As Introduced

136th General Assembly

Regular Session H. B. No. 920

2025-2026

Representative Baker

To amend sections 1337.12, 2108.23, 2108.231, 2133.01, 2133.03, 2133.07, 2133.21, 2133.22, 2133.23, 2133.24, 2133.25, 2133.26, 4765.35, 4765.37, 4765.38, and 4765.39 and to enact section 2133.151 of the Revised Code to provide for a do-not-intubate order, protocol, and identification separate from a do-not-resuscitate order, protocol, and identification.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

Section 1. That sections 1337.12, 2108.23, 2108.231, 2133.01, 2133.03, 2133.07, 2133.21, 2133.22, 2133.23, 2133.24, 2133.25, 2133.26, 4765.35, 4765.37, 4765.38, and 4765.39 be amended and section 2133.151 of the Revised Code be enacted to read as follows:

Sec. 1337.12. (A)(1) An adult who is of sound mind voluntarily may create a valid durable power of attorney for health care by executing a durable power of attorney, in accordance with section 1337.24 of the Revised Code, that authorizes an attorney in fact as described in division (A)(2) of this section to make health care decisions for the principal at any time that the attending physician of the principal determines that the principal has lost the capacity to make informed health care decisions for the principal. The durable power of attorney for health care may authorize the attorney in fact, commencing immediately upon the execution of the instrument or at any subsequent time and regardless of whether the principal has lost the capacity to make informed health care decisions, to obtain information concerning the principal's health, including protected health information as defined in 45 C.F.R. 160.103. Except as otherwise provided in divisions (B) to (F) of section 1337.13 of the Revised Code, the authorization may include the right to give informed consent, to refuse to give informed consent, or to withdraw informed consent to any health care that is being or could be provided to the principal. Additionally, to be valid, a durable power of attorney for health care shall satisfy both of the following:

(a) It shall be signed at the end of the instrument by the principal and shall state the date of its execution.

(b) It shall be witnessed in accordance with division (B) of this section or be acknowledged by the principal in accordance with division (C) of this section.

(2) Except as otherwise provided in this division, a durable power of attorney for health care may designate any competent adult as the attorney in fact. The attending physician of the principal and an administrator of any nursing home in which the principal is receiving care shall not be designated as an attorney in fact in, or act as an attorney in fact pursuant to, a durable power of attorney for health care. An employee or agent of the attending physician of the principal and an employee or agent of any health care facility in which the principal is being treated shall not be designated as an attorney in fact in, or act as an attorney in fact pursuant to, a durable power of attorney for health care, except that these limitations do not preclude a principal from designating either type of employee or agent as the principal's attorney in fact if the individual is a competent adult and related to the principal by blood, marriage, or adoption, or if the individual is a competent adult and the principal and the individual are members of the same religious order.

(3) A durable power of attorney for health care shall not expire, unless the principal specifies an expiration date in the instrument. However, when a durable power of attorney contains an expiration date, if the principal lacks the capacity to make informed health care decisions for the principal on the expiration date, the instrument shall continue in effect until the principal regains the capacity to make informed health care decisions for the principal.

(B) If witnessed for purposes of division (A)(1)(b) of this section, a durable power of attorney for health care shall be witnessed by at least two individuals who are adults and who are not ineligible to be witnesses under this division. Any person who is related to the principal by blood, marriage, or adoption, any person who is designated as the attorney in fact or alternate attorney in fact in the instrument, the attending physician of the principal, and the administrator of any nursing home in which the principal is receiving care are ineligible to be witnesses.

The witnessing of a durable power of attorney for health care shall involve the principal signing, or acknowledging the principal's signature, at the end of the instrument in the presence of each witness. Then, each witness shall subscribe the witness's signature after the signature of the principal and, by doing so, attest to the witness's belief that the principal appears to be of sound mind and not under or subject to duress, fraud, or undue influence. The signatures of the principal and the witnesses under this division are not required to appear on the same page of the instrument.

(C) If acknowledged for purposes of division (A)(1)(b) of this section, a durable power of attorney for health care shall be acknowledged before a notary public, who shall make the certification described in section 147.53 of the Revised Code and also shall attest that the principal appears to be of sound mind and not under or subject to duress, fraud, or undue influence.

(D)(1) If a principal has both a valid durable power of attorney for health care and a valid declaration, division (B) of section 2133.03 of the Revised Code applies. If a principal has both a valid durable power of attorney for health care and a DNR identification or DNI identification that is based upon a valid declaration and if the declaration supersedes the durable power of attorney for health care under division (B) of section 2133.03 of the Revised Code, the DNR identification or DNI identification supersedes the durable power of attorney for health care to the extent of any conflict between the two. A valid durable power of attorney for health care supersedes any DNR identification or DNI identification that is based upon a do-not-resuscitate order or a do-not-intubate order that a physician issued for the principal which is inconsistent with the durable power of attorney for health care or a valid decision by the attorney in fact under a durable power of attorney.

(2) As used in division (D) of this section:

(a) "Declaration" has the same meaning as in section 2133.01 of the Revised Code.

(b) "Do-not-intubate order," "Do-not-resuscitate do-not-resuscitate order," "DNI identification," and "DNR identification" have the same meanings as in section 2133.21 of the Revised Code.

(E)(1) In a durable power of attorney for health care, a principal may nominate a guardian of the principal's person, estate, or both for consideration by a court if proceedings for the appointment of a guardian for the principal's person, estate, or both are commenced at a later time. The principal may authorize the person nominated as the guardian or the attorney in fact to nominate a successor guardian for consideration by the court. The principal's nomination of a guardian of the principal's person, estate, or both is revoked by the principal's subsequent nomination of a guardian of the principal's person, estate, or both, and, except for good cause shown or disqualification, the court shall make its appointment in accordance with the principal's most recent nomination.

(2) The principal may direct that bond be waived for a person nominated as guardian or successor guardian under division (E)(1) of this section.

(3) A durable power of attorney for health care that contains the nomination of a person to be the guardian of the person, estate, or both of the principal may be filed with the probate court for safekeeping, and the probate court shall designate the nomination as the nomination of a standby guardian.

(4) If a guardian is appointed for the principal, a durable power of attorney for health care is not terminated, and the authority of the attorney in fact continues unless the court, pursuant to its authority under section 2111.50 of the Revised Code, limits, suspends, or terminates the power of attorney after notice to the attorney in fact and upon a finding that the limitation, suspension, or termination is in the best interest of the principal.

Sec. 2108.23. (A)(1) The bureau of motor vehicles shall develop and maintain a donor registry that identifies each individual who has agreed to make an anatomical gift at the time of application or renewal of a driver's license, identification card, or motor vehicle registration as provided in division (A)(1) or (2) of section 2108.05 of the Revised Code. The registry shall be fully operational not later than July 1, 2002.

(2) The registrar of motor vehicles or a deputy registrar shall ask whether each of the following wishes to certify the applicant's willingness to become a donor:

(a) A person applying for or renewing a driver's license;

(b) A person applying for or renewing an identification card;

(c) A person applying for or renewing a motor vehicle registration.

(3) The registrar or deputy registrar shall provide to any applicant who wishes to certify the applicant's willingness to become a donor the form set forth in division (C)(2)(B)(2) of section 2133.07 of the Revised Code.

(4) Any person who provides to the bureau the form set forth in division (C)(2)(B)(2) of section 2133.07 of the Revised Code requesting to be included in the donor registry shall be included.

(5) Neither the registrar nor a deputy registrar shall ask a person, who is already included in the donor registry, to be a donor.

(B) The bureau shall maintain the registry in a manner that provides to organ procurement organizations, tissue banks, and eye banks immediate access to the information in the registry twenty-four hours a day and seven days a week.

(C)(1) The registrar of motor vehicles, in consultation with the director of health and the second chance trust fund advisory committee created under section 2108.35 of the Revised Code, shall formulate proposed rules that specify all of the following:

(a) The information to be included in the registry;

(b) A process, in accordance with division (B) of section 2108.06 of the Revised Code, for an individual to revoke the individual's intent to make an anatomical gift and for updating information in the registry;

(c) How the registry will be made available to organ procurement organizations, tissue banks, and eye banks;

(d) Limitations on the use of and access to the registry;

(e) How information on organ, tissue, and eye donation will be developed and disseminated to the public by the bureau and the department of health;

(f) The manner in which a person may request to be included in the registry on a written application for a driver's license, identification card, motor vehicle registration, or the renewal thereof. The manner of the request may include either allowing the requestor to provide the necessary information on the bureau application or redirecting the requestor to another form specific to the registry.

(g) Anything else the registrar considers appropriate.

(2) In adopting the proposed rules under this division, the registrar may consult with any person or entity that expresses an interest in the matters to be dealt with in the rules.

(3) Following formulation of the proposed rules, the registrar shall adopt rules in accordance with Chapter 119. of the Revised Code.

(D) The costs of developing and initially implementing the registry shall be paid from the second chance trust fund created in section 2108.34 of the Revised Code.

Sec. 2108.231. (A) As used in this section:

(1) "Eligible person" means a person who is all of the following:

(a) A resident of this state;

(b) Eligible to make an anatomical gift under division (A) of section 2108.04 of the Revised Code;

(c) Not already included in the donor registry established under section 2108.23 of the Revised Code.

(2) "Issuer" means the chief of the division of wildlife and agents authorized under section 1533.13 of the Revised Code to issue hunting and fishing licenses.

(B)(1) Beginning on August 1, 2025, an issuer shall ask whether an eligible person wishes to certify the person's willingness to become an anatomical gift donor when the person is applying for a hunting or fishing license in person.

(2) If an eligible person indicates to the issuer the person's willingness to become an anatomical gift donor, the issuer shall register the eligible person in the donor registry maintained by the bureau of motor vehicles under section 2108.23 of the Revised Code.

(C) Beginning on August 1, 2025, the chief of the division of wildlife shall provide the form set forth in division (C)(2)(B)(2) of section 2133.07 of the Revised Code to a person applying for a hunting or fishing license by mail. An eligible person who provides the form to the bureau of motor vehicles requesting to be included in the donor registry shall be included.

(D) Beginning on August 1, 2025, the chief shall provide any person applying online for a hunting or fishing license who is willing to become an anatomical gift donor with an electronic hyperlink to the donor registry. An eligible person who registers electronically with the donor registry shall be included in the donor registry.

Sec. 2133.01. Unless the context otherwise requires, as used in sections 2133.01 to 2133.15 of the Revised Code:

(A) "Adult" means an individual who is eighteen years of age or older.

(B) "Attending physician" means the physician to whom a declarant or other patient, or the family of a declarant or other patient, has assigned primary responsibility for the treatment or care of the declarant or other patient, or, if the responsibility has not been assigned, the physician who has accepted that responsibility.

(C) "Comfort care" means any of the following:

(1) Nutrition when administered to diminish the pain or discomfort of a declarant or other patient, but not to postpone the declarant's or other patient's death;

(2) Hydration when administered to diminish the pain or discomfort of a declarant or other patient, but not to postpone the declarant's or other patient's death;

(3) Any other medical or nursing procedure, treatment, intervention, or other measure that is taken to diminish the pain or discomfort of a declarant or other patient, but not to postpone the declarant's or other patient's death.

(D) "Consulting physician" means a physician who, in conjunction with the attending physician of a declarant or other patient, makes one or more determinations that are required to be made by the attending physician, or to be made by the attending physician and one other physician, by an applicable provision of this chapter, to a reasonable degree of medical certainty and in accordance with reasonable medical standards.

(E) "Declarant" means any adult who has executed a declaration in accordance with section 2133.02 of the Revised Code.

(F) "Declaration" means a written document executed in accordance with section 2133.02 of the Revised Code.

(G) "DNI identification," "DNR identification," "do-not-intubate order," and "do-not-resuscitate order" have the same meanings as in section 2133.21 of the Revised Code.

(H) "Durable power of attorney for health care" means a document created pursuant to sections 1337.11 to 1337.17 of the Revised Code.

(H)(I) "Guardian" means a person appointed by a probate court pursuant to Chapter 2111. of the Revised Code to have the care and management of the person of an incompetent.

(I)(J) "Health care facility" means any of the following:

(1) A hospital;

(2) A hospice care program, pediatric respite care program, or other institution that specializes in comfort care of patients in a terminal condition or in a permanently unconscious state;

(3) A nursing home or residential care facility, as defined in section 3721.01 of the Revised Code;

(4) A home health agency and any residential facility where a person is receiving care under the direction of a home health agency;

(5) An intermediate care facility for individuals with intellectual disabilities.

(J)(K) "Health care personnel" means physicians, nurses, physician assistants, emergency medical technicians-basic, emergency medical technicians-intermediate, emergency medical technicians-paramedic, medical technicians, dietitians, other authorized persons acting under the direction of an attending physician, and administrators of health care facilities.

(K)(L) "Home health agency" has the same meaning as in section 3740.01 of the Revised Code.

(L)(M) "Hospice care program" and "pediatric respite care program" have the same meanings as in section 3712.01 of the Revised Code.

(M)(N) "Hospital" has the same meanings as in sections 3701.01, 3727.01, and 5122.01 of the Revised Code.

(N)(O) "Hydration" means fluids that are artificially or technologically administered.

(O)(P) "Incompetent" has the same meaning as in section 2111.01 of the Revised Code.

(P)(Q) "Intermediate care facility for the individuals with intellectual disabilities" has the same meaning as in section 5124.01 of the Revised Code.

(Q)(R) "Life-sustaining treatment" means any medical procedure, treatment, intervention, or other measure that, when administered to a qualified patient or other patient, will serve principally to prolong the process of dying.

(R)(S) "Nurse" means a person who is licensed to practice nursing as a registered nurse or to practice practical nursing as a licensed practical nurse pursuant to Chapter 4723. of the Revised Code.

(S)(T) "Nursing home" has the same meaning as in section 3721.01 of the Revised Code.

(T)(U) "Nutrition" means sustenance that is artificially or technologically administered.

(U)(V) "Permanently unconscious state" means a state of permanent unconsciousness in a declarant or other patient that, to a reasonable degree of medical certainty as determined in accordance with reasonable medical standards by the declarant's or other patient's attending physician and one other physician who has examined the declarant or other patient, is characterized by both of the following:

(1) Irreversible unawareness of one's being and environment.

(2) Total loss of cerebral cortical functioning, resulting in the declarant or other patient having no capacity to experience pain or suffering.

(V)(W) "Person" has the same meaning as in section 1.59 of the Revised Code and additionally includes political subdivisions and governmental agencies, boards, commissions, departments, institutions, offices, and other instrumentalities.

(W)(X) "Physician" means a person who is authorized under Chapter 4731. of the Revised Code to practice medicine and surgery or osteopathic medicine and surgery.

(X)(Y) "Political subdivision" and "state" have the same meanings as in section 2744.01 of the Revised Code.

(Y)(Z) "Professional disciplinary action" means action taken by the board or other entity that regulates the professional conduct of health care personnel, including the state medical board and the board of nursing.

(Z)(AA) "Qualified patient" means an adult who has executed a declaration and has been determined to be in a terminal condition or in a permanently unconscious state.

(AA)(BB) "Terminal condition" means an irreversible, incurable, and untreatable condition caused by disease, illness, or injury from which, to a reasonable degree of medical certainty as determined in accordance with reasonable medical standards by a declarant's or other patient's attending physician and one other physician who has examined the declarant or other patient, both of the following apply:

(1) There can be no recovery.

(2) Death is likely to occur within a relatively short time if life-sustaining treatment is not administered.

(BB)(CC) "Tort action" means a civil action for damages for injury, death, or loss to person or property, other than a civil action for damages for breach of a contract or another agreement between persons.

Sec. 2133.03. (A)(1) A declaration becomes operative when it is communicated to the attending physician of the declarant, the attending physician and one other physician who examines the declarant determine that the declarant is in a terminal condition or in a permanently unconscious state, whichever is addressed in the declaration, the applicable requirements of divisions (A)(2) and (3) of this section are satisfied, and the attending physician determines that the declarant no longer is able to make informed decisions regarding the administration of life-sustaining treatment. When the declaration becomes operative, the attending physician and health care facilities shall act in accordance with its provisions or comply with the provisions of section 2133.10 of the Revised Code.

(2) In order for a declaration to become operative in connection with a declarant who is in a permanently unconscious state, the consulting physician associated with the determination that the declarant is in the permanently unconscious state shall be a physician who, by virtue of advanced education or training, of a practice limited to particular diseases, illnesses, injuries, therapies, or branches of medicine or surgery or osteopathic medicine and surgery, of certification as a specialist in a particular branch of medicine or surgery or osteopathic medicine and surgery, or of experience acquired in the practice of medicine or surgery or osteopathic medicine and surgery, is qualified to determine whether the declarant is in a permanently unconscious state.

(3) In order for a declaration to become operative in connection with a declarant who is in a terminal condition or in a permanently unconscious state, the attending physician of the declarant shall determine, in good faith, to a reasonable degree of medical certainty, and in accordance with reasonable medical standards, that there is no reasonable possibility that the declarant will regain the capacity to make informed decisions regarding the administration of life-sustaining treatment.

(B)(1)(a) A declaration supersedes any general consent to treatment form signed by or on behalf of the declarant prior to, upon, or after the declarant's admission to a health care facility to the extent there is a conflict between the declaration and the form, even if the form is signed after the execution of the declaration. To the extent that the provisions of a declaration and a general consent to treatment form do not conflict, both documents shall govern the use or continuation, or the withholding or withdrawal, of life-sustaining treatment and other medical or nursing procedures, treatments, interventions, or other measures in connection with the declarant. Division (B)(1)(a) of this section does not apply if a declaration is revoked pursuant to section 2133.04 of the Revised Code after the signing of a general consent to treatment form.

(b) A declaration supersedes a DNI identification or DNR identification, as defined in section 2133.21 of the Revised Code, of the declarant that is based upon a prior, inconsistent declaration of the declarant or that is based upon a do-not-intubate order or a do-not-resuscitate order, as defined in section 2133.21 of the Revised Code, that a physician has issued for the declarant and that is inconsistent with the declaration.

(2) If a declarant has both a valid durable power of attorney for health care and a valid declaration, the declaration supersedes the durable power of attorney for health care to the extent that the provisions of the documents would conflict if the declarant should be in a terminal condition or in a permanently unconscious state. Division (B)(2) of this section does not apply if the declarant revokes the declaration pursuant to section 2133.04 of the Revised Code.

Sec. 2133.07. (A) As used in this section, "DNR identification" has the same meaning as in section 2133.21 of the Revised Code.

(B) A printed form of a declaration may be sold or otherwise distributed in this state for use by adults who are not advised by an attorney. By use of a printed form of that nature, a declarant may authorize the use or continuation, or the withholding or withdrawal, of life-sustaining treatment should the declarant be in a terminal condition, a permanently unconscious state, or either a terminal condition or a permanently unconscious state, may authorize the withholding or withdrawal of nutrition or hydration should the declarant be in a permanently unconscious state as described in division (A)(3)(a) of section 2133.02 of the Revised Code, and may designate one or more persons who are to be notified by the declarant's attending physician at any time that life-sustaining treatment would be withheld or withdrawn pursuant to the declaration. The printed form shall not be used as an instrument for granting any other type of authority or for making any other type of designation, except that the printed form may be used as a DNI identification or DNR identification if the declarant specifies on the form that the declarant wishes to use it as a DNI identification or DNR identification.

(C)(1)(B)(1) A printed form of a declaration under division (B)(A) of this section shall include, as a separate page or as a portion of a page that can be detached from the declaration, a donor registry enrollment form that permits the donor to be included in the donor registry created under section 2108.23 of the Revised Code.

(2) The donor registry enrollment form may be in any form that complies with the requirements of division (B) of section 2108.05 of the Revised Code. On completion, the form shall be forwarded to the bureau of motor vehicles.

Sec. 2133.151. Any do-not-resuscitate order that is executed not later than twelve months after the effective date of this section in accordance with former Chapter 2133. of the Revised Code as that chapter existed prior to the effective date of this section is valid until revoked by the individual.

Sec. 2133.21. As used in sections 2133.21 to 2133.26 of the Revised Code, unless the context clearly requires otherwise:

(A) "Attending physician" means the physician to whom a person, or the family of a person, has assigned primary responsibility for the treatment or care of the person or, if the person or the person's family has not assigned that responsibility, the physician who has accepted that responsibility.

(B) "CPR" means cardiopulmonary resuscitation or a component of cardiopulmonary resuscitation, but it does not include clearing a person's airway for a purpose other than as a component of CPR.

(C) "Declaration," "health care facility," "life-sustaining treatment," "physician," "professional disciplinary action," and "tort action" have the same meanings as in section 2133.01 of the Revised Code.

(C)(D) "DNI identification" means a standardized identification card, form, necklace, or bracelet that is of uniform size and design, that has been approved by the department of health pursuant to section 2133.25 of the Revised Code, and that signifies either of the following:

(1) That the person who is named on and possesses the card, form, necklace, or bracelet has executed a declaration that authorizes the withholding or withdrawal of intubation and that has not been revoked pursuant to section 2133.04 of the Revised Code;

(2) That the attending physician of the person who is named on and possesses the card, form, necklace, or bracelet has issued a current do-not-intubate order, in accordance with the do-not-intubate protocol adopted by the department of health pursuant to section 2133.25 of the Revised Code, for that person and has documented the grounds for the order in that person's medical record.

(E) "DNR identification" means a standardized identification card, form, necklace, or bracelet that is of uniform size and design, that has been approved by the department of health pursuant to section 2133.25 of the Revised Code, and that signifies either of the following:

(1) That the person who is named on and possesses the card, form, necklace, or bracelet has executed a declaration that authorizes the withholding or withdrawal of CPR and that has not been revoked pursuant to section 2133.04 of the Revised Code;

(2) That the attending physician of the person who is named on and possesses the card, form, necklace, or bracelet has issued a current do-not-resuscitate order, in accordance with the do-not-resuscitate protocol adopted by the department of health pursuant to section 2133.25 of the Revised Code, for that person and has documented the grounds for the order in that person's medical record.

(D)(F) "Do-not-intubate order" means a directive issued by a physician that identifies a person and specifies that the person so identified should not be intubated.

(G) "Do-not-intubate protocol" means the standardized method of procedure for the withholding of intubation by physicians, emergency medical service personnel, and health care facilities that is adopted in the rules of the department of health pursuant to section 2133.25 of the Revised Code.

(H) "Do-not-resuscitate order" means a directive issued by a physician that identifies a person and specifies that CPR should not be administered to the person so identified.

(E) (I) "Do-not-resuscitate protocol" means the standardized method of procedure for the withholding of CPR by physicians, emergency medical service personnel, and health care facilities that is adopted in the rules of the department of health pursuant to section 2133.25 of the Revised Code.

(F)(J) "Emergency medical services personnel" means paid or volunteer firefighters, law enforcement officers, first responders, emergency medical technicians-basic, emergency medical technicians-intermediate, emergency medical technicians-paramedic, medical technicians, or other emergency services personnel acting within the ordinary course of their profession.

(G) "CPR" means cardiopulmonary resuscitation or a component of cardiopulmonary resuscitation, but it does not include clearing a person's airway for a purpose other than as a component of CPR.(K) "Intubate" or "intubation" means the medical procedure of inserting a tube into a person's trachea to maintain an open airway and facilitate breathing. It also includes the use of a supraglottic airway device.

Sec. 2133.22. (A)(1) None of the following are subject to criminal prosecution, to liability in damages in a tort or other civil action for injury, death, or loss to person or property, or to professional disciplinary action arising out of or relating to the withholding or withdrawal of intubation or the withholding or withdrawal of CPR from a person after DNI identification or DNR identification, as applicable, is discovered in the person's possession and reasonable efforts have been made to determine that the person in possession of the DNR identification is the person named on the DNR identification:

(a) A physician who causes the withholding or withdrawal of CPR or the withholding or withdrawal of intubation from the person possessing the DNR or DNI identification, as applicable;

(b) A person who participates under the direction of or with the authorization of a physician in the withholding or withdrawal of CPR or the withholding or withdrawal of intubation from the person possessing the DNR or DNI identification, as applicable;

(c) Any emergency medical services personnel who cause or participate in the withholding or withdrawal of CPR or the withholding or withdrawal of intubation from the person possessing the DNR or DNI identification, as applicable.

(2) None of the following are subject to criminal prosecution, to liability in damages in a tort or other civil action for injury, death, or loss to person or property, or to professional disciplinary action arising out of or relating to the withholding or withdrawal of CPR or the withholding or withdrawal of intubation from a person in a health care facility after DNR or DNI identification, as applicable, is discovered in the person's possession and reasonable efforts have been made to determine that the person in possession of the DNR identification is the person named on the DNR identification, or a do-not-intubate order or do-not-resuscitate order is issued for the person:

(a) The health care facility or the administrator of the health care facility;

(b) A physician who causes the withholding or withdrawal of CPR or the withholding or withdrawal of intubation from the person possessing the DNR identification or DNI identification, as applicable, or for whom the do-not-resuscitate order or do-not-intubate order has been issued;

(c) Any person who works for the health care facility as an employee, contractor, or volunteer and who participates under the direction of or with the authorization of a physician in the withholding or withdrawal of CPR or in the withholding or withdrawal of intubation from the person possessing the DNR or DNI identification, as applicable;

(d) Any person who works for the health care facility as an employee, contractor, or volunteer and who participates under the direction of or with the authorization of a physician in the withholding or withdrawal of CPR or in the withholding or withdrawal of intubation from the person for whom the do-not-resuscitate order or do-not-intubate order has been issued.

(3) If, after DNR identification or DNI identification is discovered in the possession of a person, the person makes an oral or written request to receive CPR or intubation, as applicable, any person who provides CPR or intubation pursuant to the request, any health care facility in which CPR or intubation is provided, and the administrator of any health care facility in which CPR or intubation is provided are not subject to criminal prosecution as a result of the provision of the CPR or intubation, are not liable in damages in a tort or other civil action for injury, death, or loss to person or property that arises out of or is related to the provision of the CPR or intubation, and are not subject to professional disciplinary action as a result of the provision of the CPR or intubation.

(B) Divisions (A)(1), (A)(2), and (C) of this section do not apply when either:

(1) CPR is withheld or withdrawn from a person who possesses DNR identification or for whom a do-not-resuscitate order has been issued unless the withholding or withdrawal is in accordance with the do-not-resuscitate protocol.

(2) Intubation is withheld or withdrawn from a person who possesses DNI identification or for whom a do-not-intubate order has been issued unless the withholding or withdrawal is in accordance with the do-not-intubate protocol.

(C) Any emergency medical services personnel who comply with a do-not-resuscitate order or do-not-intubate order issued by a physician and any individuals who work for a health care facility as employees, contractors, or volunteers and who comply with a do-not-resuscitate order or do-not-intubate order issued by a physician are not subject to liability in damages in a civil action for injury, death, or loss to person or property that arises out of or is related to compliance with the order, are not subject to criminal prosecution as a result of compliance with the order, and are not subject to professional disciplinary action as a result of compliance with the order.

In an emergency situation, emergency medical services personnel and emergency department personnel are not required to search a person to determine if the person possesses DNR identification or DNI identification. If a person possesses DNR identification or DNI identification, if emergency medical services personnel or emergency department personnel provide CPR or intubation to the person in an emergency situation, and if, at that time, the personnel do not know and do not have reasonable cause to believe that the person possesses DNR identification or DNI identification, the emergency medical services personnel and emergency department personnel are not subject to criminal prosecution as a result of the provision of the CPR or intubation, are not liable in damages in a tort or other civil action for injury, death, or loss to person or property that arises out of or is related to the provision of the CPR or intubation, and are not subject to professional disciplinary action as a result of the provision of the CPR or intubation.

(D) Nothing in sections 2133.21 to 2133.26 of the Revised Code or , the do-not-resuscitate protocol, or the do-not-intubate protocol grants immunity to a physician for issuing a do-not-resuscitate order or do-not-intubate order that is contrary to reasonable medical standards or that the physician knows or has reason to know is contrary to the wishes of the patient or of a person who is lawfully authorized to make informed medical decisions on the patient's behalf.

Sec. 2133.23. (A) If emergency medical services personnel, other than physicians, are presented with DNI identification or DNR identification possessed by a person or are presented with a written do-not-intubate order or do-not-resuscitate order for a person or if a physician directly issues to emergency medical services personnel, other than physicians, an oral do-not-intubate order or do-not-resuscitate order for a person, the emergency medical services personnel shall comply with the do-not-intubate protocol or do-not-resuscitate protocol for the person. If an oral do-not-intubate order or do-not-resuscitate order is issued by a physician who is not present at the scene, the emergency medical services personnel shall verify the physician's identity.

(B) If a person possesses DNI identification or DNR identification and if the person's attending physician or the health care facility in which the person is located is unwilling or unable to comply with the do-not-intubate protocol or do-not-resuscitate protocol for the person, the attending physician or the health care facility shall not prevent or attempt to prevent, or unreasonably delay or attempt to delay, the transfer of the person to a different physician who will follow the protocol or to a different health care facility in which the protocol will be followed.

(C) If a person who possesses DNI identification or DNR identification or for whom a current do-not-intubate order or do-not-resuscitate order has been issued is being transferred from one health care facility to another, before or at the time of the transfer, the transferring health care facility shall notify the receiving health care facility and the persons transporting the person of the existence of the DNI identification or DNR identification or the order. If a current do-not-intubate order or do-not-resuscitate order was issued orally, it shall be reduced to writing before the time of the transfer. The DNI identification or DNR identification or the order shall accompany the person to the receiving health care facility and shall remain in effect unless it is revoked or unless, in the case of a do-not-intubate order or do-not-resuscitate order, the order no longer is current.

Sec. 2133.24. (A) The death of a person resulting from the withholding or withdrawal of CPR or the withholding or withdrawal of intubation for the person pursuant to the do-not-intubate protocol or do-not-resuscitate protocol and in the circumstances described in section 2133.22 of the Revised Code or in accordance with division (A) of section 2133.23 of the Revised Code does not constitute for any purpose a suicide, aggravated murder, murder, or any other homicide.

(B)(1) If a person possesses DNI identification or DNR identification or if a current do-not-intubate order or do-not-resuscitate order has been issued for a person, the possession or order shall not do either of the following:

(a) Affect in any manner the sale, procurement, issuance, or renewal of a policy of life insurance or annuity, notwithstanding any term of a policy or annuity to the contrary;

(b) Be deemed to modify in any manner or invalidate the terms of any policy of life insurance or annuity that is in effect on the effective date of this section.

(2) Notwithstanding any term of a policy of life insurance or annuity to the contrary, the withholding or withdrawal of CPR or the withholding or withdrawal of intubation, as applicable, from a person who is insured or covered under the policy or annuity and who possesses DNR identification or DNI identification or for whom a current do-not-resuscitate order or do-not-intubate order has been issued, in accordance with sections 2133.21 to 2133.26 of the Revised Code, shall not impair or invalidate any policy of life insurance or annuity.

(3) Notwithstanding any term of a policy or plan to the contrary, neither of the following shall impair or invalidate any policy of health insurance or other health care benefit plan:

(a) The withholding or withdrawal in accordance with sections 2133.21 to 2133.26 of the Revised Code of CPR or intubation from a person who is insured or covered under the policy or plan and who possesses DNR identification or DNI identification or for whom a current do-not-resuscitate order or do-not-intubate order has been issued;

(b) The provision in accordance with sections 2133.21 to 2133.26 of the Revised Code of CPR or intubation, as applicable, to a person of the nature described in division (B)(3)(a) of this section.

(4) No physician, health care facility, other health care provider, person authorized to engage in the business of insurance in this state under Title XXXIX of the Revised Code, health insuring corporation, other health care benefit plan, legal entity that is self-insured and provides benefits to its employees or members, or other person shall require an individual to possess DNI identification or DNR identification, or shall require an individual to revoke or refrain from possessing DNI identification or DNR identification, as a condition of being insured or of receiving health care benefits or services.

(C)(1) Sections 2133.21 to 2133.26 of the Revised Code do not create any presumption concerning the intent of an individual who does not possess DNR identification or DNI identification with respect to the use, withholding, or withdrawal of CPR or intubation.

(2) Sections 2133.21 to 2133.26 of the Revised Code do not affect the right of a person to make informed decisions regarding the use, withholding, or withdrawal of CPR or intubation, as applicable, for the person as long as the person is able to make those decisions.

(3) Sections 2133.21 to 2133.26 of the Revised Code are in addition to and independent of, and do not limit, impair, or supersede, any right or responsibility that a person has to effect the withholding or withdrawal of life-sustaining treatment to another pursuant to sections 2133.01 to 2133.15 of the Revised Code or in any other lawful manner.

(D) Nothing in sections 2133.21 to 2133.26 of the Revised Code condones, authorizes, or approves of mercy killing, assisted suicide, or euthanasia.

Sec. 2133.25. (A) The department of health, by rule adopted pursuant to Chapter 119. of the Revised Code, shall adopt a standardized method of procedure for the withholding of CPR and the withholding of intubation by physicians, certified nurse-midwives, clinical nurse specialists, certified nurse practitioners, emergency medical services personnel, and health care facilities in accordance with sections 2133.21 to 2133.26 of the Revised Code. The standardized method methods shall specify criteria for determining when a do-not-intubate order or do-not-resuscitate order is current. The standardized method methods so adopted shall be the "do-not-intubate protocol" and the "do-not-resuscitate protocol" for purposes of sections 2133.21 to 2133.26 of the Revised Code. The department also shall approve one or more standard forms of DNI identification and DNR identification to be used throughout this state.

(B) The department of health shall adopt rules in accordance with Chapter 119. of the Revised Code for the administration of sections 2133.21 to 2133.26 of the Revised Code.

(C) The department of health shall appoint an advisory committee to advise the department in the development of rules under this section. The advisory committee shall include, but shall not be limited to, representatives of each of the following organizations:

(1) The Ohio hospital association;

(2) The Ohio state medical association;

(3) The Ohio chapter of the American college of emergency physicians;

(4) The Ohio hospice organization;

(5) The Ohio council for home care and hospice;

(6) The Ohio health care association;

(7) The Ohio ambulance association;

(8) The Ohio medical directors association;

(9) The Ohio association of emergency medical services;

(10) The bioethics network of Ohio;

(11) The Ohio nurses association;

(12) The Ohio academy of nursing homes;

(13) The Ohio association of professional firefighters;

(14) The department of developmental disabilities;

(15) The Ohio osteopathic association;

(16) The association of Ohio philanthropic homes and housing services for the aging;

(17) The catholic conference of Ohio;

(18) The department of aging;

(19) The department of mental health and addiction servicesbehavioral health;

(20) The Ohio private residential association;

(21) The northern Ohio fire fighters association;

(22) The Ohio association of advanced practice nurses.

Sec. 2133.26. (A)(1) No physician shall purposely prevent or attempt to prevent, or delay or unreasonably attempt to delay, the transfer of a patient in violation of division (B) of section 2133.23 of the Revised Code.

(2) No person shall purposely conceal, cancel, deface, or obliterate the DNI identification or DNR identification of another person without the consent of the other person.

(3) No person shall purposely falsify or forge a revocation of a declaration that is the basis of the DNI identification or DNR identification of another person or purposely falsify or forge an order of a physician that purports to supersede a do-not-intubate order or a do-not-resuscitate order issued for another person.

(4) No person shall purposely falsify or forge the DNI identification or DNR identification of another person with the intent to cause the use, withholding, or withdrawal of CPR or intubation, as applicable, for the other person.

(5) No person who has personal knowledge that another person has revoked a declaration that is the basis of the other person's DNI identification or DNR identification or personal knowledge that a physician has issued an order that supersedes a do-not-intubate order or a do-not-resuscitate order that the physician issued for another person shall purposely conceal or withhold that personal knowledge with the intent to cause the use, withholding, or withdrawal of CPR or intubation, as applicable, for the other person.

(B)(1) Whoever violates division (A)(1) or (5) of this section is guilty of a misdemeanor of the third degree.

(2) Whoever violates division (A)(2), (3), or (4) of this section is guilty of a misdemeanor of the first degree.

Sec. 4765.35. (A) A first responder may perform any of the emergency medical services specified for first responders in rules adopted under section 4765.11 of the Revised Code by the state board of emergency medical, fire, and transportation services. A first responder shall perform the emergency medical services in accordance with this chapter and any rules adopted under it by the board.

(B)(1) Except as provided in division (B)(2) of this section, the emergency medical services provided by a first responder shall be performed only pursuant to one of the following:

(a) The written or verbal authorization of a physician or of the cooperating physician advisory board;

(b) An authorization transmitted through a direct communication device by a physician, physician assistant designated by a physician, or registered nurse designated by a physician;

(c) Any applicable protocols adopted by the emergency medical service organization with which the first responder is affiliated.

(2) Division (B)(1) of this section does not prohibit a first responder from complying with a do-not-intubate order or a do-not-resuscitate order issued by a physician assistant or advanced practice registered nurse pursuant to section 2133.211 of the Revised Code.

Sec. 4765.37. (A) An emergency medical technician-basic may perform any of the emergency medical services specified for EMTs-basic in rules adopted under section 4765.11 of the Revised Code by the state board of emergency medical, fire, and transportation services. An EMT-basic shall perform the emergency medical services in accordance with this chapter and any rules adopted under it by the board.

(B)(1) Except as provided in division (B)(2) of this section, the emergency medical services provided by an EMT-basic shall be performed only pursuant to one of the following:

(a) The written or verbal authorization of a physician or of the cooperating physician advisory board;

(b) An authorization transmitted through a direct communication device by a physician, physician assistant designated by a physician, or registered nurse designated by a physician;

(c) Any applicable protocols adopted by the emergency medical service organization with which the EMT-basic is affiliated.

(2) Division (B)(1) of this section does not prohibit an EMT-basic from complying with a do-not-intubate order or a do-not-resuscitate order issued by a physician assistant or advanced practice registered nurse pursuant to section 2133.211 of the Revised Code.

Sec. 4765.38. (A) An emergency medical technician-intermediate may perform any of the emergency medical services specified for EMTs-I in rules adopted under section 4765.11 of the Revised Code by the state board of emergency medical, fire, and transportation services. An EMT-I shall perform emergency medical services in accordance with this chapter and any rules adopted under it by the board.

(B)(1) Except as provided in division (B)(2) of this section, the emergency medical services provided by an EMT-I shall be performed only pursuant to one of the following:

(a) The written or verbal authorization of a physician or of the cooperating physician advisory board;

(b) An authorization transmitted through a direct communication device by a physician, physician assistant designated by a physician, or registered nurse designated by a physician;

(c) Any applicable protocols adopted by the emergency medical service organization with which the EMT-I is affiliated.

(2) Division (B)(1) of this section does not prohibit an EMT-I from complying with a do-not-intubate order or a do-not-resuscitate order issued by a physician assistant or advanced practice registered nurse pursuant to section 2133.211 of the Revised Code.

(C) In addition to, and in the course of, providing emergency medical treatment, an EMT-I may withdraw blood as provided under sections 1547.11, 4506.17, and 4511.19 of the Revised Code. An EMT-I shall withdraw blood in accordance with this chapter and any rules adopted under it by the board.

Sec. 4765.39. (A) An emergency medical technician-paramedic may perform any of the emergency medical services specified for paramedics in rules adopted under section 4765.11 of the Revised Code by the state board of emergency medical, fire, and transportation services. A paramedic shall perform emergency medical services in accordance with this chapter and any rules adopted under it by the state board of emergency medical, fire, and transportation services.

(B)(1) Except as provided in division (B)(2) of this section, the emergency medical services provided by a paramedic shall be performed only pursuant to one of the following:

(a) The written or verbal authorization of a physician or of the cooperating physician advisory board;

(b) An authorization transmitted through a direct communication device by a physician, physician assistant designated by a physician, or registered nurse designated by a physician;

(c) Any applicable protocols adopted by the emergency medical service organization with which the paramedic is affiliated.

(2) Division (B)(1) of this section does not prohibit a paramedic from complying with a do-not-intubate order or a do-not-resuscitate order issued by a physician assistant or advanced practice registered nurse pursuant to section 2133.211 of the Revised Code.

(C) In addition to, and in the course of, providing emergency medical treatment, a paramedic may withdraw blood as provided under sections 1547.11, 4506.17, and 4511.19 of the Revised Code. A paramedic shall withdraw blood in accordance with this chapter and any rules adopted under it by the board.

Section 2. That existing sections 1337.12, 2108.23, 2108.231, 2133.01, 2133.03, 2133.07, 2133.21, 2133.22, 2133.23, 2133.24, 2133.25, 2133.26, 4765.35, 4765.37, 4765.38, and 4765.39 of the Revised Code are hereby repealed.