                                 CODE OF VIRGINIA

MEDICALLY UNNECESSARY HEALTH CARE NOT REQUIRED; PROCEDURE WHEN PHYSICIAN REFUSES
TO COMPLY WITH AN ADVANCE DIRECTIVE OR A DESIGNATED PERSON&#8217;S HEALTH CARE
DECISION; MERCY KILLING OR EUTHANASIA PROHIBITED (§ 54.1-2990)

A. As used in this section:
			&#8220;Health care provider&#8221; has the same meaning as in &#xA7;
8.01-581.1.			&#8220;Life-sustaining treatment&#8221; means any ongoing health
care that utilizes mechanical or other artificial means to sustain, restore, or
supplant a spontaneous vital function, including hydration, nutrition,
maintenance medication, and cardiopulmonary resuscitation.

B. Nothing in this article shall be construed to require a physician to
prescribe or render health care to a patient that the physician determines to be
medically or ethically inappropriate. A determination of the medical or ethical
inappropriateness of proposed health care shall be based solely on the
patient&#8217;s medical condition and not on the patient&#8217;s age or other
demographic status, disability, or diagnosis of persistent vegetative state.
			In cases in which a physician&#8217;s determination that proposed health
care, including life-sustaining treatment, is medically or ethically
inappropriate is contrary to the request of the patient, the terms of a
patient&#8217;s advance directive, the decision of an agent or person authorized
to make decisions pursuant to &#xA7; 54.1-2986, or a Durable Do Not Resuscitate
Order, the physician or his designee shall document the physician&#8217;s
determination in the patient&#8217;s medical record, make a reasonable effort to
inform the patient or the patient&#8217;s agent or person with decision-making
authority pursuant to &#xA7; 54.1-2986 of such determination and the reasons
therefor in writing, and provide a copy of the hospital&#8217;s written policies
regarding review of decisions regarding the medical or ethical appropriateness
of proposed health care established pursuant to subdivision B 21 of &#xA7;
32.1-127.			If the conflict remains unresolved, the physician shall make a
reasonable effort to transfer the patient to another physician or facility that
is willing to comply with the request of the patient, the terms of the advance
directive, the decision of an agent or person authorized to make decisions
pursuant to &#xA7; 54.1-2986, or a Durable Do Not Resuscitate Order and shall
cooperate in transferring the patient to the physician or facility identified.
The physician shall provide the patient or his agent or person with
decision-making authority pursuant to &#xA7; 54.1-2986 a reasonable time of not
less than 14 days after the date on which the decision regarding the medical or
ethical inappropriateness of the proposed treatment is documented in the
patient&#8217;s medical record in accordance with the hospital&#8217;s written
policy developed pursuant to subdivision B 21 of &#xA7; 32.1-127 to effect such
transfer. During this period, (i) the physician shall continue to provide any
life-sustaining treatment to the patient that is reasonably available to such
physician, as requested by the patient or his agent or person with
decision-making authority pursuant to &#xA7; 54.1-2986, and (ii) the hospital in
which the patient is receiving life-sustaining treatment shall facilitate prompt
access to the patient&#8217;s medical record pursuant to &#xA7;
32.1-127.1:03.			If, at the end of the 14-day period, the conflict remains
unresolved despite compliance with the hospital&#8217;s written policy
established pursuant to subdivision B 21 of &#xA7; 32.1-127 and the physician
has been unable to identify another physician or facility willing to provide the
care requested by the patient, the terms of the advance directive, or the
decision of the agent or person authorized to make decisions pursuant to &#xA7;
54.1-2986 to which to transfer the patient despite reasonable efforts, the
physician may cease to provide the treatment that the physician has determined
to be medically or ethically inappropriate subject to the right of court review
by any party. However, artificial nutrition and hydration may be withdrawn or
withheld only if, on the basis of physician&#8217;s reasonable medical judgment,
providing such artificial nutrition and hydration would (a) hasten the
patient&#8217;s death, (b) be medically ineffective in prolonging life, or (c)
be contrary to the clearly documented wishes of the patient, the terms of the
patient&#8217;s advance directive, or the decision of an agent or person
authorized to make decisions pursuant to &#xA7; 54.1-2986 regarding the
withholding of artificial nutrition or hydration. In all cases, care directed
toward the patient&#8217;s pain and comfort shall be provided.

C. Nothing in this section shall require the provision of health care that the
physician is physically or legally unable to provide or health care that the
physician is physically or legally unable to provide without thereby denying the
same health care to another patient.

D. Nothing in this article shall be construed to condone, authorize, or approve
mercy killing or euthanasia or to permit any affirmative or deliberate act or
omission to end life other than to permit the natural process of dying.

E. Compliance with the requirements of this section shall not be admissible to
prove a violation of or compliance with the standard of care as set forth in
&#xA7; 8.01-581.20.

HISTORY: 1983, c. 532, § 54-325.8:10; 1988, c. 765; 1992, cc. 748, 772; 1999,
c. 814; 2000, cc. 590, 598; 2009, cc. 211, 268; 2018, cc. 368, 565.