A POLST order may be created by or on behalf of a person as described in this section.
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certified or licensed as an advance practice registered nurse under Subsection 58-31b-301(2)(e);
(b)
an independent practitioner;
(c)
acting under a consultation and referral plan with a physician; and
(d)
acting within the scope of practice for that individual, as provided by law, rule, and specialized certification and training in that individual's area of practice. See Utah Code 75-2a-103
Best interest: means that the benefits to the person resulting from a treatment outweigh the burdens to the person resulting from the treatment, taking into account:
(a)
the effect of the treatment on the physical, emotional, and cognitive functions of the person;
(b)
the degree of physical pain or discomfort caused to the person by the treatment or the withholding or withdrawal of treatment;
(c)
the degree to which the person's medical condition, the treatment, or the withholding or withdrawal of treatment, result in a severe and continuing impairment of the dignity of the person by subjecting the person to humiliation and dependency;
(d)
the effect of the treatment on the life expectancy of the person;
(e)
the prognosis of the person for recovery with and without the treatment;
(f)
the risks, side effects, and benefits of the treatment, or the withholding or withdrawal of treatment; and
(g)
the religious beliefs and basic values of the person receiving treatment, to the extent these may assist the decision maker in determining the best interest. See Utah Code 75-2a-103
Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
Guardian: A person legally empowered and charged with the duty of taking care of and managing the property of another person who because of age, intellect, or health, is incapable of managing his (her) own affairs.
Health care: means any care, treatment, service, or procedure to improve, maintain, diagnose, or otherwise affect an individual's physical or mental condition. See Utah Code 75-2a-103
Health care decision making capacity: means an adult's ability to make an informed decision about receiving or refusing health care, including:
(a)
the ability to understand the nature, extent, or probable consequences of health status and health care alternatives;
(b)
the ability to make a rational evaluation of the burdens, risks, benefits, and alternatives of accepting or rejecting health care; and
Health care provider: means the same as that term is defined in Section 78B-3-403, except that "health care provider" does not include an emergency medical services provider. See Utah Code 75-2a-103
Life sustaining care: means any medical intervention, including procedures, administration of medication, or use of a medical device, that maintains life by sustaining, restoring, or supplanting a vital function. See Utah Code 75-2a-103
POLST order: means an order, on a form designated by the Department of Health and Human Services under Section 75-2a-106, that gives direction to health care providers, health care facilities, and emergency medical services providers regarding the specific health care decisions of the individual to whom the order relates. See Utah Code 75-2a-103
Signature: includes a name, mark, or sign written with the intent to authenticate an instrument or writing. See Utah Code 68-3-12.5
Substituted judgment: means the standard to be applied by a surrogate when making a health care decision for an adult who previously had the capacity to make health care decisions, which requires the surrogate to consider:
(a)
specific preferences expressed by the adult:
(i)
when the adult had the capacity to make health care decisions; and
(ii)
at the time the decision is being made;
(b)
the surrogate's understanding of the adult's health care preferences;
(c)
the surrogate's understanding of what the adult would have wanted under the circumstances; and
(d)
to the extent that the preferences described in Subsections (22)(a) through (c) are unknown, the best interest of the adult. See Utah Code 75-2a-103
Surrogate: means a health care decision maker who is:
(a)
an appointed agent;
(b)
a default surrogate under the provisions of Section 75-2a-108; or
another health care provider, designated by rule as described in Subsection (10).
(3)
A POLST order shall be signed:
(a)
personally, by the physician, APRN, or, subject to Subsection (11), physician assistant of the person to whom the POLST order relates; and
(b)
(i)
if the person to whom the POLST order relates is an adult with health care decision making capacity, by:
(A)
the person; or
(B)
an adult who is directed by the person to sign the POLST order on behalf of the person;
(ii)
if the person to whom the POLST order relates is an adult who lacks health care decision making capacity, by:
(A)
the surrogate with the highest priority under Section 75-2a-111;
(B)
the majority of the class of surrogates with the highest priority under Section 75-2a-111; or
(C)
a person directed to sign the POLST order by, and on behalf of, the persons described in Subsection (3)(b)(ii)(A) or (B); or
(iii)
if the person to whom the POLST order relates is a minor, by a parent or guardian of the minor.
(4)
If a POLST order relates to a minor and directs that life sustaining treatment be withheld or withdrawn from the minor, the order shall include a certification by two physicians that, in their clinical judgment, an order to withhold or withdraw life sustaining treatment is in the best interest of the minor.
(5)
A POLST order:
(a)
shall be in writing, on a form designated by the Department of Health and Human Services;
(b)
shall state the date on which the POLST order was made;
(c)
may specify the level of life sustaining care to be provided to the person to whom the order relates; and
(d)
may direct that life sustaining care be withheld or withdrawn from the person to whom the order relates.
(6)
A health care provider or emergency medical service provider, licensed or certified under 1, is immune from civil or criminal liability, and is not subject to discipline for unprofessional conduct, for:
(a)
complying with a POLST order in good faith; or
(b)
providing life sustaining treatment to a person when a POLST order directs that the life sustaining treatment be withheld or withdrawn.
(7)
To the extent that the provisions of a POLST order described in this section conflict with the provisions of an advance health care directive made under Section 75-2a-107, the provisions of the POLST order take precedence.
(8)
An adult, or a parent or guardian of a minor, may revoke a POLST order by:
(a)
orally informing emergency service personnel;
(b)
writing “void” across the POLST order form;
(c)
burning, tearing, or otherwise destroying or defacing:
(i)
the POLST order form; or
(ii)
a bracelet or other evidence of the POLST order;
(d)
asking another adult to take the action described in this Subsection (8) on the person’s behalf;
(e)
signing or directing another adult to sign a written revocation on the person’s behalf;
(f)
stating, in the presence of an adult witness, that the person wishes to revoke the order; or
(g)
completing a new POLST order.
(9)
(a)
Except as provided in Subsection (9)(c), a surrogate for an adult who lacks health care decision making capacity may only revoke a POLST order if the revocation is consistent with the substituted judgment standard.
(b)
Except as provided in Subsection (9)(c), a surrogate who has authority under this section to sign a POLST order may revoke a POLST order, in accordance with Subsection (9)(a), by:
(i)
signing a written revocation of the POLST order; or
(ii)
completing and signing a new POLST order.
(c)
A surrogate may not revoke a POLST order during the period of time beginning when an emergency service provider is contacted for assistance, and ending when the emergency ends.
create the forms and systems described in this section; and
(ii)
develop uniform instructions for the form established in Section 75-2a-117.
(b)
The Department of Health and Human Services may make rules, in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, to designate health care professionals, in addition to those described in Subsection (2)(b)(ii), who may prepare a POLST order.
(c)
The Department of Health and Human Services may assist others with training of health care professionals regarding this chapter.
(11)
A physician assistant may not prepare or sign a POLST order, unless the physician assistant is permitted to prepare or sign the POLST order under the physician assistant’s delegation of services agreement, as defined in Section 58-70a-102.
(12)
(a)
Notwithstanding any other provision of this section:
a verbal confirmation satisfies the requirement for a signature from an individual under Subsection (3)(b)(ii) or (iii), if:
(A)
requiring the individual described in Subsection (3)(b)(i)(B), (ii), or (iii) to sign the POLST order in person or electronically would require significant difficulty or expense; and
(B)
a licensed health care provider witnesses the verbal confirmation and signs the POLST order attesting that the health care provider witnessed the verbal confirmation.
(b)
The health care provider described in Subsection (12)(a)(ii)(B):
(i)
may not be the same individual who signs the POLST order under Subsection (3)(a); and
(ii)
shall verify, in accordance with HIPAA as defined in Section 26B-3-126, the identity of the individual who is providing the verbal confirmation.
