                                 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.