An Act Regarding Patient-directed Care at the End of Life
Maine Legislature, Session 126, LD 1065
Committee: Health and Human Services
Sponsors: BROOKS, VALENTINO, BEAVERS, CHENETTE, FARNSWORTH, HAYES, NADEAU, RUSSELL, SCHNECK, WELSH
Amends: 24 MRSA §2908

Legislative Document 
No. 1065 
H.P. 758 
House of Representatives, March 19, 2013 
An Act Regarding Patient-directed Care at the End of Life 
Reference to the Committee on Health and Human Services suggested and ordered printed. 
MILLICENT M. MacFARLAND 
Clerk 
Presented by Representative BROOKS of Winterport. 
Cosponsored by Senator VALENTINO of York and 
Representatives: BEAVERS of South Berwick, CHENETTE of Saco, FARNSWORTH of 
Portland, HAYES of Buckfield, NADEAU of Winslow, RUSSELL of Portland, SCHNECK of 
Bangor, WELSH of Rockport. 
Be it enacted by the People of the State of Maine as follows: 
Sec. 1.  24 MRSA §2908 is enacted to read: 
§2908.  Patient-directed care at the end of life 
1.  Definitions.  As used in this section, unless the context otherwise indicates, the 
following terms have the following meanings. 
A.  "End-of-life care document" means a document signed by a patient that meets the 
requirements of subsection 3. 
B.  "Medical director" means a licensed physician who oversees the medical 
components of hospice services and serves on the interdisciplinary team, as defined 
in Title 22, section 8621, subsection 12, for the patient. 
C.  "Palliative care" means care that eases or relieves pain or discomfort. 
D.  "Patient" means a person who is terminally ill and has a limited life expectancy in 
the opinion of the person's physician. 
E.  "Physician" means the physician or medical director as defined in this subsection 
who provides care for the patient and who signs a physician document with regard to 
the patient. 
F.  "Physician document" means a document signed by a physician that meets the 
requirements of subsection 4. 
2.  Agreement.  A patient and physician may enter into an agreement for patient-
directed end-of-life care by signing an end-of-life care document in accordance with 
subsection 3 and a physician document in accordance with subsection 4. 
3.  Choice and directive by patient.  A patient may make choices for health care and 
direct care toward the end of the patient's life in accordance with this section. 
A.  The patient may sign an end-of-life care document that states that the patient has 
thoroughly discussed the patient's medical condition and options and choices for care 
with the patient's physician and that the patient has made the following informed 
decisions: 
(1)  The decision to reject curative or life-extending care; 
(2)  The decision to accept palliative care; and 
(3)  The decision to accept care that is ordered or delivered by the physician that 
may hasten or bring about the patient's death. 
B.  The end-of-life care document must state that the patient is directing the physician 
to provide care in conformance with the end-of-life care document and the 
companion physician document and in conformance with the professional and legal 
obligations of the physician. 
4.  Commitment by physician.  A physician who signs a physician document in 
accordance with this subsection may provide care in conformance with the physician 
document for a patient who has signed an end-of-life care document in accordance with 
subsection 3. 
A.  The physician may sign a physician document that states that the physician has 
thoroughly discussed the patient's medical condition and options and choices for care 
with the patient and that the patient has made the following informed decisions: 
(1)  The decision to reject curative or life-extending care; 
(2)  The decision to accept palliative care; and 
(3)  The decision to accept care that is ordered or delivered by the physician that 
may hasten or bring about the patient's death. 
B.  The physician document must state: 
(1)  That the patient has directed the physician to provide care in conformance 
with the end-of-life care document and the professional and legal obligations of 
the physician; and 
(2)  That the physician is committed to provide care as directed by the end-of-life 
care document. 
5.  Immunity.  A physician who has signed a physician document in accordance with 
subsection 4 with regard to a patient who has signed a companion end-of-life care 
document in accordance with subsection 3 and who provides care in accordance with 
both documents is not civilly or criminally liable for damages alleged to have been 
sustained by the patient nor for the death of the patient alleged to have occurred by reason 
of an act or omission in providing care in accordance with both documents. 
6.  Professional and licensure obligations.  A physician who has signed a physician 
document in accordance with subsection 4 with regard to a patient who has signed a 
companion end-of-life care document in accordance with subsection 3 and who provides 
care in accordance with both documents is not subject to professional discipline under 
Title 32, chapters 36 and 48 for providing care to the patient in accordance with both 
documents. 
SUMMARY 
This bill authorizes a patient who is terminally ill and the patient's physician or the 
medical director of the patient's hospice care provider to sign companion documents that 
will guide the provision of health care to the patient and the provision of care at the end 
of life.  The companion documents establish the choices and directives of the patient and 
the responsibilities of the physician or medical director.  This bill shields physicians and 
medical directors from liability or disciplinary sanctions so that the physicians and 
medical directors may provide care in conformance with patients' choices and directives.