Fiscal Summary
Increase State Expenditures – $107,500/FY24-25 and Subsequent Years
Bill Summary
WRITTEN REQUEST FOR LIFE-ENDING MEDICATION
This bill authorizes an adult who is capable, is a resident of this state, and has been determined by an attending physician and a consulting physician to be suffering from an incurable and irreversible disease that will, within reasonable medical judgment, produce death within six months ("terminal disease"), and who has voluntarily expressed the wish to die, to make a written request for medication for the purpose of ending the adult's life in a humane and dignified manner in accordance with this bill. A person does not qualify under this bill solely because of age or disability.
For purposes of this bill, "capable" means that in the opinion of a court or in the opinion of the patient's attending physician, consulting physician, psychiatrist, or psychologist, a patient has the ability to make and communicate healthcare decisions to healthcare providers.
FORM OF WRITTEN REQUEST
This bill requires a valid request for medication under this bill to be substantially in the form described below under the heading "Penalties," signed and dated by the patient and witnessed by at least two individuals who, in the presence of the patient, attest that to the best of their knowledge and belief the patient is capable, acting voluntarily, and is not being coerced to sign the request.
One of the witnesses must be a person who is not: (i) a relative of the patient by blood, marriage, or adoption; (ii) a person who at the time the request is signed would be entitled to any portion of the estate of the qualified patient upon death under any will, if known, or by operation of law; or (iii) an owner, operator, or employee of a healthcare facility where the qualified patient is receiving medical treatment or is a resident.
This bill prohibits a patient's attending physician at the time the request is signed from being a witness.
If the patient is a patient in a long-term care facility at the time the written request is made, then one of the witnesses must be an individual designated by the facility. The department of health ("department") must promulgate rules governing the qualifications of an individual designated as a witness by a long-term care facility.
ATTENDING PHYSICIAN RESPONSIBILITIES
This bill requires the attending physician to do the following:
(1) Make the initial determination of whether a patient has a terminal disease, is capable, and has made the request voluntarily;
(2) Ensure that the patient is making an informed decision by informing the patient of: (i) the patient's medical diagnosis; (ii) the patient's prognosis; (iii) the potential risks associated with taking the medication to be prescribed; (iv) the probable result of taking the medication to be prescribed; and (v) the feasible alternatives;
(3) Refer the patient to a consulting physician for medical confirmation of the diagnosis and for a determination that the patient is capable and acting voluntarily;
(4) Refer the patient for counseling, if appropriate;
(5) Recommend that the patient notify next of kin;
(6) Counsel the patient about the importance of having another person present when the patient takes the medication prescribed pursuant to this bill and of not taking the medication in a public place;
(7) Inform the patient that the patient has an opportunity to rescind the request at any time and in any manner, and offer the patient an opportunity to rescind at the time the patient makes the patient's second oral request as described under the heading "Written and Oral Requests," below;
(8) Verify, immediately prior to writing the prescription for medication under this bill, that the patient is making an informed decision;
(9) Fulfill the medical record documentation requirements described under the heading "Medical Record Documentation Requests," below;
(10) Ensure that all appropriate steps are carried out in accordance with this bill prior to writing a prescription for medication to enable a qualified patient to end the patient's life in a humane and dignified manner; and
(11) Dispense medications as follows:
(A) Directly, including ancillary medications intended to facilitate the desired effect to minimize the patient's discomfort. The attending physician must be registered as a dispensing physician with the board of pharmacy and the board of medical examiners, have a current drug enforcement administration certificate, and comply with any applicable rule; or
(B) With the patient's written consent: (i) contact a pharmacist and inform the pharmacist of the prescription; and (ii) deliver the written prescription personally or by mail to the pharmacist, who will dispense the medications to the patient, the attending physician, or an expressly identified agent of the patient.
This bill authorizes the attending physician to sign the patient's death certificate.
For purposes of this bill, "informed consent" means a decision by a capable adult who is a resident of this state and has satisfied the requirements of this bill in order to obtain a prescription for medication to end the adult's life in a humane and dignified manner ("qualified patient") to request and obtain a prescription to end the patient's life in a humane and dignified manner that is based on an appreciation of the relevant facts and after being fully informed by the attending physician of:
(1) The patient's medical diagnosis;
(2) The patient's prognosis;
(3) The potential risks associated with taking the medication to be prescribed;
(4) The probable result of taking the medication to be prescribed; and
(5) The feasible alternatives.
CONSULTING PHYSICIAN CONFIRMATION
This bill requires a consulting physician, before a patient is qualified under this bill, to examine the patient and the patient's relevant medical records. The consulting physician shall confirm, in writing, the attending physician's diagnosis that the patient is suffering from a terminal disease and verify that the patient is capable, is acting voluntarily, and has made an informed decision.
COUNSELING REFERRAL
This bill requires either physician, the attending or consulting physician, if in their opinion, a patient may be suffering from a psychiatric or psychological disorder or depression causing impaired judgment, to refer the patient for counseling. Medication to end a patient's life in a humane and dignified manner must not be prescribed until the person performing the counseling determines that the patient is not suffering from a psychiatric or psychological disorder or depression causing impaired judgment.
INFORMED DECISION
This bill prohibits a person from receiving a prescription for medication to end the person's life in a humane and dignified manner unless the person has made an informed decision. Immediately prior to writing a prescription for medication under this bill, the attending physician must verify that the patient is making an informed decision.
FAMILY NOTIFICATION
This bill requires the attending physician to recommend that the patient notify the next of kin of the patient's request for medication pursuant to this bill. A patient who declines or is unable to notify next of kin must not have the patient's request denied for that reason.
WRITTEN AND ORAL REQUESTS
This bill requires that in order for a qualified patient to receive a prescription for medication to end the patient's life in a humane and dignified manner, a qualified patient must:
(1) Make an initial oral request to the patient's attending physician;
(2) Make a written request to the patient's attending physician; and
(3) Make a second oral request to the patient's attending physician no less than 15 days after making the initial oral request.
If the qualified patient's attending physician has medically confirmed that the qualified patient will, within reasonable medical judgment, die within 15 days after making the initial oral request under this bill, then the qualified patient may reiterate the oral request to the attending physician at any time after making the initial oral request.
At the time the qualified patient makes the second oral request, the attending physician must offer the patient an opportunity to rescind the request.
For purposes of this bill, "medically confirmed" means the medical opinion of the attending physician has been confirmed by a consulting physician who has examined the patient and the patient's relevant medical records.
RIGHT TO RESCIND REQUEST
This bill authorizes a patient to rescind a request at any time and in any manner without regard to the patient's mental state. A prescription for medication under this bill must not be written without the attending physician offering the qualified patient an opportunity to rescind the request.
WAITING PERIODS
This bill provides that no less than 15 days must elapse between the patient's initial oral request and the writing of a prescription under this bill and that no less than 48 hours must elapse between the patient's written request and the writing of a prescription under this bill.
If the qualified patient's attending physician has medically confirmed that the qualified patient will, within reasonable medical judgment, die before the expiration of at least one of the waiting periods described above, then the prescription for medication under this bill may be written at any time following the latter of the qualified patient's written request or second oral request.
MEDICAL RECORD DOCUMENTATION REQUIREMENTS
This bill requires the following to be documented or filed in the patient's medical record:
(1) All oral requests by a patient for medication to end the patient's life in a humane and dignified manner;
(2) All written requests by a patient for medication to end the patient's life in a humane and dignified manner;
(3) The attending physician's diagnosis, prognosis, and determination that the patient is capable, acting voluntarily, and has made an informed decision;
(4) The consulting physician's diagnosis, prognosis, and verification that the patient is capable, acting voluntarily, and has made an informed decision;
(5) A report of the outcome and determinations made during counseling, if performed;
(6) Any medically confirmed certification of the imminence of the patient's death;
(7) The attending physician's offer to the patient to rescind the patient's request at the time of the patient's second oral request; and
(8) A note by the attending physician indicating that all requirements of this bill have been met and indicating the steps taken to carry out the request.
REPORTING REQUIREMENTS
This bill requires the department to (i) annually review a sample of records maintained pursuant to this bill; and (ii) require any healthcare provider, upon dispensing medication pursuant to this bill, to file a copy of the dispensing record with the department. The department must also make rules to facilitate the collection of information regarding compliance with this bill. The information collected is not a public record, and must not be made available for inspection by the public. Additionally, the department must generate and make available to the public an annual statistical report of information collected under this provision.
EFFECT ON CONSTRUCTION OF WILL, CONTRACTS, AND STATUTES
This bill prohibits a provision in a contract, life insurance policy, will, or other agreement, whether written or oral, to the extent the provision would affect whether a person may make or rescind a request for medication to end the person's life in a humane and dignified manner, from being valid. No obligation owing under any currently existing contract will be conditioned or affected by the making or rescinding of a request, by a person, for medication to end the person's life in a humane and dignified manner. This bill clarifies that these provisions apply to contracts, policies, wills, or agreements entered into or renewed on or after the effective date of this bill.
INSURANCE OR ANNUITY POLICIES
This bill prohibits the sale, procurement, or issuance of any life, health, or accident insurance or annuity policy, or the rate charged for any policy, from being conditioned upon or affected by the making or rescinding of a request, by a person, for medication to end the person's life in a humane and dignified manner. A qualified patient's act of ingesting medication to end the patient's life in a humane and dignified manner will not have an effect upon a life, health, or accident insurance or annuity policy.
ENDING A PATIENT'S LIFE
This bill prohibits a physician or any other person from ending a patient's life by lethal injection, mercy killing, or active euthanasia, and clarifies that actions taken in accordance with this bill do not, for any purpose, constitute suicide, assisted suicide, mercy killing, or homicide under state law.
Further, this bill clarifies that it is not an offense of assisted suicide to provide medication to a qualified patient for the purpose of ending the patient's life in a humane and dignified manner pursuant to this bill.
IMMUNITY
This bill prohibits a person from being subject to civil or criminal liability or professional disciplinary action for participating in good faith compliance with this bill. This includes being present when a qualified patient takes the prescribed medication to end the patient's life in a humane and dignified manner.
A professional organization or association, or healthcare provider, must not subject a person to censure, discipline, suspension, loss of license, loss of privileges, loss of membership, or other penalty for participating or refusing to participate in good faith compliance with this bill.
A request by a patient for, or provision by an attending physician of, medication in good faith compliance with this bill must not constitute neglect for any purpose of law or provide the sole basis for the appointment of a guardian or conservator.
A healthcare provider is not under any duty, whether by contract, by statute, or by any other legal requirement, to participate in the provision to a qualified patient of medication to end the patient's life in a humane and dignified manner. If a healthcare provider is unable or unwilling to carry out a patient's request under this bill, and the patient transfers the patient's care to a new healthcare provider, the prior healthcare provider must transfer, upon request, a copy of the patient's relevant medical records to the new healthcare provider.
A healthcare provider may prohibit another healthcare provider from participating in this bill on the premises of the prohibiting provider if the prohibiting provider has notified the healthcare provider of the prohibiting provider's policy regarding participating in this bill. Nothing in this provision prohibits a healthcare provider from providing to a patient healthcare services that do not constitute participation in this bill.
A healthcare provider may subject another healthcare provider to the following sanctions if the sanctioning healthcare provider has notified the sanctioned provider prior to participation in this bill that the sanctioning provider prohibits participation in this bill:
(1) Loss of privileges, loss of membership, or other sanctions provided pursuant to the medical staff bylaws, policies, and procedures of the sanctioning healthcare provider, if the sanctioned provider is a member of the sanctioning provider's medical staff and participates in this bill while on the healthcare facility premises of the sanctioning healthcare provider, but not including the private medical office of a physician or other provider;
(2) Termination of lease or other property contract or other nonmonetary remedies provided by lease contract, not including loss or restriction of medical staff privileges or exclusion from a provider panel, if the sanctioned provider participates in this bill while on the premises of the sanctioning healthcare provider or on property that is owned by or under the direct control of the sanctioning healthcare provider; or
(3) Termination of contract or other nonmonetary remedies provided by contract, if the sanctioned provider participates in this bill while acting in the course and scope of the sanctioned provider's capacity as an employee or independent contractor of the sanctioning healthcare provider. However, this provision does not prohibit (i) a healthcare provider from participating in this bill while acting outside the course and scope of the provider's capacity as an employee or independent contractor; or (ii) a patient from contracting with the patient's attending physician and consulting physician to act outside the course and scope of the provider's capacity as an employee or independent contractor of the sanctioning healthcare provider.
A healthcare provider that imposes sanctions must afford the sanctioned healthcare provider all due process and follow all other procedures that are required of the sanctioning healthcare provider under law or rule that are related to the imposition of sanctions on another healthcare provider.
For purposes of this bill, ''notify'' means a separate statement in writing to the healthcare provider specifically informing the healthcare provider prior to the provider's participation in this bill of the sanctioning healthcare provider's policy about participation in activities covered by this bill;
For purposed of this bill, "participates in this bill'':
(1) Means to perform the duties of an attending physician or the consulting physician or the counseling function; and
(2) Does not include (i) making an initial determination that a patient has a terminal disease and informing the patient of the medical prognosis; (ii) providing information about this bill to a patient upon the request of the patient; (iii) providing a patient, upon the request of the patient, with a referral to another physician; or (iv) a patient contracting with the patient's attending physician and consulting physician to act outside of the course and scope of the provider's capacity as an employee or independent contractor of the sanctioning healthcare provider.
Suspension or termination of staff membership or privileges is not reportable to the board of medical examiners for disciplinary purposes or by the applicable quality improvement committee to any other quality improvement committee. Action taken pursuant headings "Form of Written Request," "Attending Physician Responsibilities, "Consulting Physician Confirmation," and "Counselling Referral" must not be the sole basis for a report of immoral, unethical, unprofessional, or dishonorable conduct.
This bill does not allow a lower standard of care for patients in the community where the patient is treated or a similar community.
LIABILITY
This bill clarifies that a person who, without authorization of the patient, willfully alters or forges a request for medication, or conceals or destroys a rescission of that request with the intent or effect of causing the patient's death, commits a Class A felony. Additionally, a person who coerces or exerts undue influence on a patient to request medication for the purpose of ending the patient's life, or to destroy a rescission of a request, commits a Class A felony.
This bill does not limit further liability for civil damages resulting from other negligent conduct or intentional misconduct by any person. The penalties in this bill do not preclude criminal penalties applicable under other law for conduct which is inconsistent with this bill.
CLAIMS BY GOVERNMENTAL ENTITY FOR COSTS INCURRED
This bill clarifies that a governmental entity that incurs costs resulting from a person terminating the person's life pursuant to this bill in a public place has a claim against the estate of the person to recover costs and reasonable attorney fees related to enforcing the claim.
FORM OF THE REQUEST
This bill provides that a request for medication as authorized by this bill must be substantially in the form as provided in the bill.
PENALTIES
This bill establishes that it is a Class A felony for a person without authorization of the principal to willfully alter, forge, conceal, or destroy an instrument, the reinstatement or revocation of an instrument, or any other evidence or document reflecting the principal's desires and interests, with the intent and effect of causing a withholding or withdrawal of life-sustaining procedures or of artificially administered nutrition and hydration which hastens the death of the principal.
Additionally, it is a Class A misdemeanor for a person without authorization of the principal to willfully alter, forge, conceal, or destroy an instrument, the reinstatement or revocation of an instrument, or any other evidence or document reflecting the principal's desires and interests with the intent or effect of affecting a healthcare decision.
