BILL ANALYSIS
AB 891
Page 1
ASSEMBLY THIRD READING
AB 891 (Alquist)
As Amended April 27, 1999
Majority vote
JUDICIARY 10-3 APPROPRIATIONS 17-4
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|Ayes:|Kuehl, Ackerman, Aroner, |Ayes:|Migden, Corbett, Davis, |
| |Robert Pacheco, Corbett, | |Granlund, Hertzberg, |
| |Jackson, Knox, Longville, | |Kuehl, Ackerman, Papan, |
| |Shelley, Wiggins | |Aroner, Shelley, |
| | | |Steinberg, Thomson, |
| | | |Wesson, Wiggins, Wright, |
| | | |Zettel, Longville |
| | | | |
|-----+--------------------------+-----+--------------------------|
|Nays:|House, McClintock, |Nays:|Brewer, Ashburn, |
| |Strickland | |Campbell, Runner |
| | | | |
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SUMMARY : Streamlines and updates the provisions governing
health care decisions for adults without decisionmaking
capacity. Specifically, this bill repeals the 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 which, among other
things, does the following:
1)Creates a new advance health care directives scheme which
authorizes an adult having capacity to either make an oral or
written "individual health care instruction" which provides
direction concerning a health care decision for the patient,
or to appoint an agent through a power of attorney for health
care, or both. The individual instruction may be limited by
the patient to take effect only if specified conditions arise.
2)Creates a new "power of attorney for health care (PAHC)"
mechanism which continues many of the existing provisions
governing durable powers of attorney for health care, except
for the following key changes:
a) Witnesses are recommended, but not required, in order to
execute the instrument (unless the individual is a patient
in a skilled nursing facility at the time the advance
AB 891
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directive is executed, in which case the existing
requirement for either two witnesses or notarization is
maintained);
b) The statutory requirement that PAHC state the date of
its execution is deleted, consistent with the laws
governing wills and trusts;
c) Statutorily required warnings are deleted in favor of an
introductory explanation of the purpose and effect of an
advance health care directive, which is contained on the
new optional statutory form;
d) Rules regarding revocation are relaxed by providing that
a later advance directive revokes a prior advance directive
only to the extent of the conflict, rather than having the
effect of revoking the prior directive in its entirety as
required under current law; and,
e) Authorizes the principal (patient) in a PAHC to grant
authority 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.
3)Specifies that the authority of an agent becomes effective
only on a determination that the patient lacks capacity and
ceases to be effective on a determination that the patient has
recovered capacity. Also specifies that the primary physician
is to make these capacity determinations unless otherwise
specified in PAHC or other written advance health care
directive.
4)Requires the primary physician to make determinations whether
other conditions exist that may affect an individual health
care instruction (e.g., an individual might specify that
withdrawal or withholding of treatment that keeps the
individual alive may only occur if the individual has an
incurable or irreversible condition that will result in the
individual's death within a relatively short time), unless the
patient specifies otherwise in the instrument.
5)Establishes a uniform standard of decisionmaking for adults
without decisionmaking capacity so that the same rules apply
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whether the decisionmaker is an agent under a PAHC, another
surrogate appointed by the patient, a conservator or a court.
In each instance, the surrogate is required to make decisions
in accordance with the patient's individual health care
instructions, if any, and other wishes of the patient to the
extent known to the surrogate. Otherwise, the surrogate shall
make the decision in accordance with the best interests of the
patient. In determining the patient's best interest, the
surrogate shall consider the patient's personal values to the
extent known to the surrogate.
FISCAL EFFECT : Unknown
COMMENTS : This bill, sponsored by the California Law Revision
Commission, proposes a new Health Care Decisions Law which
consolidates the Natural Death Act and the durable power of
attorney for health care. Drawing heavily on the Uniform
Health-Care Decisions Act of 1993, this bill includes new rules
governing individual health care instructions, and provides a
new optional statutory form for advance health care directives.
According to the sponsor, conforming changes in the procedures
for obtaining court authorizations for medical treatment would
make clear that courts in proper cases have the same authority
as other surrogates to make health care decisions, including
withholding or withdrawal of life-sustaining treatment.
Similarly, the statute governing decisionmaking by conservators
for patients who have been adjudicated to lack the capacity to
make health care decisions are conformed to the standards
governing other health care surrogates.
Analysis Prepared by : Daniel Pone / JUD. / (916) 319-2334
FN:
0000953