CHAPTER 137-J WRITTEN DIRECTIVES FOR MEDICAL DECISION MAKING FOR ADULTS WITHOUT CAPACITY TO MAKE HEALTH CARE DECISIONS
Section 137-J:2
137-J:2 Definitions. –
In this chapter:
I. "Actively dying" means an incurable condition caused by injury, disease, or illness which is such that death is imminent and the application of life-sustaining treatment would, to a reasonable degree of medical certainty only postpone the moment of death to another imminent moment, as certified in the principal's medical record by 2 physicians, or a physician and another attending practitioner who is not under the supervision of the certifying physician.
II. "Advance directive" means a document allowing a person to give directions and guidance about future medical care and to designate another person to make medical decisions if the principal should lose the capacity to make health care decisions. The term "advance directive" shall include a durable power of attorney for health care and a living will.
III. "Advanced practice registered nurse" or "APRN" means a registered nurse who is licensed in good standing in the state of New Hampshire as having specialized clinical qualifications.
IV. "Agent" means an adult to whom authority to make health care decisions is delegated under a durable power of attorney for health care.
V. "Attending practitioner" means the physician, physician assistant, or advanced practice registered nurse, selected by or assigned to a patient, who has primary responsibility for the treatment and care of the patient. If more than one physician, physician assistant, or advanced practice registered nurse shares that responsibility, any one of those physicians, physician assistants, or advanced practice registered nurses may act as the attending practitioner under the provisions of this chapter.
VI. "Capacity to make health care decisions" means the ability to understand and appreciate generally the nature and consequences of a health care decision, including the significant benefits and harms of and reasonable alternatives to any proposed health care. The fact that a person has been diagnosed with mental illness, brain injury, or intellectual disability, or has declined a recommended medical procedure or therapy, shall not mean that the person necessarily lacks the capacity to make health care decisions.
VII. "Cardiopulmonary resuscitation" means those measures used to restore or support cardiac or respiratory function in the event of a cardiac or respiratory arrest.
VIII. "Certified in the principal's medical record" means the making of a statement in the medical record, whether such record is written or electronic.
IX. "Close friend" means any person 18 years of age or older who presents an affidavit to the attending physician stating that the individual is a close friend of the patient, is willing and able to become involved in the patient's health care, and has maintained such regular contact with the patient as to be familiar with the patient's activities, health, and religious and moral beliefs. The affidavit shall also state facts and circumstances that demonstrate such familiarity with the patient.
X. "Do not resuscitate identification" means a standardized identification necklace, bracelet, card, pink portable Do Not Resuscitate Order, POLST, or other written medical order that signifies that a "Do Not Resuscitate Order" has been issued for the principal.
XI. "Do not resuscitate order" or "DNR order" (also known as "Do not attempt resuscitation order" or "DNAR order") means an order that, in the event of an actual or imminent cardiac or respiratory arrest, chest compression and defibrillation will not be performed, the patient will not be intubated or manually ventilated, and there will be no administration of resuscitation drugs.
XII. "Durable power of attorney for health care" means a document delegating to an agent the authority to make health care decisions executed in accordance with the provisions of this chapter. It shall not mean forms routinely required by health and residential care providers for admissions and consent to treatment.
XIII. "Emergency services personnel" means paid or volunteer firefighters, law-enforcement officers, emergency medical technicians, paramedics or other emergency services personnel, providers, or entities acting within the usual course of their professions.
XIV. "Health care decision" means informed consent, refusal to give informed consent, or withdrawal of informed consent to any type of health care, treatment, admission to a health care facility, any service or procedure to maintain, diagnose, or treat an individual's physical or mental condition except as prohibited in this chapter or otherwise by law.
XV. "Health care provider" means a facility licensed, certified, or otherwise authorized or permitted by law to administer health care, for profit or otherwise, in the ordinary course of business or professional practice.
XVI. "Life-sustaining treatment" means any medical procedures or interventions which utilize mechanical or other medically administered means to sustain, restore, or supplant a vital function. "Life-sustaining treatment" includes, but is not limited to, the following: medically administered nutrition and hydration, mechanical respiration, kidney dialysis, or the use of other external mechanical or technological devices. Life sustaining treatment may include drugs to maintain blood pressure, blood transfusions, and antibiotics. "Life-sustaining treatment" shall not include the administration of medication, natural ingestion of food or fluids by eating and drinking, or the performance of any medical procedure deemed necessary to provide comfort or to alleviate pain.
XVII. "Living will" means a written statement of guidance that sets forth the express wishes of the principal that attempts at life sustaining treatment shall be continued or that certain life-sustaining treatment shall not be attempted when the principal has been diagnosed and certified in the principal's medical record by 2 attending physicians or a physician and another attending practitioner who is not under the supervision of the certifying physician to have lost capacity to make health care decisions and to be permanently unconscious or to suffer from an advanced life-limiting, incurable and progressive condition for which treatment has become excessively burdensome or ineffective for the principal.
XVIII. "Medically administered nutrition and hydration" means invasive procedures such as, but not limited to the following: Nasogastric tubes; gastrostomy tubes; intravenous feeding or hydration; and hyperalimentation. It shall not include the natural ingestion of food or fluids by eating and drinking.
XIX. "Permanently unconscious" means a lasting condition, indefinitely without improvement, in which thought, awareness of self and environment, and other indicators of consciousness are absent as determined by an appropriate neurological assessment by a physician in consultation with the attending physician or an appropriate neurological assessment by a physician in consultation with an APRN or PA.
XX. "Physician" means a medical doctor licensed in good standing to practice in the state of New Hampshire pursuant to RSA 329.
XXI. "Physician assistant" or "PA" means a physician assistant licensed in good standing to practice in the state of New Hampshire pursuant to RSA 328-D.
XXII. "POLST" means a form that contains a set of emergency medical orders signed by an attending practitioner. This order set may contain DNR orders, and, although it may be completed in any state under similar title, the DNR and all other orders shall conform to New Hampshire law.
XXIII. "Principal" means a person 18 years of age or older who has executed an advance directive pursuant to the provisions of this chapter or a qualified patient who has not executed an advance directive and whose health care decisions are made by a surrogate appointed pursuant to the provisions of this chapter.
XXIV. "Qualified patient" means any patient who has been certified in the patient's medical record by the attending practitioner to lack the capacity to make health care decisions.
XXV. "Reasonable degree of medical certainty" means a medical judgment that is made by the attending practitioner who is knowledgeable about the case and the treatment possibilities with respect to the medical conditions involved.
XXVI. "Residential care provider" means a "facility" as defined in RSA 161-F:11, IV, a "nursing home" as defined in RSA 151-A:1, IV, or any individual or facility licensed, certified, or otherwise authorized or permitted by law to operate, for profit or otherwise, a residential care facility for adults, including but not limited to those operating pursuant to RSA 420-D.
XXVII. "Surrogate decision-maker" or "surrogate" means an adult individual who has health care decision-making capacity, is available upon reasonable inquiry, is willing to make health care decisions on behalf of a patient who lacks health care decision-making capacity, and is identified by the attending practitioner in accordance with the provisions of this chapter as the person who is to make those decisions in accordance with the provisions of this chapter.
XXVIII. "Witness" means a competent person 18 years or older who is present when the principal signs an advance directive.