Connecticut 2014 Regular Session

Connecticut House Bill HB05326 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	General Assembly Raised Bill No. 5326
2	2	February Session, 2014 LCO No. 1569
3	3	01569_______PH_
4	4	Referred to Committee on PUBLIC HEALTH
5	5	Introduced by:
6	6	(PH)
7	7
8	8	General Assembly
9	9
10	10	Raised Bill No. 5326
11	11
12	12	February Session, 2014
13	13
14	14	LCO No. 1569
15	15
16	16	01569_______PH_
17	17
18	18	Referred to Committee on PUBLIC HEALTH
19	19
20	20	Introduced by:
21	21
22	22	(PH)
23	23
24	24	AN ACT CONCERNING COMPASSIONATE AID IN DYING FOR TERMINALLY ILL PATIENTS.
25	25
26	26	Be it enacted by the Senate and House of Representatives in General Assembly convened:
27	27
28	28	Section 1. (NEW) (Effective October 1, 2014) As used in this section and sections 2 to 18, inclusive, of this act:
29	29
30	30	(1) "Adult" means a person who is eighteen years of age or older;
31	31
32	32	(2) "Aid in dying" means the medical practice of a physician prescribing medication to a qualified patient who is terminally ill, which medication a qualified patient may self-administer to bring about his or her death;
33	33
34	34	(3) "Attending physician" means the physician who has primary responsibility for the medical care of the patient and treatment of the patient's terminal illness;
35	35
36	36	(4) "Competent" means, in the opinion of the patient's attending physician, consulting physician, psychiatrist, psychologist or a court, that the patient has the capacity to understand and acknowledge the nature and consequences of health care decisions, including the benefits and disadvantages of treatment, to make an informed decision and to communicate such decision to a health care provider, including communicating through a person familiar with the patient's manner of communicating;
37	37
38	38	(5) "Consulting physician" means a physician who is qualified by specialty or experience to make a professional diagnosis and prognosis regarding the patient's terminal illness;
39	39
40	40	(6) "Counseling" means one or more consultations as necessary between a psychiatrist or a psychologist and a patient for the purpose of determining that the patient is competent and not suffering from depression or any other psychiatric or psychological disorder that causes impaired judgment;
41	41
42	42	(7) "Health care provider" means a person licensed, certified or otherwise authorized or permitted by law to administer health care or dispense medication in the ordinary course of business or practice of a profession, including, but not limited to, a physician, psychiatrist, psychologist or pharmacist;
43	43
44	44	(8) "Health care facility" means a hospital, residential care home, nursing home or rest home, as such terms are defined in section 19a-490 of the general statutes;
45	45
46	46	(9) "Informed decision" means a decision by a qualified patient to request and obtain a prescription for medication that the qualified patient may self-administer for aid in dying, that is based on an understanding and acknowledgment of the relevant facts and after being fully informed by the attending physician of: (A) The patient's medical diagnosis and prognosis; (B) the potential risks associated with self-administering the medication to be prescribed; (C) the probable result of taking the medication to be prescribed; and (D) the feasible alternatives and health care treatment options, including, but not limited to, palliative care;
47	47
48	48	(10) "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;
49	49
50	50	(11) "Palliative care" means health care centered on a terminally ill patient and such patient's family that (A) optimizes the patient's quality of life by anticipating, preventing and treating the patient's suffering throughout the continuum of the patient's terminal illness, (B) addresses the physical, emotional, social and spiritual needs of the patient, (C) facilitates patient autonomy, the patient's access to information and patient choice, and (D) includes, but is not limited to, discussions between the patient and a health care provider concerning the patient's goals for treatment and appropriate treatment options available to the patient, including hospice care and comprehensive pain and symptom management;
51	51
52	52	(12) "Patient" means a person who is under the care of a physician;
53	53
54	54	(13) "Pharmacist" means a person licensed pursuant to chapter 400j of the general statutes;
55	55
56	56	(14) "Physician" means a person licensed to practice medicine and surgery pursuant to chapter 370 of the general statutes;
57	57
58	58	(15) "Psychiatrist" means a psychiatrist licensed pursuant to chapter 370 of the general statutes;
59	59
60	60	(16) "Psychologist" means a psychologist licensed pursuant to chapter 383 of the general statutes;
61	61
62	62	(17) "Qualified patient" means a competent adult who is a resident of this state, has a terminal illness and has satisfied the requirements of this section and sections 2 to 9, inclusive, of this act, in order to obtain aid in dying;
63	63
64	64	(18) "Self-administer" means a qualified patient's act of ingesting medication; and
65	65
66	66	(19) "Terminal illness" means the final stage of an incurable and irreversible medical condition that an attending physician anticipates, within reasonable medical judgment, will produce a patient's death within six months.
67	67
68	68	Sec. 2. (NEW) (Effective October 1, 2014) (a) A person who (1) is an adult, (2) is competent, (3) is a resident of this state, (4) has been determined by such person's attending physician to have a terminal illness, and (5) has voluntarily expressed his or her wish to receive aid in dying, may request aid in dying by making two written requests pursuant to sections 3 and 4 of this act.
69	69
70	70	(b) A person is not a qualified patient under sections 1 to 18, inclusive, of this act, solely because of age, disability or any specific illness.
71	71
72	72	(c) No person, including, but not limited to, an agent under a living will, an attorney-in-fact under a durable power of attorney, a guardian, or a conservator, may act on behalf of a patient for purposes of sections 1 to 18, inclusive, of this act.
73	73
74	74	Sec. 3. (NEW) (Effective October 1, 2014) (a) A patient wishing to receive aid in dying shall submit two written requests to such patient's attending physician in substantially the form set forth in section 4 of this act. A valid written request for aid in dying under sections 1 to 18, inclusive, of this act, shall be signed and dated by the patient. Each request shall be witnessed by at least two persons who, in the presence of the patient, attest that to the best of their knowledge and belief the patient is (1) of sound mind, and (2) acting voluntarily and not being coerced to sign the request. The patient's second written request for aid in dying shall be submitted not earlier than fifteen days after the patient submits the first request.
75	75
76	76	(b) At least one of the witnesses described in subsection (a) of this section shall be a person who is not: (1) A relative of the patient by blood, marriage or adoption; (2) at the time the request is signed, entitled to any portion of the estate of the patient upon the patient's death, under any will or by operation of law; or (3) an owner, operator or employee of a health care facility where the patient is receiving medical treatment or is a resident.
77	77
78	78	(c) The patient's attending physician at the time the request is signed shall not be a witness.
79	79
80	80	(d) If the patient is a resident of a residential care home, nursing home or rest home, as such terms are defined in section 19a-490 of the general statutes, at the time the written request is made, one of the witnesses shall be a person designated by such home.
81	81
82	82	Sec. 4. (NEW) (Effective October 1, 2014) A request for aid in dying as authorized by sections 1 to 18, inclusive, of this act, shall be in substantially the following form:
83	83
84	84	REQUEST FOR MEDICATION TO AID IN DYING
85	85
86	86	I, .…, am an adult of sound mind.
87	87
88	88	I am a resident of the State of Connecticut.
89	89
90	90	I am suffering from …., which my attending physician has determined is an incurable and irreversible medical condition that will, within reasonable medical judgment, result in death within six months. This diagnosis of a terminal illness has been confirmed by another physician.
91	91
92	92	I have been fully informed of my diagnosis, prognosis, the nature of medication to be prescribed to aid me in dying, the potential associated risks, the expected result, feasible alternatives and additional health care treatment options, including palliative care.
93	93
94	94	I request that my attending physician prescribe medication that I may self-administer for aid in dying. I authorize my attending physician to contact a pharmacist to fill the prescription for such medication, upon my request.
95	95
96	96	INITIAL ONE:
97	97
98	98	…. I have informed my family of my decision and taken their opinions into consideration.
99	99
100	100	…. I have decided not to inform my family of my decision.
101	101
102	102	…. I have no family to inform of my decision.
103	103
104	104	I understand that I have the right to rescind this request at any time.
105	105
106	106	I understand the full import of this request and I expect to die if and when I take the medication to be prescribed. I further understand that although most deaths occur within three hours, my death may take longer and my attending physician has counseled me about this possibility.
107	107
108	108	I make this request voluntarily and without reservation, and I accept full responsibility for my decision to request aid in dying.
109	109
110	110	Signed: ….
111	111
112	112	Dated: ….
113	113
114	114	DECLARATION OF WITNESSES
115	115
116	116	By initialing and signing below on the date the person named above signs, I declare that the person making and signing the above request:
117	117
118	118	Witness 1 …. Witness 2 ….
119	119
120	120	Initials …. Initials ….
121	121
122	122	…. 1. Is personally known to me or has provided proof of identity;
123	123
124	124	…. 2. Signed this request in my presence on the date of the person's signature;
125	125
126	126	…. 3. Appears to be of sound mind and not under duress, fraud or undue influence; and
127	127
128	128	…. 4. Is not a patient for whom I am the attending physician.
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130	130	Printed Name of Witness 1 ….
131	131
132	132	Signature of Witness 1 …. Date ….
133	133
134	134	Printed Name of Witness 2 ….
135	135
136	136	Signature of Witness 2 …. Date ….
137	137
138	138	Sec. 5. (NEW) (Effective October 1, 2014) (a) A qualified patient may rescind his or her request for aid in dying at any time and in any manner without regard to his or her mental state.
139	139
140	140	(b) An attending physician shall offer a qualified patient an opportunity to rescind his or her request for aid in dying at the time such patient submits a second written request for aid in dying to the attending physician.
141	141
142	142	(c) No prescription for medication for aid in dying shall be written without the qualified patient's attending physician first offering the qualified patient a second opportunity to rescind his or her request for aid in dying.
143	143
144	144	Sec. 6. (NEW) (Effective October 1, 2014) When an attending physician is presented with a patient's first written request for aid in dying made pursuant to sections 2 to 4, inclusive, of this act, the attending physician shall:
145	145
146	146	(1) Make a determination that the patient (A) is an adult, (B) has a terminal illness, (C) is competent, and (D) has voluntarily requested aid in dying;
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148	148	(2) Require the patient to demonstrate residency in this state by presenting: (A) A Connecticut driver's license; (B) a valid voter registration record authorizing the patient to vote in this state; (C) evidence that the patient owns or leases property in this state; or (D) any other government-issued document that the attending physician reasonably believes demonstrates that the patient is a current resident of this state;
149	149
150	150	(3) Ensure that the patient is making an informed decision by informing the patient of: (A) The patient's medical diagnosis; (B) the patient's prognosis; (C) the potential risks associated with self-administering the medication to be prescribed for aid in dying; (D) the probable result of self-administering the medication to be prescribed for aid in dying; and (E) the feasible alternatives and health care treatment options including, but not limited to, palliative care;
151	151
152	152	(4) Refer the patient to a consulting physician for medical confirmation of the attending physician's diagnosis of the patient's terminal illness, the patient's prognosis and for a determination that the patient is competent and acting voluntarily in requesting aid in dying.
153	153
154	154	Sec. 7. (NEW) (Effective October 1, 2014) In order for a patient to be found to be a qualified patient for the purposes of sections 1 to 18, inclusive, of this act, a consulting physician shall: (1) Examine the patient and the patient's relevant medical records; (2) confirm, in writing, the attending physician's diagnosis that the patient has a terminal illness; (3) verify that the patient is competent, is acting voluntarily and has made an informed decision to request aid in dying; and (4) refer the patient for counseling, if required in accordance with section 8 of this act.
155	155
156	156	Sec. 8. (NEW) (Effective October 1, 2014) (a) If, in the medical opinion of the attending physician or the consulting physician, a patient may be suffering from a psychiatric or psychological condition or depression that is causing impaired judgment, either the attending or consulting physician shall refer the patient for counseling to determine whether the patient is competent to request aid in dying.
157	157
158	158	(b) An attending physician shall not provide the patient aid in dying until the person providing such counseling determines that the patient is not suffering a psychiatric or psychological condition or depression that is causing impaired judgment.
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160	160	Sec. 9. (NEW) (Effective October 1, 2014) (a) After an attending physician and a consulting physician determine that a patient is a qualified patient, in accordance with sections 6 to 8, inclusive, of this act and after such qualified patient submits a second request for aid in dying in accordance with section 3 of this act, the attending physician shall:
161	161
162	162	(1) Recommend to the qualified patient that he or she notify next of kin of the qualified patient's request for aid in dying and inform the qualified patient that a failure to do so shall not be a basis for the denial of such request;
163	163
164	164	(2) Counsel the qualified patient concerning the importance of: (A) Having another person present when the qualified patient self-administers the medication prescribed for aid in dying; and (B) not taking the medication in a public place;
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166	166	(3) Inform the qualified patient that the qualified patient may rescind his or her request for aid in dying at any time and in any manner;
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168	168	(4) Verify, immediately before writing the prescription for medication for aid in dying, that the qualified patient is making an informed decision;
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170	170	(5) Fulfill the medical record documentation requirements set forth in section 10 of this act; and
171	171
172	172	(6) (A) Dispense such medications, including ancillary medications intended to facilitate the desired effect to minimize the qualified patient's discomfort, if the attending physician is authorized to dispense such medication, to the qualified patient; or (B) upon the qualified patient's request and with the qualified patient's written consent (i) contact a pharmacist and inform the pharmacist of the prescription, and (ii) deliver the written prescription personally, by mail, by facsimile or by another electronic method that is permitted by the pharmacy to the pharmacist, who shall dispense such medications directly to the qualified patient, the attending physician or an expressly-identified agent of the qualified patient.
173	173
174	174	(b) The attending physician may sign the qualified patient's death certificate that shall list the underlying terminal illness as the cause of death.
175	175
176	176	Sec. 10. (NEW) (Effective October 1, 2014) With respect to a request by a qualified patient for aid in dying, the attending physician shall ensure that the following items are documented or filed in the qualified patient's medical record:
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178	178	(1) The basis for determining that the qualified patient requesting aid in dying is an adult and is a resident of the state;
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180	180	(2) All oral requests by a qualified patient for medication for aid in dying;
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182	182	(3) All written requests by a qualified patient for medication for aid in dying;
183	183
184	184	(4) The attending physician's diagnosis of the qualified patient's terminal illness and prognosis, and a determination that the qualified patient is competent, is acting voluntarily and has made an informed decision to request aid in dying;
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186	186	(5) The consulting physician's confirmation of the qualified patient's diagnosis and prognosis, confirmation that the qualified patient is competent, is acting voluntarily and has made an informed decision to request aid in dying;
187	187
188	188	(6) A report of the outcome and determinations made during counseling, if counseling was recommended and provided in accordance with section 8 of this act;
189	189
190	190	(7) Documentation of the attending physician's offer to the qualified patient to rescind his or her request for aid in dying at the time the attending physician writes the qualified patient a prescription for medication for aid in dying; and
191	191
192	192	(8) A statement by the attending physician indicating that all requirements under this section and sections 1 to 9, inclusive, of this act, have been met and indicating the steps taken to carry out the qualified patient's request for aid in dying, including the medication prescribed.
193	193
194	194	Sec. 11. (NEW) (Effective October 1, 2014) Records or information collected or maintained pursuant to sections 1 to 18, inclusive, of this act shall not be subject to subpoena or discovery or introduced into evidence in any judicial or administrative proceeding except to resolve matters concerning compliance with the provisions of sections 1 to 18, inclusive, of this act, or as otherwise specifically provided by law.
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196	196	Sec. 12. (NEW) (Effective October 1, 2014) Any person in possession of medication prescribed for aid in dying that has not been self-administered shall dispose of such medication in accordance with section 21a-252 of the general statutes.
197	197
198	198	Sec. 13. (NEW) (Effective October 1, 2014) (a) Any provision in a contract, will, insurance policy, annuity or other agreement, whether written or oral, that is entered into on or after October 1, 2014, that would affect whether a person may make or rescind a request for aid in dying is not valid.
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200	200	(b) Any obligation owing under any currently existing contract shall not be conditioned or affected by the making or rescinding of a request for aid in dying.
201	201
202	202	(c) On and after the effective date of this section, the sale, procurement or issuance of any life, health or accident insurance or annuity policy or the rate charged for any such policy shall not be conditioned upon or affected by the making or rescinding of a request for aid in dying.
203	203
204	204	(d) A qualified patient's act of requesting aid in dying or self-administering medication prescribed for aid in dying shall not: (1) Affect a life, health or accident insurance or annuity policy, or benefits payable under such policy; (2) be grounds for eviction from a person's place of residence or a basis for discrimination in the terms, conditions or privileges of sale or rental of a dwelling or in the provision of services or facilities in connection therewith; (3) provide the sole basis for the appointment of a conservator or guardian; or (4) constitute suicide for any purpose.
205	205
206	206	Sec. 14. (NEW) (Effective October 1, 2014) (a) As used in this section, "participate in the provision of medication" means to perform the duties of an attending physician or consulting physician, a psychiatrist, psychologist or pharmacist in accordance with the provisions of sections 2 to 10, inclusive, of this act, and does not include: (1) Making an initial diagnosis of a patient's terminal illness; (2) informing a patient of his or her medical diagnosis or prognosis; (3) informing a patient concerning the provisions of this section and sections 2 to 18, inclusive, of this act, upon the patient's request; or (4) referring a patient to another health care provider for aid in dying.
207	207
208	208	(b) Participation in any act described in sections 1 to 18, inclusive, of this act by a patient, health care provider or any other person shall be voluntary. Each health care provider shall individually and affirmatively determine whether to participate in the provision of medication to a qualified patient for aid in dying. A health care facility shall not require a health care provider to participate in the provision of medication to a qualified patient for aid in dying, but may prohibit such participation in accordance with subsection (d) of this section.
209	209
210	210	(c) If a health care provider or health care facility is unwilling to participate in the provision of medication to a qualified patient for aid in dying, such health care provider or health care facility shall transfer all relevant medical records to any health care provider or health care facility, as requested by a qualified patient.
211	211
212	212	(d) A health care facility may adopt written policies prohibiting a health care provider associated with such health care facility from participating in the provision of medication to a patient for aid in dying, provided such facility provides written notice of such policy and any sanctions for violation of such policy to such health care provider. Notwithstanding the provisions of this subsection or any policies adopted in accordance with this subsection, any qualified health care provider may: (1) Diagnose a patient with a terminal illness; (2) inform a patient of his or her medical prognosis; (3) provide a patient with information concerning the provisions of sections 1 to 18, inclusive, of this act upon a patient's request; (4) refer a patient to another health care facility or health care provider; (5) transfer a patient's medical records to a health care provider or health care facility, as requested by a patient; or (6) participate in the provision of medication for aid in dying when such health care provider is acting outside the scope of his or her employment or contract with a health care facility that prohibits participation in the provision of such medication.
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214	214	Sec. 15. (NEW) (Effective October 1, 2014) (a) Any person who without authorization of a patient wilfully alters or forges a request for aid in dying, as described in sections 3 and 4 of this act, or conceals or destroys a rescission of such a request for aid in dying with the intent or effect of causing the patient's death, is guilty of attempted murder or murder under section 53a-54 of the general statutes.
215	215
216	216	(b) Any person who coerces or exerts undue influence on a patient to complete a request for aid in dying, as described in sections 3 and 4 of this act, or coerces or exerts undue influence on a patient to destroy a rescission of such request with the intent or effect of causing the patient's death, is guilty of attempted murder or murder under section 53a-54a of the general statutes.
217	217
218	218	Sec. 16. (NEW) (Effective October 1, 2014) (a) Nothing in sections 1 to 17, inclusive, of this act, authorizes a physician or any other person to end a patient's life by lethal injection, mercy killing, assisting a suicide or any other active euthanasia.
219	219
220	220	(b) Any action taken in accordance with sections 1 to 18, inclusive, of this act, does not constitute causing or assisting another person to commit suicide in violation of section 53a-54a or 53a-56 of the general statutes.
221	221
222	222	(c) No report of a public agency, as defined in section 1-200 of the general statutes, may refer to the practice of obtaining and self-administering life-ending medication to end a qualified patient's life as "suicide" or "assisted suicide", and shall refer to such practice as "aid in dying".
223	223
224	224	Sec. 17. (NEW) (Effective October 1, 2014) Sections 1 to 18, inclusive, of this act, do not limit liability for civil damages resulting from negligent conduct or intentional misconduct by any person.
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226	226	Sec. 18. (NEW) (Effective October 1, 2014) Nothing in this section or sections 1 to 17, inclusive, of this act, shall preclude criminal prosecution under any provision of law for conduct that is inconsistent with this section or sections 1 to 17, inclusive, of this act.
227	227
228	228
229	229
230	230
231	231	This act shall take effect as follows and shall amend the following sections:
232	232	Section 1 October 1, 2014 New section
233	233	Sec. 2 October 1, 2014 New section
234	234	Sec. 3 October 1, 2014 New section
235	235	Sec. 4 October 1, 2014 New section
236	236	Sec. 5 October 1, 2014 New section
237	237	Sec. 6 October 1, 2014 New section
238	238	Sec. 7 October 1, 2014 New section
239	239	Sec. 8 October 1, 2014 New section
240	240	Sec. 9 October 1, 2014 New section
241	241	Sec. 10 October 1, 2014 New section
242	242	Sec. 11 October 1, 2014 New section
243	243	Sec. 12 October 1, 2014 New section
244	244	Sec. 13 October 1, 2014 New section
245	245	Sec. 14 October 1, 2014 New section
246	246	Sec. 15 October 1, 2014 New section
247	247	Sec. 16 October 1, 2014 New section
248	248	Sec. 17 October 1, 2014 New section
249	249	Sec. 18 October 1, 2014 New section
250	250
251	251	This act shall take effect as follows and shall amend the following sections:
252	252
253	253	Section 1
254	254
255	255	October 1, 2014
256	256
257	257	New section
258	258
259	259	Sec. 2
260	260
261	261	October 1, 2014
262	262
263	263	New section
264	264
265	265	Sec. 3
266	266
267	267	October 1, 2014
268	268
269	269	New section
270	270
271	271	Sec. 4
272	272
273	273	October 1, 2014
274	274
275	275	New section
276	276
277	277	Sec. 5
278	278
279	279	October 1, 2014
280	280
281	281	New section
282	282
283	283	Sec. 6
284	284
285	285	October 1, 2014
286	286
287	287	New section
288	288
289	289	Sec. 7
290	290
291	291	October 1, 2014
292	292
293	293	New section
294	294
295	295	Sec. 8
296	296
297	297	October 1, 2014
298	298
299	299	New section
300	300
301	301	Sec. 9
302	302
303	303	October 1, 2014
304	304
305	305	New section
306	306
307	307	Sec. 10
308	308
309	309	October 1, 2014
310	310
311	311	New section
312	312
313	313	Sec. 11
314	314
315	315	October 1, 2014
316	316
317	317	New section
318	318
319	319	Sec. 12
320	320
321	321	October 1, 2014
322	322
323	323	New section
324	324
325	325	Sec. 13
326	326
327	327	October 1, 2014
328	328
329	329	New section
330	330
331	331	Sec. 14
332	332
333	333	October 1, 2014
334	334
335	335	New section
336	336
337	337	Sec. 15
338	338
339	339	October 1, 2014
340	340
341	341	New section
342	342
343	343	Sec. 16
344	344
345	345	October 1, 2014
346	346
347	347	New section
348	348
349	349	Sec. 17
350	350
351	351	October 1, 2014
352	352
353	353	New section
354	354
355	355	Sec. 18
356	356
357	357	October 1, 2014
358	358
359	359	New section
360	360
361	361	Statement of Purpose:
362	362
363	363	To allow a physician to prescribe medication at the request of a mentally competent patient that has a terminal illness that such patient may self-administer to bring about his or her death.
364	364
365	365	[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not underlined.]