What is considered 'artificial nourishment' in regard to a living will?
Full Question:
Answer:
A living will is a document that allows a person to explain in writing which medical treatment he or she does or does not want during a terminal illness. A living will takes effect only when the patient is incapacitated and can no longer express his or her wishes. The will states which medical treatments may be used and which may not be used to die naturally and without the patient’s life being artificially prolonged by various medical procedures. The living will allows a person to make the decision of whether life-prolonging medical or surgical procedures are to be continued, withheld, or withdrawn, as well as when artificial feeding and fluids are to be used or withheld.
The following are Colorado statutes:
15-18-103. Definitions.
As used in this article, unless the context otherwise requires:
(1) "Adult" means any person eighteen years of age or older.
(1.5) "Artificial nourishment" means nourishment supplied through a tube
inserted into the stomach or intestines or nutrients injected intravenously
into the bloodstream.
(2) "Attending physician" means the physician, whether selected by or
assigned to a patient, who has primary responsibility for the treatment and
care of said patient.
(3) "Court" means the district court of the county in which a declarant
having a terminal condition is located at the time of commencement of a
proceeding pursuant to this article or, in the city and county of Denver,
the probate court.
(4) "Declarant" means a mentally competent adult who executes a
declaration.
(5) "Declaration" means a written document voluntarily executed by a
declarant in accordance with the requirements of section 15-18-104.
(6) "Hospital" means an institution holding a license or certificate of
compliance as a hospital issued by the department of public health and
environment of this state and includes hospitals operated by the federal
government in Colorado.
(7) "Life-sustaining procedure" means any medical procedure or
intervention that, if administered to a qualified patient, would serve
only to prolong the dying process. "Life-sustaining procedure" shall not
include any medical procedure or intervention for nourishment of the
qualified patient or considered necessary by the attending physician to
provide comfort or alleviate pain. However, artificial nourishment may be
withdrawn or withheld pursuant to section 15-18-104 (2.5).
(8) "Physician" means a person duly licensed under the provisions of
article 36 of title 12, C.R.S.
(9) "Qualified patient" means a patient who has executed a declaration in
accordance with this article and who has been certified by the attending
physician and one other physician to be in a terminal condition.
(10) "Terminal condition" means an incurable or irreversible condition for
which the administration of life-sustaining procedures will serve only to
postpone the moment of death.
15-18-104. Declaration as to medical treatment.
(1) Any competent adult may execute a declaration directing that
life-sustaining procedures be withheld or withdrawn if, at some future
time, he is in a terminal condition and either unconscious or otherwise
incompetent to decide whether any medical procedure or intervention should
be accepted or rejected. It shall be the responsibility of the declarant or
someone acting for him to submit the declaration to the attending physician
for entry in the declarant's medical record.
Editor's note: This version of subsection (1) is effective until
January 1, 2009.
(1) Any competent adult may execute a declaration directing that
life-sustaining procedures be withheld or withdrawn if, at some future
time, he or she is in a terminal condition and either unconscious or
otherwise incompetent to decide whether any medical procedure or
intervention should be accepted or rejected. It shall be the responsibility
of the declarant or someone acting for him or her to submit the declaration
to the attending physician or advanced practice nurse for entry in the
declarant's medical record.
Editor's note: This version of subsection (1) is effective January
1, 2009.
(2) In the case of a declaration of a qualified patient known to the
attending physician to be pregnant, a medical evaluation shall be made as
to whether the fetus is viable and could with a reasonable degree of
medical certainty develop to live birth with continued application of
life-sustaining procedures. If such is the case, the declaration shall be
given no force or effect.
Editor's note: This version of subsection (2) is effective until
January 1, 2009.
(2) In the case of a declaration of a qualified patient known to the
attending physician or advanced practice nurse to be pregnant, a medical
evaluation shall be made as to whether the fetus is viable and could with a
reasonable degree of medical certainty develop to live birth with continued
application of life-sustaining procedures. If such is the case, the
declaration shall be given no force or effect.
Editor's note: This version of subsection (2) is effective January
1, 2009.
(2.5)
(a) The declarant may provide in his declaration that, in the event
that the only procedure being provided is artificial nourishment, one of
the following actions shall be taken:
(I) That artificial nourishment not be continued when it is the only
procedure being provided; or
(II) That artificial nourishment be continued for a specified period of
time when it is the only procedure being provided; or
(III) That artificial nourishment be continued when it is the only
procedure being provided.
(b) A declaration executed prior to March 29, 1989, may be amended by a
codicil to include the provisions of this subsection (2.5).
(2.6) Notwithstanding the provisions of subsection (2.5) of this section
and section 15-18-103 (7), when an attending physician has determined that
pain results from a discontinuance of artificial nourishment, he may order
that such nourishment be provided but only to the extent necessary to
provide comfort and alleviate such pain.
Editor's note: This version of subsection (2.6) is effective until
January 1, 2009.
(2.6) Notwithstanding the provisions of subsection (2.5) of this section
and section 15-18-103 (7), when an attending physician or advanced
practice nurse has determined that pain results from a discontinuance of
artificial nourishment, he or she may order that such nourishment be
provided but only to the extent necessary to provide comfort and alleviate
such pain.
Editor's note: This version of subsection (2.6) is effective January 1,
2009.
(3) A declaration executed before two witnesses by any competent adult
shall be legally effective for the purposes of this article and may, but
need not, be in the following form:
DECLARATION AS TO MEDICAL OR SURGICAL TREATMENT
I, (name of declarant), being of sound mind and at least eighteen
years of age, direct that my life shall not be artificially prolonged under
the circumstances set forth below and hereby declare that:
1. If at any time my attending physician and one other qualified physician
certify in writing that:
a. I have an injury, disease, or illness which is not curable or
reversible and which, in their judgment, is a terminal condition, and
b. For a period of seven consecutive days or more, I have been
unconscious, comatose, or otherwise incompetent so as to be unable to
make or communicate responsible decisions concerning my person, thenI direct that, in accordance with Colorado law, life-sustaining procedures
shall be withdrawn and withheld pursuant to the terms of this declaration,
it being understood that life-sustaining procedures shall not include any
medical procedure or intervention for nourishment considered necessary by
the attending physician to provide comfort or alleviate pain. However, I
may specifically direct, in accordance with Colorado law, that artificial
nourishment be withdrawn or withheld pursuant to the terms of this
declaration.
2. In the event that the only procedure I am being provided is artificial
nourishment, I direct that one of the following actions be taken:
(initials of declarant) a. Artificial nourishment shall not be continued
when it is the only procedure being provided; or
(initials of declarant) b. Artificial nourishment shall be continued for
___ days when it is the only procedure being provided; or
(initials of declarant) c. Artificial nourishment shall be continued when
it is the only procedure being provided.
3. I execute this declaration, as my free and voluntary act, this ______
day of ___, 20___.
By ______________________
Declarant
The foregoing instrument was signed and declared by ___ to be his
declaration, in the presence of us, who, in his presence, in the presence
of each other, and at his request, have signed our names below as
witnesses, and we declare that, at the time of the execution of this
instrument, the declarant, according to our best knowledge and belief,
was of sound mind and under no constraint or undue influence.
Dated at ___, Colorado, this ___ day of ___, 20___.
______________________________
Name and Address
______________________________
Name and Address
(STATE OF COLORADO)
ss.
County of ___________________)
SUBSCRIBED and sworn to before me by ___, the declarant, and __________
and ___, witnesses, as the voluntary act and deed of the declarant this
___ day of ___, 20___.
My commission expires:
_________________________
Notary Public
Editor's note: This version of subsection (3) is effective until
January 1, 2009.
(3) A declaration executed before two witnesses by any competent adult
shall be legally effective for the purposes of this article and may, but
need not, be in the following form:
DECLARATION AS TO MEDICAL OR SURGICAL TREATMENT
I, (name of declarant), being of sound mind and at least eighteen
years of age, direct that my life shall not be artificially prolonged under
the circumstances set forth below and hereby declare that:
1. If at any time my attending physician or advanced practice nurse and
one other qualified physician or advanced practice nurse certify in writing
that:
a. I have an injury, disease, or illness which is not curable or
reversible and which, in their judgment, is a terminal condition, and
b. For a period of seven consecutive days or more, I have been
unconscious, comatose, or otherwise incompetent so as to be unable to
make or communicate responsible decisions concerning my person, thenI direct that, in accordance with Colorado law, life-sustaining procedures
shall be withdrawn and withheld pursuant to the terms of this declaration,
it being understood that life-sustaining procedures shall not include any
medical procedure or intervention for nourishment considered necessary by
the attending physician or advanced practice nurse to provide comfort or
alleviate pain. However, I may specifically direct, in accordance with
Colorado law, that artificial nourishment be withdrawn or withheld pursuant
to the terms of this declaration.
2. In the event that the only procedure I am being provided is artificial
nourishment, I direct that one of the following actions be taken:
(initials of declarant) a. Artificial nourishment shall not be continued
when it is the only procedure being provided; or
(initials of declarant) b. Artificial nourishment shall be continued for
___ days when it is the only procedure being provided; or
(initials of declarant) c. Artificial nourishment shall be continued when
it is the only procedure being provided.
3. I execute this declaration, as my free and voluntary act, this ______
day of ___, 20___.
By ______________________
Declarant
The foregoing instrument was signed and declared by ___ to be his
declaration, in the presence of us, who, in his presence, in the presence
of each other, and at his request, have signed our names below as
witnesses, and we declare that, at the time of the execution of this
instrument, the declarant, according to our best knowledge and belief,
was of sound mind and under no constraint or undue influence.
Dated at ___, Colorado, this ___ day of ___, 20___.
______________________________
Name and Address
______________________________
Name and Address
STATE OF COLORADO)
ss.
County of ___________________)
SUBSCRIBED and sworn to before me by ___, the declarant, and __________
and ___, witnesses, as the voluntary act and deed of the declarant this
___ day of ___, 20___.
My commission expires:
_________________________
Notary Public
Editor's note: This version of subsection (3) is effective January
1, 2009.
(4) Any declaration made pursuant to subsection (3) of this section may
also have a document with a written statement as provided in section
12-34-105 (b), C.R.S., or a written statement in substantially similar
form, indicating a decision regarding organ and tissue donation. Such a
document shall be executed in accordance with the provisions of the
"Revised Uniform Anatomical Gift Act", part 1 of article 34 of title 12,
C.R.S. Such a written statement may be in the following form:
I hereby make an anatomical gift, to be effective upon my death, of:
A. ____ Any needed organs/tissues
B. ____ The following organs/tissues:
___________________________________________
Donor signature: _____________________________