SB336: Bill Text

SB336,2,14 1. If I have a TERMINAL CONDITION, as determined by 2 physicians who have personally examined me, I do not want my dying to be artificially prolonged and I do not want life-sustaining procedures to be used. In addition, the following are my directions regarding the use of feeding tubes:

SB336,2,15 .... YES, I want feeding tubes used if I have a terminal condition.

SB336,2,16 .... NO, I do not want feeding tubes used if I have a terminal condition.

SB336,2,17 If you have not checked either box, feeding tubes will be used.

SB336,3,3 2. If I am in a PERSISTENT VEGETATIVE STATE, as determined by 2 physicians who have personally examined me, the following are my directions regarding the use of life-sustaining procedures:

SB336,3,5 .... YES, I want life-sustaining procedures used if I am in a persistent vegetative state.

SB336,3,7 .... NO, I do not want life-sustaining procedures used if I am in a persistent vegetative state.

SB336,3,8 If you have not checked either box, life-sustaining procedures will be used.

SB336,3,11 3. If I am in a PERSISTENT VEGETATIVE STATE, as determined by 2 physicians who have personally examined me, the following are my directions regarding the use of feeding tubes:

SB336,3,12 .... YES, I want feeding tubes used if I am in a persistent vegetative state.

SB336,3,13 .... NO, I do not want feeding tubes used if I am in a persistent vegetative state.

SB336,3,14 If you have not checked either box, feeding tubes will be used.

SB336,3,17 If you are interested in more information about the significant terms used in this document, see section 154.01 of the Wisconsin Statutes or the information accompanying this document.

SB336,3,19 ATTENTION: You and the 2 witnesses must sign the document at the same time.

SB336,3,20 Signed .... Date ....

SB336,3,21 Address .... Date of birth ....

SB336,3,25 I believe that the person signing this document is of sound mind. I am an adult and am not related to the person signing this document by blood, marriage or adoption. I am not entitled to and do not have a claim on any portion of the person's estate and am not otherwise restricted by law from being a witness.

SB336,4,1 Witness signature .... Date signed ....

SB336,4,2 Print name ....

SB336,4,3 Witness signature ... Date signed ....

SB336,4,4 Print name ....

SB336,4,5 DIRECTIVES TO ATTENDING PHYSICIAN

SB336,4,9 1. This document authorizes the withholding or withdrawal of life-sustaining procedures or of feeding tubes when 2 physicians, one of whom is the attending physician, have personally examined and certified in writing that the patient has a terminal condition or is in a persistent vegetative state.

SB336,4,15 2. The choices in this document were made by a competent adult. Under the law, the patient's stated desires must be followed unless you believe that withholding or withdrawing life-sustaining procedures or feeding tubes would cause the patient pain or reduced comfort and that the pain or discomfort cannot be alleviated through pain relief measures. If the patient's stated desires are that life-sustaining procedures or feeding tubes be used, this directive must be followed.

SB336,4,18 3. If you feel that you cannot comply with this document, you must make a good faith attempt to transfer the patient to another physician who will comply. Refusal or failure to make a good faith attempt to do so constitutes unprofessional conduct.

SB336,4,20 4. If you know that the patient is pregnant, this document has no effect during her pregnancy.

SB336,5,1 * * * * *

SB336,5,4 The person making this living will may use the following space to record the names of those individuals and health care providers to whom he or she has given copies of this document:

SB336,5,5 .................................................................

SB336,5,6 .................................................................

SB336,5,7 .................................................................

SB336,5,8 * * * * *

SB336,5,9 ANATOMICAL GIFTS (optional)

SB336,5,10 At my death, the following are my directions regarding donation of my organs:

SB336,5,11 .... YES, I want to donate all of my body as an anatomical gift.

SB336,5,12 OR

SB336,5,14 .... YES, I want to donate the following specific parts or organs of my body as an anatomical gift: ....

SB336,5,16 If I have signified "YES" to either of the options above, in addition, I may, but do not have to, indicate any or all of the following:

SB336,5,17 a. I want to donate all or part of my body to: .... (name of the donee)

SB336,5,18 b. I want to donate all or part of my body for this purpose: ....

SB336,5,19 c. I want Dr. .... (name of physician) to carry out the appropriate procedures.

SB336,5,20 OR

SB336,5,24 .... NO, I do not want to donate all or any part of my body as an anatomical gift. (If this revokes a prior commitment that I have made to make an anatomical gift to a designated donee, I will attempt to notify the donee to which or to whom I agreed to donate.)

SB336,6,2 If I do not check any of the lines immediately above, no presumption is created about my desire to make or refuse to make an anatomical gift.

SB336,6,3 Signed .... Date ....

SB336, s. 2 Section 2. 154.06 of the statutes is created to read:

SB336,6,8 154.06 Organ donation; amendment; revocation; refusal. (1) A declarant may make an anatomical gift of all or part of his or her body by indicating his or her intent in the space provided on the declaration. A declaration that so indicates the declarant's intent serves as a document of gift under s. 157.06 (2) (b).

SB336,6,12 (2) A declarant who has made an anatomical gift as specified in sub. (1) may amend his or her gift by adding to or changing the donor authorization in the space provided on the declaration or by performing any of the procedures specified in s. 157.06 (2) (f) 1. to 4.

SB336,6,16 (3) A declarant who has made an anatomical gift as specified in sub. (1) may revoke his or her gift by crossing out the donor authorization in the space provided on the declaration or by performing any of the procedures specified in s. 157.06 (2) (f) 1. to 4.

SB336,6,20 (4) A declarant may refuse to make an anatomical gift of all or part of his or her body by indicating his or her intent in the space provided on the declaration. A declaration that so indicates the declarant's intent serves as a document of refusal to make an anatomical gift under s. 157.06 (2) (i).

SB336,6,24 (5) Nothing in this section requires a declarant to make, amend, or refuse to make an anatomical gift by means of a declaration or otherwise limits a declarant from making, amending, or refusing to make an anatomical gift under alternative procedures specified in s. 157.06.

SB336, s. 3 Section 3. 157.06 (2) (f) 7. of the statutes is created to read:

SB336,7,4 157.06 (2) (f) 7. For a declarant who executes a living will, crossing out or amending the donor authorization or refusal in the space provided on the declaration as prescribed in s. 154.06 (2) and (4) or revoking the declaration as prescribed in s.154.06 (3).

SB336, s. 4 Section 4. 157.06 (2) (i) 2m. of the statutes is created to read:

SB336,7,8 157.06 (2) (i) 2m. For a declarant who executes a living will, making a statement of refusal in the space provided in the declaration as prescribed in s. 154.06 (4).

SB336,7,9 (End)