LRB-1737/1
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2019 - 2020 LEGISLATURE
June 13, 2019 - Introduced by Representatives Snyder, Doyle, Brostoff, Hintz,
Kolste, Kulp, B. Meyers, Ohnstad, Oldenburg, Ramthun, Rohrkaste,
Sinicki, Spiros, Spreitzer, Subeck, Tittl, VanderMeer, Vining, Magnafici
and Brooks, cosponsored by Senators Marklein, Ringhand, Bewley,
Carpenter, Feyen, Hansen, Kooyenga, Olsen, Schachtner, Shilling,
Testin, Tiffany, Wanggaard and Bernier. Referred to Committee on Health.
AB287,1,11 1An Act to renumber 155.01 (1); to renumber and amend 154.01 (1), 154.01
2(3) and 302.384; to amend 154.01 (5) (intro.), subchapter II (title) of chapter
3154 [precedes 154.02], 154.02 (3), 154.03 (title), 154.03 (1) (intro.), 154.03 (2),
4154.05 (1) (c), 154.05 (2), 154.07 (1) (a) (intro.), 154.07 (1) (a) 3., 154.07 (2),
5154.19 (1) (intro.), 154.19 (1) (e), 154.19 (2) (a), 154.19 (2) (b) (intro.), 154.21 (2),
6154.23 (intro.), 154.27 (1), 155.05 (2), 155.20 (4), 155.30 (1), 155.30 (3), 155.50
7(1) (b), 165.77 (1) (a) and 441.07 (1g) (d) (intro.); and to create 154.01 (1g),
8154.01 (3) (a), 154.01 (3) (b), 154.01 (3) (c), 155.01 (1g), 302.384 (1m) and
9448.015 (4) (am) 2m. of the statutes; relating to: certifications for advance
10directives and findings of incapacity related to powers of attorney for health
11care.
Analysis by the Legislative Reference Bureau
This bill makes the following changes regarding certifications for advance
directives and health care powers of attorney:
1. Allows, unless a health care power of attorney instrument specifies
otherwise, one physician and one qualified physician assistant or nurse practitioner

to personally examine principals and make findings of incapacity upon which a
health care power of attorney becomes effective. Under a health care power of
attorney instrument executed under current law, unless specified otherwise, two
physicians or one physician and one psychologist must personally examine and
determine that a principal has incapacity for a health care power of attorney to
become effective. Also, a physician assistant may make findings of incapacity under
the bill only if a physician who oversees the physician assistant's practice affirms
that the physician assistant is competent to evaluate the capacity of patients to
manage health care decisions. A health care power of attorney instrument
designates another person as an agent to make health care decisions on behalf of an
individual who is incapable of making those decisions.
2. Allows an attending physician assistant or attending advanced practice
registered nurse to issue do-not-resuscitate orders. Current law allows only
attending physicians to issue do-not-resuscitate orders. Under current law, if a
person has a serious medical condition that satisfies certain requirements, the
person may request a do-not-resuscitate order which directs medical personnel to
not attempt various types of resuscitation procedures on a person if the person
suffers cardiac or respiratory arrest.
3. Specifies that under a declaration to physicians, also called a living will,
unless specified otherwise, a physician assistant or advanced practice registered
nurse may certify that a patient is afflicted with a terminal condition or is in a
persistent vegetative state. Under current law, unless a declaration specifies
otherwise, only physicians may make those certifications. If a patient has executed
a declaration, and is certified to have a terminal condition or to be in a persistent
vegetative state, in certain situations the declaration authorizes the withholding or
withdrawal of life-sustaining procedures or of feeding tubes from the patient.
For further information see the state fiscal estimate, which will be printed as
an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB287,1 1Section 1. 154.01 (1) of the statutes is renumbered 154.01 (1r) and amended
2to read:
AB287,2,53 154.01 (1r) “Attending physician health care professional" means a physician
4licensed under ch. 448
health care professional who has primary responsibility for
5the treatment and care of the patient.
AB287,2 6Section 2. 154.01 (1g) of the statutes is created to read:
AB287,3,4
1154.01 (1g) “Advanced practice registered nurse” means a nurse licensed
2under ch. 441 who is currently certified by a national certifying body approved by the
3board of nursing as a nurse practitioner, certified nurse-midwife, certified registered
4nurse anesthetist, or clinical nurse specialist.
AB287,3 5Section 3. 154.01 (3) of the statutes is renumbered 154.01 (3) (intro.) and
6amended to read:
AB287,3,87 154.01 (3) (intro.) “Health care professional" means a person licensed, certified
8or registered under ch. 441, 448 or 455.
any of the following:
AB287,4 9Section 4. 154.01 (3) (a) of the statutes is created to read:
AB287,3,1010 154.01 (3) (a) A physician licensed under ch. 448.
AB287,5 11Section 5. 154.01 (3) (b) of the statutes is created to read:
AB287,3,1212 154.01 (3) (b) A physician assistant licensed under ch. 448.
AB287,6 13Section 6. 154.01 (3) (c) of the statutes is created to read:
AB287,3,1414 154.01 (3) (c) An advanced practice registered nurse.
AB287,7 15Section 7. 154.01 (5) (intro.) of the statutes is amended to read:
AB287,3,2116 154.01 (5) (intro.) “Life-sustaining procedure" means any medical procedure
17or intervention that, in the judgment of the attending physician health care
18professional
, would serve only to prolong the dying process but not avert death when
19applied to a qualified patient. “Life-sustaining procedure" includes assistance in
20respiration, artificial maintenance of blood pressure and heart rate, blood
21transfusion, kidney dialysis and other similar procedures, but does not include:
AB287,8 22Section 8. Subchapter II (title) of chapter 154 [precedes 154.02] of the statutes
23is amended to read:
AB287,3,2424 CHAPTER 154
AB287,4,3
1SUBCHAPTER II
2 DECLARATION TO PHYSICIANS
3health care professionals
AB287,9 4Section 9. 154.02 (3) of the statutes is amended to read:
AB287,4,95 154.02 (3) “Qualified patient" means a declarant who has been diagnosed and
6certified in writing to be afflicted with a terminal condition or to be in a persistent
7vegetative state by 2 physicians health care professionals, one of whom is the
8attending physician health care professional and one of whom is a physician, who
9have personally examined the declarant.
AB287,10 10Section 10. 154.03 (title) of the statutes is amended to read:
AB287,4,11 11154.03 (title) Declaration to physicians health care professionals .
AB287,11 12Section 11. 154.03 (1) (intro.) of the statutes is amended to read:
AB287,5,1013 154.03 (1) (intro.) Any person of sound mind and 18 years of age or older may
14at any time voluntarily execute a declaration, which shall take effect on the date of
15execution, authorizing the withholding or withdrawal of life-sustaining procedures
16or of feeding tubes when the person is in a terminal condition or is in a persistent
17vegetative state. A declarant may not authorize the withholding or withdrawal of
18any medication, life-sustaining procedure or feeding tube if the declarant's
19attending physician health care professional advises that, in his or her professional
20judgment, the withholding or withdrawal will cause the declarant pain or reduce the
21declarant's comfort and the pain or discomfort cannot be alleviated through pain
22relief measures. A declarant may not authorize the withholding or withdrawal of
23nutrition or hydration that is administered or otherwise received by the declarant
24through means other than a feeding tube unless the declarant's attending physician
25health care professional advises that, in his or her professional judgment, the

1administration is medically contraindicated. A declaration must be signed by the
2declarant in the presence of 2 witnesses. If the declarant is physically unable to sign
3a declaration, the declaration must be signed in the declarant's name by one of the
4witnesses or some other person at the declarant's express direction and in his or her
5presence; such a proxy signing shall either take place or be acknowledged by the
6declarant in the presence of 2 witnesses. The declarant is responsible for notifying
7his or her attending physician health care professional of the existence of the
8declaration. An attending physician health care professional who is so notified shall
9make the declaration a part of the declarant's medical records. No witness to the
10execution of the declaration may, at the time of the execution, be any of the following:
AB287,12 11Section 12. 154.03 (2) of the statutes is amended to read:
AB287,6,312 154.03 (2) The department shall prepare and provide copies of the declaration
13and accompanying information for distribution in quantities to health care
14professionals
persons licensed, certified, or registered under ch. 441, 448, or 455,
15hospitals, nursing homes, county clerks and local bar associations and individually
16to private persons. The department shall include, in information accompanying the
17declaration, at least the statutory definitions of terms used in the declaration,
18statutory restrictions on who may be witnesses to a valid declaration, a statement
19explaining that valid witnesses acting in good faith are statutorily immune from civil
20or criminal liability, an instruction to potential declarants to read and understand
21the information before completing the declaration and a statement explaining that
22an instrument may, but need not be, filed with the register in probate of the
23declarant's county of residence. The department may charge a reasonable fee for the
24cost of preparation and distribution. The declaration distributed by the department
25of health services shall be easy to read, the type size may be no smaller than 10 point,

1and the declaration shall be in the following form, setting forth on the first page the
2wording before the ATTENTION statement and setting forth on the 2nd page the
3ATTENTION statement and remaining wording:
AB287,6,4 4Declaration to physicians health care professionals
AB287,6,55 (WISCONSIN LIVING WILL)
AB287,6,126 I,...., being of sound mind, voluntarily state my desire that my dying not be
7prolonged under the circumstances specified in this document. Under those
8circumstances, I direct that I be permitted to die naturally. If I am unable to give
9directions regarding the use of life-sustaining procedures or feeding tubes, I intend
10that my family and physician, physician assistant, or advanced practice registered
11nurse
honor this document as the final expression of my legal right to refuse medical
12or surgical treatment.
AB287,6,1813 1. If I have a TERMINAL CONDITION, as determined by 2 physicians a
14physician, physician assistant, or advanced practice registered nurse
who have has
15personally examined me, and if a physician who has also personally examined me
16agrees with that determination,
I do not want my dying to be artificially prolonged
17and I do not want life-sustaining procedures to be used. In addition, the following
18are my directions regarding the use of feeding tubes:
AB287,6,1919 .... YES, I want feeding tubes used if I have a terminal condition.
AB287,6,2020 .... NO, I do not want feeding tubes used if I have a terminal condition.
AB287,6,2121 If you have not checked either box, feeding tubes will be used.
AB287,7,222 2. If I am in a PERSISTENT VEGETATIVE STATE, as determined by 2
23physicians
a physician, physician assistant, or advanced practice registered nurse
24who have has personally examined me, and if a physician who has also personally

1examined me agrees with that determination,
the following are my directions
2regarding the use of life-sustaining procedures:
AB287,7,43 .... YES, I want life-sustaining procedures used if I am in a persistent
4vegetative state.
AB287,7,65 .... NO, I do not want life-sustaining procedures used if I am in a persistent
6vegetative state.
AB287,7,77 If you have not checked either box, life-sustaining procedures will be used.
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