Missouri Code of State Regulations › Title 9 - DEPARTMENT OF MENTAL HEALTH › Division 10 - Director, Department of Mental Health › Chapter 5 - General Program Procedures › Section 9 CSR 10-5.180 - Advance Directives

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This rule defines terms and establishes
				  policies and procedures to be followed by all facilities operated by the
				  Department of Mental Health and by other department related facilities for
				  assuring the rights of residents and patients to participate in and direct
				  health care decisions affecting them.
(1) Terms defined in sections
				630.005,
				631.005,
				632.005 and 633.005,
				RSMo are incorporated by reference for use in this rule. Also, as used in this
				rule, unless the context clearly indicates otherwise, the following terms shall
				mean:
(A) Adult an individual eighteen (18)
				years of age or older;
(B) Advance
				directive a written instrument, such as a living will or durable power of
				attorney for health care, relating to the provision of health care for an
				individual when that individual is in a terminal condition or is
				incapacitated;
(C) Attending
				physician the physician selected by or assigned to an individual and who has
				primary responsibility for the treatment and care of the individual. If more
				than one (1) physician shares that responsibility, any of those physicians may
				act as the attending physician;
(D)
				Attorney in fact an individual or corporation appointed to act as an agent of a
				principal (resident or patient) in a written power of attorney for health care
				allowed under law;
(E) Competent
				not having been adjudicated incapacitated;
(F) Death prolonging procedure any medical
				procedure or intervention that, when applied to an individual, would serve only
				to artificially prolong the dying process and where, in the judgment of the
				attending physician pursuant to usual and customary medical standards, death
				will occur within a short time whether the procedure or intervention is used.
				Death prolonging procedures shall not include administration of medication or
				performance of a medical procedure considered necessary to provide comfort or
				care or to alleviate pain, or the performance of any procedure to provide
				nutrition or hydration;
(G)
				Decision making capacity ability to make choices that reflect an understanding
				of the nature and effect of treatment options as well as the consequences of
				choices;
(H) Department facilities
				facilities operated by the department;
(I) Durable power of attorney for health care
				a written instrument executed by a competent adult, notarized and expressly
				giving an agent or attorney in fact the authority to consent to or to prohibit
				any type of health care, medical care, treatment or procedures to the extent
				authorized in sections 404.800404.865, RSMo;
(J) Health care any treatment, service or
				procedure to diagnose or treat the physical or mental condition of a resident
				or patient;
(K) Health care
				facility an individual or agency licensed, certified or otherwise authorized or
				permitted by law to administer health care in the ordinary course of business
				or professional practice;
(L)
				Incapacitated unable by reason of any physical or mental condition to receive
				and evaluate information or to communicate decisions to an extent that an
				individual lacks capacity to meet essential requirements for food, clothing,
				shelter, safety or other care such that serious physical injury, illness or
				disease is likely to occur;
(M)
				Living will a written instrument executed by a competent adult under sections
				459.010459.055, RSMo and declaring direction for the withholding or withdrawal
				of death prolonging procedures and becoming operative if the adult is in a
				terminal condition;
(N) Patient an
				individual under observation, care, treatment or rehabilitation by any hospital
				or other mental health facility pursuant to the provisions of Chapter 632,
				RSMo;
(O) Resident a person
				receiving residential services from a facility, other than a mental health
				facility, operated by the department;
(P) Terminal conditionan incurable or
				irreversible condition that, in the opinion of the attending physician, is such
				that death will occur within a short time, regardless of the application of
				medical procedures; and
(Q)
				Voluntary resident or patient a person who has willingly chosen or consented to
				receive services from the department and who is receiving services in a
				department facility, or a person for whom a guardian has been appointed under
				Chapter 475, RSMo and the guardian has been authorized to admit the resident or
				patient for services from the department.