                                 CODE OF VIRGINIA

WHEN PERSON DEEMED MEDICALLY AND LEGALLY DEAD; DETERMINATION OF DEATH;
NURSES&#8217;, LICENSED PRACTICAL NURSES&#8217;, PHYSICIAN ASSISTANTS&#8217;, OR
ADVANCED PRACTICE REGISTERED NURSES&#8217; AUTHORITY TO PRONOUNCE DEATH UNDER
CERTAIN CIRCUMSTANCES (§ 54.1-2972)

A. As used in this section, &#8220;autonomous nurse practitioner&#8221; means a
nurse practitioner who is authorized to practice without a practice agreement
pursuant to subsection I of &#xA7; 54.1-2957.

B. A person shall be medically and legally dead if:

   1. In the opinion of a physician duly authorized to practice medicine in the
   Commonwealth or autonomous nurse practitioner, based on the ordinary standards
   of medical practice, there is the absence of spontaneous respiratory and
   spontaneous cardiac functions and, because of the disease or condition that
   directly or indirectly caused these functions to cease, or because of the
   passage of time since these functions ceased, attempts at resuscitation would
   not, in the opinion of such physician or autonomous nurse practitioner, be
   successful in restoring spontaneous life-sustaining functions, and, in such
   event, death shall be deemed to have occurred at the time these functions
   ceased; or

   2. In the opinion of a physician, who shall be duly licensed to practice
   medicine in the Commonwealth and board-eligible or board-certified in the
   field of neurology, neurosurgery, or critical care medicine, when based on the
   ordinary standards of medical practice, there is irreversible cessation of all
   functions of the entire brain, including the brain stem, and, in the opinion
   of such physician, based on the ordinary standards of medical practice and
   considering the irreversible cessation of all functions of the entire brain,
   including the brain stem, and the patient&#8217;s medical record, further
   attempts at resuscitation or continued supportive maintenance would not be
   successful in restoring such functions, and, in such event, death shall be
   deemed to have occurred at the time when all such functions have ceased.

C. A registered nurse, a physician assistant, or an advanced practice registered
nurse who is not an autonomous nurse practitioner may pronounce death if the
following criteria are satisfied: (i) the nurse is employed by or the physician
assistant or advanced practice registered nurse who is not an autonomous nurse
practitioner works at (a) a home care organization as defined in &#xA7;
32.1-162.7, (b) a hospice as defined in &#xA7; 32.1-162.1, (c) a hospital or
nursing home as defined in &#xA7; 32.1-123, including state-operated hospitals
for the purposes of this section, (d) the Department of Corrections, or (e) a
continuing care retirement community registered with the State Corporation
Commission pursuant to Chapter 49 (&#xA7; 38.2-4900 et seq.) of Title 38.2; (ii)
the nurse, physician assistant, or advanced practice registered nurse who is not
an autonomous nurse practitioner is directly involved in the care of the
patient; (iii) the patient&#8217;s death has occurred; (iv) the patient is under
the care of a physician or autonomous nurse practitioner when his death occurs;
(v) the patient&#8217;s death has been anticipated; and (vi) the physician or
autonomous nurse practitioner is unable to be present within a reasonable period
of time to determine death. A licensed practical nurse may pronounce death for a
patient in hospice pursuant to a valid Do Not Resuscitate Order issued in
accordance with &#xA7; 54.1-2987.1. The nurse, licensed practical nurse,
physician assistant, or advanced practice registered nurse who is not an
autonomous nurse practitioner shall inform the patient&#8217;s attending and
consulting physician or autonomous nurse practitioner of the patient&#8217;s
death as soon as practicable.
			The nurse, licensed practical nurse, physician assistant, or advanced
practice registered nurse who is not an autonomous nurse practitioner shall have
the authority to pronounce death in accordance with such procedural regulations,
if any, as may be promulgated by the Board of Medicine; however, if the
circumstances of the death are not anticipated or the death requires an
investigation by the Office of the Chief Medical Examiner, such nurse, licensed
practical nurse, physician assistant, or advanced practice registered nurse
shall notify the Office of the Chief Medical Examiner of the death and the body
shall not be released to the funeral director.
			This subsection shall not authorize a nurse, licensed practical nurse,
physician assistant, or advanced practice registered nurse who is not an
autonomous nurse practitioner to determine the cause of death. Determination of
cause of death shall continue to be the responsibility of the attending
physician or autonomous nurse practitioner, except as provided in &#xA7;
32.1-263. Further, this subsection shall not be construed to impose any
obligation to carry out the functions of this subsection.
			This subsection shall not relieve any registered nurse, licensed practical
nurse, physician assistant, or nurse practitioner who is not an autonomous nurse
practitioner from any civil or criminal liability that might otherwise be
incurred for failure to follow statutes or Board of Nursing or Board of Medicine
regulations.

D. The alternative definitions of death provided in subdivisions B 1 and 2 may
be utilized for all purposes in the Commonwealth, including the trial of civil
and criminal cases.

HISTORY: Code 1950, § 32-364.3:1; 1973, c. 252; 1979, c. 720, § 54-325.7;
1986, c. 237; 1988, c. 765; 1996, c. 1028; 1997, cc. 107, 453; 2002, c. 92;
2004, c. 92; 2010, c. 46; 2011, c. 613; 2012, c. 136; 2014, cc. 73, 583; 2016,
c. 97; 2021, Sp. Sess. I, c. 210; 2022, cc. 184, 198; 2023, c. 183.