GENERAL ASSEMBLY OF NORTH CAROLINA

SESSION 1993

S	2 

SENATE BILL 525
Judiciary II Committee Substitute Adopted 4/27/93

Short Title:  Revise Natural Death Act.	(Public)
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Sponsors:
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Referred to:  
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March 23, 1993

A BILL TO BE ENTITLED
AN ACT TO MAKE REVISIONS TO THE RIGHT TO A NATURAL DEATH ACT.
The General Assembly of North Carolina enacts:
Section 1. G.S. 90-321(a) reads as rewritten:
"(a)	As used in this Article the term:
(1)	'Declarant' means a person who has signed a declaration in accordance with subsection (c);
(2)	'Extraordinary means' is defined as any medical procedure or intervention which in the judgment of the attending physician would serve only to postpone artificially the moment of death by sustaining, restoring, or supplanting a vital function;
(2a)	'Health care' means any care, treatment, service, or procedure to maintain, diagnose, treat, or provide for a person's physical or mental health, including extraordinary means and artificial nutrition or hydration;
(3)	'Physician' means any person licensed to practice medicine under Article 1 of Chapter 90 of the laws of the State of North Carolina;
(4)	'Persistent vegetative state' is a medical condition whereby in the judgment of the attending physician the patient suffers from a sustained complete loss of self-aware cognition and, without the use of extraordinary means or artificial nutrition or hydration, will succumb to death within a short period of time."
Sec. 2.  G.S. 90-321(b) reads as rewritten:
"(b)	If a person has declared, in accordance with subsection (c) below, a desire that his life not be prolonged by extraordinary means or any other health care except health care that provides comfort or alleviates pain, and the declaration has not been revoked in accordance with subsection (e); and
(1)	It is determined by the attending physician that the declarant's present condition is
a.	Terminal; and
b.	Incurable; or
c.	Diagnosed as a persistent vegetative state; and
(2)	There is confirmation of the declarant's present condition as set out above in subdivision (b)(1) by a physician other than the attending physician;
then extraordinary means or artificial nutrition or hydration, as specified by the declarant, may be withheld or discontinued upon the direction and under the supervision of the attending physician."
Sec. 3.  G.S. 90-321(c) reads as rewritten:
"(c)	The attending physician may rely upon a signed, witnessed, dated and proved declaration:
(1)	Which expresses a desire of the declarant that extraordinary means or any other health care except health care that provides comfort or alleviates pain not be used to prolong his life if his condition is determined to be terminal and incurable, or if the declarant is diagnosed as being in a persistent vegetative state; and
(2)	Which states that the declarant is aware that the declaration authorizes a physician to withhold or discontinue the extraordinary means or any other health care except health care that provides comfort or alleviates pain; and
(3)	Which has been signed by the declarant in the presence of two witnesses who believe the declarant to be of sound mind and who state that they (i) are not related within the third degree to the declarant or to the declarant's spouse, (ii) do not know or have a reasonable expectation that they would be entitled to any portion of the estate of the declarant upon his death under any will of the declarant or codicil thereto then existing or under the Intestate Succession Act as it then provides, (iii) are not the attending physician, or an employee of the attending physician, or an employee of a health facility in which the declarant is a patient, or an employee of a nursing home or any group-care home in which the declarant resides, and (iv) do not have a claim against any portion of the estate of the declarant at the time of the declaration; and
(4)	Which has been proved before a clerk or assistant clerk of superior court, or a notary public who certifies substantially as set out in subsection (d) below."
Sec. 4.  G.S. 90-321(d) reads as rewritten:
"(d)	The following form is specifically determined to meet the requirements above:

'Declaration Of A Desire For A Natural Death'

'I, ..............., being of sound mind, hereby make this declaration of my desire that my life not be artificially prolonged in accordance with the lines I have initialed below: 

' 1.	If my condition is determined to be terminal
and incurable, I authorize the following:

......	My physician may withhold or discontinue extraordinary means.

......	My physician may withhold or discontinue any health care including, without limitation, extraordinary means and artificial nutrition or hydration except health care that provides comfort or alleviates pain.

' 2.	If my condition is diagnosed to be a persistent vegetative state, I authorize the following:

......	My physician may withhold or discontinue extraordinary means.

......	My physician may withhold or discontinue any health care including, without limitation, extraordinary means and artificial nutrition or hydration except health care that provides comfort or alleviates pain.

' I am aware that this declaration authorizes a physician to withhold or discontinue health care in accordance with the instructions provided above.
'This the ............day of..................................
Signature...............................

'I hereby state that the declarant,..............., being of sound mind, signed the foregoing declaration in my presence. I am not related to the declarant by blood or marriage and I do not know or have a reasonable expectation that I would be entitled to any portion of the estate of the declarant upon the declarant's death under any existing will or codicil or under the Intestate Succession Act. I am not the declarant's attending physician, an employee of the declarant's attending physician, or an employee of a health care facility, nursing home, or group care home in which the declarant is a patient or resident. I do not have any claim against the declarant.
Witness	.................................
	Witness	.................................

The clerk or the assistant clerk, or a notary public may, upon proper proof, certify the declaration as follows:

'Certificate'

'I, ..............., Clerk (Assistant Clerk) of Superior Court or Notary Public (circle one as appropriate) for ..................................................County hereby certify that...................., declarant, appeared before me and swore to me and to the witnesses in my presence that this declaration is declarant's Declaration Of A Desire For A Natural Death, and that declarant had willingly and voluntarily made and executed it as declarant's free act and deed for the purposes expressed in it.
'I further certify that ............... and ................, witnesses, appeared before me and swore that they witnessed ............., declarant, sign this declaration, believing declarant to be of sound mind; and also swore that at the time they witnessed its execution that (i)	they were not related within the third degree to the declarant or to the declarant's spouse, (ii) they did not know or have a reasonable expectation that they would be entitled to any portion of the declarant's estate upon the declarant's death under any existing will or codicil or under the Intestate Succession Act, (iii) they were not a physician attending the declarant, an employee of an attending physician, or an employee of a health care facility, nursing home, or group care home in which the declarant was a patient or resident, and (iv) they did not have a claim against the declarant. I further certify that I am satisfied as to the genuineness and due execution of this declaration.
'This the ............ day of ........................,  .....

' Notary Public for               County   OR       Clerk of Superior Court for
______________County.

My Commission Expires: ____________'.
"
The above declaration may be proved by the clerk or the assistant clerk, or a notary public in the following manner:
(1)	Upon the testimony of the two witnesses; or
(2)	If the testimony of only one witness is available, then
a.	Upon the testimony of such witness, and
b.	Upon proof of the handwriting of the witness who is dead or whose testimony is otherwise unavailable, and
c.	Upon proof of the handwriting of the declarant, unless he signed by his mark; or upon proof of such other circumstances as will satisfy the clerk or assistant clerk of the superior court, or a notary public as to the genuineness and due execution of the declaration.
(3)	If the testimony of none of the witnesses is available, such declaration may be proved by the clerk or assistant clerk, or a notary public
a.	Upon proof of the handwriting of the two witnesses whose testimony is unavailable, and
b.	Upon compliance with paragraph c of subdivision (2) above.
Due execution may be established, where the evidence required above is unavoidably lacking or inadequate, by testimony of other competent witnesses as to the requisite facts.
The testimony of a witness is unavailable within the meaning of this subsection when the witness is dead, out of the State, not to be found within the State, insane or otherwise incompetent, physically unable to testify or refuses to testify.
If the testimony of one or both of the witnesses is not available the clerk or the assistant clerk, or a notary public or superior court may, upon proper proof, certify the declaration as follows:

'Certificate'

'I .........., Clerk (Assistant Clerk) of Court for the Superior Court or Notary Public (circle one as appropriate) of.......... County hereby certify that based upon the evidence before me I am satisfied as to the genuineness and due execution of the attached declaration by .............., declarant, and that the declarant's signature was witnessed by............, and .............., who at the time of the declaration met the qualifications of G.S. 90-321(c)(3).
'This the ...... day of ............, ......

Clerk (Assistant Clerk) of Superior Court or Notary Public (circle one as appropriate) for ............... County.'"
Sec. 5.  G.S. 90-321(i) reads as rewritten:
"(i)	Any certificate in the form provided by this section prior to January 1, 1994, shall continue to be valid."
Sec. 6.  This act becomes effective October 1, 1993, and applies to declarations executed on or after that date.  This act does not affect the validity of any "Declaration Of A Desire For A Natural Death" executed prior to the effective date of this act.