<?xml version="1.0"?>
<law><site_title>Virginia Decoded</site_title><site_url>https://vacode.org</site_url><law_id>83098</law_id><section_number>54.1-2990</section_number><catch_line>Medically unnecessary health care not required; procedure when physician refuses to comply with an advance directive or a designated person&amp;#8217;s health care decision; mercy killing or euthanasia prohibited</catch_line><edition url="https://vacode.org/2025/" slug="2025" current="TRUE" last_updated="">2025</edition><referred_to_by><reference>54.1-2987</reference><reference>54.1-2988</reference><reference>54.1-2992</reference></referred_to_by><structure><unit label="title" level="1" order_by="1" identifier="54.1">Professions and Occupations</unit><unit label="subtitle" level="2" order_by="1" identifier="III">Professions and Occupations Regulated by Boards Within the Department of Health Professions</unit><unit label="chapter" level="3" order_by="1" identifier="29">Medicine and Other Healing Arts</unit><unit label="article" level="4" order_by="1" identifier="8">Health Care Decisions Act</unit></structure><text>
						<section id="A"><p><span class="prefix-number">A.</span> As used in this section:
			&#x201C;<span class="dictionary">Health care provider</span>&#x201D; has the same meaning as in &#xA7; <a class="law" title="Definitions" href="/8.01-581.1/">8.01-581.1</a>.
			&#x201C;<span class="dictionary">Life-sustaining treatment</span>&#x201D; means any ongoing health care that utilizes mechanical or other artificial means to <span class="dictionary">sustain</span>, restore, or supplant a spontaneous vital function, including hydration, nutrition, maintenance medication, and cardiopulmonary resuscitation. <a id="paragraph-297806" class="section-permalink" href="https://vacode.org/54.1-2990/#A"><i class="fa fa-link"/></a></p></section>
						<section id="B"><p><span class="prefix-number">B.</span> Nothing in this article shall be construed to require a <span class="dictionary">physician</span> to prescribe or render health care to a patient that the <span class="dictionary">physician</span> 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&#x2019;s medical condition and not on the patient&#x2019;s age or other demographic status, disability, or diagnosis of <span class="dictionary">persistent vegetative state</span>.
			In cases in which a <span class="dictionary">physician</span>&#x2019;s determination that proposed health care, including <span class="dictionary">life-sustaining treatment</span>, is medically or ethically inappropriate is contrary to the request of the patient, the terms of a patient&#x2019;s <span class="dictionary">advance directive</span>, the decision of an <span class="dictionary">agent</span> or person authorized to make decisions pursuant to &#xA7; <a class="law" title="Procedure in absence of an advance directive; procedure for advance directive without agent; no presumption; persons who may authorize health care for patients incapable of informed decisions" href="/54.1-2986/">54.1-2986</a>, or a <span class="dictionary">Durable Do Not Resuscitate Order</span>, the <span class="dictionary">physician</span> or his designee shall document the <span class="dictionary">physician</span>&#x2019;s determination in the patient&#x2019;s medical record, make a reasonable effort to inform the patient or the patient&#x2019;s <span class="dictionary">agent</span> or person with decision-making authority pursuant to &#xA7; <a class="law" title="Procedure in absence of an advance directive; procedure for advance directive without agent; no presumption; persons who may authorize health care for patients incapable of informed decisions" href="/54.1-2986/">54.1-2986</a> of such determination and the reasons therefor in writing, and provide a copy of the hospital&#x2019;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; <a class="law" title="(Effective January 1, 2026) Regulations" href="/32.1-127/">32.1-127</a>.
			If the conflict remains unresolved, the <span class="dictionary">physician</span> shall make a reasonable effort to transfer the patient to another <span class="dictionary">physician</span> or facility that is willing to comply with the request of the patient, the terms of the <span class="dictionary">advance directive</span>, the decision of an <span class="dictionary">agent</span> or person authorized to make decisions pursuant to &#xA7; <a class="law" title="Procedure in absence of an advance directive; procedure for advance directive without agent; no presumption; persons who may authorize health care for patients incapable of informed decisions" href="/54.1-2986/">54.1-2986</a>, or a <span class="dictionary">Durable Do Not Resuscitate Order</span> and shall cooperate in transferring the patient to the <span class="dictionary">physician</span> or facility identified. The <span class="dictionary">physician</span> shall provide the patient or his <span class="dictionary">agent</span> or person with decision-making authority pursuant to &#xA7; <a class="law" title="Procedure in absence of an advance directive; procedure for advance directive without agent; no presumption; persons who may authorize health care for patients incapable of informed decisions" href="/54.1-2986/">54.1-2986</a> 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&#x2019;s medical record in accordance with the hospital&#x2019;s written policy developed pursuant to subdivision B 21 of &#xA7; <a class="law" title="(Effective January 1, 2026) Regulations" href="/32.1-127/">32.1-127</a> to effect such transfer. During this period, (i) the <span class="dictionary">physician</span> shall continue to provide any <span class="dictionary">life-sustaining treatment</span> to the patient that is reasonably available to such <span class="dictionary">physician</span>, as requested by the patient or his <span class="dictionary">agent</span> or person with decision-making authority pursuant to &#xA7; <a class="law" title="Procedure in absence of an advance directive; procedure for advance directive without agent; no presumption; persons who may authorize health care for patients incapable of informed decisions" href="/54.1-2986/">54.1-2986</a>, and (ii) the hospital in which the patient is receiving <span class="dictionary">life-sustaining treatment</span> shall facilitate prompt access to the patient&#x2019;s medical record pursuant to &#xA7; <a class="law" title="Health records privacy" href="/32.1-127.1_03/">32.1-127.1:03</a>.
			If, at the end of the 14-day period, the conflict remains unresolved despite compliance with the hospital&#x2019;s written policy established pursuant to subdivision B 21 of &#xA7; <a class="law" title="(Effective January 1, 2026) Regulations" href="/32.1-127/">32.1-127</a> and the <span class="dictionary">physician</span> has been unable to identify another <span class="dictionary">physician</span> or facility willing to provide the care requested by the patient, the terms of the <span class="dictionary">advance directive</span>, or the decision of the <span class="dictionary">agent</span> or person authorized to make decisions pursuant to &#xA7; <a class="law" title="Procedure in absence of an advance directive; procedure for advance directive without agent; no presumption; persons who may authorize health care for patients incapable of informed decisions" href="/54.1-2986/">54.1-2986</a> to which to transfer the patient despite reasonable efforts, the <span class="dictionary">physician</span> may cease to provide the treatment that the <span class="dictionary">physician</span> has determined to be medically or ethically inappropriate subject to the right of <span class="dictionary">court</span> review by any <span class="dictionary">party</span>. However, artificial nutrition and hydration may be withdrawn or withheld only if, on the basis of <span class="dictionary">physician</span>&#x2019;s reasonable medical <span class="dictionary">judgment</span>, providing such artificial nutrition and hydration would (a) hasten the patient&#x2019;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&#x2019;s <span class="dictionary">advance directive</span>, or the decision of an <span class="dictionary">agent</span> or person authorized to make decisions pursuant to &#xA7; <a class="law" title="Procedure in absence of an advance directive; procedure for advance directive without agent; no presumption; persons who may authorize health care for patients incapable of informed decisions" href="/54.1-2986/">54.1-2986</a> regarding the withholding of artificial nutrition or hydration. In all cases, care directed toward the patient&#x2019;s pain and comfort shall be provided. <a id="paragraph-297807" class="section-permalink" href="https://vacode.org/54.1-2990/#B"><i class="fa fa-link"/></a></p></section>
						<section id="C"><p><span class="prefix-number">C.</span> Nothing in this section shall require the provision of health care that the <span class="dictionary">physician</span> is physically or legally unable to provide or health care that the <span class="dictionary">physician</span> is physically or legally unable to provide without thereby denying the same health care to another patient. <a id="paragraph-297808" class="section-permalink" href="https://vacode.org/54.1-2990/#C"><i class="fa fa-link"/></a></p></section>
						<section id="D"><p><span class="prefix-number">D.</span> 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. <a id="paragraph-297809" class="section-permalink" href="https://vacode.org/54.1-2990/#D"><i class="fa fa-link"/></a></p></section>
						<section id="E"><p><span class="prefix-number">E.</span> Compliance with the requirements of this section shall not be <span class="dictionary">admissible</span> to prove a violation of or compliance with the standard of care as set forth in &#xA7; <a class="law" title="Standard of care in proceeding before medical malpractice review panel; expert testimony; determination of standard in action for damages" href="/8.01-581.20/">8.01-581.20</a>. <a id="paragraph-297810" class="section-permalink" href="https://vacode.org/54.1-2990/#E"><i class="fa fa-link"/></a></p></section></text><history>1983, c. 532, &#xA7; 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.</history><metadata></metadata></law>
