Source: http://wnylc.com/health/entry/142/
Timestamp: 2019-04-21 07:51:40+00:00

Document:
New York’s Family Health Care Decisions Act (FHCDA)(Chapter 8 of the Laws of 2010, adding Public Health Law Ch. 29-CC and 29-CCC) allows a patient’s family member or close friend to make health care decisions for a patient who is in a hospital or nursing home, if the patient lacks decisional capacity and did not leave prior instructions or sign a health care proxy. This “surrogate” decisionmaker would also be empowered to direct the withdrawal or withholding of life-sustaining treatment (including consenting to a DNR order), when standards listed in the statute are satisfied. The key provisions of the FHCDA became effective on June 1, 2010.
The law ONLY applies to patients in hospitals and nursing homes who have lost the capacity to make medical treatment decisions and who have not appointed an agent under a health care proxy. PHL § 2994-b(1). There are other laws that govern people whose treatment is governed by the state Office of Mental Health (OMH) or NYS Office for People with Developmental Disabilities (formerly OMRDD). PHL § 2994-b(3). Private hospitals (as opposed to general hospitals) and individual health care providers are not required to honor decisions made by surrogates pursuant to FHCDA, and may make "conscience objections" based upon sincerely held religious beliefs or moral convictions. PHL § 2994-n.
How is lack of capacity determined?
For a surrogate to be allowed by make medical treatment decisions on the patient's behalf, the facility must first make a determination of patient incapacity, following the procedures outlined below. All adults are presumed to have decision-making capacity unless determined otherwise, or unless there has been a legal guardian or court order. PHL § 2994-c(1). The law contains special rules for patients who are minors. PHL § 2994-e.
The initial determination of incapacity must be made by an attending physician to a reasonable degree of medical certainty. The determination must include an assessment of the cause and extent of the patient's incapacity and the likelihood that they will regain capacity. PHL § 2994-c(2). An attending physician must confirm the patient's continued lack of capacity for future treatment decisions after the initial determination. PHL § 2994-c(7).
In a hospital, the concurring determination of a social worker or other health practitioner is only required when the surrogate's decision involves the withdrawal or withholding of life-sustaining treatment.
If the concurring determination disagrees with the initial determination, then the matter must be referred to the ethics review committee at the facility. PHL § 2994-c(3)(d).
if the patient was transferred from a mental hygiene facility, to the director of the mental hygiene facility and to the mental hygiene legal service under article 47 of the mental hygiene law.
another legal basis exists for overriding the patient's decision.
Who can be a surrogate under FHCDA?
Legal guardian appointed under Article 81 (the act amends Article 81 to authorize guardian of a person to act as a surrogate under the FHCDA and repeals old Article 81 provision restricting a guardian from making life-sustaining treatment decisions).
dependent or mutually interdependent on the other person for support, as evidenced on the totality of circumstances indicating a mutual intent to be domestic partners, including jointly owned or leased property, shared income or expenses, children in common, signs of intent to marry or become domestic partners, or the length of the two parties’ relationship.
Close friend, age 18 or over, or a relative other than those listed above, who presents a signed statement to the treating physician stating that s/he is in regular contact with the patient so as to be familiar with the patient's activities, health, religious and moral beliefs. PHL § 2994-a(4).
In a nursing home, the medical director of the facility, or a physician designated by the medical director, must independently concur that the recommendation is appropriate.
Withholding or withdrawal of life-sustaining treatment, defined as any procedure without which the patient will die within a relatively short time, as determined by an attending physician to a reasonable degree of medical certainty. CPR is presumed to be life-sustaining treatment without the necessity of a determination by an attending physician.
What decisions are governed by the FHCDA?
The new law provides for a surrogate to make all health care decisions in a hospital or nursing home that the adult patient could make for him or herself prior to losing capacity. PHL § 2994-d(3)(a)(i). Providing nutrition and hydration orally, without reliance on medical treatment, is not a health care decision covered by the FHCDA. PHL § 2994-d(5)(d).
the relief of the patient's suffering; and any medical condition and such other concerns and values as a reasonable person in the patient's circumstances would wish to consider.
The provision of treatment would involve such pain, suffering or other burden that it would reasonably be deemed inhumane or extraordinarily burdensome under the circumstances and the patient has an irreversible or incurable condition, as determined by an attending physician with the independent concurrence of another physician to a reasonable degree of medical certainty and in accord with accepted medical standards.
How does FHCDA affect Do Not Resuscitate (DNR) Orders?
FHCDA has largely replaced those sections of Public Health Law 29-B that granted a surrogate with a close relationship to an incapacitated patient authority to consent to a “do not resuscitate” (DNR) order regarding the use of cardio-pulmonary resuscitation. The authority to consent to a DNR order for an incapacitated patient now adheres to the surrogacy order of priority and the standards and procedures used throughout the other sections of the FHCDA. The changes are minor, such as permitting a friend to enter a DNR order after writing a statement describing their closeness to the patient rather than signing an affidavit attesting to knowledge of the patient’s wishes. PHL Art. 29-CCC.
Other sections of the new law govern DNR orders in non-hospital settings such a hospice (PHL Article 29-CCC), permitting FHCDA’s surrogacy provisions also to apply in such cases, and in mental hygiene facilities (renamed PHL Article 29-B).

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