Bill S.923

SENATE DOCKET, NO. 277 FILED ON: 1/10/2019

SENATE . . . . . . . . . . . . . . No. 923

By Ms. DiZoglio (by request), a petition (accompanied by bill, Senate, No. 923) of Brian Coppola for legislation to establish psychiatric advance directives for mental health care. The Judiciary.

[SIMILAR MATTER FILED IN PREVIOUS SESSION
SEE HOUSE, NO. 2269 OF 2017-2018.]

The Commonwealth of Massachusetts

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In the One Hundred and Ninety-First General Court
(2019-2020)

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An Act establishing psychiatric advance directives for mental health care.

Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:

SECTION 1. Section 1 of chapter 201D of the General Laws, as appearing in the 2014 Official Edition, is hereby amended by inserting after the word “proxy”, in line 29, the following words:- or psychiatric advance directive.

SECTION 2. Said section 1 of said chapter 201D is hereby further amended by adding the following definition:- “Psychiatric advance directive” or “directive”, a document setting forth specific instructions, preferences and details relative to the principal’s mental health care executed in accordance with the requirements of this chapter.

SECTION 3. Said chapter 201D is hereby amended by inserting after section 1 the following section:-

Section 1A. (a) Every competent person who is 18 years of age or older may execute a psychiatric advance directive, setting forth specific instructions, preferences and details relative to their mental health care . A health care agent, if one is appointed pursuant to section 2, attending physician, or any other person with the authority to make health care decisions on the principal’s behalf shall act in accordance with the directive, in the event that the principal lacks capacity to make health care decisions because of mental illness or developmental disability, as determined pursuant to section 6.

(b) A psychiatric advance directive shall be in writing and signed by the principal, or at the direction of the principal, in the presence of 2 other adults who shall subscribe their names as witnesses to the signature. The witnesses shall affirm in writing that the principal appeared to be at least 18 years of age, of sound mind and under no constraint or undue influence. If the principal has appointed a health care agent pursuant to section 2, the health care agent shall not act as a witness to the execution of the directive. For the purposes of this section, every adult shall be presumed to be competent and every psychiatric advance directive shall be presumed to be properly executed unless a court determines otherwise.

(c) A psychiatric advance directive may include: (i) preferences and instructions relative to treatment facilities, medications or treatments; (ii) a list of known allergies, side effects or other medical conditions; (iii) a list of persons authorized to visit the principal at a treatment facility; (iv) a list of a persons authorized to receive information about the principal’s mental health and treatment; (v) a list of names and contact information for the principal’s mental health care physicians; and (vi) any other special considerations, preferences or instructions related to mental health treatment that the principal wishes to include.

(d) An agent shall comply with a principal’s individual health care instructions as provided in a psychiatric advance directive, and the agent shall not revoke the principal’s psychiatric advance directive, except as authorized by a court of competent jurisdiction.

SECTION 4. Section 5 of said chapter 201D is hereby amended by inserting after the word “proxy”, in line 4, the following words:- or any preferences or instructions in a psychiatric advance directive.

SECTION 5. Said section 5 of said chapter 201D is hereby further amended by inserting after the word “beliefs”, in lines 9 and 10, the following words:- , and the principal’s preferences and instructions if expressed in a psychiatric advance directive.

SECTION 6. Said section 5 of said chapter 201D is hereby further amended by inserting after the word “proxy”, in lines 17, 21, 23, 27 and 29, the following words, in each instance:- or psychiatric advance directive.

SECTION 7. Said section 5 of said chapter 201D is hereby further amended by inserting after the word “proxy”, in lines 22 and 24, the following words, in each instance:- or directive.

SECTION 8. The second paragraph of section 6 of said chapter 201D is hereby amended by adding the following sentence:- A psychiatric advance directive executed pursuant to section 1A shall become binding upon an agent, attending physician or any person authorized to make health care decisions on behalf of a principal, in accordance with this chapter, upon a determination by a physician that the principal lacks capacity to make health care decisions because of mental illness or developmental disability.

SECTION 9. Said section 6 of said chapter 201D is hereby further amended by inserting after the word “proxy”, in line 29, the following words:- or to cause a psychiatric advance directive to become binding upon an agent, attending physician, or any person authorized to make health care decisions on behalf of a principal who is determined to lack capacity to make health care decisions pursuant to this section.

SECTION 10. Said section 6 of said chapter 201D is hereby further amended by inserting after the word “proxy”, in line 33, the following words:- , or a decision made by an agent that the principal believes is contrary to the preferences or instructions expressed by the principal in a psychiatric advance directive,.

SECTION 11. Section 7 of said chapter 201D is hereby amended by inserting after the word “proxy”, in lines 1, 5, 12, and 17, the following words, in each instance:- or psychiatric advance directive.

SECTION 12. Said section 7 of said chapter 201D is hereby further amended by inserting after the word “proxy”, in line 3, the following words:- or directive.

SECTION 13. Said section 7 of said chapter 201D is hereby further amended by striking out the third paragraph and inserting in place thereof the following paragraph:-

A health care proxy or psychiatric advance directive shall be revoked upon execution by the principal of a subsequent proxy or directive. A health care proxy shall also be revoked upon the divorce or legal separation of the principal and their spouse if the spouse is the principal’s agent under the health care proxy.

SECTION 14. Section 8 of said chapter 201D is hereby amended by inserting after the word “proxy”, in lines 4 and 5, the following words, in each instance:- or psychiatric advance directive.

SECTION 15. Section 10 of said chapter 201D is hereby amended by inserting after the word “proxy”, in line 2, the following words:- or psychiatric advance directive.

SECTION 16. Section 11 of said chapter 201D is hereby amended by inserting after the word “proxy”, in line 2, the following words:- , psychiatric advance directive.

SECTION 17. Said section 11 of said chapter 201D is hereby further amended by inserting after the word “proxy”, in line 5, the following words:- or directive.

SECTION 18. Section 14 of chapter 201D is hereby amended by inserting after the word “decision”, in line 3, the following words:- or a principal’s decision as expressed in a psychiatric advance directive.

SECTION 19. Said section 14 of said chapter 201D is hereby further amended by inserting after the word “principal”, in line 4, the following words:- when the principal had capacity to make health care decisions.

SECTION 20. Said section 14 of said chapter 201D is hereby further amended by inserting after the word “decision”, in lines 9 and 11, the following words, in each instance:- or the principal’s psychiatric advance directive.

SECTION 21. Said section 14 of said chapter 201D is hereby further amended by inserting after the word “agent”, in line 12, the following words:- or by the principal in a psychiatric advance directive.

SECTION 22. Section 15 of said chapter 201D is hereby amended by inserting after the word “decision”, in line 3, the following words:- or a principal’s decision as expressed in a psychiatric advance directive.

SECTION 23. Said section 15 of said chapter 201D is hereby further amended by inserting after the word “principal”, in lines 4 and 8, the following words, in each instance:- when the principal had capacity to make health care decisions.

SECTION 24. Said section 15 of said chapter 201D is hereby further amended by inserting after the word “decision”, in lines 13 and 15, the following words, in each instance:- or the principal’s psychiatric advance directive.

SECTION 25. Section 16 of said chapter 201D is hereby amended by inserting after the word “proxy”, in line 1, the following words:- or psychiatric advance directive.

SECTION 26. Said section 16 of said chapter 201D is hereby further amended by striking out the third paragraph and inserting in place thereof the following paragraph:- A competent adult’s failure to appoint a health care agent, to provide the agent with specific health care instructions, or to execute a psychiatric advance directive shall create no presumptions regarding the adult’s wishes about health care.

SECTION 27. Section 17 of said chapter 201D is hereby amended by inserting after the word “proxy”, in line 7, the following words:- or psychiatric advance directive.

SECTION 28. Said section 17 of said chapter 201D is hereby further amended by striking out, in line 13, the word “five” and inserting in place thereof the following words:- 5, or with the instructions or preferences set forth by the principal in a psychiatric advance directive.

SECTION 29. The department of mental health shall create a form to be used as a psychiatric advance directive, and shall promulgate rules and regulations as necessary to carry out this act.

Name:	District/Address:
Brian Coppola