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PS 1272

“Para enmendar los Artículos 2, 3, 4, 5, 9, 10, 12 y 15 de la Ley Núm. 160 de 17 de noviembre de 2001, según enmendada, conocida como la “Ley de Declaración previa de voluntad sobre tratamiento médico”; añadir unos nuevos Artículos 4-A, 9-A y 10-A a dicha Ley; a los fines de ampliar y aclarar los derechos de las personas en torno a decisiones clínicas al final de la vida; reconocer expresamente la planificación anticipada de cuidado, la orden médica de tratamiento al final de la vida, el cuidado paliativo, la sedación paliativa, el manejo adecuado del dolor, el rechazo o retiro de tratamientos médicos, la evaluación de tratamientos fútiles o médicamente no beneficiosos, la intervención de comités de ética clínica y el deber de no abandono clínico; establecer deberes de orientación, documentación, coordinación y cumplimiento para médicos e instituciones de servicios de salud; disponer protecciones de responsabilidad para profesionales e instituciones que actúen de buena fe conforme a la voluntad válida del paciente; ordenar la preparación de formularios y guías uniformes; y para otros fines relacionados.”

2025-2028 Session

The bill strengthens patient autonomy by formalizing advance care planning and end-of-life orders, ensuring clear documentation, ethics oversight, and protections for those acting

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Bill Summary · PS 1272

Overview

Bill PS 1272 (Session 2025-2028, Puerto Rico) aims to enmend and expand the current Law Number 160 of November 17, 2001 (the "Ley de Declaración previa de voluntad sobre tratamiento médico"), adding new articles and clarifying end-of-life clinical decision-making. The measure emphasizes patient autonomy, advance care planning, palliative care, and ethical oversight while including protections for professionals acting in good faith according to a patient’s valid will. It explicitly states that it does not authorize euthanasia or active physician-assisted death.

Purpose and Intent

  • Strengthen the protections and clarity around end-of-life decisions.
  • Explicitly recognize and formalize:
    • Advance care planning
    • End-of-life medical orders
    • Palliative care and palliative sedation
    • Pain management
    • Rejection or withdrawal of medical treatments
    • Evaluation of futile or non-beneficial treatments
    • Involvement of clinical ethics committees
    • Duty of non-abandonment by clinicians
  • Establish duties for physicians and health care institutions regarding guidance, documentation, coordination, and compliance.
  • Provide liability protections for professionals and institutions acting in good faith according to a patient’s valid will.
  • Create uniform forms and guidelines for implementation.

Key Provisions and Changes

  • Definitions (Article 2, new terms included):
    • Clarifies terms like treatment medical, terminal condition, persistent vegetative state, palliative care, palliative sedation, futile or non-beneficial treatment, and order of medical treatment at end of life.
    • Defines roles: physician, health care institution, declarant, witness, and clinical ethics committee.
  • Declaration of Prior Will (Article 3):
    • Allows adults with full mental capacity to declare in advance what treatments they want or refuse if they become incapable.
    • May include designation of a proxy or broad “support persons.”
    • Clarifies that advance directives should be interpreted according to the declarant’s values and dignity.
  • Requirements for the Advance Directive (Article 4):
    • Written, signed, and sworn before a notary or authorized official; or witnessed with medical professional presence and two non-heir witnesses.
    • May include instructions on resuscitation, ventilation, hospital transfer, ICU admission, nutrition/hydration, palliative care, hospice, pain management, sedation, and other end-of-life preferences.
    • May designate additional support persons to assist communication, without substituting the declarant’s will.
    • May incorporate an End-of-Life Medical Treatment Order (see Article 4-A).
  • End-of-Life Medical Treatment Order (Article 4-A, new):
    • Authorized for adults in good standing who request it.
    • Clinically oriented, compatible with the advance directive and patient preferences.
    • Covers CPR, intubation, mechanical ventilation, hospital transfer, ICU admission, artificial nutrition/hydration, dialysis, transfusions, antibiotics, palliative care, hospice, pain management, and other pertinent interventions.
    • Must be written or electronically authorized, dated, signed by the issuing physician, signed by patient or authorized representative, included in the medical record, revisable with material changes, and revocable while capacity remains.
    • Health Department to prepare a uniform form and regulate minimum requirements for inter-institutional use and transfer.
  • Notification, Recordkeeping, and Availability (Article 5):
    • Declarant must notify the physician or health care institution and share a copy.
    • If incapacity prevents direct communication, designated witnesses or the attorney-in-fact notify the physician.
    • Health care institutions must have procedures to identify, receive, and incorporate advance directives and EOL orders into patient records.
    • When transferring patients, the sending institution must include the relevant documents unless otherwise instructed.
  • Compliance and Accountability (Article 9) and Ethical Oversight (Article 9-A):
    • Medical staff and institutions must faithfully comply with the declarant’s wishes; violations may entail damages.
    • Protections for decisions made in accordance with the law; mediation and consultation with ethics committees when needed.
    • If doubt exists about scope or validity, reasonable steps to consult the designated surrogate, supporters, records, and the ethics committee.
    • Hospitals must establish an ethics committee or equivalent mechanism; if not available, arrangements with another institution or network are required.
    • Parties may seek judicial resolution if substantial controversy cannot be resolved clinically or ethically in time.
  • Basic Care, Dignity, and Non-Abandonment (Article 10) and Palliative Care Provisions (Article 10-A):
    • Reaffirmation that honoring the patient’s will does not compromise basic care, dignity, or comfort.
    • Rejection or withdrawal of treatment cannot be interpreted as abandonment; patients retain access to pain management, palliative care, and supportive services.
    • Palliative sedation may be used for refractory suffering but not as a primary means to cause death.
    • If a treatment is deemed futile or non-beneficial, clinical justification must be documented; alternatives should be discussed; substantial controversy may be referred to ethics committees.
  • Prohibition of Euthanasia (Article 12):
    • Reiterates that the law does not authorize euthanasia or physician-assisted death; it permits withdrawal/withholding of treatments and palliative care under accepted standards.
  • Public Outreach and Forms (Article 15):
    • State Department and Elder Affairs Office will run a public information campaign.
    • Health Department, in coordination with multiple agencies and professional bodies, will develop uniform forms, guides, and educational materials on advance directives, care planning, EOL orders, revocation, modification, palliative care, and ethics committee activation.
    • Regulations to implement the law to be issued within 180 days of enactment.

Who Is Affected

  • Adult patients capable of giving informed consent.
  • Patients facing grave, advanced, terminal, incurable, or irreversible conditions.
  • Patients’ designated mandatarios (agents) and designated supporters.
  • Health care professionals (physicians, nurses, hospital staff) and health care institutions (hospitals, hospices, long-term care facilities, etc.).
  • Ethics committees within hospitals or via cross-institutional arrangements.
  • Medical and legal professionals involved in advance directives, end-of-life decisions, and organ donation processes.

Procedural and Timeline Aspects

  • Passage and enactment: If enacted, the law would start once approved; the Health Department must implement regulations and uniform forms within up to 180 days.
  • Documentation flow: Requires immediate incorporation of advance directives and EOL orders into patient records; procedures for inter-facility transfer of documents.
  • Review and revision: End-of-life orders are revisable as long as the patient retains decisional capacity.
  • Dispute resolution: Ethics committees provide expedited consultative input; court involvement remains possible for unresolved substantial controversies.
  • Outreach: A nationwide campaign and distribution of standardized forms/guides are mandated to raise awareness and facilitate implementation.

This bill is a comprehensive update to advance care planning and end-of-life decision-making in Puerto Rico, balancing patient autonomy with clinical guidance, ethics oversight, and clear safeguards for care continuity and dignity.

Compiled from official sources — confirm details with the bill’s official record.

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