full treatment relative to treatment covered by	1038
that section of the form, as specified in rules adopted by the	1039
director of health pursuant to section 2133.31 of the Revised	1040
Code, is to be considered unless the form indicates that the	1041
patient has authorized another individual to make all medical	1042
decisions on the patient's behalf as described in division (D)	1043
of section 2133.35 of the Revised Code.	1044

Sec. 2133.43. If an emergency medical services worker	1045
determines in an emergency situation that either of the following	1046
applies, the emergency medical services worker shall proceed to	1047
treat the patient as directed, verbally or in writing, by a	1048
physician or the cooperating physician advisory board of the	1049
emergency medical service organization with which the emergency	1050
medical services worker is affiliated:	1051

(A) An instruction in the patient's MOLST form is	1052
inconsistent with an instruction in any of the following:	1053

(1) A do-not-resuscitate order that applies to the patient;

1054

(2) A general consent to treatment form signed by or on	1055
behalf of the patient;	1056

(3) A declaration executed by the patient;

1057

(4) A durable power of attorney for health care executed by	1058
the patient.	1059

(B) The section of the MOLST form that relates to the	1060
patient's treatment in that emergency situation has not been	1061
completed.	1062

Sec. 2133.44. (A) Subject to division (B) of this section, no	1063
health care facility, health care professional, emergency	1064
services worker, or other individual who works for a health care	1065
facility as an employee, contractor, or volunteer and who works	1066
under the direction of or with the authorization of a physician or	1067
advanced practice nurse shall be subject to criminal prosecution,	1068
liable in damages in tort or other civil action, or subject to	1069
professional disciplinary action for acting in accordance with, or	1070
otherwise being in compliance with, a valid MOLST form or sections	1071
2133.31 to 2133.48 of the Revised Code.	1072

(B) Division (A) of this section does not grant an immunity	1073
from criminal or civil liability or from professional disciplinary	1074
action to health care personnel for actions that are outside their	1075
scope of authority.	1076

Sec. 2133.45.  The death of an individual that occurs as a	1077
result of actions taken consistent with instructions in a MOLST	1078
form does not constitute for any purpose a suicide, aggravated	1079
murder, murder, or any other homicide.	1080

Sec. 2133.46.  The issuance of a MOLST form shall not do any	1081
of the following:	1082

(A) Affect in any manner the sale, procurement, issuance, or	1083
renewal of a policy of life insurance or annuity, notwithstanding	1084
any term of a policy or annuity to the contrary;	1085

(B) Modify in any manner or invalidate the terms of a policy	1086
of life insurance or annuity that is in effect on the effective	1087
date of this section;	1088

(C) Impair or invalidate a policy of life insurance or	1089
annuity or any health benefit plan.	1090

Sec. 2133.47.  No physician, health care facility, other	1091
health care provider, person authorized to engage in the business	1092
of insurance in this state under Title XXXIX of the Revised Code,	1093
health insuring corporation, other health care benefit plan, legal	1094
entity that is self-insured and provides benefits to its employees	1095
or members, governmental entity, or other person shall require	1096
that an individual be the subject of a MOLST form, or require an	1097
individual to revoke or refrain from being the subject of a MOLST	1098
form, as a condition of being insured or of receiving health care	1099
benefits or services.	1100

Sec. 2133.48.  In the absence of actual knowledge to the	1101
contrary and if acting in good faith, an attending physician,	1102
other health care professional, emergency services worker, or	1103
health care facility may assume that a MOLST form complies with	1104
sections 2133.31 to 2133.47 of the Revised Code and is valid.	1105

Sec. 2133.49. (A) There is hereby created the medical orders	1106
for life-sustaining treatment advisory council. The council shall	1107
consist of the following thirty-one members:	1108

(1) An employee of the department of aging, appointed by the	1109
director of aging;	1110

(2) An employee of the department of mental health, appointed	1111
by the director of mental health;	1112

(3) An employee of the department of mental retardation and	1113
developmental disabilities, appointed by the director of mental	1114
retardation and developmental disabilities;	1115

(4) The executive director of the Ohio medical transportation	1116
board;	1117

(5) The executive director of the state board of emergency	1118
medical services;	1119

(6) The state long-term care ombudsperson;

1120

(7) One representative from each of the following	1121
organizations, appointed by the president or chief administrative	1122
officer of the organization:	1123

(a) The Ohio hospital association;

1124

(b) The Ohio state medical association;

1125

(c) The Ohio chapter of the American college of emergency	1126
physicians;	1127

(d) The Ohio hospice and palliative care organization;

1128

(e) The Ohio health care association;

1129

(f) The Ohio ambulance and medical transportation	1130
Association;	1131

(g) The Ohio medical directors association;

1132

(h) The Ohio association of emergency medical services;

1133

(i) The bioethics network of Ohio;

1134

(j) The Ohio nurses association;

1135

(k) The Ohio academy of nursing homes;

1136

(l) The Ohio association of professional firefighters;

1137

(m) The Ohio osteopathic association;

1138

(n) The association of Ohio philanthropic homes, housing and	1139
services for the aging;	1140

(o) The catholic conference of Ohio;

1141

(p) The Ohio private residential association;

1142

(q) The northern Ohio fire fighters association;

1143

(r) The Ohio assisted living association;

1144

(s) The Ohio council for home care;

1145

(t) Lifeline of Ohio;

1146

(u) The Ohio state bar association;

1147

(v) The Ohio association of advanced practice nurses;

1148

(w) The Ohio fire chiefs association;

1149

(x) The Ohio state firefighters association;

1150

(y) Agudath Israel of America.

1151

(B) The council shall meet at the call of the director of	1152
health. The department of health shall provide meeting space,	1153
staff services, and technical assistance required by the council	1154
in carrying out its duties.	1155

(C) The council shall advise the director of health regarding	1156
the rules the director must adopt under section 2133.31 of the	1157
Revised Code and, at such times that the rules are subject to	1158
review pursuant to section 119.032 of the Revised Code, whether	1159
and to what extent the rules should be continued without change,	1160
amended, or rescinded.	1161

Each member of the council has one vote. A majority of the	1162
members present at a meeting constitutes a quorum, and the	1163
affirmative vote of a majority of the members present is necessary	1164
for the council to make an official recommendation to the director	1165
on a particular rule.	1166

The director may assign other duties to the council, as the	1167
director considers appropriate.	1168

(D) Members of the council shall serve without compensation,	1169
except to the extent that serving on the council is considered	1170
part of their regular duties of employment.	1171

(E) Sections 101.82 to 101.87 of the Revised Code do not	1172
apply to the council.	1173

Sec. 3795.03. Nothing in section 3795.01 or 3795.02 of the	1174
Revised Code shall do any of the following:	1175

(A) Prohibit or preclude a physician, certified nurse	1176
practitioner, certified nurse-midwife, or clinical nurse	1177
specialist who carries out the responsibility to provide comfort	1178
care to a patient in good faith and while acting within the scope	1179
of the physician's or nurse's authority from prescribing,	1180
dispensing, administering, or causing to be administered any	1181
particular medical procedure, treatment, intervention, or other	1182
measure to the patient, including, but not limited to,	1183
prescribing, personally furnishing, administering, or causing to	1184
be administered by judicious titration or in another manner any	1185
form of medication, for the purpose of diminishing the patient's	1186
pain or discomfort and not for the purpose of postponing or	1187
causing the patient's death, even though the medical procedure,	1188
treatment, intervention, or other measure may appear to hasten or	1189
increase the risk of the patient's death;	1190

(B) Prohibit or preclude health care personnel acting under	1191
the direction of a person authorized to prescribe a patient's	1192
treatment and who carry out the responsibility to provide comfort	1193
care to the patient in good faith and while acting within the	1194
scope of their authority from dispensing, administering, or	1195
causing to be administered any particular medical procedure,	1196
treatment, intervention, or other measure to the patient,	1197
including, but not limited to, personally furnishing,	1198
administering, or causing to be administered by judicious	1199
titration or in another manner any form of medication, for the	1200
purpose of diminishing the patient's pain or discomfort and not	1201
for the purpose of postponing or causing the patient's death, even	1202
though the medical procedure, treatment, intervention, or other	1203
measure may appear to hasten or increase the risk of the patient's	1204
death;	1205

(C) Prohibit or affect the use or continuation, or the	1206
withholding or withdrawal, of life-sustaining treatment, CPR, or	1207
comfort care under Chapter 2133. of the Revised Code;	1208

(D) Prohibit or affect the provision or withholding of health	1209
care, life-sustaining treatment, or comfort care to a principal	1210
under a durable power of attorney for health care or any other	1211
health care decision made by an attorney in fact under sections	1212
1337.11 to 1337.17 of the Revised Code;	1213

(E) Affect or limit the authority of a physician, a health	1214
care facility, a person employed by or under contract with a	1215
health care facility, or emergency service personnel to provide or	1216
withhold health care to a person in accordance with reasonable	1217
medical standards applicable in an emergency situation;	1218

(F) Affect or limit the authority of a person to refuse to	1219
give informed consent to health care, including through the	1220
execution of a durable power of attorney for health care under	1221
sections 1337.11 to 1337.17 of the Revised Code, the execution of	1222
a declaration under sections 2133.01 to 2133.15 of the Revised	1223
Code, the completion of a MOLST form under sections 2133.30 to	1224
2133.48 of the Revised Code, or authorizing the withholding or	1225
withdrawal of CPR under sections 2133.21 to 2133.262133.27 of the	1226
Revised Code.	1227

Section 2. That existing sections 2133.02, 2133.21, 2133.211,	1228
2133.22, 2133.23, 2133.24, 2133.25, 2133.26, and 3795.03 of the	1229
Revised Code are hereby repealed.	1230