Ohio § 1337.17

§ 1337.17.

A printed form of durable power of attorney for health care may be sold or otherwise

distributed in this state for use by adults who are not advised by an attorney.  By use of such a printed form, a principal may authorize an attorney in fact to

make health care decisions on the principal's behalf, but the printed form shall not

be used as an instrument for granting authority for any other decisions.  Any printed form that is sold or otherwise distributed in this state for the purpose

described in this section shall include the following notice: “Notice to Adult Executing This Document This is an important legal document.  Before executing this document, you should know these facts: This document gives the person you designate (the attorney in fact) the power to make

most* health care decisions for you if you lose the capacity to make informed health

care decisions for yourself.  This power is effective only when your attending physician determines that you have

lost the capacity to make informed health care decisions for yourself and, notwithstanding

this document, as long as you have the capacity to make informed health care decisions

for yourself, you retain the right to make all medical and other health care decisions

for yourself. You may include specific limitations in this document on the authority of the attorney

in fact to make health care decisions for you. Subject to any specific limitations you include in this document, if your attending

physician determines that you have lost the capacity to make an informed decision

on a health care matter, the attorney in fact generally* will be authorized by this

document to make health care decisions for you to the same extent as you could make

those decisions yourself, if you had the capacity to do so.  The authority of the attorney in fact to make health care decisions for you generally*

will include the authority to give informed consent, to refuse to give informed consent,

or to withdraw informed consent to any care, treatment, service, or procedure to maintain,

diagnose, or treat a physical or mental condition. However*, even if the attorney in fact has general authority to make health care decisions

for you under this document, the attorney in fact never* will be authorized to do

any of the following: (1) Refuse or withdraw informed consent to life-sustaining treatment (unless your attending

physician and one other physician who examines you determine, to a reasonable degree

of medical certainty and in accordance with reasonable medical standards, that either

of the following applies: (a) You are suffering from an irreversible, incurable, and untreatable condition caused

by disease, illness, or injury from which (i) there can be no recovery and (ii) your

death is likely to occur within a relatively short time if life-sustaining treatment

is not administered, and your attending physician additionally determines, to a reasonable

degree of medical certainty and in accordance with reasonable medical standards, that

there is no reasonable possibility that you will regain the capacity to make informed

health care decisions for yourself. (b) You are in a state of permanent unconsciousness that is characterized by you being

irreversibly unaware of yourself and your environment and by a total loss of cerebral

cortical functioning, resulting in you having no capacity to experience pain or suffering,

and your attending physician additionally determines, to a reasonable degree of medical

certainty and in accordance with reasonable medical standards, that there is no reasonable

possibility that you will regain the capacity to make informed health care decisions

for yourself); (2) Refuse or withdraw informed consent to health care necessary to provide you with

comfort care (except that, if the attorney in fact is not prohibited from doing so

under (4) below, the attorney in fact could refuse or withdraw informed consent to

the provision of nutrition or hydration to you as described under (4) below).  (You should understand that comfort care is defined in Ohio law to mean artificially or technologically administered sustenance

(nutrition) or fluids (hydration) when administered to diminish your pain or discomfort,

not to postpone your death, and any other medical or nursing procedure, treatment,

intervention, or other measure that would be taken to diminish your pain or discomfort,

not to postpone your death.  Consequently, if your attending physician were to determine that a previously described

medical or nursing procedure, treatment, intervention, or other measure will not or

no longer will serve to provide comfort to you or alleviate your pain, then, subject

to (4) below, your attorney in fact would be authorized to refuse or withdraw informed

consent to the procedure, treatment, intervention, or other measure.*); (3) Refuse or withdraw informed consent to health care for you if you are pregnant and

if the refusal or withdrawal would terminate the pregnancy (unless the pregnancy or

health care would pose a substantial risk to your life, or unless your attending physician

and at least one other physician who examines you determine, to a reasonable degree

of medical certainty and in accordance with reasonable medical standards, that the

fetus would not be born alive); (4) Refuse or withdraw informed consent to the provision of artificially or technologically

administered sustenance (nutrition) or fluids (hydration) to you, unless: (a) You are in a terminal condition or in a permanently unconscious state. (b) Your attending physician and at least one other physician who has examined you determine,

to a reasonable degree of medical certainty and in accordance with reasonable medical

standards, that nutrition or hydration will not or no longer will serve to provide

comfort to you or alleviate your pain. (c) If, but only if, you are in a permanently unconscious state, you authorize the attorney

in fact to refuse or withdraw informed consent to the provision of nutrition or hydration

to you by doing both of the following in this document: (i) Including a statement in capital letters or other conspicuous type, including, but

not limited to, a different font, bigger type, or boldface type, that the attorney

in fact may refuse or withdraw informed consent to the provision of nutrition or hydration

to you if you are in a permanently unconscious state and if the determination that

nutrition or hydration will not or no longer will serve to provide comfort to you

or alleviate your pain is made, or checking or otherwise marking a box or line (if

any) that is adjacent to a similar statement on this document; (ii) Placing your initials or signature underneath or adjacent to the statement, check,

or other mark previously described. (d) Your attending physician determines, in good faith, that you authorized the attorney

in fact to refuse or withdraw informed consent to the provision of nutrition or hydration

to you if you are in a permanently unconscious state by complying with the requirements

of (4)(c)(i) and (ii) above. (5) Withdraw informed consent to any health care to which you previously consented, unless

a change in your physical condition has significantly decreased the benefit of that

health care to you, or unless the health care is not, or is no longer, significantly

effective in achieving the purposes for which you consented to its use; (6) Provide, refuse, or withdraw informed consent to life-sustaining treatment, or the

provision of artificially or technologically administered sustenance (nutrition) or

fluids (hydration) to you, if the attorney in fact is subject to a temporary protection

order, civil protection order, or any other protection order in this state or another

state in which you are the alleged victim. Additionally, when exercising authority to make health care decisions for you, the

attorney in fact will have to act consistently with your desires or, if your desires

are unknown, to act in your best interest.  You may express your desires to the attorney in fact by including them in this document

or by making them known to the attorney in fact in another manner. When acting pursuant to this document, the attorney in fact generally* will have the

same rights that you have to receive information about proposed health care, to review

health care records, and to consent to the disclosure of health care records.  You can limit that right in this document if you so choose. Generally, you may designate any competent adult as the attorney in fact under this

document.  However, you cannot* designate your attending physician or the administrator of

any nursing home in which you are receiving care as the attorney in fact under this

document.  Additionally, you cannot* designate an employee or agent of your attending physician,

or an employee or agent of a health care facility at which you are being treated,

as the attorney in fact under this document, unless either type of employee or agent

is a competent adult and related to you by blood, marriage, or adoption, or unless

either type of employee or agent is a competent adult and you and the employee or

agent are members of the same religious order. This document has no expiration date under Ohio law, but you may choose to specify

a date upon which your durable power of attorney for health care generally will expire.  However, if you specify an expiration date and then lack the capacity to make informed

health care decisions for yourself on that date, the document and the power it grants

to your attorney in fact will continue in effect until you regain the capacity to

make informed health care decisions for yourself. You have the right to revoke the designation of the attorney in fact and the right

to revoke this entire document at any time and in any manner.  Any such revocation generally will be effective when you express your intention

to make the revocation.  However, if you made your attending physician aware of this document, any such revocation

will be effective only when you communicate it to your attending physician, or when

a witness to the revocation or other health care personnel to whom the revocation

is communicated by such a witness communicate it to your attending physician. If you execute this document and create a valid durable power of attorney for health

care with it, it will revoke any prior, valid durable power of attorney for health

care that you created, unless you indicate otherwise in this document. This document is not valid as a durable power of attorney for health care unless it

is acknowledged before a notary public or is signed by at least two adult witnesses

who are present when you sign or acknowledge your signature.  No person who is related to you by blood, marriage, or adoption may be a witness.  The attorney in fact, your attending physician, and the administrator of any nursing

home in which you are receiving care also are ineligible to be witnesses. If there is anything in this document that you do not understand, you should ask your

lawyer to explain it to you.” In the preceding notice, the single words, and the two sentences in the second set

of parentheses in paragraph (2), followed by an asterisk and all of paragraph (4)

shall appear in the printed form in capital letters or other conspicuous type, including,

but not limited to, a different font, bigger type, or boldface type.