Advance medical directives; revises Health Care Decisions Act to clarify process. (HB2396)

Introduced By

Del. Rob Bell (R-Charlottesville) with support from co-patron Del. Phil Hamilton (R-Newport News)


Passed Committee
Passed House
Passed Senate
Signed by Governor
Became Law


Advance medical directives. Revises the Health Care Decisions Act to (i) clarify the process for determining a patient to be incapable of making an informed decision regarding health care; (ii) require that determinations of incapacity be made by two physicians, or one physician and one licensed clinical psychologist, one of whom is not otherwise involved in the care of the patient; (iii) allow any one physician to declare that a patient is again capable of making an informed decision; (iv) clarify the authority of an agent named in an advance directive, or a person otherwise given authority to make medical decisions for an incompetent patient; and (v) determine when a physician may treat a patient over his protests. Read the Bill »


Bill Has Passed


01/14/2009Prefiled and ordered printed; offered 01/14/09 090534432
01/14/2009Referred to Committee on Health, Welfare and Institutions
01/29/2009Reported from Health, Welfare and Institutions with substitute (21-Y 0-N) (see vote tally)
01/29/2009Committee substitute printed 094137432-H1
01/30/2009Read first time
02/02/2009Passed by for the day
02/03/2009Passed by for the day
02/04/2009Read second time
02/04/2009Committee substitute rejected 094137432-H1
02/04/2009Floor substitute printed 094143432-H2 (Bell)
02/04/2009Substitute by Delegate Bell agreed to 094143432-H2
02/04/2009Passed by for the day
02/05/2009Engrossed by House - floor substitute with amendments HB2396EH1
02/05/2009Read second time
02/05/2009Passed by temporarily
02/05/2009Amendments #1-6 by Delegate Bell agreed to
02/05/2009Amendments #7-10 by Delegate Bell agreed to
02/05/2009Amendment #11 by Delegate Bell agreed to
02/05/2009Amendments by Delegate Armstrong rejected
02/05/2009Amendment by Delegate Armstrong agreed to
02/05/2009Amendment by Delegate Janis agreed to
02/05/2009Engrossed by House - floor substitute with amendments HB2396EH2
02/05/2009Printed as engrossed 094143432-EH2
02/06/2009Read third time and passed House (97-Y 0-N)
02/06/2009VOTE: --- PASSAGE (97-Y 0-N) (see vote tally)
02/09/2009Constitutional reading dispensed
02/09/2009Referred to Committee on Education and Health
02/19/2009Reported from Education and Health with substitute (15-Y 0-N) (see vote tally)
02/19/2009Committee substitute printed 099301432-S1
02/20/2009Constitutional reading dispensed (39-Y 0-N) (see vote tally)
02/23/2009Read third time
02/23/2009Reading of substitute waived
02/23/2009Committee substitute agreed to 099301432-S1
02/23/2009Engrossed by Senate - committee substitute HB2396S1
02/23/2009Passed Senate with substitute (40-Y 0-N) (see vote tally)
02/24/2009Placed on Calendar
02/25/2009Senate substitute rejected by House (1-Y 95-N)
02/25/2009VOTE: --- REJECTED (1-Y 95-N) (see vote tally)
02/26/2009Senate insisted on substitute (34-Y 4-N) (see vote tally)
02/26/2009Senate requested conference committee
02/26/2009House acceded to request
02/26/2009Conferees appointed by House
02/26/2009Delegates: Bell, Janis, BaCote
02/26/2009Conferees appointed by Senate
02/26/2009Senators: Whipple, Northam, Quayle
02/28/2009Conference substitute printed 093296432-H3
02/28/2009Conference report agreed to by House (97-Y 0-N)
02/28/2009VOTE: --- ADOPTION (97-Y 0-N) (see vote tally)
02/28/2009Conference report agreed to by Senate (40-Y 0-N) (see vote tally)
03/09/2009Bill text as passed House and Senate (HB2396ER)
03/09/2009Signed by President
03/11/2009Signed by Speaker
03/12/2009Impact statement from DPB (HB2396ER)
03/27/2009G Approved by Governor-Chapter 211 (effective 7/1/09)
03/27/2009G Acts of Assembly Chapter text (CHAP0211)


This bill was discussed on the floor of the General Assembly. Below is all of the video that we have of that discussion, 3 clips in all, totaling 1 minute.


Riley writes:

The advance directive parts are good, but the parts for forcibly treating a protesting patient remind me of something from "One Flew Over The Cuckoo's Nest" or "1984." Really, aren't we better than this? Let's not go back to the 1940's

Alison Hymes writes:

This part: (ii) aims to increase scientific understanding of any condition that the declarant may have or otherwise to promote human well-being, even though it offers no prospect of direct benefit to the patient.
should not even be in an advanced directive, it's a violaton of the Nuremberg code for an incapacitated person to participate in research without informed consent by THEM, not anyone else.

Alison Hymes writes:

This bill does not protect terminal patients from experimentationsufficently. It allows for verbal consent to experimentation not intended for the benefit of the patient if the patient is terminal. There is no check to see if the person who is dying has truly consented if there is no signature and no witness required.

There also is not sufficient protection from people signing advanced directives full of boilerplate and not realizing this clause is in their advanced directive. If this bad bill passes it should at the very least require an affirmative check off box that the signer agrees to give this power to their medical power of attorney. This is a dangerous bill for all people who will someday be incapacitated. Which is almost all of us unless we die suddenly.

Art writes:

Sunlight really should put the updated version of this bill up. There have been significant changes

Waldo Jaquith writes:

I'm awfully glad that you mentioned that, Art. Richmond Sunlight is totally automated—nobody ever "puts up" anything. So when a new version of a bill is filed, it should appear on Richmond Sunlight within the hour. It turns out that there was a bug in my code that prevented the text of some bills from being updated if more than two versions had been filed. I've gotten that fixed now. Thanks for mentioning it!