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LRB-5096/1
KP:ahe
2019 - 2020 LEGISLATURE
January 8, 2020 - Introduced by Senators Shilling, L. Taylor and Schachtner,
cosponsored by Representatives Doyle, Anderson, Billings, Considine,
Emerson, Ohnstad, Pope, Spreitzer, Stubbs, Subeck, Vruwink, Zamarripa
and Bowen. Referred to Committee on Judiciary and Public Safety.
SB655,1,6 1An Act to renumber and amend 154.03 (1) (d) and 155.10 (2) (d); to amend
2154.02 (1), 154.03 (1) (intro.), 154.03 (2), 154.07 (1) (b) 1., 154.07 (1) (b) 2., 155.10
3(title), 155.10 (1) (c), 155.10 (2) (intro.) and 155.30 (3); and to create 154.03 (1)
4(d) 4. and 155.10 (2) (d) 4. of the statutes; relating to: notarial officers taking
5acknowledgments of health care powers of attorney and declarations to
6physicians.
Analysis by the Legislative Reference Bureau
Under this bill, a power of attorney for health care instrument is validly
executed if an individual who grants authority to a health care agent makes an
acknowledgment of the instrument before an authorized notarial officer. Current
law requires two witnesses in order to execute a health care power of attorney
instrument. Additionally, the bill allows an authorized notarial officer who is
employed by an individual's health care provider or inpatient health care facility to
take an acknowledgement of the individual's health care power of attorney
instrument if the notarial officer satisfies all of the following: 1) is not related by
blood, marriage, adoption, or domestic partnership to the individual executing the
instrument; 2) does not have knowledge of being entitled to a portion of the
individual's estate; 3) is not directly financially responsible for the individual's
health care; and 4) is not a finance or billing officer of the individual's inpatient
health care facility. Under current law, a witness to a health care power of attorney

instrument must meet those requirements, and also may not be an employee, other
than a chaplain or a social worker, of the individual's health care provider or
inpatient health care facility. A health care power of attorney designates another
person as an agent to make health care decisions on behalf of an individual who is
incapable of making those decisions.
The bill also allows an individual to execute a declaration to physicians, also
known as a living will, if the individual makes an acknowledgement of the
declaration before an authorized notarial officer. Current law requires two witnesses
in order to execute a declaration to physicians. The bill allows an authorized notarial
officer who is employed by the individual's health care provider or inpatient health
care facility to take an acknowledgement of the individual's declaration to physicians
if the notarial officer satisfies all of the following: 1) is not related by blood, marriage,
adoption, or domestic partnership to the individual executing the declaration; 2) does
not have knowledge of being entitled to a portion of the individual's estate; 3) is not
directly financially responsible for the individual's health care; and 4) is not a finance
or billing officer of the individual's inpatient health care facility. Under current law,
a witness to a declaration to physicians must meet those requirements, and also may
not be an employee, other than a chaplain or a social worker, of the individual's
health care provider or inpatient health care facility. If an individual has executed
a declaration, and is certified to have a terminal condition or to be in a persistent
vegetative state, in certain situations the declaration authorizes the withholding or
withdrawal of life-sustaining procedures or of feeding tubes from the individual.
For further information see the state fiscal estimate, which will be printed as
an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
SB655,1 1Section 1 . 154.02 (1) of the statutes is amended to read:
SB655,2,42 154.02 (1) “Declaration" means a written , witnessed document voluntarily
3executed by the declarant and witnessed or acknowledged under s. 154.03 (1), but
4is not limited in form or substance to that provided in s. 154.03 (2).
SB655,2 5Section 2. 154.03 (1) (intro.) of the statutes is amended to read:
SB655,3,236 154.03 (1) (intro.) Any person of sound mind and 18 years of age or older may
7at any time voluntarily execute a declaration, which shall take effect on the date of
8execution, authorizing the withholding or withdrawal of life-sustaining procedures
9or of feeding tubes when the person is in a terminal condition or is in a persistent

1vegetative state. A declarant may not authorize the withholding or withdrawal of
2any medication, life-sustaining procedure or feeding tube if the declarant's
3attending physician advises that, in his or her professional judgment, the
4withholding or withdrawal will cause the declarant pain or reduce the declarant's
5comfort and the pain or discomfort cannot be alleviated through pain relief
6measures. A declarant may not authorize the withholding or withdrawal of nutrition
7or hydration that is administered or otherwise received by the declarant through
8means other than a feeding tube unless the declarant's attending physician advises
9that, in his or her professional judgment, the administration is medically
10contraindicated. A declaration must be signed by the declarant in the presence of 2
11witnesses or the declarant must make an acknowledgment of the declaration before
12a notarial officer authorized under s. 706.07 to take acknowledgments
. If the
13declarant is physically unable to sign a declaration, the declaration must be signed
14in the declarant's name by one of the witnesses witness or some other person at the
15declarant's express direction and in his or her presence; such a proxy signing shall
16either take place or be acknowledged by the declarant in the presence of 2 witnesses
17or be acknowledged by the declarant before a notarial officer authorized under s.
18706.07 to take acknowledgments
. The declarant is responsible for notifying his or
19her attending physician of the existence of the declaration. An attending physician
20who is so notified shall make the declaration a part of the declarant's medical records.
21No witness to the execution of the declaration or notarial officer who takes an
22acknowledgment of the declaration
may, at the time of the execution, be any of the
23following:
SB655,3 24Section 3 . 154.03 (1) (d) of the statutes is renumbered 154.03 (1) (d) (intro.)
25and amended to read:
SB655,4,1
1154.03 (1) (d) (intro.) An individual who is a any of the following:
SB655,4,3 21. A health care provider, as defined in s. 155.01 (7), who is serving the
3declarant at the time of execution, an.
SB655,4,6 42. An employee, other than an employee authorized as a notarial officer under
5s. 706.07,
a chaplain, or a social worker, of the a health care provider or an who is
6serving the declarant at the time of execution.
SB655,4,9 73. An employee, other than an employee authorized as a notarial officer under
8s. 706.07,
a chaplain, or a social worker, of an inpatient health care facility in which
9the declarant is a patient.
SB655,4 10Section 4 . 154.03 (1) (d) 4. of the statutes is created to read:
SB655,4,1211 154.03 (1) (d) 4. A finance or billing officer of an inpatient health care facility
12in which the declarant is a patient.
SB655,5 13Section 5. 154.03 (2) of the statutes is amended to read:
SB655,5,514 154.03 (2) The department shall prepare and provide copies of the declaration
15and accompanying information for distribution in quantities to health care
16professionals, hospitals, nursing homes, county clerks and local bar associations and
17individually to private persons. The department shall include, in information
18accompanying the declaration, at least the statutory definitions of terms used in the
19declaration, statutory restrictions on who may be witnesses a witness to or be a
20notarial officer that takes an acknowledgment of
a valid declaration, a statement
21explaining that valid witnesses or notarial officers acting in good faith are statutorily
22immune from civil or criminal liability, an instruction to potential declarants to read
23and understand the information before completing the declaration and a statement
24explaining that an instrument may, but need not be, filed with the register in probate
25of the declarant's county of residence. The department may charge a reasonable fee

1for the cost of preparation and distribution. The declaration distributed by the
2department of health services shall be easy to read, the type size may be no smaller
3than 10 point, and the declaration shall be in the following form, setting forth on the
4first page the wording before the ATTENTION statement and setting forth on the
52nd page the ATTENTION statement and remaining wording:
SB655,5,6 6Declaration to physicians
SB655,5,77 (WISCONSIN LIVING WILL)
SB655,5,138 I,...., being of sound mind, voluntarily state my desire that my dying not be
9prolonged under the circumstances specified in this document. Under those
10circumstances, I direct that I be permitted to die naturally. If I am unable to give
11directions regarding the use of life-sustaining procedures or feeding tubes, I intend
12that my family and physician honor this document as the final expression of my legal
13right to refuse medical or surgical treatment.
SB655,5,1714 1. If I have a TERMINAL CONDITION, as determined by 2 physicians who
15have personally examined me, I do not want my dying to be artificially prolonged and
16I do not want life-sustaining procedures to be used. In addition, the following are
17my directions regarding the use of feeding tubes:
SB655,5,1818 .... YES, I want feeding tubes used if I have a terminal condition.
SB655,5,1919 .... NO, I do not want feeding tubes used if I have a terminal condition.
SB655,5,2020 If you have not checked either box, feeding tubes will be used.
SB655,5,2321 2. If I am in a PERSISTENT VEGETATIVE STATE, as determined by 2
22physicians who have personally examined me, the following are my directions
23regarding the use of life-sustaining procedures:
SB655,5,2524 .... YES, I want life-sustaining procedures used if I am in a persistent
25vegetative state.
SB655,6,2
1.... NO, I do not want life-sustaining procedures used if I am in a persistent
2vegetative state.
SB655,6,33 If you have not checked either box, life-sustaining procedures will be used.
SB655,6,64 3. If I am in a PERSISTENT VEGETATIVE STATE, as determined by 2
5physicians who have personally examined me, the following are my directions
6regarding the use of feeding tubes:
SB655,6,77 .... YES, I want feeding tubes used if I am in a persistent vegetative state.
SB655,6,88 .... NO, I do not want feeding tubes used if I am in a persistent vegetative state.
SB655,6,99 If you have not checked either box, feeding tubes will be used.
SB655,6,1210 If you are interested in more information about the significant terms used in
11this document, see section 154.01 of the Wisconsin Statutes or the information
12accompanying this document.
SB655,6,1413 ATTENTION: You and the 2 witnesses or a notarial officer must sign the
14document at the same time.
SB655,6,1515 Signed ....   Date ....
SB655,6,1616 Address ....   Date of birth ....
SB655,6,2017 I believe that the person signing this document is of sound mind. I am an adult
18and am not related to the person signing this document by blood, marriage or
19adoption. I am not entitled to and do not have a claim on any portion of the person's
20estate and am not otherwise restricted by law from being a witness.
SB655,6,2121 Witness signature ....   Date signed ....
SB655,6,2222 Print name ....
SB655,6,2424 Witness signature ....   Date signed ....
SB655,6,2525 Print name ....
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