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A BILL FOR A LAW TO PROVIDE FOR HEALTH CARE DIRECTIVES; AND FOR INCIDENTAL AND CONNETED PURPOSES Introduced PUBLISHING DETAILS Sponsoring Ministry\/Portfolio: Ministry of Health, Environment, Culture and Housing Health Care Decisions Bill, 2019 Objects and Reasons Introduced Memorandum of OBJECTS AND REASONS This Bill provides for the use of Health Care Directives. The Bill contains 7 Parts and 53 clauses. Clause 1 provides for the short title of the Bill. Clause 2 provides for the interpretation section and outlines the definitions of the terms and expressions used throughout the Bill. Clause 3 provides that the giving or receiving of palliative care shall not be affected. Clause 4 expressly provides that euthanasia and assisted suicide are not authorized. It further states that it does not affect the operation of Part VI of the Penal Code except as provided in clauses 37 and 41 of the Bill. Part 2 outlines the principles that are to be applied in relation to making of decisions and orders in respect of health care directives. Clause 5 provides that the principles only apply as far as they are practicable. Clause 6 provides that decisions must be made based in the best interests of the person except where a directive, proxy or order states otherwise. Clause 7 lists the eight principles which must guide the making of a directive, inter alia, that the directive-maker is a mentally competent adult, that the wishes of the directive-maker must be respected and are paramount and any directive must be validly made. Clause 8 provides for the principles which govern the operation of proxies which, inter alia, include that the views of the proxy, in the absence of specific instructions, must be consistent with what would be the views of the directivemaker. Part 3 sets out the formalities for the making of an advance health care directive. Objects and Reasons Health Care Decisions Bill, 2019 Introduced Clause 9 provides for the validity of a directive where the directive complies with the provisions of the Part and has not been revoked. Clause 10 outlines the capacity required to make a directive. A person must be an adult, who is mentally competent and that person need not be terminally ill or undergoing any health care. Clause 11 provides for the form of the directive which is found in the Schedule to the Bill. Clause 12 sets out the duties of the witnessing doctor. Clause 13 states that, in the absence of evidence to the contrary, there must be a presumption of validity in relation to any directives. Clause 14 provides that a directive or parts thereof may be ineffective where it purports to do something unlawful, in breach of a professional standard or code of conduct or anything else prescribed by regulations. Clause 15 provides that a directive may only operate where the directive-maker has become mentally incompetent. A directive shall cease to operate where it has been expressly revoked, expires or the directive-maker has died. Clause 16 provides that a directive will prevail over a power of attorney or the wishes of the directive-maker\u2019s nearest relative. Clause 17 provides for the revocation of a directive in writing. Clause 18 provides for the making of a temporary order to effect a revocation by an Ethics Committee. Clause 19 creates an offence for contravening a temporary order made by an Ethics Committee. Clause 20 provides for a revocation order by the Ethics Committee where the directive-maker did not have an opportunity to make a revocation in writing but had expressed that wish orally. Health Care Decisions Bill, 2019 Objects and Reasons Introduced Clause 21 sets out the grounds on which an Ethics Committee may make a revocation order. Clause 22 provides how a directive is to be acted on generally stipulating that it must be complied with as far as is practicable except in relation to barred provisions. Clause 23 provides for the exceptions to acting on a directive such as where it is believed that the directive-maker did not intend the consequences or had subsequently altered the directive-makers wishes. Clause 24 states that a directive acts as consent to health care. Clause 25 provides that a directive-maker may withdraw consent to health care despite the directive. Clause 26 provides for the seeking of a second opinion where a directive-maker\u2019s nearest relative or proxy disagrees with the health care being provided. It also provides for a directive-maker\u2019s nearest relative or proxy to ask the Ethics Committee to make a decision where there is a disagreement. Clause 27 creates the offence of knowingly making a false or misleading statement in relation to a directive or the making of a directive. Part 4 deals with the appointment, functions and other matters in relation to a proxy. Clause 28 sets out the persons who may be appointed as a proxy by a directive maker. A proxy must be a mentally competent adult. Clause 29 provides for the functions of a proxy being primarily to make decisions in relation to the directive-maker\u2019s health care. Clause 30 states that a proxy can only exercise the functions under section 29 if the proxy remains eligible to be a proxy and is not otherwise prevented by any other law. Clause 31 sets out the criteria for the exercise of the proxy functions. These include, inter alia, giving effect to the directive-makers wishes, ascertaining what Objects and Reasons Health Care Decisions Bill, 2019 Introduced the directive-maker\u2019s wishes would have been and to act expeditiously and in good faith. Clause 32 provides for the issuing of a notice of a proxy decision by a proxy to any other proxies and the nearest relative. Clause 33 provides for a duty of confidentiality to apply to a proxy. Clause 34 provides for the renouncement of a proxy appointment. Clause 35 provides for the effect of a proxy\u2019s death or renouncement in relation to a directive-maker and the directive. Part 5 sets out the protections that apply to a proxy and a registered practitioner operating under a directive. Clause 36 provides for immunity, where a doctor acts in good faith and without negligence, for a decision made in relation to the validity of a directive; whether the directive has been revoked or was intended to be revoked and the competency of a directive-maker. Clause 37 provides for immunity, where a doctor, registered practitioner or proxy acts in good faith and without negligence and in compliance or purported compliance of a directive. Clause 38 provides that a registered practitioner shall not be required to provide any particular type of health care other than the denial of that health care. Clause 39 provides for immunity where a registered practitioner or proxy acting in good faith communicates a revocation wish to an Ethics Committee. Clause 40 provides for immunity where a proxy makes a proxy decision in contravention of section 32 if the decision is made in good faith. Clause 41 provides for brainstem death cases. Part 6 provides for the establishment and operation of Ethics Committees. Health Care Decisions Bill, 2019 Objects and Reasons Introduced Clause 42 makes it mandatory for each hospital to have an Ethics Committee or to designate an Ethics Committee if they are unable to establish a committee of its own. Clause 43 outlines the composition of an Ethics Committee. Each committee must have two doctors, a social worker, an attorney-at-law or ethicist, a mental health practitioner, a registered nurse, a lay person and a religious person. Clause 44 provides that the Committee may regulate its own procedure. Clause 45 stipulates that decisions of the committee must be done with procedural fairness. Clause 46 provides that the form of a decision must be by order and that notice of the decision must be given to all interested persons. Clause 47 provides for the right of appeal of an order of the committee to the Court. Clause 48 provides for the hearing of an appeal and the decisions which may be made on appeal. Part 7 sets out miscellaneous matters. Clause 49 provides for the Grand Court\u2019s general jurisdiction in relation to this Law. Clause 50 provides for the recognition of similar directives from certain jurisdictions namely the United Kingdom, Australia, Canada, South Africa, New Zealand, Jamaica and the United States of America, among others. Clause 51 provides that if a provision of the legislation imposes an obligation but does not state that a contravention of the obligation is an offence, a person who contravenes the obligation can still be civilly liable for the contravention if any such liability exists outside this Law. Clause 52 provides that Cabinet to amend the Schedule by Order. Clause 53 gives Cabinet regulation making powers. Objects and Reasons Health Care Decisions Bill, 2019 Introduced The Schedule sets out the form a directive should take. Health Care Decisions Bill, 2019 Arrangement of Clauses Introduced HEALTH CARE DECISIONS BILL, 2019 Arrangement of Clauses Clause PART 1 - PRELIMINARY 1. 2. 3.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_4\", \"num\": \"4.\", \"text\": \"PART 2 - PRINCIPLES OF ADVANCE HEALTH CARE DIRECTIVES 5. 6. 7.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_8\", \"num\": \"8.\", \"text\": \"PART 3 - ADVANCE HEALTH CARE DIRECTIVES\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_9\", \"num\": \"9.\", \"text\": \"Arrangement of Clauses Health Care Decisions Bill, 2019 Introduced PART 4 \u2013 HEALTH CARE PROXY PART 5 - PROTECTIONS FOR PROXY AND REGISTERED PRACTITIONERS 38. Registered practitioners not compellable to provide positive health care ... 34 Health Care Decisions Bill, 2019 Arrangement of Clauses Introduced PART 6 - ETHICS COMMITTEES PART 7 - MISCELLANEOUS SCHEDULE Health Care Decisions Bill, 2019 Clause 1 Introduced HEALTH CARE DECISIONS BILL, 2019 A BILL FOR A LAW TO PROVIDE FOR HEALTH CARE DIRECTIVES; AND FOR INCIDENTAL AND CONNETED PURPOSES ENACTED by the Legislature of the Cayman Islands. PART 1 - PRELIMINARY\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_1\", \"num\": \"1.\", \"text\": \"Short title 1. This Law may be cited as the Health Care Decisions Law, 2019.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_2\", \"num\": \"2.\", \"text\": \"Interpretation 2. In this Law \u2014 \u201cacting\u201d, on a directive, means \u2014 (a) for a registered practitioner, to provide health care, in a way wished for under the directive, including, for example, a wish to be denied particular health care or any health care (except under a barred provision); or (b) for a proxy, to make a proxy decision that the directive-maker is to be provided health care in a way wished for under the directive, including, for example, a wish to be denied particular health care or any health care (except under a barred provision); Clause 2 Health Care Decisions Bill, 2019 Introduced \u201cadvance health care directive\u201d means a document made by a person expressing that person\u2019s health care wishes in the event that that person becomes mentally incompetent, including, for example, that that person \u2014 (a) wishes to be denied life-sustaining measures if that person becomes terminally ill; or (b) does not wish to undergo another stated type of health care; \u201cadvance health care directive principles\u201d means the principles for applying and making decisions and orders under this Law; \u201cappeal\u201d means an appeal under section 47; \u201cattorney\u201d means the grantee of a power of attorney given under the Powers of Attorney Law (1996 Revision); \u201cbarred provision\u201d means a provision of a directive that is ineffective pursuant to section 14; \u201cbest interest\u201d, of a directive-maker, means the directive-maker\u2019s proper health care and the protection of the directive-maker\u2019s health interests, having regard to \u2014 (a) the relevant guidelines of the General Medical Council of the United Kingdom; and (b) the Code of Ethics and Standards of Practice under section 35 of the Health Practice Law (2017 Revision); \u201cbrainstem death\u201d means an irreversible loss of the capacity of consciousness combined with the irreversible loss of all brainstem functions, including the capacity to breathe; \u201ccivilly liable\u201d includes \u2014 (a) liability for professional misconduct; and (b) susceptibility to sanction or other adverse action for contravening a code of professional ethics or a departure from an accepted form of professional conduct; \u201cCourt\u201d means the Grand Court; \u201cdeny\u201d, in relation to health care to a person, means to withdraw or withhold health care (including life-sustaining measures) from that person; \u201cdeath\u201d includes brainstem death and when there is an irreversible cessation of circulation of blood in a person\u2019s body; Health Care Decisions Bill, 2019 Clause 2 Introduced \u201cdirective\u201d means \u2014 (a) an advance health care directive generally; and (b) for a provision of this Law about a particular proxy, the directive under which the proxy was appointed; \u201cdirective-maker\u201d means \u2014 (a) a person who makes a directive pursuant to this Law; and (b) for a provision of this Law about a particular proxy, the directivemaker who appointed the proxy; \u201cdoctor\u201d means an individual registered as a medical doctor under Schedule 4 of the Health Practice Law (2017 Revision); \u201cEthics Committee\u201d, of a hospital, means that hospital\u2019s Ethics Committee established or designated under section 42; \u201cfunction\u201d includes a duty, power or responsibility; \u201chealth care\u201d means a registered practitioner doing either or both of the following \u2014 (a) providing a measure, procedure, service, or medical treatment to diagnose, maintain or treat a physical or mental condition of a person; or (b) withdrawing or withholding a matter mentioned in paragraph (a) (including withdrawing or withholding life-sustaining measures); \u201cinterested person\u201d means \u2014 (a) a directive-maker, to the extent that the directive-maker is able to express the directive-maker\u2019s wishes; (b) a proxy of the directive-maker; (c) a registered practitioner providing, or proposing to provide, health care to the directive-maker; (d) the directive-maker\u2019s nearest relative; or (e) any person who satisfies the Ethics Committee that that person has a proper interest in the issue; \u201clife-sustaining measures\u201d means health care intended to sustain or prolong life and that supplants or maintains the operation of vital bodily functions that are temporarily or permanently incapable of independent operation, including \u2014 (a) cardiopulmonary resuscitation; (b) assisted ventilation; or Clause 2 Health Care Decisions Bill, 2019 Introduced (c) artificial nutrition and hydration, but does not include a blood transfusion; \u201cmedical treatment\u201d means the provision by a doctor of physical, surgical or psychological therapy, including, for example, a doctor \u2014 (a) providing therapy to prevent disease, restore or replace bodily function in the face of disease or injury or to improve comfort and quality of life; and (b) prescribing or supplying medication; \u201cmentally competent\u201d, in relation to a person, at a particular time, means that that person is conscious and, during the course of making that person\u2019s decisions, has the faculties to be able to \u2014 (a) understand, retain and use relevant information being any information needed to make the decision and to understand its consequences, except for technical or trivial information; (b) understand the nature and effect of the decision; and (c) communicate the decision in some way; \u201cmentally incompetent\u201d, in relation to a person, at a particular time, means that that person is unable to make a decision as that person does not possess the faculties to be able to \u2014 (a) understand, retain and use relevant information being any information needed to make the decision and to understand its consequences, except for technical or trivial information; (b) understand the nature and effect of the decision; and (c) communicate the decision in some way; \u201cnearest relative\u201d, of a directive-maker, means the person most closely connected to the directive-maker, using the following order of relationships with the directive-maker, and, if there is more than one of any type, priority shall be given to the most senior in age of that type \u2014 (a) spouse; (b) children; (c) parents; (d) siblings; (e) grandparents; (f) grandchildren; Health Care Decisions Bill, 2019 Clause 2 Introduced (g) uncle or aunt; (h) nephew or niece; (i) cousin; (j) close friend; (k) the mental health professional treating the directive-maker; (l) a social worker or probation officer employed in that capacity in Government or a statutory body; or (m) attorney; \u201cnegligence\u201d includes not having regard, or sufficient regard, in the circumstances to the relevant provisions of this Law; \u201cnotice\u201d means a notice in writing; \u201cproxy\u201d means a person appointed by a directive-maker to make decisions about that directive-maker\u2019s health care; \u201cproxy decision\u201d means a decision made by a proxy in relation to a directive-maker\u2019s health care; \u201creasonably practicable\u201d means reasonably practicable in all the circumstances; \u201cregistered practitioner\u201d means an individual registered under the Health Practice Law (2017 Revision) to practice a profession mentioned in Schedules 4 to 7 of that Law; \u201crevocation wish\u201d means a wish expressed by the directive-maker to revoke the directive at any time while the directive-maker was or is mentally competent; \u201cspouse\u201d, of a directive-maker, means a person who is a legal resident and who is \u2014 (a) the legal husband or wife of that person; or (b) a person of the opposite sex who, although not legally married to that person, lives with that person in the same household under the same domestic arrangements as a legal husband or wife and has been so living with that person for a continuous period of five years, and any reference in this Law to marriage or to a married person shall be construed, with the necessary changes being made, so as to give effect to paragraph (a) or (b), as the case may be; but where a person is Clause 3 Health Care Decisions Bill, 2019 Introduced judicially or otherwise separated from a legal spouse that person shall not be considered to have any other spouse except that legal spouse; \u201cterminally ill\u201d means having an incurable condition caused by injury or disease from which there is no reasonable prospect of a permanent recovery and for which condition \u2014 (a) death would, within reasonable medical judgment, be imminent regardless of life-sustaining measures; and (b) life-sustaining measures would only serve to postpone death; \u201ctemporary order\u201d means an order under section 18; \u201cwishes\u201d includes directions and instructions and wishes impliedly expressed, but does not include a wish that is a barred provision of a directive or would be a barred provision had the wish been included in a directive; and \u201cwitnessing doctor\u201d means a doctor chosen by a directive-maker to witness the execution of that directive-maker\u2019s directive.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_3\", \"num\": \"3.\", \"text\": \"Palliative care unaffected 3. This Law shall not affect the functions of registered practitioners for the giving of palliative care or a person\u2019s right to receive palliative care. 4. Law shall not authorize euthanasia 4. This Law shall not \u2014 (a) authorize euthanasia or assisted suicide; or (b) affect Part VI of the Penal Code, except as provided for under sections 37 and 41. PART 2 - PRINCIPLES OF ADVANCE HEALTH CARE DIRECTIVES\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_5\", \"num\": \"5.\", \"text\": \"Advance health care directives principles 5. (1) This Part sets out the principles for the application of this Law in relation to making decisions and orders in respect of health care directives. (2) The requirements under the advance health care directive principles only apply so far as it is reasonably practicable. Health Care Decisions Bill, 2019 Clause 6 Introduced\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_6\", \"num\": \"6.\", \"text\": \"Paramount principle: registered practitioners decide best interest 6. The paramount principle shall be that questions of what is in a person\u2019s best interest and what health care that person receives are ultimately up to that person\u2019s registered practitioner or practitioners to decide, except under the following \u2014 (a) the denial of health care, as expressed in an operative directive; (b) a proxy decision to deny health care; and (c) an order under this Law that health care is to be denied or any type of other order that has the same effect.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_7\", \"num\": \"7.\", \"text\": \"Principles for directives 7. The principles in respect of directives are \u2014 (a) this Law recognizes a validly made directive; (b) a mentally competent adult may make a directive and, by directive decide what quality of life that adult wishes should that adult become mentally incompetent; (c) an adult is, in the absence of evidence or a law to the contrary, presumed to be mentally competent to make decisions about that adult\u2019s own health care; (d) an adult is to be \u2014 (i) allowed to decide that adult\u2019s health care to the extent that that adult is able; and (ii) supported in the making of any decisions for as long as reasonably practicable; (e) a mentally competent adult has the right to decide that adult\u2019s health care in any of (or in any combination of) the following ways according to that adult\u2019s background, culture, history, spiritual and religious beliefs \u2014 (i) by making the decision on that adult\u2019s own free will; (ii) by delegating the decision to another person; or (iii) by making the decision collaboratively within that adult\u2019s family or community, or both; (f) if a directive-maker later becomes mentally incompetent, the directive has the same authority as if the directive-maker were mentally competent; Clause 8 Health Care Decisions Bill, 2019 Introduced (g) if a dispute arises, a directive-maker\u2019s wishes are paramount and are to be implemented; and (h) in deciding what a directive-maker\u2019s wishes are, the following may be considered \u2014 (i) past wishes the directive-maker has expressed; (ii) the directive-maker\u2019s values displayed or expressed during the directive maker\u2019s life; and (iii) any other relevant matter. 8. Principles for proxies 8. The principles in respect of a proxy are \u2014 (a) if the directive-maker later becomes mentally incompetent, the proxy has the same authority as the directive-maker as if the directive-maker were mentally competent; and (b) proxy decisions \u2014 (i) are to reflect the decision that the directive-maker would have made in the circumstances; (ii) are, in the absence of specific instructions or expressed views by the directive-maker, to be consistent with what the proxy believes the directive-maker would have decided; and (iii) cannot restrict the directive-maker\u2019s rights and freedoms under the Bill of Rights under Part I of the Constitution, in light of the state of the directive-maker\u2019s health and wishes under the directive. PART 3 - ADVANCE HEALTH CARE DIRECTIVES 9. Validity of directive 9. An advance health care directive shall be valid if it complies with this Part and has not been revoked.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_10\", \"num\": \"10.\", \"text\": \"Capacity to make a directive 10. (1) Any adult who is mentally competent may make a directive, even though that adult is not terminally ill and not undergoing any health care. Health Care Decisions Bill, 2019 Clause 11 Introduced (2) A directive\u2019s validity shall not be affected if the directive-maker later becomes mentally incompetent.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_11\", \"num\": \"11.\", \"text\": \"Form of directive 11. (1) A directive shall be made by \u2014 (a) completion of the relevant parts of the form in the Schedule and following the instructions contained in the form (either by or on behalf of the directive-maker); (b) the directive-maker signing the form personally in the presence of two adult witnesses; and (c) both witnesses signing it. (2) A witness shall not be a person who has been appointed as a proxy under the directive. (3) At least one of the witnesses shall be a doctor witnessing in that capacity after having complied with section 12. (4) The witnessing doctor shall be chosen by the directive-maker. (5) A directive shall have no effect if, when the directive-maker signed the directive, either of the witnesses to the directive knew, or ought reasonably to have known, that that witness was a beneficiary of the directive-maker. (6) Where a witness to a directive, or that witness\u2019 spouse is a beneficiary of any beneficial devise, legacy, estate, interest, gift or appointment of or affecting any real or personal estate (other than and except charges and directions for the payment of any debt or debts), that devise, legacy, estate, interest, gift or appointment shall be null and void. (7) In this section, \u201cbeneficiary\u201d, of a directive-maker, means someone who \u2014 (a) might benefit under the directive-maker\u2019s will or estate in intestacy or an insurance policy under which a life insured is, or includes, the directive-maker; or (b) has an interest granted under an instrument under which the directive-maker is the donor, grantor or settlor.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_12\", \"num\": \"12.\", \"text\": \"Witnessing doctor's duty 12. (1) Before witnessing a directive a witnessing doctor shall take reasonable steps to be satisfied that the directive-maker \u2014 Clause 13 Health Care Decisions Bill, 2019 Introduced (a) is an adult who is mentally competent; (b) is giving the directive voluntarily and without coercion, duress or inducement; and (c) has been told about the directive\u2019s nature and consequences. (2) A doctor responsible for a person\u2019s health care may still witness a directive by that person even though the doctor conscientiously objects to later acting on it. (3) Where a witnessing doctor conscientiously objects to a directive, the witnessing doctor shall take reasonable steps to transfer the directivemaker\u2019s health care to another doctor.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_13\", \"num\": \"13.\", \"text\": \"Presumption of validity and declarations about validity 13. (1) In the absence of evidence to the contrary, a registered practitioner or proxy is entitled to presume that \u2014 (a) a document that purports to be a directive apparently made under this Part is valid; (b) the directive-maker was an adult and mentally competent when the directive was made; and (c) the witnessing doctor complied with section 12(1). (2) A directive is valid even though \u2014 (a) a part of the directive was not completed if the corresponding part in the form states that the part is optional; (b) it does not appoint any proxy; (c) the directive-maker \u2014 (i) was not fully informed of all medical conditions, or other circumstances, to which the directive relates; or (ii) did not seek legal or other professional advice about the directive; (d) the directive has a minor error (including, for example, a misspelling or an obsolete reference) that does not affect a person\u2019s ability to understand the directive-maker\u2019s wishes under the directive; (e) any or all of the following apply for wishes under the directive \u2014 (i) the wish is expressed in informal language rather than medical or technical terminology; Health Care Decisions Bill, 2019 Clause 14 Introduced (ii) the wish is expressed in general terms rather than as specific instructions; (iii) the wish needs to be inferred from their context or from other provisions of the directive; or (iv) the wish is based solely on moral, religious or social grounds; (f) the directive does not contain, or has deleted, a note or checklist in the form in the Schedule; or (g) the directive\u2019s form is different from the form in the Schedule but its effect is the same, or substantially the same, as that under the form, including, because \u2014 (i) of different formatting; or (ii) the directive contains extra material or information consistent with this Law. (3) In the absence of an order under this Law or of evidence of revocation under this Part, a directive is taken to have not been revoked.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_14\", \"num\": \"14.\", \"text\": \"Ineffective directive provisions 14. (1) A provision of a directive wishing for any of the following shall be of no effect and the directive shall be read as if the directive did not so wish \u2014 (a) something unlawful, including, euthanasia or assisted suicide; (b) something that would cause a registered practitioner to contravene a professional standard or code of conduct (however described); (c) a refusal of mental health treatment; or (d) anything else prescribed under Regulations. (2) In this section \u2014 \u201cmental health treatment\u201d means medical treatment under an order under the Mental Health Law, 2013 or detention permitted under that Law; and \u201cprofessional standard or code of conduct\u201d does not include a standard or code of conduct prepared by or on behalf of a hospital, clinic, hospice, nursing home or another place at which health care is provided that regulates the provision of health care or other services at that place. Clause 15 Health Care Decisions Bill, 2019 Introduced\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_15\", \"num\": \"15.\", \"text\": \"Operative directive 15. (1) A directive operates only while the directive-maker is mentally incompetent. (2) A directive shall cease to operate on the occasion of the following \u2014 (a) if the directive is revoked pursuant to this Law; (b) if the directive states an expiry day, on that day; or (c) if the directive-maker dies. (3) A directive that is in operation under subsection (1) is an \u201coperative\u201d directive.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_16\", \"num\": \"16.\", \"text\": \"Directive prevails over attorney and nearest relative 16. While a directive is operative, it prevails over any right of an attorney of the directive-maker or of the directive-maker\u2019s nearest relative.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_17\", \"num\": \"17.\", \"text\": \"Revocation 17. (1) A directive-maker who is mentally competent may revoke the directive in writing and that revocation shall be signed and dated. (2) The writing need not refer to the revoked directive\u2019s date. (3) The directive-maker shall take reasonable steps to tell the following persons about the revocation \u2014 (a) any proxy appointed under the revoked directive; (b) any other person who the directive-maker has given a copy of the directive; and (c) if the witnessing doctor for the directive is on the Islands, the witnessing doctor. (4) A contravention of subsection (3) does not affect the revocation\u2019s validity. (5) The making of a subsequent directive revokes any earlier directive made by the same directive-maker.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_18\", \"num\": \"18.\", \"text\": \"Temporary order 18. (1) A registered practitioner or any other person shall, if \u2014 (a) a directive is operative and the directive-maker is receiving health care at or from a hospital; and Health Care Decisions Bill, 2019 Clause 19 Introduced (b) that registered practitioner or person becomes aware that the directive-maker expressed a wish to revoke the directive at any time while the directive-maker was or is mentally competent, notify the Ethics Committee about the wish to revoke. (2) The Ethics Committee may, on being notified, make any temporary order it thinks fit until it has an opportunity to decide the matter under section 20, including, for example, that no registered practitioner can act on the directive until the decision has been made. (3) The temporary order expires on the making of the decision.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_19\", \"num\": \"19.\", \"text\": \"Offence: contravening temporary order 19. (1) A registered practitioner who, without reasonable excuse, contravenes a temporary order commits an offence and is liable to a fine of twenty thousand dollars or to imprisonment for a term of one year, or both. (2) In a proceeding for an offence against subsection (1), it is a defence for the defendant to prove that the defendant did not know, and could not reasonably have been expected to know, that the defendant\u2019s conduct amounted to the offence.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_20\", \"num\": \"20.\", \"text\": \"Revocation by Ethics Committee because of revocation wish 20. (1) If a hospital\u2019s Ethics Committee is notified of a revocation wish, the Ethics Committee may revoke the relevant directive if the Ethics Committee is satisfied that \u2014 (a) when the wish was expressed, the directive-maker understood the nature and consequences of revoking the directive; (b) the revocation genuinely reflected the directive-maker\u2019s wishes at the time; and (c) the revocation is appropriate in the circumstances. (2) Where a directive expressly provides that it cannot be revoked because of a change in the directive-maker\u2019s wishes, the Ethics Committee may only revoke the directive if the Ethics Committee is satisfied that the directive-maker\u2019s state of mind at the time the revocation wish was made, was a conscious wish to override that provision.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_21\", \"num\": \"21.\", \"text\": \"Revocation by Ethics Committee on request 21. (1) The Ethics Committee may, if \u2014 Clause 22 Health Care Decisions Bill, 2019 Introduced (a) a directive-maker is mentally incompetent and receiving health care at or from a hospital; and (b) a person acting on the directive-makers behalf asks the Ethics Committee to revoke the directive, revoke the directive. (2) The Ethics Committee may only revoke the directive if the Ethics Committee is satisfied that \u2014 (a) acting on the directive would not be in the directive-maker\u2019s best interest; and (b) assuming the following, medical advances since the making of the directive are likely to cause the directive-maker\u2019s health care wishes to be significantly different from those under the directive \u2014 (i) that the directive-maker is mentally competent; and (ii) that the directive-maker had been generally informed of the nature of the medical advances. (3) Revocation under subsection (1) may not depend on a revocation wish. (4) In considering the issue of causation in respect of subsection (2)(b), the Ethics Committee shall take into account any \u2014 (a) express provision in the directive that it cannot be revoked because of a change in the directive-maker\u2019s wishes; (b) wish not to revoke the directive expressed by the directive-maker before the directive-maker\u2019s mental incompetency; and (c) revocation wish by the directive-maker, or a wish by the directivemaker not to revoke.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_22\", \"num\": \"22.\", \"text\": \"How directive is to be acted on generally 22. (1) A registered practitioner who is providing, or is to provide, health care to a directive-maker and that directive-maker has a valid and operative directive shall \u2014 (a) comply with any provision of the directive wishing for the denial of particular health care or of any health care, including, for example, the following words in the directive \u2014 (i) \u201cdo not resuscitate\u201d; or (ii) its acronym \u201cDNR\u201d; Health Care Decisions Bill, 2019 Clause 23 Introduced (b) not comply with any provision of the directive which \u2014 (i) is unlawful, including, euthanasia and assisted suicide; (ii) would cause a registered practitioner to contravene a professional standard or code of conduct (however described); (iii) would be a refusal of mental health treatment; or (iv) is prohibited under this Law or Regulations; and (c) as far as is reasonably practicable \u2014 (i) seek to avoid any outcome or intervention that the directivemaker may have wished to avoid; and (ii) endeavour to comply with the advance health care directive principles. (2) The registered practitioner shall, as far as is reasonably practicable, comply with other provisions of the directive relating to health care of the relevant type.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_23\", \"num\": \"23.\", \"text\": \"Exceptions to acting on directive 23. (1) Notwithstanding section 22, a registered practitioner may refuse to act on a directive if the practitioner \u2014 (a) reasonably believes the directive-maker did not intend the directive to apply in the particular circumstances; or (b) reasonably believes the directive does not reflect the directivemaker\u2019s current wishes and the registered practitioner complies with section 18. (2) A registered practitioner may refuse to comply with a provision of a directive that specifies the type of health care the directive-maker wishes to receive if the provision \u2014 (a) is not consistent with any relevant professional standards; or (b) does not reflect the Islands\u2019 current health care standards. (3) Subsection (2) shall not apply to any provision of the directive, except a barred provision, that wishes for the denial of particular or of any health care. (4) A registered practitioner may refuse to comply with a provision of a directive on conscientious grounds. Clause 24 Health Care Decisions Bill, 2019 Introduced (5) Where a registered practitioner refuses to comply pursuant to subsection (4), the registered practitioner shall take reasonable steps to transfer the directive-maker\u2019s health care to another registered practitioner.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_24\", \"num\": \"24.\", \"text\": \"Directive acts as the directive-maker's consent 24. If a registered practitioner acts or proposes to act on an operative directive \u2014 (a) the directive-maker shall be taken to have consented to the health care provided by so acting, subject to section 25; and (b) that consent has the same effect as if the directive-maker were mentally competent.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_25\", \"num\": \"25.\", \"text\": \"Withdrawal of directive-maker's consent to health care 25. (1) Where \u2014 (a) the directive-maker has expressed, or expresses, a wish to a registered practitioner to withdraw consent to the provision of particular health care, or health care of a particular type, under the directive; and (b) the wish was or is expressed while the directive-maker is mentally competent, the registered practitioner shall treat the consent as withdrawn. (2) Notwithstanding subsection (1), the registered practitioner shall provide the health care if \u2014 (a) the directive expressly provides that the consent cannot be withdrawn because of a change in the directive-maker\u2019s wishes; and (b) the registered practitioner is not satisfied the directive-maker\u2019s current state of mind is a conscious wish to override that provision. (3) Any act or omission that took place before the withdrawal shall be valid if it was done or made in the course of acting on the directive and done or made in good faith and without negligence. Health Care Decisions Bill, 2019 Clause 26 Introduced\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_26\", \"num\": \"26.\", \"text\": \"Second opinion and dispute referral to Ethics Committee 26. (1) The directive-maker\u2019s nearest relative or proxy may, if the directivemaker\u2019s nearest relative or proxy disagrees with the doctor about the health care or proposed health care to be provided to the directivemaker, seek a second opinion from another doctor. (2) The medical director shall, if requested, assist the directive-maker\u2019s nearest relative or proxy to seek an appropriate second medical opinion on the matter from another doctor. (3) Where the directive-maker\u2019s nearest relative or proxy still disagrees with the doctor after obtaining the second opinion, the directivemaker\u2019s nearest relative or proxy may ask the hospital\u2019s Ethics Committee to make a decision on the matter. (4) In this section \u201cmedical director\u201d means \u2014 (a) if the hospital is operated by the Health Services Authority under the Health Services Authority Law (2018 Revision), the Medical Director of  that Authority; or (b) for another hospital, the doctor with similar functions for the hospital as that of the Health Services Authority\u2019s Medical Director.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_27\", \"num\": \"27.\", \"text\": \"Offences concerning directives 27. (1) A person who knowingly makes a false or misleading statement in, or relating to, a directive commits an offence and is liable on summary conviction \u2014 (a) to, if the offence was committed when the person was a proxy appointed under the directive, a fine of twenty thousand dollars or to imprisonment for two years, or both; or (b) to a fine of ten thousand dollars. (2) A person who knowingly makes a false or misleading statement relating to an attempt to make a directive commits an offence and is liable on summary conviction to a fine of ten thousand dollars. Clause 28 Health Care Decisions Bill, 2019 Introduced PART 4 \u2013 HEALTH CARE PROXY\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_28\", \"num\": \"28.\", \"text\": \"Appointment 28. (1) A directive-maker may, in the same directive, appoint one or more persons to be that directive-maker\u2019s health care proxy. (2) The following persons shall not be appointed as a proxy \u2014 (a) a person who is not an adult; (b) a person who is mentally incompetent; (c) a registered practitioner who is responsible, solely or with others, for the directive-maker\u2019s health care; and (d) any other person of a type prescribed under Regulations. (3) A person shall be a proxy only while that person\u2019s appointment is in force under this Part. (4) An appointment of two or more proxies shall be both joint and several. (5) A proxy\u2019s appointment only has force while the directive is operative.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_29\", \"num\": \"29.\", \"text\": \"Functions 29. (1) While a proxy\u2019s appointment is in force, the proxy may make decisions about the directive-maker\u2019s health care as if the directive-maker were mentally competent. (2) The following apply for proxy decisions \u2014 (a) they are exercisable during all periods during which the directivemaker is mentally incompetent, and not otherwise; (b) they are subject to the directive\u2019s provisions; (c) they cannot be made about matters that are not about health care; (d) they prevail over the rights of the directive-maker\u2019s attorney or nearest relative; (e) they cannot refuse palliative care to the directive-maker; and (f) they can only instruct the refusal of artificial nutrition and hydration to the directive-maker if \u2014 (i) the directive-maker is terminally ill; and (ii) the directive provides that the directive-maker does not wish to undergo life-sustaining measures. (3) A proxy decision is of no effect to the extent that it contravenes subsection (2). Health Care Decisions Bill, 2019 Clause 30 Introduced\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_30\", \"num\": \"30.\", \"text\": \"Exercise of functions 30. (1) A proxy can only make a proxy decision if the proxy \u2014 (a) remains eligible for appointment under section 28; and (b) is not prevented under this or another Law from acting under the directive. (2) If a proxy asks a registered practitioner to deny health care and the registered practitioner has not already seen the directive, the registered practitioner shall ask the proxy to produce it before complying with the proxy\u2019s request. (3) The directive may be produced by giving a hard copy of a certified copy of the directive or, under Part II of the Electronic Transactions Law (2003 Revision), sending an electronic record of a certified copy of the directive. (4) Until the directive is so produced, the registered practitioner may continue to provide the directive-maker with the health care that the practitioner would have provided had the directive-maker not made a directive.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_31\", \"num\": \"31.\", \"text\": \"Criteria for exercise of functions 31. In making a proxy decision, a proxy is to \u2014 (a) as far as is reasonably practicable \u2014 (i) give effect to the wishes under the directive; (ii) seek to avoid an outcome or intervention that the directivemaker would have wished to avoid; (iii) to the extent the directive is silent about the directive-maker\u2019s wishes on a matter, find out and have regard to, the directivemaker\u2019s wishes expressed outside the directive while the directive-maker was mentally competent; and (iv) give effect to the advance health care directive principles to the extent the advance health care directive principles are relevant to the decision; (b) give effect to the decision that the proxy considers the directivemaker would have made in the circumstances had the directivemaker been mentally competent at the time; and (c) act expeditiously and in good faith. Clause 32 Health Care Decisions Bill, 2019 Introduced\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_32\", \"num\": \"32.\", \"text\": \"Notice of proxy decision 32. If there are two or more proxies for the same directive-maker and a proxy makes a proxy decision alone, that proxy shall take reasonable steps to give notice of the decision to all of the other proxies and the directive-maker\u2019s nearest relative.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_33\", \"num\": \"33.\", \"text\": \"Proxy's confidentiality duty 33. (1) A proxy shall keep details of the directive-maker\u2019s health care, any advice obtained and the making of proxy decisions confidential. (2) Subsection (1) shall not apply to a disclosure by a proxy \u2014 (a) to a registered practitioner who needs to be told about the decisions; (b) to the directive-maker\u2019s nearest relative; or (c) required by law or under a Court order.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_34\", \"num\": \"34.\", \"text\": \"Renouncement 34. (1) A proxy may renounce that proxy\u2019s appointment by notice \u2014 (a) to the directive-maker; or (b) if the directive-maker is mentally incompetent, to the doctor responsible for treating the directive-maker. (2) Where more than one proxy was appointed the renouncing proxy shall also give the notice to the other proxies.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_35\", \"num\": \"35.\", \"text\": \"Effect of proxy's death or renouncement 35. (1) A proxy\u2019s death or the renouncement of a proxy\u2019s appointment shall not affect \u2014 (a) the directive\u2019s validity; and (b) if there were other proxies for the same directive-maker, the other proxies\u2019 powers. (2) Where, the proxy who died or renounced was the only proxy appointed and the directive-maker is mentally incompetent, the doctor responsible for treating the directive-maker may continue to provide the health care to the directive-maker that the doctor considers is in the directivemaker\u2019s best interest and is consistent with the directive. Health Care Decisions Bill, 2019 Clause 36 Introduced PART 5 - PROTECTIONS FOR PROXY AND REGISTERED PRACTITIONERS\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_36\", \"num\": \"36.\", \"text\": \"Immunity: doctor's decisions 36. (1) Where a doctor makes a decision in respect of \u2014 (a) whether or not an adult is mentally competent or suffering from a terminal illness; (b) whether or not a directive-maker has revoked, or intended to revoke, the directive; or (c) whether or not a directive is valid, if that decision was made in good faith and without negligence that doctor shall not be criminally or civilly liable for making the decision. (2) If the decision was made by an HSA doctor, the decision is taken to have been made in performing the doctor\u2019s functions for that employment and section 54 of the Public Authorities Law, 2017 shall apply. (3) In this section, \u201cHSA doctor\u201d means a doctor employed by the Cayman Islands Health Services Authority established under section 3 of the Health Services Authority Law (2018 Revision). 37'. Immunity: acting on a directive\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_37\", \"num\": \"37.\", \"text\": \"(1) Where acting on an operative directive \u2014 (a) a doctor; (b) another registered practitioner acting on a doctor\u2019s instructions; or (c) a proxy, does an act in good faith, without negligence and in compliance or purported compliance with a directive, that doctor, registered practitioner or proxy shall not be criminally or civilly liable for that act. (2) Subsection (1) includes acting on a revoked directive or a directive that the directive-maker intended to revoke if the doctor, registered practitioner or proxy did not know of the revocation or intended revocation. (3) Subsection (2) shall apply notwithstanding the following sections of the Penal Code (2019 Revision) \u2014 (a) 188(d) (causing death defined); (b) 191 (responsibility of person who has charge of another); and Clause 38 Health Care Decisions Bill, 2019 Introduced (c) 211 (other negligent acts causing harm).\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_38\", \"num\": \"38.\", \"text\": \"Registered practitioners not compellable to provide positive health care 38. (1) A registered practitioner shall not be required to provide any particular type of health care to a person other than the denial of that health care under a directive, order or decision. (2) The directive, order or decision shall be of no effect to the extent that the directive, order or decision contravenes subsection (1). (3) Subsection (2) shall not prevent the directive-maker\u2019s wishes in the directive from being taken into account.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_39\", \"num\": \"39.\", \"text\": \"Immunity: communicating revocation wish 39. A registered practitioner or proxy shall not be criminally or civilly liable for communicating to an Ethics Committee about a revocation wish if that registered practitioner or proxy did so in good faith.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_40\", \"num\": \"40.\", \"text\": \"Immunity: proxy decisions in good faith 40. A proxy shall not be criminally or civilly liable for making a proxy decision in contravention of section 32 if the decision was made in good faith.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_41\", \"num\": \"41.\", \"text\": \"Brainstem death cases 41. (1) If a person has been certified as brainstem dead, a doctor may withdraw all life-sustaining measures from the deceased. (2) In making the certification of brainstem death, due regard shall be given to any relevant codes of practice about the diagnosis and certification of death of the United Kingdom or the Islands. (3) Subsection (1) shall apply notwithstanding any directive of the deceased to the contrary. (4) The withdrawal of life-sustaining measures shall not constitute causation of death under section 188 (causing death defined) of the Penal Code (2019 Revision). Health Care Decisions Bill, 2019 Clause 42 Introduced PART 6 - ETHICS COMMITTEES\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_42\", \"num\": \"42.\", \"text\": \"Requirement for hospitals to have an Ethics Committee 42. (1) Each hospital shall have an Ethics Committee to perform functions under this Law for its patients. (2) A hospital may establish its own Ethics Committee or designate another hospital\u2019s Ethics Committee to be its Ethics Committee. (3) If no Ethics Committee has been designated, the Ethics Committee of the Cayman Islands Hospital shall be taken to have been designated.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_43\", \"num\": \"43.\", \"text\": \"Membership 43. An Ethics Committee shall consist of \u2014 (a) two doctors; (b) a social worker; (c) an attorney-at-law or ethicist; (d) a mental health practitioner being either a community psychiatric nurse, psychologist or psychiatrist; (e) a registered nurse; (f) a faith based person; and (g) a lay person.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_44\", \"num\": \"44.\", \"text\": \"General power to regulate own procedures 44. (1) Subject to section 45, an Ethics Committee may regulate its own procedures for deciding issues that come before it under Part 2. (2) The Ethics Committee shall ensure that all decisions are made as expeditiously as possible, having regard to \u2014 (a) the relevant directive-maker\u2019s best interest; and (b) the duty of public officials under section 19 of the Constitution.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_45\", \"num\": \"45.\", \"text\": \"Procedural fairness requirements 45. (1) This section applies for issues about which an Ethics Committee may make decisions under this Law except a decision to make a temporary order. (2) An Ethics Committee shall allow an interested person an opportunity to be heard on an issue before it makes a decision on the issue. \u2014 (3) Subsection (2) shall not apply in relation to a nearest relative if \u2014 Clause 46 Health Care Decisions Bill, 2019 Introduced (a) after having made reasonable endeavours to locate that nearest relative, the Ethics Committee is unaware of that nearest relative\u2019s whereabouts; or (b) all of the following apply \u2014 (i) that nearest relative is not in the Islands; (ii) it is not practicable to communicate with that nearest relative electronically; and (iii) the Ethics Committee considers that delaying its decision is not in the relevant directive-maker\u2019s best interest. (4) An Ethics Committee may, but need not, conduct enquiries and act on any information or opinion it has, forms or obtains about an issue. (5) An Ethics Committee may only rely on the information or opinion if it has given all interested persons an opportunity to respond to the information or opinion. (6) In deciding the nature and extent of the opportunity required under this section, an Ethics Committee may take into account the directivemaker\u2019s best interest and the need to decide the issue expeditiously.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_46\", \"num\": \"46.\", \"text\": \"Form of decision and notice of right to appeal 46. (1) An Ethics Committee\u2019s decision on an issue that comes before it shall be by way of an order. (2) The order may be made orally if doing so is in the relevant directivemaker\u2019s best interest. (3) As soon as practicable after making the order (whether oral or written), the Ethics Committee shall \u2014 (a) tell, or give notice to, each interested person whom it heard in coming to the decision (except only as a witness) \u2014 (i) about the order; and (ii) that the interested person may, within three days, appeal to the Court against the decision; and (b) if the order was oral, do the following as soon as practicable \u2014 (i) reduce to writing the order and the Ethics Committee\u2019s reasons for making the decision; and Health Care Decisions Bill, 2019 Clause 47 Introduced (ii) give each interested person told of the order a copy of the order and reasons, and a notice stating that the interested person has a right to appeal.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_47\", \"num\": \"47.\", \"text\": \"Appeal 47. An interested person may, within three days after being told of, notified of or entitled to be told of or given notice of an Ethics Committee\u2019s order, appeal to the Court against the decision.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_48\", \"num\": \"48.\", \"text\": \"Hearing and decision on appeal 48. (1) The Court shall decide the appeal as expeditiously as possible, taking into account the relevant directive-maker\u2019s best interest. (2) After hearing the appeal, the Court may \u2014 (a) affirm, set aside or vary the decision appealed against; or (b) set aside the decision and remit the matter to the relevant Ethics Committee for the Ethics Committee to reconsider with any directions the Court considers fit. (3) If the Court\u2019s decision is other than to remit, that decision is taken to have been the Ethics Committee\u2019s decision. PART 7 - MISCELLANEOUS\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_49\", \"num\": \"49.\", \"text\": \"Grand Court's general jurisdiction for Law 49. (1) The Court has jurisdiction for matters arising in relation to this Law, including whether \u2014 (a) an adult is mentally competent; and (b) a directive or a proxy\u2019s appointment is valid. (2) Where this Law permits a matter to be brought before an Ethics Committee, subsection (1) shall only allow a person to bring the matter before the Court (other than by an appeal) if the Court considers there are exceptional circumstances. (3) In exercising the jurisdiction, the Court may make an order, give directions or grant any other relief it thinks fit. Clause 50 Health Care Decisions Bill, 2019 Introduced\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_50\", \"num\": \"50.\", \"text\": \"Recognition of similar directives and proxies from certain jurisdictions 50. (1) The following instruments, by whatever name called, having been made under a law of a jurisdiction listed in subsection (2) shall be recognized in the Islands \u2014 (a) documents that have, or include, similar functions to that of a directive (each a \u201crecognised directive\u201d); and (b) written appointments similar to, or that include, the appointment of a person (whatever called) to perform functions that are similar to, or include, a proxy\u2019s functions under this Law (each a \u201crecognised appointment\u201d). (2) The list of the jurisdictions is \u2014 (a) the United Kingdom; (b) Australia; (c) Canada; (d) South Africa; (e) New Zealand; (f) Jamaica; (g) the United States of America; and (h) a jurisdiction that is a member State of the European Union under the Treaty on European Union signed in Maastricht on 7th February, 1992. (3) The Cabinet may, by Order, amend subsection (2). (4) The following shall apply for persons in the Islands \u2014 (a) a recognised directive that has not been revoked under the laws of the relevant jurisdiction has effect as if it had been made under this Law; (b) a recognised appointment that has not been revoked under the laws of the relevant jurisdiction has effect as if it had been made under this Law; (c) the functions of registered practitioners and proxies concerning a recognised directive or appointment are those under this Law and not the laws of the jurisdiction under which the directive or appointment was made; and (d) a provision of a recognised directive is of no effect to the extent that the provision \u2014 Health Care Decisions Bill, 2019 Clause 51 Introduced (i) requires a registered practitioner to provide a person with any particular type of health care, except the denial under the directive of particular health care or of any health care; or (ii) is a barred provision. (5) Subsection (4) applies despite the other jurisdiction\u2019s laws and the provisions of the recognised directive or appointment. (6) Subsections (4)(d) and (5) do not apply for a law of England to the extent it applies to the Islands. (7) In this section, \u201cjurisdiction\u201d includes a Province, State or another governmental body with legislative functions within a jurisdiction.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_51\", \"num\": \"51.\", \"text\": \"Effect of contraventions not being an offence 51. If a provision of this Law imposes an obligation but does not state that a contravention of the obligation is an offence, a person who contravenes the obligation can still be civilly liable for the contravention if any such liability exists outside this Law.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_52\", \"num\": \"52.\", \"text\": \"Cabinet's power to amend Schedule 52. The Cabinet may, by Order, amend the Schedule.\", \"element\": \"section\", \"heading\": null}, {\"eId\": \"sec_53\", \"num\": \"53.\", \"text\": \"Regulations 53. The Cabinet may make Regulations about \u2014 (a) matters permitted under this Law to be prescribed by Regulations; (b) codes of practice about directives and proxies; and (c) matters that are necessary or convenient to give effect to the advance health care directives principles. Health Care Decisions Bill, 2019 SCHEDULE Introduced SCHEDULE (Sections 11(1)(a), 13(2) and 52) COMBINED FORM OF ADVANCE HEALTH CARE DIRECTIVE AND PROXY APPOINTMENT Cayman Island Advance Health Care Directive: Planning for future health care decisions The Health Care Decisions Law, 2019 By: ______________________ Date of Birth: ______________________ (Print Name)                                                           (Month\/Day\/Year) This directive has two parts to state your wishes, and a third part for needed signatures. Part 1 lets you answer this question: If you cannot (or do not want to) make your own health care decisions, who do you want to make them for you? The person you pick is called your proxy. More than one proxy can be appointed, in which case Part 1 will need to be expanded. Under the Law, proxies may act separately. Make sure you talk to your proxy about this important role. Part 2 lets you write your preferences about efforts to extend your life in three (3) situations: terminal condition, persistent vegetative state, and end-stage condition. Use the directive to reflect your wishes, then sign in front of two witnesses one of which shall be a doctor (Part 3). If your wishes change, make a new directive. Make sure you give a copy of the completed directive to your proxy, your doctor, and others who might need it. Keep a copy at home in a place where someone can get it if needed. Review what you have written periodically. Note: Marriage or divorce does not automatically revoke an advance health care directive. If you later marry or divorce you should review this directive and any proxy\/ies appointed to see if this directive still agrees with your wishes. SCHEDULE Health Care Decisions Bill, 2019 Introduced Note: While a directive is operative, it prevails over any right of an attorney of the directive-maker or of the directive-maker\u2019s nearest relative. Part 1: Appointment of proxy (Optional; directive valid if no proxy appointed) A. Appointment Note: To be eligible for appointment, an individual must be an adult, mentally competent and not your doctor or other registered practitioner. I appoint the following individual\/s as my proxy\/ies to make health care decisions for me: Name: Address: Date of Birth: Telephone numbers: Home: Cell: (Optional for Additional Proxy. Directive Valid if left blank.) Name: Address: Date of Birth: Telephone numbers: Home: Cell: Health Care Decisions Bill, 2019 SCHEDULE Introduced B. Powers and rights of proxy. Note: 1. These powers and rights will only apply while you are not mentally competent. 2. These powers and rights are optional. Strike out and initial any that you do not wish to apply. 3. If nothing is provided for here, the default position is that your proxy will (subject to certain limitations) have full power to make decisions about your health care during any period in which you are not mentally competent. I want my proxy to have full power to make health care decisions for me, including the power to: 1. consent or not to consent to medical procedures and treatments which my doctors offer, including things that are intended to keep me alive, for example CPR\/cardiopulmonary resuscitation, ventilators and feeding tubes; 2. decide who my doctor and other health care providers should be; 3. decide where I should be treated, including whether I should be in a hospital, nursing home, other medical care facility or hospice programme. I also want my proxy to: 1. ride with me, if possible, in an ambulance if ever I need to be rushed to the hospital; and 2. be able to visit me, with the same access rights as my nearest relative, if I am in a hospital or any other health care facility. This power is subject to the following conditions or limitations: (Optional; Directive valid if left blank.) SCHEDULE Health Care Decisions Bill, 2019 Introduced C. How my proxy is to decide specific issues I trust my proxy\u2019s judgment. My proxy should look first to see if there is anything in Part 2 of this directive that may help to decide the issue. Then, my proxy should think about the conversations we have had, my religious and other beliefs and values, my personality, and how I handled medical and other important issues in the past. If what I would decide is still unclear, then my proxy is to make decisions for me that my proxy believes are in my best interest. In doing so, my proxy should consider the benefits, burdens, and risks of the choices presented by my doctors. D. People my proxy should consult (Optional; Directive valid if left blank.) In making important decisions on my behalf, I encourage my proxy to consult with the following people. By filling this in, I do not intend to limit the number of people with whom my proxy might want to consult or my proxy\u2019s power to make decisions. Name Telephone Number Health Care Decisions Bill, 2019 SCHEDULE Introduced E. In Case of Pregnancy (Optional for women of child-bearing years only; Directive valid if left blank.) F. Access to my health information 1. If, before my proxy has power to act, my doctor wants to discuss with that person my capacity to make my own health care decisions, I authorize my doctor to disclose protected health information relating to that issue. 2. Once my proxy has power to act, my proxy may request, receive, and review any information, oral or written, regarding my physical or mental health, including medical and hospital records and other protected health information, and consent to disclosure of this information. 3. For all purposes relating to my health care, my proxy is my personal agent during any period in which I am not mentally competent. SCHEDULE Health Care Decisions Bill, 2019 Introduced Part 2: Treatment preferences A. Statement of Goals and Values (Optional; Directive valid if left blank.) Note: Giving a directive does not affect you receiving palliative care. I want to say something about my goals and values, and especially what is most important to me during the last part of my life. B. Preference in Case of Terminal Condition Note: If you want to state what your preference is, initial one only. If you do not want to state a preference here, cross through the whole section. Directive valid if left blank. If my doctors certify that my death from a terminal condition is imminent, even if life-sustaining measures are used: 1. Keep me comfortable, which includes medication to relieve pain and distress, and allow natural death to occur. I do not want any medical interventions used to try to extend my life. I do not want to receive nutrition and fluids by tube or other medical means. >>OR<<                                                                 \u270e___________________ 2. Keep me comfortable, which includes medication to relieve pain and distress, and allow natural death to occur. I do not want medical interventions used to try to extend my life. If I am unable to take enough nourishment by mouth, however, I want to receive nutrition and fluids by tube or other medical means. Health Care Decisions Bill, 2019 SCHEDULE Introduced >>OR<<                                                               \u270e___________________ 3. Try to extend my life for as long as possible, using all available interventions that in reasonable medical judgment would prevent or delay my death. If I am unable to take enough nourishment by mouth, I want to receive nutrition and fluids by tube or other medical means. \u270e________________________ C. Preference in Case of Persistent Vegetative State Note: If you want to state what your preference is, initial one only. If you do not want to state a preference here, cross through the whole section. Directive valid if left blank. If my doctors certify that I am in a persistent vegetative state, that is, if I am not conscious and am not aware of myself or my environment or able to interact with others, and there is no reasonable expectation that I will ever regain consciousness: 1. Keep me comfortable, which includes medication to relieve pain and distress, and allow natural death to occur. I do not want any medical interventions used to try to extend my life. I do not want to receive nutrition and fluids by tube or other medical means. >>OR<<                                                                 \u270e___________________ 2. Keep me comfortable, which includes medication to relieve pain and distress, and allow natural death to occur. I do not want medical interventions used to try to extend my life. If I am unable to take enough nourishment by mouth, however, I want to receive nutrition and fluids by tube or other medical means. >>OR<<                                                               \u270e___________________ 3. Try to extend my life for as long as possible, using all available interventions that in reasonable medical judgment would prevent or delay my death. If I am unable to take enough nourishment by mouth, I want to receive nutrition and fluids by tube or other medical means. \u270e___________________ D. Preference in Case of End-Stage Condition Note: If you want to state what your preference is, initial one only. If you do not want to state a preference here, cross through the whole SCHEDULE Health Care Decisions Bill, 2019 Introduced section. Directive valid if left blank. If my doctors certify that I am in an end-stage condition, that is, an incurable condition that will continue in its course until death and that has already resulted in loss of mental capacity and complete physical dependency: 1. Keep me comfortable, which includes medication to relieve pain and distress and allow natural death to occur. I do not want any medical interventions used to try to extend my life. I do not want to receive nutrition and fluids by tube or other medical means. >>OR<<                                                               \u270e___________________ 2. Keep me comfortable, which includes medication to relieve pain and distress, and allow natural death to occur. I do not want medical interventions used to try to extend my life. If I am unable to take enough nourishment by mouth, however, I want to receive nutrition and fluids by tube or other medical means. >>OR<<                                                               \u270e___________________ 3. Try to extend my life for as long as possible, using all available interventions that in reasonable medical judgment would prevent or delay my death. If I am unable to take enough nourishment by mouth, I want to receive nutrition and fluids by tube or other medical means. \u270e___________________ E. In Case of Pregnancy (Optional, for women of child-bearing years only. Directive valid if left blank.) If I am pregnant, my decision concerning life-sustaining procedures shall be modified as follows: F. Effect of Stated Preferences Note: Read both of these statements carefully. Then, initial one only. Directive valid if left blank. 1. I realize I cannot foresee everything that might happen after I can no longer decide for myself. My stated preferences are meant to guide Health Care Decisions Bill, 2019 SCHEDULE Introduced whoever is making decisions on my behalf and my health care providers, but I authorize them to be flexible in applying these statements if they feel that doing so would be in my best interest. >>OR<<                                                               \u270e___________________ 2. I realize I cannot foresee everything that might happen after I can no longer decide for myself. Still, I want whoever is making decisions on my behalf and my health care providers to follow my stated preferences exactly as written, even if they think that some alternative is better. \u270e___________________ Part 3: Signature and witnesses By signing below, I indicate that I am mentally competent to make this directive and that I understand its purpose and effect. I also understand that this document replaces any similar advance health care directive I may have completed before this date. I declare that this directive is made voluntarily and without coercion, duress or inducement. _____________________________ _______________________ Signature of Directive-Maker Date Witnessing doctor\u2019s statement: The directive-maker signed this document in my presence. I am satisfied that: (a) the directive-maker is an adult who is mentally competent; (b) this directive was given voluntarily and without coercion, duress or inducement; and (c) the directive-maker has been told about the nature and consequences of making this directive. _____________________________ ______________________ Signature of Witnessing Doctor Date Doctor\u2019s name in print: ___________________________________________ Doctor\u2019s registration number: _______________________________________ Signature of the other witness: The directive-maker signed this document in my presence:* SCHEDULE Health Care Decisions Bill, 2019 Introduced _____________________________ _______________________ Signature of Witness Date Witness\u2019 name in print:__________________________________________ *Note: Certain people cannot be a witness. Anyone appointed under Part 1 of this directive as a proxy and anyone who is a beneficiary - that is a person who might benefit under the directive-maker\u2019s will or estate in intestacy or an insurance policy under which a life insured is, or includes, the directive-maker; or has an interest granted under an instrument under which the directive-maker is the donor, grantor or settlor - of the directive-maker are not eligible. CHECKLIST Did you remember to: \uf063 Fill out Part 1 if you want to name a proxy (or proxies)? \uf063 Talk to your proxy about your values and priorities, and decide whether that\u2019s enough guidance or whether you also want to make specific health care decisions in your directive? \uf063 If you want to make specific decisions, fill out Part 2, choosing carefully among alternatives? \uf063 Sign and date the directive in Part 3, in front of a witnessing doctor and another independent witness? \uf063 Did the witnessing doctor and the other witness also sign the directive just after you did? \uf063 Make sure your proxy (if you named one), your family, and your doctor know about your advance health care planning Health Care Decisions Bill, 2019 SCHEDULE Introduced Give a copy of your directive to your: \uf063 Proxy \uf063 Family members \uf063 Doctors \uf063 Hospital \uf063 Nursing Home (if applicable) Passed by the Legislative Assembly the day of , 2019 Speaker Clerk of the Legislative Assembly\", \"element\": \"section\", \"heading\": null}], \"meta\": {\"notes\": null, \"workflow\": null, \"lifecycle\": {\"source\": \"#cilegis\", \"eventRef\": [{\"eId\": \"e_commence_2019_01_01\", \"date\": \"2019-01-01\", \"type\": \"generation\", \"source\": \"#cilegis\"}]}, \"references\": {\"source\": \"#canary\", \"TLCRole\": [], \"TLCEvent\": [{\"eId\": \"ev_commencement\", \"href\": \"\/akn\/ontology\/canary\/event\/commencement\", \"showAs\": \"commencement\"}], \"TLCPerson\": [], \"TLCConcept\": [{\"eId\": \"inForce\", \"href\": \"\/akn\/ontology\/canary\/concept\/temporal\/in-force\", \"showAs\": \"in force\"}], \"TLCProcess\": [], \"TLCLocation\": [], \"TLCOrganization\": [{\"eId\": \"cilegis\", \"href\": \"\/akn\/ontology\/canary\/organization\/editor\/cilegis\", \"showAs\": \"Cayman Islands legislation mirror (kyleg)\"}]}, \"temporalData\": {\"source\": \"#cilegis\", \"temporalGroup\": [{\"eId\": \"tg_inforce_2019_01_01\", \"timeInterval\": [{\"end\": null, \"start\": \"#e_commence_2019_01_01\", \"duration\": null, \"refersTo\": \"#inForce\"}]}]}, \"classification\": null, \"identification\": {\"source\": \"#cilegis\", \"FRBRWork\": {\"FRBRuri\": \"\/akn\/ky\/bill\/2019\/6\", \"FRBRdate\": [{\"date\": \"2019-01-01\", \"name\": \"generation\"}], \"FRBRthis\": \"\/akn\/ky\/bill\/2019\/6\/!main\", \"FRBRalias\": [{\"name\": \"cmsId\", \"value\": \"2019-0006\"}], \"FRBRauthor\": [{\"as\": \"#editor\", \"href\": \"\/akn\/ontology\/canary\/organization\/editor\/cilegis\"}], \"FRBRnumber\": \"6 of 2019\", \"FRBRcountry\": \"ky\", \"FRBRsubtype\": \"bill\"}, \"FRBRExpression\": {\"FRBRuri\": \"\/akn\/ky\/bill\/2019\/6\/eng@2019-01-01\", \"FRBRdate\": [{\"date\": \"2019-01-01\", \"name\": \"generation\"}], \"FRBRthis\": \"\/akn\/ky\/bill\/2019\/6\/eng@2019-01-01\/!main\", \"FRBRauthor\": [{\"as\": \"#editor\", \"href\": \"\/akn\/ontology\/canary\/organization\/editor\/cilegis\"}], \"FRBRlanguage\": \"eng\"}, \"FRBRManifestation\": {\"FRBRuri\": \"\/akn\/ky\/bill\/2019\/6\/eng@2019-01-01.xml\", \"FRBRdate\": [{\"date\": \"2026-06-22\", \"name\": \"generation\"}], \"FRBRthis\": \"\/akn\/ky\/bill\/2019\/6\/eng@2019-01-01.xml\", \"FRBRauthor\": [{\"as\": \"#editor\", \"href\": \"\/akn\/ontology\/canary\/organization\/editor\/cilegis\"}], \"FRBRformat\": \"application\/xml\"}}}, \"name\": \"bill\", \"header\": {\"title\": \"Monetary Authority (Amendment) Law, 2019\", \"actNumber\": \"6 of 2019\", \"longTitle\": null}}, \"judgment\": null}}","akn_full_text":"CAYMAN ISLANDS\n\nHEALTH CARE DECISIONS BILL, 2019\nSupplement No. 5 published with Legislation Gazette No. 8 dated 13th\nMarch, 2019.\nA BILL FOR A LAW TO PROVIDE FOR HEALTH CARE DIRECTIVES;\nAND FOR INCIDENTAL AND CONNETED PURPOSES\n\nPage 2\nIntroduced\nc\n\nPUBLISHING DETAILS\nSponsoring Ministry\/Portfolio: Ministry of Health, Environment, Culture and\nHousing\n\nHealth Care Decisions Bill, 2019\nObjects and Reasons\n\nc\nIntroduced\nPage 3\n\nMemorandum of\nOBJECTS AND REASONS\nThis Bill provides for the use of Health Care Directives. The Bill contains 7 Parts\nand 53 clauses.\n\nClause 1 provides for the short title of the Bill.\n\nClause 2 provides for the interpretation section and outlines the definitions of the\nterms and expressions used throughout the Bill.\n\nClause 3 provides that the giving or receiving of palliative care shall not be\naffected.\n\nClause 4 expressly provides that euthanasia and assisted suicide are not\nauthorized. It further states that it does not affect the operation of Part VI of the\nPenal Code except as provided in clauses 37 and 41 of the Bill.\n\nPart 2 outlines the principles that are to be applied in relation to making of\ndecisions and orders in respect of health care directives.\n\nClause 5 provides that the principles only apply as far as they are practicable.\n\nClause 6 provides that decisions must be made based in the best interests of the\nperson except where a directive, proxy or order states otherwise.\n\nClause 7 lists the eight principles which must guide the making of a directive,\ninter alia, that the directive-maker is a mentally competent adult, that the wishes\nof the directive-maker must be respected and are paramount and any directive\nmust be validly made.\n\nClause 8 provides for the principles which govern the operation of proxies which,\ninter alia, include that the views of the proxy, in the absence of specific\ninstructions, must be consistent with what would be the views of the directivemaker.\n\nPart 3 sets out the formalities for the making of an advance health care directive.\n\nObjects and Reasons\nHealth Care Decisions Bill, 2019\n\nPage 4\nIntroduced\nc\n\nClause 9 provides for the validity of a directive where the directive complies with\nthe provisions of the Part and has not been revoked.\n\nClause 10 outlines the capacity required to make a directive. A person must be an\nadult, who is mentally competent and that person need not be terminally ill or\nundergoing any health care.\n\nClause 11 provides for the form of the directive which is found in the Schedule to\nthe Bill.\n\nClause 12 sets out the duties of the witnessing doctor.\n\nClause 13 states that, in the absence of evidence to the contrary, there must be a\npresumption of validity in relation to any directives.\n\nClause 14 provides that a directive or parts thereof may be ineffective where it\npurports to do something unlawful, in breach of a professional standard or code\nof conduct or anything else prescribed by regulations.\n\nClause 15 provides that a directive may only operate where the directive-maker\nhas become mentally incompetent. A directive shall cease to operate where it has\nbeen expressly revoked, expires or the directive-maker has died.\n\nClause 16 provides that a directive will prevail over a power of attorney or the\nwishes of the directive-maker\u2019s nearest relative.\n\nClause 17 provides for the revocation of a directive in writing.\n\nClause 18 provides for the making of a temporary order to effect a revocation by\nan Ethics Committee.\n\nClause 19 creates an offence for contravening a temporary order made by an\nEthics Committee.\n\nClause 20 provides for a revocation order by the Ethics Committee where the\ndirective-maker did not have an opportunity to make a revocation in writing but\nhad expressed that wish orally.\n\nHealth Care Decisions Bill, 2019\nObjects and Reasons\n\nc\nIntroduced\nPage 5\n\nClause 21 sets out the grounds on which an Ethics Committee may make a\nrevocation order.\n\nClause 22 provides how a directive is to be acted on generally stipulating that it\nmust be complied with as far as is practicable except in relation to barred\nprovisions.\n\nClause 23 provides for the exceptions to acting on a directive such as where it is\nbelieved that the directive-maker did not intend the consequences or had\nsubsequently altered the directive-makers wishes.\n\nClause 24 states that a directive acts as consent to health care.\n\nClause 25 provides that a directive-maker may withdraw consent to health care\ndespite the directive.\n\nClause 26 provides for the seeking of a second opinion where a directive-maker\u2019s\nnearest relative or proxy disagrees with the health care being provided. It also\nprovides for a directive-maker\u2019s nearest relative or proxy to ask the Ethics\nCommittee to make a decision where there is a disagreement.\n\nClause 27 creates the offence of knowingly making a false or misleading\nstatement in relation to a directive or the making of a directive.\n\nPart 4 deals with the appointment, functions and other matters in relation to a\nproxy.\n\nClause 28 sets out the persons who may be appointed as a proxy by a directive\nmaker. A proxy must be a mentally competent adult.\n\nClause 29 provides for the functions of a proxy being primarily to make\ndecisions in relation to the directive-maker\u2019s health care.\n\nClause 30 states that a proxy can only exercise the functions under section 29 if\nthe proxy remains eligible to be a proxy and is not otherwise prevented by any\nother law.\n\nClause 31 sets out the criteria for the exercise of the proxy functions. These\ninclude, inter alia, giving effect to the directive-makers wishes, ascertaining what\n\nObjects and Reasons\nHealth Care Decisions Bill, 2019\n\nPage 6\nIntroduced\nc\n\nthe directive-maker\u2019s wishes would have been and to act expeditiously and in\ngood faith.\n\nClause 32 provides for the issuing of a notice of a proxy decision by a proxy to\nany other proxies and the nearest relative.\n\nClause 33 provides for a duty of confidentiality to apply to a proxy.\n\nClause 34 provides for the renouncement of a proxy appointment.\n\nClause 35 provides for the effect of a proxy\u2019s death or renouncement in relation\nto a directive-maker and the directive.\n\nPart 5 sets out the protections that apply to a proxy and a registered practitioner\noperating under a directive.\n\nClause 36 provides for immunity, where a doctor acts in good faith and without\nnegligence, for a decision made in relation to the validity of a directive; whether\nthe directive has been revoked or was intended to be revoked and the competency\nof a directive-maker.\n\nClause 37 provides for immunity, where a doctor, registered practitioner or proxy\nacts in good faith and without negligence and in compliance or purported\ncompliance of a directive.\n\nClause 38 provides that a registered practitioner shall not be required to provide\nany particular type of health care other than the denial of that health care.\n\nClause 39 provides for immunity where a registered practitioner or proxy acting\nin good faith communicates a revocation wish to an Ethics Committee.\n\nClause 40 provides for immunity where a proxy makes a proxy decision in\ncontravention of section 32 if the decision is made in good faith.\n\nClause 41 provides for brainstem death cases.\n\nPart 6 provides for the establishment and operation of Ethics Committees.\n\nHealth Care Decisions Bill, 2019\nObjects and Reasons\n\nc\nIntroduced\nPage 7\n\nClause 42 makes it mandatory for each hospital to have an Ethics Committee or\nto designate an Ethics Committee if they are unable to establish a committee of\nits own.\n\nClause 43 outlines the composition of an Ethics Committee. Each committee\nmust have two doctors, a social worker, an attorney-at-law or ethicist, a mental\nhealth practitioner, a registered nurse, a lay person and a religious person.\n\nClause 44 provides that the Committee may regulate its own procedure.\n\nClause 45 stipulates that decisions of the committee must be done with\nprocedural fairness.\n\nClause 46 provides that the form of a decision must be by order and that notice of\nthe decision must be given to all interested persons.\n\nClause 47 provides for the right of appeal of an order of the committee to the\nCourt.\n\nClause 48 provides for the hearing of an appeal and the decisions which may be\nmade on appeal.\n\nPart 7 sets out miscellaneous matters.\n\nClause 49 provides for the Grand Court\u2019s general jurisdiction in relation to this\nLaw.\n\nClause 50 provides for the recognition of similar directives from certain\njurisdictions namely the United Kingdom, Australia, Canada, South Africa, New\nZealand, Jamaica and the United States of America, among others.\n\nClause 51 provides that if a provision of the legislation imposes an obligation but\ndoes not state that a contravention of the obligation is an offence, a person who\ncontravenes the obligation can still be civilly liable for the contravention if any\nsuch liability exists outside this Law.\n\nClause 52 provides that Cabinet to amend the Schedule by Order.\n\nClause 53 gives Cabinet regulation making powers.\n\nObjects and Reasons\nHealth Care Decisions Bill, 2019\n\nPage 8\nIntroduced\nc\n\nThe Schedule sets out the form a directive should take.\n\nHealth Care Decisions Bill, 2019\nArrangement of Clauses\n\nc\nIntroduced\nPage 9\n\nCAYMAN ISLANDS\n\nHEALTH CARE DECISIONS BILL, 2019\n\nArrangement of Clauses\nClause\nPage\nPART 1 - PRELIMINARY\n1.\nShort title .......................................................................................... 13\n2.\nInterpretation .................................................................................... 13\n3.\nPalliative care unaffected .................................................................... 18\n4.\nLaw shall not authorize euthanasia ....................................................... 18\nPART 2 - PRINCIPLES OF ADVANCE HEALTH CARE\nDIRECTIVES\n5.\nAdvance health care directives principles ............................................. 18\n6.\nParamount principle: registered practitioners decide best interest ............. 19\n7.\nPrinciples for directives ...................................................................... 19\n8.\nPrinciples for proxies ......................................................................... 20\nPART 3 - ADVANCE HEALTH CARE DIRECTIVES\n9.\nValidity of directive ........................................................................... 20\n10. Capacity to make a directive ............................................................... 20\n11. Form of directive ............................................................................... 21\n12. Witnessing doctor's duty ..................................................................... 21\n\nArrangement of Clauses\nHealth Care Decisions Bill, 2019\n\nPage 10\nIntroduced\nc\n\n13. Presumption of validity and declarations about validity .......................... 22\n14. Ineffective directive provisions ........................................................... 23\n15. Operative directive ............................................................................ 24\n16. Directive prevails over attorney and nearest relative .............................. 24\n17. Revocation ....................................................................................... 24\n18. Temporary order ............................................................................... 24\n19. Offence: contravening temporary order ................................................ 25\n20. Revocation by Ethics Committee because of revocation wish .................. 25\n21. Revocation by Ethics Committee on request ......................................... 25\n22. How directive is to be acted on generally .............................................. 26\n23. Exceptions to acting on directive ......................................................... 27\n24. Directive acts as the directive-maker's consent ...................................... 28\n25. Withdrawal of directive-maker's consent to health care .......................... 28\n26. Second opinion and dispute referral to Ethics Committee ....................... 29\n27. Offences concerning directives ............................................................ 29\nPART 4 \u2013 HEALTH CARE PROXY\n28. Appointment ..................................................................................... 30\n29. Functions.......................................................................................... 30\n30. Exercise of functions ......................................................................... 31\n31. Criteria for exercise of functions ......................................................... 31\n32. Notice of proxy decision .................................................................... 32\n33. Proxy's confidentiality duty ................................................................ 32\n34. Renouncement .................................................................................. 32\n35. Effect of proxy's death or renouncement ............................................... 32\nPART 5 - PROTECTIONS FOR PROXY AND\nREGISTERED PRACTITIONERS\n36. Immunity: doctor's decisions ............................................................... 33\n37'. Immunity: acting on a directive ........................................................... 33\n38. Registered practitioners not compellable to provide positive health care ... 34\n39. Immunity: communicating revocation wish .......................................... 34\n40. Immunity: proxy decisions in good faith ............................................... 34\n41. Brainstem death cases ........................................................................ 34\n\nHealth Care Decisions Bill, 2019\nArrangement of Clauses\n\nc\nIntroduced\nPage 11\n\nPART 6 - ETHICS COMMITTEES\n42. Requirement for hospitals to have an Ethics Committee ......................... 35\n43. Membership ...................................................................................... 35\n44. General power to regulate own procedures ............................................ 35\n45. Procedural fairness requirements ......................................................... 35\n46. Form of decision and notice of right to appeal ....................................... 36\n47. Appeal ............................................................................................. 37\n48. Hearing and decision on appeal ........................................................... 37\nPART 7 - MISCELLANEOUS\n49. Grand Court's general jurisdiction for Law............................................ 37\n50. Recognition of similar directives and proxies from certain jurisdictions .... 38\n51. Effect of contraventions not being an offence ........................................ 39\n52. Cabinet's power to amend Schedule ..................................................... 39\n53. Regulations ....................................................................................... 39\nSCHEDULE\n41\n\nHealth Care Decisions Bill, 2019\nClause 1\n\nc\nIntroduced\nPage 13\n\nCAYMAN ISLANDS\n\nHEALTH CARE DECISIONS BILL, 2019\n\nA BILL FOR A LAW TO PROVIDE FOR HEALTH CARE DIRECTIVES;\nAND FOR INCIDENTAL AND CONNETED PURPOSES\nENACTED by the Legislature of the Cayman Islands.\nPART 1 - PRELIMINARY\n1.\nShort title\n1.\nThis Law may be cited as the Health Care Decisions Law, 2019.\n2.\nInterpretation\n2.\nIn this Law \u2014\n\u201cacting\u201d, on a directive, means \u2014\n(a) for a registered practitioner, to provide health care, in a way\nwished for under the directive, including, for example, a wish to\nbe denied particular health care or any health care (except under a\nbarred provision); or\n(b) for a proxy, to make a proxy decision that the directive-maker is to\nbe provided health care in a way wished for under the directive,\nincluding, for example, a wish to be denied particular health care\nor any health care (except under a barred provision);\n\nClause 2\nHealth Care Decisions Bill, 2019\n\nPage 14\nIntroduced\nc\n\n\u201cadvance health care directive\u201d means a document made by a person\nexpressing that person\u2019s health care wishes in the event that that person\nbecomes mentally incompetent, including, for example, that that\nperson \u2014\n(a) wishes to be denied life-sustaining measures if that person\nbecomes terminally ill; or\n(b) does not wish to undergo another stated type of health care;\n\u201cadvance health care directive principles\u201d means the principles for\napplying and making decisions and orders under this Law;\n\u201cappeal\u201d means an appeal under section 47;\n\u201cattorney\u201d means the grantee of a power of attorney given under the\nPowers of Attorney Law (1996 Revision);\n\u201cbarred provision\u201d means a provision of a directive that is ineffective\npursuant to section 14;\n\u201cbest interest\u201d, of a directive-maker, means the directive-maker\u2019s\nproper health care and the protection of the directive-maker\u2019s health\ninterests, having regard to \u2014\n(a) the relevant guidelines of the General Medical Council of the\nUnited Kingdom; and\n(b) the Code of Ethics and Standards of Practice under section 35 of\nthe Health Practice Law (2017 Revision);\n\u201cbrainstem death\u201d means an irreversible loss of the capacity of\nconsciousness combined with the irreversible loss of all brainstem\nfunctions, including the capacity to breathe;\n\u201ccivilly liable\u201d includes \u2014\n(a) liability for professional misconduct; and\n(b) susceptibility to sanction or other adverse action for contravening\na code of professional ethics or a departure from an accepted form\nof professional conduct;\n\u201cCourt\u201d means the Grand Court;\n\u201cdeny\u201d, in relation to health care to a person, means to withdraw or\nwithhold health care (including life-sustaining measures) from that\nperson;\n\u201cdeath\u201d includes brainstem death and when there is an irreversible\ncessation of circulation of blood in a person\u2019s body;\n\nHealth Care Decisions Bill, 2019\nClause 2\n\nc\nIntroduced\nPage 15\n\n\u201cdirective\u201d means \u2014\n(a) an advance health care directive generally; and\n(b) for a provision of this Law about a particular proxy, the directive\nunder which the proxy was appointed;\n\u201cdirective-maker\u201d means \u2014\n(a) a person who makes a directive pursuant to this Law; and\n(b) for a provision of this Law about a particular proxy, the directivemaker who appointed the proxy;\n \u201cdoctor\u201d means an individual registered as a medical doctor under\nSchedule 4 of the Health Practice Law (2017 Revision);\n\u201cEthics Committee\u201d, of a hospital, means that hospital\u2019s Ethics\nCommittee established or designated under section 42;\n\u201cfunction\u201d includes a duty, power or responsibility;\n\u201chealth care\u201d means a registered practitioner doing either or both of\nthe following \u2014\n(a) providing a measure, procedure, service, or medical treatment to\ndiagnose, maintain or treat a physical or mental condition of a\nperson; or\n(b) withdrawing or withholding a matter mentioned in paragraph (a)\n(including withdrawing or withholding life-sustaining measures);\n\u201cinterested person\u201d means \u2014\n(a) a directive-maker, to the extent that the directive-maker is able to\nexpress the directive-maker\u2019s wishes;\n(b) a proxy of the directive-maker;\n(c) a registered practitioner providing, or proposing to provide, health\ncare to the directive-maker;\n(d) the directive-maker\u2019s nearest relative; or\n(e) any person who satisfies the Ethics Committee that that person has\na proper interest in the issue;\n\u201clife-sustaining measures\u201d means health care intended to sustain or\nprolong life and that supplants or maintains the operation of vital bodily\nfunctions that are temporarily or permanently incapable of independent\noperation, including \u2014\n(a) cardiopulmonary resuscitation;\n(b) assisted ventilation; or\n\nClause 2\nHealth Care Decisions Bill, 2019\n\nPage 16\nIntroduced\nc\n\n(c) artificial nutrition and hydration,\nbut does not include a blood transfusion;\n\u201cmedical treatment\u201d means the provision by a doctor of physical,\nsurgical or psychological therapy, including, for example, a doctor \u2014\n(a) providing therapy to prevent disease, restore or replace bodily\nfunction in the face of disease or injury or to improve comfort and\nquality of life; and\n(b) prescribing or supplying medication;\n\u201cmentally competent\u201d, in relation to a person, at a particular time,\nmeans that that person is conscious and, during the course of making\nthat person\u2019s decisions, has the faculties to be able to \u2014\n(a) understand, retain and use relevant information being any\ninformation needed to make the decision and to understand its\nconsequences, except for technical or trivial information;\n(b) understand the nature and effect of the decision; and\n(c) communicate the decision in some way;\n\u201cmentally incompetent\u201d, in relation to a person, at a particular time,\nmeans that that person is unable to make a decision as that person does\nnot possess the faculties to be able to \u2014\n(a) understand, retain and use relevant information being any\ninformation needed to make the decision and to understand its\nconsequences, except for technical or trivial information;\n(b) understand the nature and effect of the decision; and\n(c) communicate the decision in some way;\n\u201cnearest relative\u201d, of a directive-maker, means the person most closely\nconnected to the directive-maker, using the following order of\nrelationships with the directive-maker, and, if there is more than one of\nany type, priority shall be given to the most senior in age of that\ntype \u2014\n(a) spouse;\n(b) children;\n(c) parents;\n(d) siblings;\n(e) grandparents;\n(f) grandchildren;\n\nHealth Care Decisions Bill, 2019\nClause 2\n\nc\nIntroduced\nPage 17\n\n(g) uncle or aunt;\n(h) nephew or niece;\n(i) cousin;\n(j) close friend;\n(k) the mental health professional treating the directive-maker;\n(l) a social worker or probation officer employed in that capacity in\nGovernment or a statutory body; or\n(m) attorney;\n\u201cnegligence\u201d includes not having regard, or sufficient regard, in the\ncircumstances to the relevant provisions of this Law;\n\u201cnotice\u201d means a notice in writing;\n\u201cproxy\u201d means a person appointed by a directive-maker to make\ndecisions about that directive-maker\u2019s health care;\n\u201cproxy decision\u201d means a decision made by a proxy in relation to a\ndirective-maker\u2019s health care;\n\u201creasonably practicable\u201d means reasonably practicable in all the\ncircumstances;\n\u201cregistered practitioner\u201d means an individual registered under the\nHealth Practice Law (2017 Revision) to practice a profession\nmentioned in Schedules 4 to 7 of that Law;\n\u201crevocation wish\u201d means a wish expressed by the directive-maker to\nrevoke the directive at any time while the directive-maker was or is\nmentally competent;\n\u201cspouse\u201d, of a directive-maker, means a person who is a legal resident\nand who is \u2014\n(a) the legal husband or wife of that person; or\n(b) a person of the opposite sex who, although not legally married to\nthat person, lives with that person in the same household under the\nsame domestic arrangements as a legal husband or wife and has\nbeen so living with that person for a continuous period of five\nyears,\nand any reference in this Law to marriage or to a married person shall\nbe construed, with the necessary changes being made, so as to give\neffect to paragraph (a) or (b), as the case may be; but where a person is\n\nClause 3\nHealth Care Decisions Bill, 2019\n\nPage 18\nIntroduced\nc\n\njudicially or otherwise separated from a legal spouse that person shall\nnot be considered to have any other spouse except that legal spouse;\n\u201cterminally ill\u201d means having an incurable condition caused by injury\nor disease from which there is no reasonable prospect of a permanent\nrecovery and for which condition \u2014\n(a) death would, within reasonable medical judgment, be imminent\nregardless of life-sustaining measures; and\n(b) life-sustaining measures would only serve to postpone death;\n\u201ctemporary order\u201d means an order under section 18;\n\u201cwishes\u201d includes directions and instructions and wishes impliedly\nexpressed, but does not include a wish that is a barred provision of a\ndirective or would be a barred provision had the wish been included in\na directive; and\n\u201cwitnessing doctor\u201d means a doctor chosen by a directive-maker to\nwitness the execution of that directive-maker\u2019s directive.\n3.\nPalliative care unaffected\n3.\nThis Law shall not affect the functions of registered practitioners for the\ngiving of palliative care or a person\u2019s right to receive palliative care.\n4.\nLaw shall not authorize euthanasia\n4.\nThis Law shall not \u2014\n(a) authorize euthanasia or assisted suicide; or\n(b) affect Part VI of the Penal Code, except as provided for under\nsections 37 and 41.\nPART 2 - PRINCIPLES OF ADVANCE HEALTH CARE DIRECTIVES\n5.\nAdvance health care directives principles\n5.\n(1) This Part sets out the principles for the application of this Law in\nrelation to making decisions and orders in respect of health care\ndirectives.\n(2) The requirements under the advance health care directive principles\nonly apply so far as it is reasonably practicable.\n\nHealth Care Decisions Bill, 2019\nClause 6\n\nc\nIntroduced\nPage 19\n\n6.\nParamount principle: registered practitioners decide best interest\n6.\nThe paramount principle shall be that questions of what is in a person\u2019s best\ninterest and what health care that person receives are ultimately up to that\nperson\u2019s registered practitioner or practitioners to decide, except under the\nfollowing \u2014\n(a) the denial of health care, as expressed in an operative directive;\n(b) a proxy decision to deny health care; and\n(c) an order under this Law that health care is to be denied or any type\nof other order that has the same effect.\n7.\nPrinciples for directives\n7.\nThe principles in respect of directives are \u2014\n(a) this Law recognizes a validly made directive;\n(b) a mentally competent adult may make a directive and, by directive\ndecide what quality of life that adult wishes should that adult\nbecome mentally incompetent;\n(c) an adult is, in the absence of evidence or a law to the contrary,\npresumed to be mentally competent to make decisions about that\nadult\u2019s own health care;\n(d) an adult is to be \u2014\n(i) allowed to decide that adult\u2019s health care to the extent that\nthat adult is able; and\n(ii) supported in the making of any decisions for as long as\nreasonably practicable;\n(e) a mentally competent adult has the right to decide that adult\u2019s\nhealth care in any of (or in any combination of) the following\nways according to that adult\u2019s background, culture, history,\nspiritual and religious beliefs \u2014\n(i) by making the decision on that adult\u2019s own free will;\n(ii) by delegating the decision to another person; or\n(iii) by making the decision collaboratively within that adult\u2019s\nfamily or community, or both;\n(f) if a directive-maker later becomes mentally incompetent, the\ndirective has the same authority as if the directive-maker were\nmentally competent;\n\nClause 8\nHealth Care Decisions Bill, 2019\n\nPage 20\nIntroduced\nc\n\n(g) if a dispute arises, a directive-maker\u2019s wishes are paramount and\nare to be implemented; and\n(h) in deciding what a directive-maker\u2019s wishes are, the following\nmay be considered \u2014\n(i) past wishes the directive-maker has expressed;\n(ii) the directive-maker\u2019s values displayed or expressed during\nthe directive maker\u2019s life; and\n(iii) any other relevant matter.\n8.\nPrinciples for proxies\n8.\nThe principles in respect of a proxy are \u2014\n(a) if the directive-maker later becomes mentally incompetent, the\nproxy has the same authority as the directive-maker as if the\ndirective-maker were mentally competent; and\n(b) proxy decisions \u2014\n(i) are to reflect the decision that the directive-maker would have\nmade in the circumstances;\n(ii) are, in the absence of specific instructions or expressed views\nby the directive-maker, to be consistent with what the proxy\nbelieves the directive-maker would have decided; and\n(iii) cannot restrict the directive-maker\u2019s rights and freedoms\nunder the Bill of Rights under Part I of the Constitution, in\nlight of the state of the directive-maker\u2019s health and wishes\nunder the directive.\nPART 3 - ADVANCE HEALTH CARE DIRECTIVES\n9.\nValidity of directive\n9.\nAn advance health care directive shall be valid if it complies with this Part\nand has not been revoked.\n10.\nCapacity to make a directive\n10. (1) Any adult who is mentally competent may make a directive, even\nthough that adult is not terminally ill and not undergoing any health\ncare.\n\nHealth Care Decisions Bill, 2019\nClause 11\n\nc\nIntroduced\nPage 21\n\n(2) A directive\u2019s validity shall not be affected if the directive-maker later\nbecomes mentally incompetent.\n11.\nForm of directive\n11. (1) A directive shall be made by \u2014\n(a) completion of the relevant parts of the form in the Schedule and\nfollowing the instructions contained in the form (either by or on\nbehalf of the directive-maker);\n(b) the directive-maker signing the form personally in the presence of\ntwo adult witnesses; and\n(c) both witnesses signing it.\n(2) A witness shall not be a person who has been appointed as a proxy\nunder the directive.\n(3) At least one of the witnesses shall be a doctor witnessing in that\ncapacity after having complied with section 12.\n(4) The witnessing doctor shall be chosen by the directive-maker.\n(5) A directive shall have no effect if, when the directive-maker signed the\ndirective, either of the witnesses to the directive knew, or ought\nreasonably to have known, that that witness was a beneficiary of the\ndirective-maker.\n(6) Where a witness to a directive, or that witness\u2019 spouse is a beneficiary\nof any beneficial devise, legacy, estate, interest, gift or appointment of\nor affecting any real or personal estate (other than and except charges\nand directions for the payment of any debt or debts), that devise,\nlegacy, estate, interest, gift or appointment shall be null and void.\n(7) In this section, \u201cbeneficiary\u201d, of a directive-maker, means someone\nwho \u2014\n(a) might benefit under the directive-maker\u2019s will or estate in\nintestacy or an insurance policy under which a life insured is, or\nincludes, the directive-maker; or\n(b) has an interest granted under an instrument under which the\ndirective-maker is the donor, grantor or settlor.\n12.\nWitnessing doctor's duty\n12. (1) Before witnessing a directive a witnessing doctor shall take reasonable\nsteps to be satisfied that the directive-maker \u2014\n\nClause 13\nHealth Care Decisions Bill, 2019\n\nPage 22\nIntroduced\nc\n\n(a) is an adult who is mentally competent;\n(b) is giving the directive voluntarily and without coercion, duress or\ninducement; and\n(c) has been told about the directive\u2019s nature and consequences.\n(2) A doctor responsible for a person\u2019s health care may still witness a\ndirective by that person even though the doctor conscientiously objects\nto later acting on it.\n(3) Where a witnessing doctor conscientiously objects to a directive, the\nwitnessing doctor shall take reasonable steps to transfer the directivemaker\u2019s health care to another doctor.\n13.\nPresumption of validity and declarations about validity\n13. (1) In the absence of evidence to the contrary, a registered practitioner or\nproxy is entitled to presume that \u2014\n(a) a document that purports to be a directive apparently made under\nthis Part is valid;\n(b) the directive-maker was an adult and mentally competent when the\ndirective was made; and\n(c) the witnessing doctor complied with section 12(1).\n(2) A directive is valid even though \u2014\n(a) a part of the directive was not completed if the corresponding part\nin the form states that the part is optional;\n(b) it does not appoint any proxy;\n(c) the directive-maker \u2014\n(i) was not fully informed of all medical conditions, or other\ncircumstances, to which the directive relates; or\n(ii) did not seek legal or other professional advice about the\ndirective;\n(d) the directive has a minor error (including, for example, a\nmisspelling or an obsolete reference) that does not affect a\nperson\u2019s ability to understand the directive-maker\u2019s wishes under\nthe directive;\n(e) any or all of the following apply for wishes under the directive \u2014\n(i) the wish is expressed in informal language rather than\nmedical or technical terminology;\n\nHealth Care Decisions Bill, 2019\nClause 14\n\nc\nIntroduced\nPage 23\n\n(ii) the wish is expressed in general terms rather than as specific\ninstructions;\n(iii) the wish needs to be inferred from their context or from other\nprovisions of the directive; or\n(iv) the wish is based solely on moral, religious or social grounds;\n(f) the directive does not contain, or has deleted, a note or checklist in\nthe form in the Schedule; or\n(g) the directive\u2019s form is different from the form in the Schedule but\nits effect is the same, or substantially the same, as that under the\nform, including, because \u2014\n(i) of different formatting; or\n(ii) the directive contains extra material or information consistent\nwith this Law.\n(3) In the absence of an order under this Law or of evidence of revocation\nunder this Part, a directive is taken to have not been revoked.\n14.\nIneffective directive provisions\n14. (1) A provision of a directive wishing for any of the following shall be of\nno effect and the directive shall be read as if the directive did not so\nwish \u2014\n(a) something unlawful, including, euthanasia or assisted suicide;\n(b) something that would cause a registered practitioner to contravene\na professional standard or code of conduct (however described);\n(c) a refusal of mental health treatment; or\n(d) anything else prescribed under Regulations.\n(2) In this section \u2014\n\u201cmental health treatment\u201d means medical treatment under an order\nunder the Mental Health Law, 2013 or detention permitted under that\nLaw; and\n\u201cprofessional standard or code of conduct\u201d does not include a standard\nor code of conduct prepared by or on behalf of a hospital, clinic,\nhospice, nursing home or another place at which health care is provided\nthat regulates the provision of health care or other services at that place.\n\nClause 15\nHealth Care Decisions Bill, 2019\n\nPage 24\nIntroduced\nc\n\n15.\nOperative directive\n15. (1) A directive operates only while the directive-maker is mentally\nincompetent.\n(2) A directive shall cease to operate on the occasion of the following \u2014\n(a) if the directive is revoked pursuant to this Law;\n(b) if the directive states an expiry day, on that day; or\n(c) if the directive-maker dies.\n(3) A directive that is in operation under subsection (1) is an \u201coperative\u201d\ndirective.\n16.\nDirective prevails over attorney and nearest relative\n16. While a directive is operative, it prevails over any right of an attorney of the\ndirective-maker or of the directive-maker\u2019s nearest relative.\n17.\nRevocation\n17. (1) A directive-maker who is mentally competent may revoke the directive\nin writing and that revocation shall be signed and dated.\n(2) The writing need not refer to the revoked directive\u2019s date.\n(3) The directive-maker shall take reasonable steps to tell the following\npersons about the revocation \u2014\n(a) any proxy appointed under the revoked directive;\n(b) any other person who the directive-maker has given a copy of the\ndirective; and\n(c) if the witnessing doctor for the directive is on the Islands, the\nwitnessing doctor.\n(4) A contravention of subsection (3) does not affect the revocation\u2019s\nvalidity.\n(5) The making of a subsequent directive revokes any earlier directive\nmade by the same directive-maker.\n18.\nTemporary order\n18. (1) A registered practitioner or any other person shall, if \u2014\n(a) a directive is operative and the directive-maker is receiving health\ncare at or from a hospital; and\n\nHealth Care Decisions Bill, 2019\nClause 19\n\nc\nIntroduced\nPage 25\n\n(b) that registered practitioner or person becomes aware that the\ndirective-maker expressed a wish to revoke the directive at any\ntime while the directive-maker was or is mentally competent,\nnotify the Ethics Committee about the wish to revoke.\n(2) The Ethics Committee may, on being notified, make any temporary\norder it thinks fit until it has an opportunity to decide the matter under\nsection 20, including, for example, that no registered practitioner can\nact on the directive until the decision has been made.\n(3) The temporary order expires on the making of the decision.\n19.\nOffence: contravening temporary order\n19. (1) A registered practitioner who, without reasonable excuse, contravenes a\ntemporary order commits an offence and is liable to a fine of twenty\nthousand dollars or to imprisonment for a term of one year, or both.\n(2) In a proceeding for an offence against subsection (1), it is a defence for\nthe defendant to prove that the defendant did not know, and could not\nreasonably have been expected to know, that the defendant\u2019s conduct\namounted to the offence.\n20.\nRevocation by Ethics Committee because of revocation wish\n20. (1) If a hospital\u2019s Ethics Committee is notified of a revocation wish, the\nEthics Committee may revoke the relevant directive if the Ethics\nCommittee is satisfied that \u2014\n(a) when the wish was expressed, the directive-maker understood the\nnature and consequences of revoking the directive;\n(b) the revocation genuinely reflected the directive-maker\u2019s wishes at\nthe time; and\n(c) the revocation is appropriate in the circumstances.\n(2) Where a directive expressly provides that it cannot be revoked because\nof a change in the directive-maker\u2019s wishes, the Ethics Committee may\nonly revoke the directive if the Ethics Committee is satisfied that the\ndirective-maker\u2019s state of mind at the time the revocation wish was\nmade, was a conscious wish to override that provision.\n21.\nRevocation by Ethics Committee on request\n21. (1) The Ethics Committee may, if \u2014\n\nClause 22\nHealth Care Decisions Bill, 2019\n\nPage 26\nIntroduced\nc\n\n(a) a directive-maker is mentally incompetent and receiving health\ncare at or from a hospital; and\n(b) a person acting on the directive-makers behalf asks the Ethics\nCommittee to revoke the directive,\nrevoke the directive.\n(2) The Ethics Committee may only revoke the directive if the Ethics\nCommittee is satisfied that \u2014\n(a) acting on the directive would not be in the directive-maker\u2019s best\ninterest; and\n(b) assuming the following, medical advances since the making of the\ndirective are likely to cause the directive-maker\u2019s health care\nwishes to be significantly different from those under the directive\n\u2014\n(i) that the directive-maker is mentally competent; and\n(ii) that the directive-maker had been generally informed of the\nnature of the medical advances.\n(3) Revocation under subsection (1) may not depend on a revocation wish.\n(4) In considering the issue of causation in respect of subsection (2)(b), the\nEthics Committee shall take into account any \u2014\n(a) express provision in the directive that it cannot be revoked because\nof a change in the directive-maker\u2019s wishes;\n(b) wish not to revoke the directive expressed by the directive-maker\nbefore the directive-maker\u2019s mental incompetency; and\n(c) revocation wish by the directive-maker, or a wish by the directivemaker not to revoke.\n22.\nHow directive is to be acted on generally\n22. (1) A registered practitioner who is providing, or is to provide, health care\nto a directive-maker and that directive-maker has a valid and operative\ndirective shall \u2014\n(a) comply with any provision of the directive wishing for the denial\nof particular health care or of any health care, including, for\nexample, the following words in the directive \u2014\n(i) \u201cdo not resuscitate\u201d; or\n(ii) its acronym \u201cDNR\u201d;\n\nHealth Care Decisions Bill, 2019\nClause 23\n\nc\nIntroduced\nPage 27\n\n(b) not comply with any provision of the directive which \u2014\n(i) is unlawful, including, euthanasia and assisted suicide;\n(ii) would cause a registered practitioner to contravene a\nprofessional standard or code of conduct (however\ndescribed);\n(iii) would be a refusal of mental health treatment; or\n(iv) is prohibited under this Law or Regulations; and\n(c) as far as is reasonably practicable \u2014\n(i) seek to avoid any outcome or intervention that the directivemaker may have wished to avoid; and\n(ii) endeavour to comply with the advance health care directive\nprinciples.\n(2) The registered practitioner shall, as far as is reasonably practicable,\ncomply with other provisions of the directive relating to health care of\nthe relevant type.\n23.\nExceptions to acting on directive\n23. (1) Notwithstanding section 22, a registered practitioner may refuse to act\non a directive if the practitioner \u2014\n(a) reasonably believes the directive-maker did not intend the\ndirective to apply in the particular circumstances; or\n(b) reasonably believes the directive does not reflect the directivemaker\u2019s current wishes and the registered practitioner complies\nwith section 18.\n(2) A registered practitioner may refuse to comply with a provision of a\ndirective that specifies the type of health care the directive-maker\nwishes to receive if the provision \u2014\n(a) is not consistent with any relevant professional standards; or\n(b) does not reflect the Islands\u2019 current health care standards.\n(3) Subsection (2) shall not apply to any provision of the directive, except a\nbarred provision, that wishes for the denial of particular or of any\nhealth care.\n(4) A registered practitioner may refuse to comply with a provision of a\ndirective on conscientious grounds.\n\nClause 24\nHealth Care Decisions Bill, 2019\n\nPage 28\nIntroduced\nc\n\n(5) Where a registered practitioner refuses to comply pursuant to\nsubsection (4), the registered practitioner shall take reasonable steps to\ntransfer the directive-maker\u2019s health care to another registered\npractitioner.\n24.\nDirective acts as the directive-maker's consent\n24. If a registered practitioner acts or proposes to act on an operative\ndirective \u2014\n(a) the directive-maker shall be taken to have consented to the health\ncare provided by so acting, subject to section 25; and\n(b) that consent has the same effect as if the directive-maker were\nmentally competent.\n25.\nWithdrawal of directive-maker's consent to health care\n25. (1) Where \u2014\n(a) the directive-maker has expressed, or expresses, a wish to a\nregistered practitioner to withdraw consent to the provision of\nparticular health care, or health care of a particular type, under the\ndirective; and\n(b) the wish was or is expressed while the directive-maker is mentally\ncompetent,\nthe registered practitioner shall treat the consent as withdrawn.\n(2) Notwithstanding subsection (1), the registered practitioner shall provide\nthe health care if \u2014\n(a) the directive expressly provides that the consent cannot be\nwithdrawn because of a change in the directive-maker\u2019s wishes;\nand\n(b) the registered practitioner is not satisfied the directive-maker\u2019s\ncurrent state of mind is a conscious wish to override that\nprovision.\n(3) Any act or omission that took place before the withdrawal shall be\nvalid if it was done or made in the course of acting on the directive and\ndone or made in good faith and without negligence.\n\nHealth Care Decisions Bill, 2019\nClause 26\n\nc\nIntroduced\nPage 29\n\n26.\nSecond opinion and dispute referral to Ethics Committee\n26. (1) The directive-maker\u2019s nearest relative or proxy may, if the directivemaker\u2019s nearest relative or proxy disagrees with the doctor about the\nhealth care or proposed health care to be provided to the directivemaker, seek a second opinion from another doctor.\n(2) The medical director shall, if requested, assist the directive-maker\u2019s\nnearest relative or proxy to seek an appropriate second medical opinion\non the matter from another doctor.\n(3) Where the directive-maker\u2019s nearest relative or proxy still disagrees\nwith the doctor after obtaining the second opinion, the directivemaker\u2019s nearest relative or proxy may ask the hospital\u2019s Ethics\nCommittee to make a decision on the matter.\n(4) In this section \u201cmedical director\u201d means \u2014\n(a) if the hospital is operated by the Health Services Authority under\nthe Health Services Authority Law (2018 Revision), the Medical\nDirector of  that Authority; or\n(b) for another hospital, the doctor with similar functions for the\nhospital as that of the Health Services Authority\u2019s Medical\nDirector.\n27.\nOffences concerning directives\n27. (1) A person who knowingly makes a false or misleading statement in, or\nrelating to, a directive commits an offence and is liable on summary\nconviction \u2014\n(a) to, if the offence was committed when the person was a proxy\nappointed under the directive, a fine of twenty thousand dollars or\nto imprisonment for two years, or both; or\n(b) to a fine of ten thousand dollars.\n(2) A person who knowingly makes a false or misleading statement\nrelating to an attempt to make a directive commits an offence and is\nliable on summary conviction to a fine of ten thousand dollars.\n\nClause 28\nHealth Care Decisions Bill, 2019\n\nPage 30\nIntroduced\nc\n\nPART 4 \u2013 HEALTH CARE PROXY\n28.\nAppointment\n28. (1) A directive-maker may, in the same directive, appoint one or more\npersons to be that directive-maker\u2019s health care proxy.\n(2) The following persons shall not be appointed as a proxy \u2014\n(a) a person who is not an adult;\n(b) a person who is mentally incompetent;\n(c) a registered practitioner who is responsible, solely or with others,\nfor the directive-maker\u2019s health care; and\n(d) any other person of a type prescribed under Regulations.\n(3) A person shall be a proxy only while that person\u2019s appointment is in\nforce under this Part.\n(4) An appointment of two or more proxies shall be both joint and several.\n(5) A proxy\u2019s appointment only has force while the directive is operative.\n29.\nFunctions\n29. (1) While a proxy\u2019s appointment is in force, the proxy may make decisions\nabout the directive-maker\u2019s health care as if the directive-maker were\nmentally competent.\n(2) The following apply for proxy decisions \u2014\n(a) they are exercisable during all periods during which the directivemaker is mentally incompetent, and not otherwise;\n(b) they are subject to the directive\u2019s provisions;\n(c) they cannot be made about matters that are not about health care;\n(d) they prevail over the rights of the directive-maker\u2019s attorney or\nnearest relative;\n(e) they cannot refuse palliative care to the directive-maker; and\n(f) they can only instruct the refusal of artificial nutrition and\nhydration to the directive-maker if \u2014\n(i) the directive-maker is terminally ill; and\n(ii) the directive provides that the directive-maker does not wish\nto undergo life-sustaining measures.\n(3) A proxy decision is of no effect to the extent that it contravenes\nsubsection (2).\n\nHealth Care Decisions Bill, 2019\nClause 30\n\nc\nIntroduced\nPage 31\n\n30.\nExercise of functions\n30. (1) A proxy can only make a proxy decision if the proxy \u2014\n(a) remains eligible for appointment under section 28; and\n(b) is not prevented under this or another Law from acting under the\ndirective.\n(2) If a proxy asks a registered practitioner to deny health care and the\nregistered practitioner has not already seen the directive, the registered\npractitioner shall ask the proxy to produce it before complying with the\nproxy\u2019s request.\n\n(3) The directive may be produced by giving a hard copy of a certified\ncopy of the directive or, under Part II of the Electronic Transactions\nLaw (2003 Revision), sending an electronic record of a certified copy of\nthe directive.\n(4) Until the directive is so produced, the registered practitioner may\ncontinue to provide the directive-maker with the health care that the\npractitioner would have provided had the directive-maker not made a\ndirective.\n31.\nCriteria for exercise of functions\n31. In making a proxy decision, a proxy is to \u2014\n(a) as far as is reasonably practicable \u2014\n(i) give effect to the wishes under the directive;\n(ii) seek to avoid an outcome or intervention that the directivemaker would have wished to avoid;\n(iii) to the extent the directive is silent about the directive-maker\u2019s\nwishes on a matter, find out and have regard to, the directivemaker\u2019s wishes expressed outside the directive while the\ndirective-maker was mentally competent; and\n(iv) give effect to the advance health care directive principles to\nthe extent the advance health care directive principles are\nrelevant to the decision;\n(b) give effect to the decision that the proxy considers the directivemaker would have made in the circumstances had the directivemaker been mentally competent at the time; and\n(c) act expeditiously and in good faith.\n\nClause 32\nHealth Care Decisions Bill, 2019\n\nPage 32\nIntroduced\nc\n\n32.\nNotice of proxy decision\n32. If there are two or more proxies for the same directive-maker and a proxy\nmakes a proxy decision alone, that proxy shall take reasonable steps to give\nnotice of the decision to all of the other proxies and the directive-maker\u2019s\nnearest relative.\n33.\nProxy's confidentiality duty\n33. (1) A proxy shall keep details of the directive-maker\u2019s health care, any\nadvice obtained and the making of proxy decisions confidential.\n(2) Subsection (1) shall not apply to a disclosure by a proxy \u2014\n(a) to a registered practitioner who needs to be told about the\ndecisions;\n(b) to the directive-maker\u2019s nearest relative; or\n(c) required by law or under a Court order.\n34.\nRenouncement\n34. (1) A proxy may renounce that proxy\u2019s appointment by notice \u2014\n(a) to the directive-maker; or\n(b) if the directive-maker is mentally incompetent, to the doctor\nresponsible for treating the directive-maker.\n(2) Where more than one proxy was appointed the renouncing proxy shall\nalso give the notice to the other proxies.\n35.\nEffect of proxy's death or renouncement\n35. (1) A proxy\u2019s death or the renouncement of a proxy\u2019s appointment shall\nnot affect \u2014\n(a) the directive\u2019s validity; and\n(b) if there were other proxies for the same directive-maker, the other\nproxies\u2019 powers.\n(2) Where, the proxy who died or renounced was the only proxy appointed\nand the directive-maker is mentally incompetent, the doctor responsible\nfor treating the directive-maker may continue to provide the health care\nto the directive-maker that the doctor considers is in the directivemaker\u2019s best interest and is consistent with the directive.\n\nHealth Care Decisions Bill, 2019\nClause 36\n\nc\nIntroduced\nPage 33\n\nPART 5 - PROTECTIONS FOR PROXY AND REGISTERED\nPRACTITIONERS\n36.\nImmunity: doctor's decisions\n36. (1) Where a doctor makes a decision in respect of \u2014\n(a) whether or not an adult is mentally competent or suffering from a\nterminal illness;\n(b) whether or not a directive-maker has revoked, or intended to\nrevoke, the directive; or\n(c) whether or not a directive is valid,\nif that decision was made in good faith and without negligence that\ndoctor shall not be criminally or civilly liable for making the decision.\n(2) If the decision was made by an HSA doctor, the decision is taken to\nhave been made in performing the doctor\u2019s functions for that\nemployment and section 54 of the Public Authorities Law, 2017 shall\napply.\n(3) In this section, \u201cHSA doctor\u201d means a doctor employed by the Cayman\nIslands Health Services Authority established under section 3 of the\nHealth Services Authority Law (2018 Revision).\n37'.\nImmunity: acting on a directive\n37. (1) Where acting on an operative directive \u2014\n(a) a doctor;\n(b) another registered practitioner acting on a doctor\u2019s instructions; or\n(c) a proxy,\ndoes an act in good faith, without negligence and in compliance or\npurported compliance with a directive, that doctor, registered\npractitioner or proxy shall not be criminally or civilly liable for that act.\n(2) Subsection (1) includes acting on a revoked directive or a directive that\nthe directive-maker intended to revoke if the doctor, registered\npractitioner or proxy did not know of the revocation or intended\nrevocation.\n(3) Subsection (2) shall apply notwithstanding the following sections of the Penal\nCode (2019 Revision) \u2014\n(a) 188(d) (causing death defined);\n(b) 191 (responsibility of person who has charge of another); and\n\nClause 38\nHealth Care Decisions Bill, 2019\n\nPage 34\nIntroduced\nc\n\n(c) 211 (other negligent acts causing harm).\n38.\nRegistered practitioners not compellable to provide positive health care\n38. (1) A registered practitioner shall not be required to provide any particular\ntype of health care to a person other than the denial of that health care\nunder a directive, order or decision.\n(2) The directive, order or decision shall be of no effect to the extent that\nthe directive, order or decision contravenes subsection (1).\n(3) Subsection (2) shall not prevent the directive-maker\u2019s wishes in the\ndirective from being taken into account.\n39.\nImmunity: communicating revocation wish\n39. A registered practitioner or proxy shall not be criminally or civilly liable for\ncommunicating to an Ethics Committee about a revocation wish if that\nregistered practitioner or proxy did so in good faith.\n40.\nImmunity: proxy decisions in good faith\n40. A proxy shall not be criminally or civilly liable for making a proxy decision\nin contravention of section 32 if the decision was made in good faith.\n41.\nBrainstem death cases\n41. (1) If a person has been certified as brainstem dead, a doctor may withdraw\nall life-sustaining measures from the deceased.\n(2) In making the certification of brainstem death, due regard shall be\ngiven to any relevant codes of practice about the diagnosis and\ncertification of death of the United Kingdom or the Islands.\n(3) Subsection (1) shall apply notwithstanding any directive of the\ndeceased to the contrary.\n(4) The withdrawal of life-sustaining measures shall not constitute\ncausation of death under section 188 (causing death defined) of the\nPenal Code (2019 Revision).\n\nHealth Care Decisions Bill, 2019\nClause 42\n\nc\nIntroduced\nPage 35\n\nPART 6 - ETHICS COMMITTEES\n42.\nRequirement for hospitals to have an Ethics Committee\n42. (1) Each hospital shall have an Ethics Committee to perform functions\nunder this Law for its patients.\n(2) A hospital may establish its own Ethics Committee or designate\nanother hospital\u2019s Ethics Committee to be its Ethics Committee.\n(3) If no Ethics Committee has been designated, the Ethics Committee of\nthe Cayman Islands Hospital shall be taken to have been designated.\n43.\nMembership\n43. An Ethics Committee shall consist of \u2014\n(a) two doctors;\n(b) a social worker;\n(c) an attorney-at-law or ethicist;\n(d) a mental health practitioner being either a community psychiatric\nnurse, psychologist or psychiatrist;\n(e) a registered nurse;\n(f) a faith based person; and\n(g) a lay person.\n44.\nGeneral power to regulate own procedures\n44. (1) Subject to section 45, an Ethics Committee may regulate its own\nprocedures for deciding issues that come before it under Part 2.\n(2) The Ethics Committee shall ensure that all decisions are made as\nexpeditiously as possible, having regard to \u2014\n(a) the relevant directive-maker\u2019s best interest; and\n(b) the duty of public officials under section 19 of the Constitution.\n45.\nProcedural fairness requirements\n45. (1) This section applies for issues about which an Ethics Committee may\nmake decisions under this Law except a decision to make a temporary\norder.\n(2) An Ethics Committee shall allow an interested person an opportunity to\nbe heard on an issue before it makes a decision on the issue. \u2014\n(3) Subsection (2) shall not apply in relation to a nearest relative if \u2014\n\nClause 46\nHealth Care Decisions Bill, 2019\n\nPage 36\nIntroduced\nc\n\n(a) after having made reasonable endeavours to locate that nearest\nrelative, the Ethics Committee is unaware of that nearest relative\u2019s\nwhereabouts; or\n(b) all of the following apply \u2014\n(i) that nearest relative is not in the Islands;\n(ii) it is not practicable to communicate with that nearest relative\nelectronically; and\n(iii) the Ethics Committee considers that delaying its decision is\nnot in the relevant directive-maker\u2019s best interest.\n(4) An Ethics Committee may, but need not, conduct enquiries and act on\nany information or opinion it has, forms or obtains about an issue.\n(5) An Ethics Committee may only rely on the information or opinion if it\nhas given all interested persons an opportunity to respond to the\ninformation or opinion.\n(6) In deciding the nature and extent of the opportunity required under this\nsection, an Ethics Committee may take into account the directivemaker\u2019s best interest and the need to decide the issue expeditiously.\n46.\nForm of decision and notice of right to appeal\n46. (1) An Ethics Committee\u2019s decision on an issue that comes before it shall\nbe by way of an order.\n(2) The order may be made orally if doing so is in the relevant directivemaker\u2019s best interest.\n(3) As soon as practicable after making the order (whether oral or written),\nthe Ethics Committee shall \u2014\n(a) tell, or give notice to, each interested person whom it heard in\ncoming to the decision (except only as a witness) \u2014\n(i) about the order; and\n(ii) that the interested person may, within three days, appeal to\nthe Court against the decision; and\n(b) if the order was oral, do the following as soon as practicable \u2014\n(i) reduce to writing the order and the Ethics Committee\u2019s\nreasons for making the decision; and\n\nHealth Care Decisions Bill, 2019\nClause 47\n\nc\nIntroduced\nPage 37\n\n(ii) give each interested person told of the order a copy of the\norder and reasons, and a notice stating that the interested\nperson has a right to appeal.\n47.\nAppeal\n47. An interested person may, within three days after being told of, notified of\nor entitled to be told of or given notice of an Ethics Committee\u2019s order,\nappeal to the Court against the decision.\n48.\nHearing and decision on appeal\n48. (1) The Court shall decide the appeal as expeditiously as possible, taking\ninto account the relevant directive-maker\u2019s best interest.\n(2) After hearing the appeal, the Court may \u2014\n(a) affirm, set aside or vary the decision appealed against; or\n(b) set aside the decision and remit the matter to the relevant Ethics\nCommittee for the Ethics Committee to reconsider with any\ndirections the Court considers fit.\n(3) If the Court\u2019s decision is other than to remit, that decision is taken to\nhave been the Ethics Committee\u2019s decision.\nPART 7 - MISCELLANEOUS\n49.\nGrand Court's general jurisdiction for Law\n49. (1) The Court has jurisdiction for matters arising in relation to this Law,\nincluding whether \u2014\n(a) an adult is mentally competent; and\n(b) a directive or a proxy\u2019s appointment is valid.\n(2) Where this Law permits a matter to be brought before an Ethics\nCommittee, subsection (1) shall only allow a person to bring the matter\nbefore the Court (other than by an appeal) if the Court considers there\nare exceptional circumstances.\n(3) In exercising the jurisdiction, the Court may make an order, give\ndirections or grant any other relief it thinks fit.\n\nClause 50\nHealth Care Decisions Bill, 2019\n\nPage 38\nIntroduced\nc\n\n50.\nRecognition of similar directives and proxies from certain jurisdictions\n50. (1) The following instruments, by whatever name called, having been\nmade under a law of a jurisdiction listed in subsection (2) shall be\nrecognized in the Islands \u2014\n(a) documents that have, or include, similar functions to that of a\ndirective (each a \u201crecognised directive\u201d); and\n(b) written appointments similar to, or that include, the appointment\nof a person (whatever called) to perform functions that are similar\nto, or include, a proxy\u2019s functions under this Law (each a\n\u201crecognised appointment\u201d).\n(2) The list of the jurisdictions is \u2014\n(a) the United Kingdom;\n(b) Australia;\n(c) Canada;\n(d) South Africa;\n(e) New Zealand;\n(f) Jamaica;\n(g) the United States of America; and\n(h) a jurisdiction that is a member State of the European Union under\nthe Treaty on European Union signed in Maastricht on 7th\nFebruary, 1992.\n(3) The Cabinet may, by Order, amend subsection (2).\n(4) The following shall apply for persons in the Islands \u2014\n(a) a recognised directive that has not been revoked under the laws of\nthe relevant jurisdiction has effect as if it had been made under this\nLaw;\n(b) a recognised appointment that has not been revoked under the laws\nof the relevant jurisdiction has effect as if it had been made under\nthis Law;\n(c) the functions of registered practitioners and proxies concerning a\nrecognised directive or appointment are those under this Law and\nnot the laws of the jurisdiction under which the directive or\nappointment was made; and\n(d) a provision of a recognised directive is of no effect to the extent\nthat the provision \u2014\n\nHealth Care Decisions Bill, 2019\nClause 51\n\nc\nIntroduced\nPage 39\n\n(i) requires a registered practitioner to provide a person with any\nparticular type of health care, except the denial under the\ndirective of particular health care or of any health care; or\n(ii) is a barred provision.\n(5) Subsection (4) applies despite the other jurisdiction\u2019s laws and the\nprovisions of the recognised directive or appointment.\n(6) Subsections (4)(d) and (5) do not apply for a law of England to the\nextent it applies to the Islands.\n(7) In this section, \u201cjurisdiction\u201d includes a Province, State or another\ngovernmental body with legislative functions within a jurisdiction.\n51.\nEffect of contraventions not being an offence\n51. If a provision of this Law imposes an obligation but does not state that a\ncontravention of the obligation is an offence, a person who contravenes the\nobligation can still be civilly liable for the contravention if any such liability\nexists outside this Law.\n52.\nCabinet's power to amend Schedule\n52. The Cabinet may, by Order, amend the Schedule.\n53.\nRegulations\n53. The Cabinet may make Regulations about \u2014\n(a) matters permitted under this Law to be prescribed by Regulations;\n(b) codes of practice about directives and proxies; and\n(c) matters that are necessary or convenient to give effect to the\nadvance health care directives principles.\n\nHealth Care Decisions Bill, 2019\nSCHEDULE\n\nc\nIntroduced\nPage 41\n\n SCHEDULE\n(Sections 11(1)(a), 13(2) and 52)\nCOMBINED FORM OF ADVANCE HEALTH CARE DIRECTIVE AND\nPROXY APPOINTMENT\nCayman Island Advance Health Care Directive:\nPlanning for future health care decisions\n\nThe Health Care Decisions Law, 2019\nBy: ______________________ Date of Birth: ______________________\n                (Print Name)                                                           (Month\/Day\/Year)\n\nThis directive has two parts to state your wishes, and a third part for\nneeded signatures.\n\nPart 1 lets you answer this question: If you cannot (or do not want to)\nmake your own health care decisions, who do you want to make them\nfor you? The person you pick is called your proxy. More than one\nproxy can be appointed, in which case Part 1 will need to be expanded.\nUnder the Law, proxies may act separately. Make sure you talk to\nyour proxy about this important role.\n\nPart 2 lets you write your preferences about efforts to extend your life\nin three (3) situations: terminal condition, persistent vegetative state,\nand end-stage condition.\nUse the directive to reflect your wishes, then sign in front of two\nwitnesses one of which shall be a doctor (Part 3). If your wishes\nchange, make a new directive.\nMake sure you give a copy of the completed directive to your proxy,\nyour doctor, and others who might need it. Keep a copy at home in a\nplace where someone can get it if needed. Review what you have\nwritten periodically.\nNote:\nMarriage or divorce does not automatically revoke an advance\nhealth care directive. If you later marry or divorce you should\nreview this directive and any proxy\/ies appointed to see if this\ndirective still agrees with your wishes.\n\nSCHEDULE\nHealth Care Decisions Bill, 2019\n\nPage 42\nIntroduced\nc\n\nNote:\nWhile a directive is operative, it prevails over any right of an\nattorney of the directive-maker or of the directive-maker\u2019s nearest\nrelative.\nPart 1: Appointment of proxy\n(Optional; directive valid if no proxy appointed)\n\nA.\nAppointment\nNote:\nTo be eligible for appointment, an individual must be an adult,\nmentally competent and not your doctor or other registered\npractitioner.\nI appoint the following individual\/s as my proxy\/ies to make health care\ndecisions for me:\nName:\n\nAddress:\n\nDate of\nBirth:\n\nTelephone\nnumbers:\nHome:\nCell:\n\n(Optional for Additional Proxy. Directive Valid if left\nblank.)\nName:\n\nAddress:\n\nDate of\nBirth:\n\nTelephone\nnumbers:\nHome:\nCell:\n\nHealth Care Decisions Bill, 2019\nSCHEDULE\n\nc\nIntroduced\nPage 43\n\nB.\nPowers and rights of proxy.\n\nNote:\n  1. These powers and rights will only apply while you are not\n\nmentally competent.\n2.\nThese powers and rights are optional. Strike out and initial\n\nany that you do not wish to apply.\n3.\nIf nothing is provided for here, the default position is that\nyour proxy will (subject to certain limitations) have full\npower to make decisions about your health care during any\nperiod in which you are not mentally competent.\nI want my proxy to have full power to make health care decisions for me,\nincluding the power to:\n1. consent or not to consent to medical procedures and treatments\nwhich my doctors offer, including things that are intended to keep\nme alive, for example CPR\/cardiopulmonary resuscitation,\nventilators and feeding tubes;\n2. decide who my doctor and other health care providers should be;\n3. decide where I should be treated, including whether I should be in a\nhospital, nursing home, other medical care facility or hospice\nprogramme.\nI also want my proxy to:\n1.\nride with me, if possible, in an ambulance if ever I need to be rushed to\nthe hospital; and\n2.\nbe able to visit me, with the same access rights as my nearest relative, if\nI am in a hospital or any other health care facility.\nThis power is subject to the following conditions or limitations:\n(Optional; Directive valid if left blank.)\n\nSCHEDULE\nHealth Care Decisions Bill, 2019\n\nPage 44\nIntroduced\nc\n\nC. How my proxy is to decide specific issues\nI trust my proxy\u2019s judgment. My proxy should look first to see if there is\nanything in Part 2 of this directive that may help to decide the issue. Then, my\nproxy should think about the conversations we have had, my religious and other\nbeliefs and values, my personality, and how I handled medical and other\nimportant issues in the past. If what I would decide is still unclear, then my proxy\nis to make decisions for me that my proxy believes are in my best interest. In\ndoing so, my proxy should consider the benefits, burdens, and risks of the\nchoices presented by my doctors.\nD.\nPeople my proxy should consult\n\n(Optional; Directive valid if left blank.)\nIn making important decisions on my behalf, I encourage my proxy to consult\nwith the following people. By filling this in, I do not intend to limit the number\nof people with whom my proxy might want to consult or my proxy\u2019s power to\nmake decisions.\nName\nTelephone Number\n\nHealth Care Decisions Bill, 2019\nSCHEDULE\n\nc\nIntroduced\nPage 45\n\nE. In Case of Pregnancy\n(Optional for women of child-bearing years only; Directive valid if left blank.)\n\nF.\nAccess to my health information\n1. If, before my proxy has power to act, my doctor wants to discuss with that\nperson my capacity to make my own health care decisions, I authorize my\ndoctor to disclose protected health information relating to that issue.\n2. Once my proxy has power to act, my proxy may request, receive, and review\nany information, oral or written, regarding my physical or mental health,\nincluding medical and hospital records and other protected health\ninformation, and consent to disclosure of this information.\n\n3.\nFor all purposes relating to my health care, my proxy is my personal agent\nduring any period in which I am not mentally competent.\n\nSCHEDULE\nHealth Care Decisions Bill, 2019\n\nPage 46\nIntroduced\nc\n\nPart 2: Treatment preferences\n\nA. Statement of Goals and Values\n\n(Optional; Directive valid if left blank.)\n\nNote: Giving a directive does not affect you receiving palliative\ncare.\nI want to say something about my goals and values, and especially\nwhat is most important to me during the last part of my life.\nB.\nPreference in Case of Terminal Condition\nNote:\nIf you want to state what your preference is, initial one only. If you\ndo not want to state a preference here, cross through the whole\nsection. Directive valid if left blank.\n\nIf my doctors certify that my death from a terminal condition is\nimminent, even if life-sustaining measures are used:\n1. Keep me comfortable, which includes medication to relieve pain and\ndistress, and allow natural death to occur. I do not want any medical\ninterventions used to try to extend my life. I do not want to receive\nnutrition and fluids by tube or other medical means.\n\n>>OR<<                                                                 \u270e___________________\n2. Keep me comfortable, which includes medication to relieve pain and\ndistress, and allow natural death to occur. I do not want medical\ninterventions used to try to extend my life. If I am unable to take enough\nnourishment by mouth, however, I want to receive nutrition and fluids\nby tube or other medical means.\n\nHealth Care Decisions Bill, 2019\nSCHEDULE\n\nc\nIntroduced\nPage 47\n\n>>OR<<                                                               \u270e___________________\n3. Try to extend my life for as long as possible, using all available\ninterventions that in reasonable medical judgment would prevent or\ndelay my death. If I am unable to take enough nourishment by mouth, I\nwant to receive nutrition and fluids by tube or other medical means.\n\u270e________________________\nC. Preference in Case of Persistent Vegetative State\nNote:\nIf you want to state what your preference is, initial one only. If you\ndo not want to state a preference here, cross through the whole\nsection. Directive valid if left blank.\nIf my doctors certify that I am in a persistent vegetative state, that is, if\nI am not conscious and am not aware of myself or my environment or\nable to interact with others, and there is no reasonable expectation that\nI will ever regain consciousness:\n1. Keep me comfortable, which includes medication to relieve pain and\ndistress, and allow natural death to occur. I do not want any medical\ninterventions used to try to extend my life. I do not want to receive\nnutrition and fluids by tube or other medical means.\n\n>>OR<<                                                                 \u270e___________________\n2. Keep me comfortable, which includes medication to relieve pain and\ndistress, and allow natural death to occur. I do not want medical\ninterventions used to try to extend my life. If I am unable to take enough\nnourishment by mouth, however, I want to receive nutrition and fluids by\ntube or other medical means.\n\n>>OR<<                                                               \u270e___________________\n3. Try to extend my life for as long as possible, using all available\ninterventions that in reasonable medical judgment would prevent or\ndelay my death. If I am unable to take enough nourishment by mouth, I\nwant to receive nutrition and fluids by tube or other medical means.\n\n                                                                                           \u270e___________________\nD. Preference in Case of End-Stage Condition\nNote:\nIf you want to state what your preference is, initial one only. If you\ndo not want to state a preference here, cross through the whole\n\nSCHEDULE\nHealth Care Decisions Bill, 2019\n\nPage 48\nIntroduced\nc\n\nsection. Directive valid if left blank.\nIf my doctors certify that I am in an end-stage condition, that is, an\nincurable condition that will continue in its course until death and that has\nalready resulted in loss of mental capacity and complete physical\ndependency:\n1. Keep me comfortable, which includes medication to relieve pain and\ndistress and allow natural death to occur. I do not want any medical\ninterventions used to try to extend my life. I do not want to receive\nnutrition and fluids by tube or other medical means.\n\n>>OR<<                                                               \u270e___________________\n2. Keep me comfortable, which includes medication to relieve pain and\ndistress, and allow natural death to occur. I do not want medical\ninterventions used to try to extend my life. If I am unable to take enough\nnourishment by mouth, however, I want to receive nutrition and fluids\nby tube or other medical means.\n\n>>OR<<                                                               \u270e___________________\n3. Try to extend my life for as long as possible, using all available\ninterventions that in reasonable medical judgment would prevent or\ndelay my death. If I am unable to take enough nourishment by mouth, I\nwant to receive nutrition and fluids by tube or other medical means.\n\n        \u270e___________________\nE. In Case of Pregnancy\n(Optional, for women of child-bearing years only. Directive valid if left\nblank.)\nIf I am pregnant, my decision concerning life-sustaining procedures shall be\nmodified as follows:\n\nF.\nEffect of Stated Preferences\nNote:\nRead both of these statements carefully. Then, initial one only.\nDirective valid if left blank.\n1. I realize I cannot foresee everything that might happen after I can no\nlonger decide for myself. My stated preferences are meant to guide\n\nHealth Care Decisions Bill, 2019\nSCHEDULE\n\nc\nIntroduced\nPage 49\n\nwhoever is making decisions on my behalf and my health care providers,\nbut I authorize them to be flexible in applying these statements if they\nfeel that doing so would be in my best interest.\n\n>>OR<<                                                               \u270e___________________\n2. I realize I cannot foresee everything that might happen after I can no\nlonger decide for myself. Still, I want whoever is making decisions on\nmy behalf and my health care providers to follow my stated preferences\nexactly as written, even if they think that some alternative is better.\n\n                                                                            \u270e___________________\nPart 3: Signature and witnesses\nBy signing below, I indicate that I am mentally competent to make this directive\nand that I understand its purpose and effect. I also understand that this document\nreplaces any similar advance health care directive I may have completed before\nthis date. I declare that this directive is made voluntarily and without coercion,\nduress or inducement.\n_____________________________\n\n_______________________\nSignature of Directive-Maker\n\nDate\n\nWitnessing doctor\u2019s statement:\nThe directive-maker signed this document in my presence. I am satisfied that:\n(a)\nthe directive-maker is an adult who is mentally competent;\n(b)\nthis directive was given voluntarily and without coercion, duress or\ninducement; and\n(c)\nthe directive-maker has been told about the nature and consequences of\nmaking this directive.\n_____________________________\n\n______________________\nSignature of Witnessing Doctor\n\nDate\nDoctor\u2019s name in print: ___________________________________________\nDoctor\u2019s registration number: _______________________________________\nSignature of the other witness:\n\nThe directive-maker signed this document in my presence:*\n\nSCHEDULE\nHealth Care Decisions Bill, 2019\n\nPage 50\nIntroduced\nc\n\n_____________________________\n\n_______________________\nSignature of Witness\n\nDate\n\nWitness\u2019 name in print:__________________________________________\n\n*Note:\nCertain people cannot be a witness. Anyone appointed under Part 1 of\nthis directive as a proxy and anyone who is a beneficiary - that is a\nperson who might benefit under the directive-maker\u2019s will or estate in\nintestacy or an insurance policy under which a life insured is, or\nincludes, the directive-maker; or has an interest granted under an\ninstrument under which the directive-maker is the donor, grantor or\nsettlor - of the directive-maker are not eligible.\n\nCHECKLIST\nDid you remember to:\n\uf063 Fill out Part 1 if you want to name a proxy (or proxies)?\n\uf063 Talk to your proxy about your values and priorities, and decide whether\nthat\u2019s enough guidance or whether you also want to make specific health\ncare decisions in your directive?\n\uf063 If you want to make specific decisions, fill out Part 2, choosing carefully\namong alternatives?\n\uf063 Sign and date the directive in Part 3, in front of a witnessing doctor and\nanother independent witness?\n\uf063 Did the witnessing doctor and the other witness also sign the directive just\nafter you did?\n\uf063 Make sure your proxy (if you named one), your family, and your doctor\nknow about your advance health care planning\n\nHealth Care Decisions Bill, 2019\nSCHEDULE\n\nc\nIntroduced\nPage 51\n\n      Give a copy of your directive to your:\n\uf063\nProxy\n\uf063\nFamily members\n\uf063\nDoctors\n\uf063\nHospital\n\uf063\nNursing Home (if applicable)\nPassed by the Legislative Assembly the\nday of\n, 2019\nSpeaker\nClerk of the Legislative Assembly","akn_extracted_at":"2026-06-22 15:41:51.028886+00","cms_id":"2019-0006","law_type":"bill","year":"2019","number":"6","title":"Monetary Authority (Amendment) Law, 2019","status":"bill"},"provenance":{"files":[{"file_id":"6976","expr_id":"2177","kind":"akn_xml","filename":"2019-0006.akn.xml","source_url":null,"storage_path":"\/Users\/q\/kyleg-data\/working\/BILLS\/2019\/2019-0006\/2019-0006.akn.xml","content_md5":"c1b3a17c6fb3f916c9b35a26f624a931","byte_size":"79604","http_last_modified":null,"fetched_at":"2026-06-22 15:41:51.384477+00"},{"file_id":"4353","expr_id":"2177","kind":"pristine_pdf","filename":"2019-0006.pdf","source_url":"\/cms\/images\/LEGISLATION\/BILLS\/2019\/2019-0006\/2019-0006.pdf","storage_path":"\/Users\/q\/kyleg-data\/pristine\/BILLS\/2019\/2019-0006\/2019-0006.pdf","content_md5":"b6466cb23f6d87a6242fe0cc64856527","byte_size":"826101","http_last_modified":null,"fetched_at":"2026-06-16 04:01:11.271103+00"},{"file_id":"4354","expr_id":"2177","kind":"working_pdf","filename":"2019-0006.pdf","source_url":"\/cms\/images\/LEGISLATION\/BILLS\/2019\/2019-0006\/2019-0006.pdf","storage_path":"\/Users\/q\/kyleg-data\/working\/BILLS\/2019\/2019-0006\/2019-0006.pdf","content_md5":"b6466cb23f6d87a6242fe0cc64856527","byte_size":"826101","http_last_modified":null,"fetched_at":"2026-06-16 04:01:11.271103+00"}],"paragraph_count":48,"latest_history":null},"quality":{"expr_id":"2177","doc_id":"2177","quality_state":"known_issue","quality_score":"55","needs_human_review":"t","deterministic_categories":"{duplicate_text,page_header_footer_noise,paragraph_numbering_problem,title_mismatch}","llm_categories":"{}","repair_actions":"{collapse_duplicate_text,rebuild_paragraphs,strip_page_furniture,verify_title_metadata}","finding_severity_counts":"{\"low\": 2, \"high\": 1, \"medium\": 1}","finding_summary":"stored title is not visible in the opening extracted text; repeated line furniture detected: cayman islands x3; health care decisions bill 2019 x50; introduced x48","assessed_at":"2026-06-22 15:29:46.508115+00","updated_at":"2026-06-22 15:29:46.508115+00"}}