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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
A bill to be entitled 1
An act relating to patient -directed medical orders; 2
amending s. 765.101, F.S.; revising and providing 3
definitions; amending s. 765.102, F.S.; revising 4
legislative findings and intent to include palliative 5
care for progressive illnesses; creating s. 765.3041, 6
F.S.; providing purpose and requirements for a 7
patient-directed medical order; authorizing the use of 8
telehealth for a specified purpose; requiring that 9
certain health care services be provided to the 10
principal regardless of the decision to withhold or 11
withdraw life-prolonging procedures; authorizing 12
physicians, physician assistants, and advanced 13
practice registered nurses to withhold or withdraw 14
life-prolonging procedures under certain circumstances 15
without penalty; providing construction; amending ss. 16
395.1041, 400.142, 400.487, 400.605, 400.6095, 17
400.611, 401.35, 401.45, 429.255, 429.73, 744.4431, 18
752.001, 765.110, 765.204, 765.205, and 765.305, F.S .; 19
conforming cross-references and provisions to changes 20
made by the act; requiring the Agency for Health Care 21
Administration to create and update a database for the 22
storage of patient-directed medical orders; providing 23
an effective date. 24
25
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Be It Enacted by the Legislature of the State of Florida: 26
27
Section 1. Subsections (15) through (22) of section 28
765.101, Florida Statutes, are renumbered as subsections (16) 29
through (23), respectively, subsections (1) and (7) are amended, 30
and a new subsection (15) is added to that section, to read: 31
765.101 Definitions. —As used in this chapter: 32
(1) "Advance directive" means a witnessed written document 33
or oral statement in which instructions are given by a principal 34
or in which the principal's desires are express ed concerning any 35
aspect of the principal's health care or health information, and 36
includes, but is not limited to, the designation of a health 37
care surrogate, a living will, or an anatomical gift made 38
pursuant to part V of this chapter. An advance directive may 39
also include a patient -directed medical order. 40
(7) "Health care facility" means a hospital, nursing home, 41
hospice, home health agency, or health maintenance organization 42
licensed in this state, a or any facility subject to part I of 43
chapter 394, or an assisted living facility or adult family -care 44
home licensed under chapter 429 . 45
(15) "Patient-directed medical order" means a medical 46
order created by the principal in collaboration with a 47
physician, a physician assistant, or an advanced practice 48
registered nurse registered under s. 464.0123 which is portable 49
across health care settings and accessible in a volunteer, 50
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online registry. 51
Section 2. Subsection (6) of section 765.102, Florida 52
Statutes, is amended to read: 53
765.102 Legislative findings and intent.— 54
(6) For purposes of this chapter: 55
(a) Palliative care is the comprehensive management of the 56
physical, psychological, social, spiritual, and existential 57
needs of patients. Palliative care is especially suited to the 58
care of persons who hav e incurable or, progressive illnesses. 59
(b) Palliative care may must include: 60
1. An opportunity to discuss and plan for end -of-life 61
care. 62
2. Assurance that physical and mental suffering will be 63
carefully attended to. 64
3. Assurance that preferences fo r withholding and 65
withdrawing life-sustaining interventions will be honored. 66
4. Assurance that the personal goals of the dying person 67
will be addressed. 68
5. Assurance that the dignity of the dying person will be 69
a priority. 70
6. Assurance that health care providers will not abandon 71
the dying person. 72
7. Assurance that the burden to family and others will be 73
addressed. 74
8. Assurance that advance directives for care , orders not 75
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to resuscitate executed pursuant to s. 401.45, and patient -76
directed medical orders executed pursuant to s. 765.3041 will be 77
respected regardless of the location of care. 78
9. Assurance that organizational mechanisms are in place 79
to evaluate the availability and quality of end -of-life, 80
palliative, and hospice care services, includ ing the evaluation 81
of administrative and regulatory barriers. 82
10. Assurance that necessary health care services will be 83
provided and that relevant reimbursement policies are available. 84
11. Assurance that the goals expressed in subparagraphs 85
1.-10. will be accomplished in a culturally appropriate manner. 86
Section 3. Section 765.3041, Florida Statutes, is created 87
to read: 88
765.3041 Patient-directed medical orders. — 89
(1) To facilitate a principal's instructions concerning 90
treatment preferences, a pati ent-directed medical order may be 91
executed in advance to direct the actions of health care 92
providers and health care facilities. 93
(2) A valid patient -directed medical order must: 94
(a) Be on a form adopted by rule of the Department of 95
Health and may be co mbined with an order not to resuscitate 96
executed pursuant to s. 401.45. The form must: 97
1. Address medical interventions to be withheld or 98
withdrawn when the application of life -prolonging procedures 99
would serve only to prolong artificially the process of dying. 100
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2. Be signed by the principal and the principal's 101
physician, physician assistant, or advanced practice registered 102
nurse registered under s. 464.0123. 103
a. If the principal is physically unable to sign the form, 104
the physician, physician assistant, or advanced practice 105
registered nurse present at the discussion as required by 106
subparagraph (b)2. may subscribe the principal's signature in 107
the principal's presence and at the principal's direction. If 108
telehealth is used, the physician, physician assista nt, or 109
advanced practice registered nurse may be present at either 110
location where telehealth is being administered. 111
b. If the principal is incapacitated, the form may be 112
signed by the principal's health care surrogate or proxy, court -113
appointed guardian a s provided in chapter 744, or attorney in 114
fact under a durable power of attorney as provided in chapter 115
709. The court-appointed guardian or attorney in fact must be 116
delegated authority to make health care decisions on behalf of 117
the principal. 118
c. All signatures may be electronic signatures. 119
(b) Clearly express the principal's preferences and 120
instructions for care, which may include all treatments 121
available, modified treatments that are not prolonged or 122
burdensome, or comfort measures that do not pursue or continue 123
interventions. 124
1. The principal and a physician, a physician assistant, 125
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or an advanced practice registered nurse registered under s. 126
464.0123 must discuss the principal's medical treatment wishes 127
relating to medical interventions to be withhe ld or withdrawn 128
based on the principal's values and preferences in the event the 129
principal becomes unable to make her or his own decisions. 130
2. The discussion must be in person and may be conducted 131
using telehealth. 132
(3) Regardless of the decision to wit hhold or withdraw 133
life-prolonging procedures, necessary health care services must 134
be provided for the care and comfort of the principal or to 135
alleviate pain. 136
(4) A physician, a physician assistant, or an advanced 137
practice registered nurse registered unde r s. 464.0123 may 138
withhold or withdraw cardiopulmonary resuscitation or other 139
life-prolonging procedures if presented with an order not to 140
resuscitate executed pursuant to s. 401.45 or a patient -directed 141
medical order executed pursuant to this section whic h contains 142
an order not to resuscitate or an order to withhold or withdraw 143
life-prolonging procedures. A physician, a physician assistant, 144
or an advanced practice registered nurse registered under s. 145
464.0123 is not subject to any disciplinary action under s. 146
456.072 or criminal prosecution or civil liability, or 147
considered to have engaged in negligent or unprofessional 148
conduct, for withholding or withdrawing cardiopulmonary 149
resuscitation or other life -prolonging procedures pursuant to 150
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such orders. The abse nce of an order not to resuscitate executed 151
pursuant to s. 401.45 or a patient -directed medical order 152
executed pursuant to this section does not preclude a physician, 153
a physician assistant, or an advanced practice registered nurse 154
registered under s. 464.0 123 from withholding or withdrawing 155
cardiopulmonary resuscitation or other life -prolonging 156
procedures as otherwise authorized by law. 157
Section 4. Paragraph (l) of subsection (3) of section 158
395.1041, Florida Statutes, is amended to read: 159
395.1041 Access to and ensurance of emergency services; 160
transfers; patient rights; diversion programs; reports of 161
controlled substance overdoses. — 162
(3) EMERGENCY SERVICES; DISCRIMINATION; LIABILITY OF 163
FACILITY OR HEALTH CARE PERSONNEL. — 164
(l) Hospital personnel may wit hhold or withdraw 165
cardiopulmonary resuscitation or other life-prolonging 166
procedures if presented with an order not to resuscitate 167
executed pursuant to s. 401.45 or a patient-directed medical 168
order executed pursuant to s. 765.3041 which contains an order 169
not to resuscitate or an order to withhold or withdraw life -170
prolonging procedures . Facility staff and facilities are shall 171
not be subject to criminal prosecution or civil liability, or 172
nor be considered to have engaged in negligent or unprofessional 173
conduct, for withholding or withdrawing cardiopulmonary 174
resuscitation or other life-prolonging procedures pursuant to 175
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such orders an order. The absence of an order not to resuscitate 176
executed pursuant to s. 401.45 or a patient-directed medical 177
order executed pursuant to s. 765.3041 does not preclude a 178
physician from withholding or withdrawing cardiopulmonary 179
resuscitation or other life-prolonging procedures as otherwise 180
authorized permitted by law. 181
Section 5. Subsection (3) of section 400.142, Florida 182
Statutes, is amended to read: 183
400.142 Emergency medication kits; orders not to 184
resuscitate and patient-directed medical orders .— 185
(3) Facility staff may withhold or withdraw 186
cardiopulmonary resuscitation or other life-prolonging 187
procedures if presented with an order not to resuscitate 188
executed pursuant to s. 401.45 or a patient-directed medical 189
order executed pursuant to s. 765.3041 which contains an order 190
not to resuscitate or an order to withhold or withdraw life -191
prolonging procedures . Facility staff and facilities are not 192
subject to criminal prosecution or civil liability, or 193
considered to have engaged in negligent or unprofession al 194
conduct, for withholding or withdrawing cardiopulmonary 195
resuscitation or other life-prolonging procedures pursuant to 196
such orders order. The absence of an order not to resuscitate 197
executed pursuant to s. 401.45 or a patient-directed medical 198
order executed pursuant to s. 765.3041 does not preclude a 199
physician from withholding or withdrawing cardiopulmonary 200
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resuscitation or other life-prolonging procedures as otherwise 201
authorized permitted by law. 202
Section 6. Subsection (7) of section 400.487, Florida 203
Statutes, is amended to read: 204
400.487 Home health service agreements; physician's, 205
physician assistant's, and advanced practice registered nurse's 206
treatment orders; patient assessment; establishment and review 207
of plan of care; provision of services; order s not to 208
resuscitate and patient-directed medical orders .— 209
(7) Home health agency personnel may withhold or withdraw 210
cardiopulmonary resuscitation or other life-prolonging 211
procedures if presented with an order not to resuscitate 212
executed pursuant to s. 4 01.45 or a patient-directed medical 213
order executed pursuant to s. 765.3041 which contains an order 214
not to resuscitate or an order to withhold or withdraw life -215
prolonging procedures . The agency shall adopt rules providing 216
for the implementation of such orde rs. Home health personnel and 217
agencies are shall not be subject to criminal prosecution or 218
civil liability, or nor be considered to have engaged in 219
negligent or unprofessional conduct, for withholding or 220
withdrawing cardiopulmonary resuscitation or other life-221
prolonging procedures pursuant to such orders an order and rules 222
adopted by the agency. The absence of an order not to 223
resuscitate executed pursuant to s. 401.45 or a patient -directed 224
medical order executed pursuant to s. 765.3041 does not preclude 225
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a physician from withholding or withdrawing cardiopulmonary 226
resuscitation or other life -prolonging procedures as otherwise 227
authorized by law. 228
Section 7. Paragraph (e) of subsection (1) of section 229
400.605, Florida Statutes, is amended to read: 230
400.605 Administration; forms; fees; rules; inspections; 231
fines.— 232
(1) The agency shall by rule establish minimum standards 233
and procedures for a hospice pursuant to this part. The rules 234
must include: 235
(e) Procedures relating to the implementation of advance 236
advanced directives, patient-directed medical orders executed 237
pursuant to s. 765.3041, and do-not-resuscitate orders not to 238
resuscitate executed pursuant to s. 401.45 . 239
Section 8. Subsection (8) of section 400.6095, Florida 240
Statutes, is amended to read: 241
400.6095 Patient admission; assessment; plan of care; 242
discharge; death.— 243
(8) The hospice care team may withhold or withdraw 244
cardiopulmonary resuscitation or other life-prolonging 245
procedures if presented with an order not to resuscitate 246
executed pursuant to s. 401.45 or a patient-directed medical 247
order executed pursuant to s. 765.3041 which contains an order 248
not to resuscitate or an order to withhold or withdraw life -249
prolonging procedures . The agency shall adopt rules providing 250
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for the implementation of s uch orders. Hospice staff are shall 251
not be subject to criminal prosecution or civil liability, or 252
nor be considered to have engaged in negligent or unprofessional 253
conduct, for withholding or withdrawing cardiopulmonary 254
resuscitation or other life-prolonging procedures pursuant to 255
such orders an order and applicable rules. The absence of an 256
order not to resuscitate executed pursuant to s. 401.45 or a 257
patient-directed medical order executed pursuant to s. 765.3041 258
does not preclude a physician from withholdin g or withdrawing 259
cardiopulmonary resuscitation or other life-prolonging 260
procedures as otherwise authorized permitted by law. 261
Section 9. Paragraph (b) of subsection (4) of section 262
400.611, Florida Statutes, is amended to read: 263
400.611 Interdisciplinar y records of care; 264
confidentiality; release of records. — 265
(4) A hospice may not release a patient's 266
interdisciplinary record or any portion thereof, unless the 267
person requesting the information provides to the hospice: 268
(b) In the case of an incapacitate d patient, a patient 269
authorization executed before prior to the patient's death by 270
the patient's then acting legal guardian, health care surrogate 271
as defined in s. 765.101 s. 765.101(21), health care proxy as 272
defined in s. 765.101 s. 765.101(19), or agent under power of 273
attorney; 274
Section 10. Subsection (4) of section 401.35, Florida 275
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Statutes, is amended to read: 276
401.35 Rules.—The department shall adopt rules, including 277
definitions of terms, necessary to carry out the purposes of 278
this part. 279
(4) The rules must establish circumstances and procedures 280
under which emergency medical technicians and paramedics may 281
honor orders not to resuscitate executed pursuant to s. 401.45 282
or patient-directed medical orders executed pursuant to s. 283
765.3041 which contains an order not to resuscitate or an order 284
to withhold or withdraw life -prolonging procedures by the 285
patient's physician, physician assistant, or advanced practice 286
registered nurse registered under s. 464.0123 not to resuscitate 287
and the documentation and repo rting requirements for handling 288
such orders requests. 289
Section 11. Paragraphs (a) and (b) of subsection (3) of 290
section 401.45, Florida Statutes, are amended to read: 291
401.45 Denial of emergency treatment; civil liability. — 292
(3)(a) Resuscitation may be withheld or withdrawn from a 293
patient by An emergency medical technician or paramedic may 294
withhold or withdraw cardiopulmonary resuscitation or other 295
life-prolonging procedures if presented with evidence of an 296
order not to resuscitate executed pursuant to this subsection or 297
a patient-directed medical order executed pursuant to s. 298
765.3041 which contains an order not to resuscitate or an order 299
to withhold or withdraw life -prolonging procedures by the 300
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patient's physician or physician assistant is presented to the 301
emergency medical technician or paramedic . An order not to 302
resuscitate executed pursuant to this subsection or a patient -303
directed medical order executed pursuant to s. 765.3041 which 304
contains an order not to resuscitate or an order to withhold or 305
withdraw life-prolonging procedures , to be valid, must be on the 306
form adopted by rule of the department. The form must be signed 307
by the patient's physician , or physician assistant, or advanced 308
practice registered nurse registered under s. 464.0123 and by 309
the patient or, if the patient is incapacitated, the patient's 310
health care surrogate or proxy as provided in chapter 765, 311
court-appointed guardian as provided in chapter 744, or attorney 312
in fact under a durable power of attorney as provided in chap ter 313
709. The court-appointed guardian or attorney in fact must have 314
been delegated authority to make health care decisions on behalf 315
of the patient. 316
(b) Any licensee, physician, medical director, or 317
emergency medical technician or paramedic who acts unde r the 318
direction of a medical director is not subject to criminal 319
prosecution or civil liability, and has not engaged in negligent 320
or unprofessional conduct, as a result of the withholding or 321
withdrawal of cardiopulmonary resuscitation or other life-322
prolonging procedures from a patient pursuant to this subsection 323
and rules adopted by the department. 324
Section 12. Subsection (4) of section 429.255, Florida 325
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Statutes, is amended to read: 326
429.255 Use of personnel; emergency care. — 327
(4) Facility staff may wi thhold or withdraw 328
cardiopulmonary resuscitation , or the use of an automated 329
external defibrillator , or other life-prolonging procedures if 330
presented with an order not to resuscitate executed pursuant to 331
s. 401.45 or a patient-directed medical order execut ed pursuant 332
to s. 765.3041 which contains an order not to resuscitate or an 333
order to withhold or withdraw life -prolonging procedures . The 334
agency shall adopt rules providing for the implementation of 335
such orders. Facility staff and facilities are may not be 336
subject to criminal prosecution or civil liability, or nor be 337
considered to have engaged in negligent or unprofessional 338
conduct, for withholding or withdrawing cardiopulmonary 339
resuscitation, the or use of an automated external 340
defibrillator, or other life-prolonging procedures pursuant to 341
such orders an order and rules adopted by the agency. The 342
absence of an order not to resuscitate executed pursuant to s. 343
401.45 or a patient-directed medical order executed pursuant to 344
s. 765.3041 does not preclude a phys ician from withholding or 345
withdrawing cardiopulmonary resuscitation , the or use of an 346
automated external defibrillator , or other life-prolonging 347
procedures as otherwise authorized permitted by law. 348
Section 13. Subsection (3) of section 429.73, Florida 349
Statutes, is amended to read: 350
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429.73 Rules and standards relating to adult family -care 351
homes.— 352
(3) The agency shall adopt rules providing for the 353
implementation of orders not to resuscitate and patient-directed 354
medical orders. The provider may withhold or withdraw 355
cardiopulmonary resuscitation or other life-prolonging 356
procedures if presented with an order not to resuscitate 357
executed pursuant to s. 401.45 or a patient-directed medical 358
order executed pursuant to s. 765.3041 which contains an order 359
not to resuscitate or an order to withhold or withdraw life -360
prolonging procedures . The provider is shall not be subject to 361
criminal prosecution or civil liability, or nor be considered to 362
have engaged in negligent or unprofessional conduct, for 363
withholding or withdrawing cardiopulmonary resuscitation or 364
other life-prolonging procedures pursuant to such orders an 365
order and applicable rules. The absence of an order not to 366
resuscitate executed pursuant to s. 401.45 or a patient -directed 367
medical order executed pursuan t to s. 765.3041 does not preclude 368
a physician from withholding or withdrawing cardiopulmonary 369
resuscitation or other life -prolonging procedures as otherwise 370
authorized by law. 371
Section 14. Subsections (1), (7), and (8) of section 372
744.4431, Florida Statutes, are amended to read: 373
744.4431 Guardianship power regarding life -prolonging 374
procedures.— 375
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(1) Except as provided in this section, decisions by a 376
professional guardian, as defined in s. 744.102, to withhold or 377
withdraw life-prolonging procedures from, or to execute an order 378
not to resuscitate pursuant to s. 401.45 or a patient -directed 379
medical order pursuant to s. 765.3041 which contains an order 380
not to resuscitate or an order to withhold or withdraw life -381
prolonging procedures for, a ward must be approved by the court. 382
A professional guardian appointed to act on behalf of a ward's 383
person must petition the court pursuant to the Florida Probate 384
Rules for authority to consent to withhold or withdraw life -385
prolonging procedures or to execute an order n ot to resuscitate 386
pursuant to s. 401.45 or a patient -directed medical order 387
pursuant to s. 765.3041. Court approval must be obtained before 388
taking such action, except as provided in subsection (7). 389
(7) Court approval is not required for the following 390
decisions: 391
(a) A decision to withhold or withdraw life -prolonging 392
procedures made by a professional guardian to whom authority has 393
been granted by the court under s. 744.3115 to carry out the 394
instructions in or to take actions consistent with the ward's 395
advance directive, order not to resuscitate executed pursuant to 396
s. 401.45, or patient -directed medical order executed pursuant 397
to s. 765.3041 which contains an order not to resuscitate or an 398
order to withhold or withdraw life -prolonging procedures , as 399
long as there are no known objections from the ward; the ward's 400
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attorney; the ward's next of kin, if known; and any other 401
interested persons as the court may direct based on s. 402
765.105(1). 403
(b) A decision by a professional guardian who has been 404
delegated health care decisionmaking authority to execute an 405
order not to resuscitate pursuant to s. 401.45 or a patient -406
directed medical order pursuant to s. 765.3041 , as described in 407
s. 401.45(3)(a), if the ward is in a hospital and the following 408
conditions are met: 409
1. The ward's primary treating physician and at least one 410
other consulting physician document in the ward's medical record 411
that: 412
a. There is no reasonable medical probability for recovery 413
from or a cure of the ward's underlying medical condition; 414
b. The ward is in an end-stage condition, a terminal 415
condition, or a persistent vegetative state as those terms are 416
defined in s. 765.101, and that the ward's death is imminent; 417
and 418
c. Resuscitation will cause the ward physical harm or 419
additional pain. 420
2. The professional guardian has notified the ward's next 421
of kin, if known, and any interested persons as the court may 422
direct and the decision is not contrary to the ward's expressed 423
wishes and there are no known objections from the ward; the 424
ward's attorney; the ward's next of kin, if known; or any other 425
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interested persons as the court may direct on the basis of s. 426
765.105(1). 427
(8) Within 2 business days after executing an order not to 428
resuscitate pursuant to s. 401.45 or a patient -directed medical 429
order pursuant to s. 765.3041 which contains an order not to 430
resuscitate or an order to withhold or withdraw life -prolonging 431
procedures under paragraph (7)(b) , a professional guardian must 432
notify the court in writing of all of the following: 433
(a) The date the order not to resuscitate or patient-434
directed medical order was executed. 435
(b) The location of the ward when the order not to 436
resuscitate or patient-directed medical order was executed. 437
(c) The names of the physicians who documented the ward's 438
condition in the ward's medical record. 439
Section 15. Subsection (3) of section 752.001, Florida 440
Statutes, is amended to read: 441
752.001 Definitions. —As used in this chapter, the term: 442
(3) "Persistent vegetative state" has the same meaning as 443
provided in s. 765.101 s. 765.101(15). 444
Section 16. Subsections (1) and (4) of section 765.110, 445
Florida Statutes, are amended to read: 446
765.110 Health care facilities and providers; discipline. — 447
(1) A health care facility must, pursuant to Pub. L. No. 448
101-508, ss. 4206 and 4751, shall provide to each patient 449
written information concerning the individual's rights 450
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concerning advance directives , orders not to resuscitate 451
executed pursuant to s. 401.45, or patient -directed medical 452
orders executed pursuant to s. 765.3041 which co ntains an order 453
not to resuscitate or an order to withhold or withdraw life -454
prolonging procedures and the health care facility's policies 455
respecting the implementation of such rights, and shall document 456
in the patient's medical records whether or not the individual 457
has executed an advance directive , an order not to resuscitate 458
pursuant to s. 401.45, or a patient -directed medical order 459
pursuant to s. 765.3041 which contains an order not to 460
resuscitate or an order to withhold or withdraw life -prolonging 461
procedures. 462
(4) The Department of Health, in consultation with the 463
Department of Elderly Affairs, for health care providers; the 464
Agency for Health Care Administration for hospitals, hospices, 465
nursing homes, home health agencies, assisted living facilities, 466
adult family-care homes, and health maintenance organizations; 467
and the Department of Children and Families for facilities 468
subject to part I of chapter 394 shall adopt rules to implement 469
this section. 470
Section 17. Subsection (3) of section 765.204, Florida 471
Statutes, is amended to read: 472
765.204 Capacity of principal; procedure. — 473
(3) The surrogate's authority commences either upon a 474
determination under subsection (2) that the principal lacks 475
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capacity or upon a stipulation of such authority pursuant to s. 476
765.101 s. 765.101(21). Such authority remains in effect until a 477
determination that the principal has regained such capacity, if 478
the authority commenced as a result of incapacity, or until the 479
authority is revoked, if the authority commenced immediately 480
pursuant to s. 765.101 s. 765.101(21). Upon commencement of the 481
surrogate's authority, a surrogate who is not the principal's 482
spouse shall notify the principal's spouse or adult children of 483
the principal's designation of the surrogate. Except if the 484
principal provided immediately exercisable authority to the 485
surrogate pursuant to s. 765.101 s. 765.101(21), in the event 486
that the primary or attending physician determines that the 487
principal has regained capacity, the authority of the surrogate 488
shall cease, but recommences if the principal subsequently loses 489
capacity as determined pursuant to this section. A health care 490
provider is not liable for relying upon health care decisions 491
made by a surrogate while the principal lacks capacity. At any 492
time when a principal lacks capacity, a health care decision 493
made on the principal's behalf by a surrogate is effective to 494
the same extent as a decision made by the principal. If a 495
principal possesses capacity, health care decisions of the 496
principal take precedence over decisi ons made by the surrogate 497
that present a material conflict. 498
Section 18. Paragraph (c) of subsection (1) of section 499
765.205, Florida Statutes, is amended to read: 500
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765.205 Responsibility of the surrogate. — 501
(1) The surrogate, in accordance with the pr incipal's 502
instructions, unless such authority has been expressly limited 503
by the principal, shall: 504
(c) Provide written consent using an appropriate form 505
whenever consent is required, including the execution of an a 506
physician's order not to resuscitate pursuant to s. 401.45 or a 507
patient-directed medical order pursuant to s. s. 765.3041 which 508
contains an order not to resuscitate or an order to withhold or 509
withdraw life-prolonging procedures . 510
Section 19. Subsection (2) of section 765.305, Florida 511
Statutes, is amended to read: 512
765.305 Procedure in absence of a living will. — 513
(2) Before exercising the incompetent patient's right to 514
forego treatment, including the execution of an order not to 515
resuscitate pursuant to s. 401.45 or a patient -directed medical 516
order pursuant to s. 765.3041 which contains an order not to 517
resuscitate or an order to withhold or withdraw life -prolonging 518
procedures, the surrogate must be satisfied that: 519
(a) The patient does not have a reasonable medical 520
probability of recov ering capacity so that the right could be 521
exercised by the patient. 522
(b) The patient has an end -stage condition, the patient is 523
in a persistent vegetative state, or the patient's physical 524
condition is terminal. 525
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Section 20. The Agency for Health Care A dministration 526
shall create and update a database for the storage of patient -527
directed medical orders, which shall be stored solely at the 528
option of the patient in electronic form by the agency. 529
Section 21. This act shall take effect July 1, 2025. 530