BILL ANALYSIS                                                                                                                                                                                                    



                                                          AB 891
                                                          Page 1

Date of Hearing: May 19, 1999

              ASSEMBLY COMMITTEE ON APPROPRIATIONS 
                    Carole Migden, Chairwoman

         AB 891 (Alquist) - As Amended: April 27, 1999 

Policy Committee:                              JudiciaryVote:10  
- 3

Urgency:     No                   State Mandated Local  
Program:YesReimbursable:          No

  SUMMARY  

This bill revises current law governing health care decisions  
for adults without decisionmaking capacity. In general, the bill  
repeals provisions governing durable powers of attorney for  
health care and the Natural Death Act, and revises and recasts  
these provisions as part of a new Health Care Decisions Law. In  
addition to numerous minor and technical changes, the bill:

1)Creates revised advance health care directives that authorize  
  an adult to make an oral or written "individual health care  
  instruction," appointing an agent through a power of attorney,  
  or both. 

2)Creates a new "power of attorney for health care" (PAHC)  
  mechanism which continues many of the existing provisions  
  governing durable powers of attorney, except for the following  
  key changes:

       Recommends, rather than requires, witnesses in order to  
     execute the instrument (unless the individual is a patient  
     in a skilled nursing facility at the time the advance  
     directive is executed, in which case the existing  
     requirement for either two witnesses or notarization is  
     maintained).

       Deletes the requirement that a PAHC state the date of  
     its execution, consistent with current law governing wills  
     and trusts.

       Deletes currently required warnings in favor of an  
     explanation of the purpose and effect of an advance health  








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     care directive, to be contained on a new suggested form.

       Relaxes rules regarding modifications to advance  
     directives by specifying that a later advance directive  
     revokes a prior advance directive only to the extent the  
     two conflict. 

1)Authorizes individuals to grant authority through a PAHC to a  
  designee to make decisions relating to the personal care of  
  the patient, including, but not limited to, determining where  
  the patient will live, providing meals, hiring household  
  employees, providing transportation, handling mail, and  
  arranging recreation and entertainment. 

2)Specifies the authority of an agent becomes effective only on  
  a determination that the patient lacks capacity. The authority  
  ceases to be effective on a determination that the patient has  
  recovered capacity. 

3)Requires an individual's primary physician to render  
  judgements regarding the existence of conditions governing an  
  advance health care instruction, such as whether the  
  individual has an incurable or irreversible condition, unless  
  the patient specifies otherwise. 

4)Establishes judicial review procedures pertaining to PAHCs and  
  advance directives similar to those in current law, but  
  indicates that judicial intervention is "disfavored."

  FISCAL EFFECT  

1)No state costs.

2)The bill consolidates two misdemeanors into one. Accordingly,  
  any county enforcement costs would be minimal and are not  
  state-reimbursable.

  COMMENTS  

  Purpose of the Bill  .  According to the sponsor, the California  
Law Revision Commission, the bill is intended to establish  
uniform standards governing health care decision-making for  
adults without decision-making capacity.  The original durable  
power of attorney for health care was subject to a number of  
restrictions that now are considered overly restrictive.  It is  








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currently recognized that overly restrictive execution  
requirements for powers of attorney for health care can  
interfere with accomplishing an individual's intent.