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General Assembly Committee Bill No. 5898
January Session, 2019
LCO No. 3838
Referred to Committee on PUBLIC HEALTH
Introduced by:
(PH)
AN ACT CONCERNING AI D IN DYING FOR TERMINALLY ILL
PATIENTS.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. (NEW) (Effective October 1, 2019) As used in this section 1
and sections 2 to 19, inclusive, of this act: 2
(1) "Adult" means a person who is eighteen years of age or older; 3
(2) "Aid in dying" means the medical practice of a physician 4
prescribing medication to a qualified patient who is terminally ill, 5
which medication a qualified patient may self-administer to bring 6
about his or her death; 7
(3) "Attending physician" means the physician who has primary 8
responsibility for the medical care of a patient and treatment of a 9
patient's terminal illness; 10
(4) "Competent" means, in the opinion of a patient's attending 11
physician, consulting physician, psychiatrist, psychologist or a court, 12
that a patient has the capacity to understand and acknowledge the 13
nature and consequences of health care decisions, including the 14
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benefits and disadvantages of treatment, to make an informed decision 15
and to communicate such decision to a health care provider, including 16
communicating through a person familiar with a patient's manner of 17
communicating; 18
(5) "Consulting physician" means a physician other than a patient's 19
attending physician who (A) is qualified by specialty or experience to 20
make a professional diagnosis and prognosis regarding a patient's 21
terminal illness, and (B) does not routinely share office space with a 22
patient's attending physician; 23
(6) "Counseling" means one or more consultations as necessary 24
between a psychiatrist or a psychologist and a patient for the purpose 25
of determining that a patient is competent and not suffering from 26
depression or any other psychiatric or psychological disorder that 27
causes impaired judgment; 28
(7) "Health care provider" means a person licensed, certified or 29
otherwise authorized or permitted by the laws of this state to 30
administer health care or dispense medication in the ordinary course 31
of business or practice of a profession, including, but not limited to, a 32
physician, psychiatrist, psychologist or pharmacist; 33
(8) "Health care facility" means a hospital, residential care home, 34
nursing home or rest home, as such terms are defined in section 19a-35
490 of the general statutes; 36
(9) "Informed decision" means a decision by a qualified patient to 37
request and obtain a prescription for medication that the qualified 38
patient may self-administer for aid in dying, that is based on an 39
understanding and acknowledgment of the relevant facts and after 40
being fully informed by the attending physician of: (A) The qualified 41
patient's medical diagnosis and prognosis; (B) the potential risks 42
associated with self-administering the medication to be prescribed; (C) 43
the probable result of taking the medication to be dispensed or 44
prescribed; and (D) the feasible alternatives to aid in dying and health 45
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care treatment options, including, but not limited to, palliative care; 46
(10) "Medically confirmed" means the medical opinion of the 47
attending physician has been confirmed by a consulting physician who 48
has examined the patient and the patient's relevant medical records; 49
(11) "Palliative care" means health care centered on a seriously ill 50
patient and such patient's family that (A) optimizes a patient's quality 51
of life by anticipating, preventing and treating a patient's suffering 52
throughout the continuum of a patient's terminal illness, (B) addresses 53
the physical, emotional, social and spiritual needs of a patient, (C) 54
facilitates patient autonomy, patient access to information and patient 55
choice, and (D) includes, but is not limited to, discussions between a 56
patient and a health care provider concerning a patient's goals for 57
treatment and appropriate treatment options available to a patient, 58
including hospice care and comprehensive pain and symptom 59
management; 60
(12) "Patient" means a person who is under the care of a physician; 61
(13) "Pharmacist" means a person licensed to practice pharmacy 62
pursuant to chapter 400j of the general statutes; 63
(14) "Physician" means a person licensed to practice medicine and 64
surgery pursuant to chapter 370 of the general statutes; 65
(15) "Psychiatrist" means a physician specializing in psychiatry and 66
licensed pursuant to chapter 370 of the general statutes; 67
(16) "Psychologist" means a person licensed to practice psychology 68
pursuant to chapter 383 of the general statutes; 69
(17) "Qualified patient" means a competent adult who is a resident 70
of this state, has a terminal illness and has satisfied the requirements of 71
this section and sections 2 to 9, inclusive, of this act, in order to obtain 72
aid in dying; 73
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(18) "Self-administer" means a qualified patient's act of ingesting 74
medication; and 75
(19) "Terminal illness" means the final stage of an incurable and 76
irreversible medical condition that an attending physician anticipates, 77
within reasonable medical judgment, will produce a patient's death 78
within six months. 79
Sec. 2. (NEW) (Effective October 1, 2019) (a) A patient who (1) is an 80
adult, (2) is competent, (3) is a resident of this state, (4) has been 81
determined by such patient's attending physician to have a terminal 82
illness, and (5) has voluntarily expressed his or her wish to receive aid 83
in dying, may request aid in dying by making two written requests to 84
such patient's attending physician pursuant to sections 3 and 4 of this 85
act. 86
(b) No person, including, but not limited to, an agent under a living 87
will, an attorney-in-fact under a durable power of attorney, a guardian, 88
or a conservator, may act on behalf of a patient for purposes of this 89
section, section 1 or sections 3 to 19, inclusive, of this act. 90
Sec. 3. (NEW) (Effective October 1, 2019) (a) A patient wishing to 91
receive aid in dying shall submit two written requests to such patient's 92
attending physician in substantially the form set forth in section 4 of 93
this act. A patient's second written request for aid in dying shall be 94
submitted not earlier than fifteen days after the date on which a patient 95
submits the first request. A valid written request for aid in dying 96
under sections 1 and 2 of this act and sections 4 to 19, inclusive, of this 97
act shall be signed and dated by the patient. Each request shall be 98
witnessed by at least two persons in the presence of the patient. Each 99
person serving as a witness shall attest, in writing, that to the best of 100
his or her knowledge and belief (1) the patient appears to be of sound 101
mind, (2) the patient is acting voluntarily and not being coerced to sign 102
the request, and (3) the witness is not: (A) A relative of the patient by 103
blood, marriage or adoption, (B) entitled to any portion of the estate of 104
the patient upon the patient's death, under any will or by operation of 105
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law, or (C) an owner, operator or employee of a health care facility 106
where the patient is a resident or receiving medical treatment. 107
(b) No person serving as a witness to a patient's request to receive 108
aid in dying shall be: (1) A relative of such patient by blood, marriage 109
or adoption; (2) at the time the request is signed, entitled to any 110
portion of the estate of the patient upon the patient's death, under any 111
will or by operation of law; (3) an owner, operator or employee of a 112
health care facility where the patient is a resident or receiving medical 113
treatment; or (4) such patient's attending physician at the time the 114
request is signed. 115
(c) Any patient's act of requesting aid in dying or a qualified 116
patient's self-administration of medication prescribed for aid in dying 117
shall not provide the sole basis for appointment of a conservator or 118
guardian for such patient or qualified patient. 119
Sec. 4. (NEW) (Effective October 1, 2019) A request for aid in dying as 120
authorized by this section, sections 1 to 3, inclusive, of this act and 121
sections 5 to 19, inclusive, of this act shall be in substantially the 122
following form: 123
REQUEST FOR MEDICATION TO AID IN DYING 124
I, .…, am an adult of sound mind. 125
I am a resident of the State of Connecticut. 126
I am suffering from …., which my attending physician has 127
determined is an incurable and irreversible medical condition that will, 128
within reasonable medical judgment, result in death within six months 129
from the date on which this document is executed. This diagnosis of a 130
terminal illness has been medically confirmed by another physician. 131
I have been fully informed of my diagnosis, prognosis, the nature of 132
medication to be dispensed or prescribed to aid me in dying, the 133
potential associated risks, the expected result, feasible alternatives to 134
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aid in dying and additional health care treatment options, including 135
palliative care and the availability of counseling with a psychologist, 136
psychiatrist or licensed clinical social worker. 137
I request that my attending physician dispense or prescribe 138
medication that I may self-administer for aid in dying. I authorize my 139
attending physician to contact a pharmacist to fill the prescription for 140
such medication, upon my request. 141
INITIAL ONE: 142
…. I have informed my family of my decision and taken family 143
opinions into consideration. 144
…. I have decided not to inform my family of my decision. 145
…. I have no family to inform of my decision. 146
I understand that I have the right to rescind this request at any time. 147
I understand the full import of this request and I expect to die if and 148
when I take the medication to be dispensed or prescribed. I further 149
understand that although most deaths occur within three hours, my 150
death may take longer and my attending physician has counseled me 151
about this possibility. 152
I make this request voluntarily and without reservation, and I 153
accept full responsibility for my decision to request aid in dying. 154
Signed: …. 155
Dated: …. 156
DECLARATION OF WITNESSES 157
By initialing and signing below on the date the person named above 158
signs, I declare that: 159
Witness 1 …. Witness 2 …. 160
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Initials …. Initials …. 161
…. 1. The person making and signing the request is personally 162
known to me or has provided proof of identity; 163
…. 2. The person making and signing the request signed this request 164
in my presence on the date of the person's signature; 165
…. 3. The person making the request appears to be of sound mind 166
and not under duress, fraud or undue influence; 167
…. 4. I am not the attending physician for the person making the 168
request; 169
…. 5. The person making the request is not my relative by blood, 170
marriage or adoption; 171
…. 6. I am not entitled to any portion of the estate of the person 172
making the request upon such person's death under any will or by 173
operation of law; and 174
…. 7. I am not an owner, operator or employee of a health care 175
facility where the person making the request is a resident or receiving 176
medical treatment. 177
Printed Name of Witness 1 …. 178
Signature of Witness 1 …. Date …. 179
Printed Name of Witness 2 …. 180
Signature of Witness 2 …. Date …. 181
Sec. 5. (NEW) (Effective October 1, 2019) (a) A qualified patient may 182
rescind his or her request for aid in dying at any time and in any 183
manner without regard to his or her mental state. 184
(b) An attending physician shall offer a qualified patient an 185
opportunity to rescind his or her request for aid in dying at the time 186
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such patient submits a second written request for aid in dying to the 187
attending physician. 188
(c) No attending physician shall dispense or prescribe medication 189
for aid in dying without the attending physician first offering the 190
qualified patient a second opportunity to rescind his or her request for 191
aid in dying. 192
Sec. 6. (NEW) (Effective October 1, 2019) When an attending 193
physician is presented with a patient's first written request for aid in 194
dying made pursuant to sections 2 to 4, inclusive, of this act, the 195
attending physician shall: 196
(1) Make a determination that the patient (A) is an adult, (B) has a 197
terminal illness, (C) is competent, and (D) has voluntarily requested 198
aid in dying. Such determination shall not be made solely on the basis 199
of age, disability or any specific illness; 200
(2) Require the patient to demonstrate residency in this state by 201
presenting: (A) A Connecticut driver's license; (B) a valid voter 202
registration record authorizing the patient to vote in this state; or (C) 203
any other government-issued document that the attending physician 204
reasonably believes demonstrates that the patient is a current resident 205
of this state; 206
(3) Ensure that the patient is making an informed decision by 207
informing the patient of: (A) The patient's medical diagnosis; (B) the 208
patient's prognosis; (C) the potential risks associated with self-209
administering the medication to be dispensed or prescribed for aid in 210
dying; (D) the probable result of self-administering the medication to 211
be dispensed or prescribed for aid in dying; (E) the feasible alternatives 212
to aid in dying and health care treatment options including, but not 213
limited to, palliative care; and (F) the availability of counseling with a 214
psychologist, psychiatrist or licensed clinical social worker; and 215
(4) Refer the patient to a consulting physician for medical 216
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confirmation of the attending physician's diagnosis of the patient's 217
terminal illness, the patient's prognosis and for a determination that 218
the patient is competent and acting voluntarily in requesting aid in 219
dying. 220
Sec. 7. (NEW) (Effective October 1, 2019) In order for a patient to be 221
found to be a qualified patient for the purposes of this section, sections 222
1 to 6, inclusive, of this act and sections 8 to 19, inclusive, of this act, a 223
consulting physician shall: (1) Examine the patient and the patient's 224
relevant medical records; (2) confirm, in writing, the attending 225
physician's diagnosis that the patient has a terminal illness; (3) verify 226
that the patient is competent, is acting voluntarily and has made an 227
informed decision to request aid in dying; and (4) refer the patient for 228
counseling, if required in accordance with section 8 of this act. 229
Sec. 8. (NEW) (Effective October 1, 2019) (a) If, in the medical opinion 230
of the attending physician or the consulting physician, a patient may 231
be suffering from a psychiatric or psychological condition including, 232
but not limited to, depression, that is causing impaired judgment, 233
either the attending or consulting physician shall refer the patient for 234
counseling to determine whether the patient is competent to request 235
aid in dying. 236
(b) An attending physician shall not provide the patient aid in dying 237
until the person providing such counseling determines that the patient 238
is not suffering a psychiatric or psychological condition including, but 239
not limited to, depression, that is causing impaired judgment. 240
Sec. 9. (NEW) (Effective October 1, 2019) (a) After an attending 241
physician and a consulting physician determine that a patient is a 242
qualified patient, in accordance with sections 6 to 8, inclusive, of this 243
act and after such qualified patient submits a second request for aid in 244
dying in accordance with sections 3 and 4 of this act, the attending 245
physician shall: 246
(1) Recommend to the qualified patient that he or she notify his or 247
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her next of kin of the qualified patient's request for aid in dying and 248
inform the qualified patient that a failure to do so shall not be a basis 249
for the denial of such request; 250
(2) Counsel the qualified patient concerning the importance of: (A) 251
Having another person present when the qualified patient self-252
administers the medication dispensed or prescribed for aid in dying; 253
and (B) not taking the medication in a public place; 254
(3) Inform the qualified patient that he or she may rescind his or her 255
request for aid in dying at any time and in any manner; 256
(4) Verify, immediately before dispensing or prescribing medication 257
for aid in dying, that the qualified patient is making an informed 258
decision; 259
(5) Fulfill the medical record documentation requirements set forth 260
in section 10 of this act; and 261
(6) (A) Dispense such medication, including ancillary medication 262
intended to facilitate the desired effect to minimize the qualified 263
patient's discomfort, if the attending physician is authorized to 264
dispense such medication, to the qualified patient; or (B) upon the 265
qualified patient's request and with the qualified patient's written 266
consent (i) contact a pharmacist and inform the pharmacist of the 267
prescription, and (ii) personally deliver the written prescription, by 268
mail, facsimile or electronic transmission to the pharmacist, who shall 269
dispense such medication directly to the qualified patient, the 270
attending physician or an expressly identified agent of the qualified 271
patient. 272
(b) The person signing the qualified patient's death certificate shall 273
list the underlying terminal illness as the cause of death. 274
Sec. 10. (NEW) (Effective October 1, 2019) The attending physician 275
shall ensure that the following items are documented or filed in a 276
qualified patient's medical record: 277
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(1) The basis for determining that a qualified patient is an adult and 278
a resident of the state; 279
(2) All oral requests by a qualified patient for medication for aid in 280
dying; 281
(3) All written requests by a qualified patient for medication for aid 282
in dying; 283
(4) The attending physician's diagnosis of a qualified patient's 284
terminal illness and prognosis, and a determination that a qualified 285
patient is competent, is acting voluntarily and has made an informed 286
decision to request aid in dying; 287
(5) The consulting physician's confirmation of a qualified patient's 288
diagnosis and prognosis, confirmation that a qualified patient is 289
competent, is acting voluntarily and has made an informed decision to 290
request aid in dying; 291
(6) A report of the outcome and determinations made during 292
counseling, if counseling was recommended and provided in 293
accordance with section 8 of this act; 294
(7) Documentation of the attending physician's offer to a qualified 295
patient to rescind his or her request for aid in dying at the time the 296
attending physician dispenses or prescribes medication for aid in 297
dying; and 298
(8) A statement by the attending physician indicating that (A) all 299
requirements under this section and sections 1 to 9, inclusive, of this 300
act have been met, and (B) the steps taken to carry out a qualified 301
patient's request for aid in dying, including the medication dispensed 302
or prescribed. 303
Sec. 11. (NEW) (Effective October 1, 2019) Any person, other than a 304
qualified patient, in possession of medication dispensed or prescribed 305
for aid in dying that has not been self-administered shall return such 306
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medication to the attending physician or the Commissioner of 307
Consumer Protection in accordance with section 21a-252 of the general 308
statutes. 309
Sec. 12. (NEW) (Effective October 1, 2019) (a) Any provision of a 310
contract, including, but not limited to, a contract related to an 311
insurance policy or annuity, conditioned on or affected by the making 312
or rescinding of a request for aid in dying shall not be valid. 313
(b) On and after October 1, 2019, the sale, procurement or issuance 314
of any life, health or accident insurance or annuity policy or the rate 315
charged for any such policy shall not be conditioned upon or affected 316
by the making or rescinding of a request for aid in dying. 317
(c) A qualified patient's act of requesting aid in dying or self-318
administering medication dispensed or prescribed for aid in dying 319
shall not constitute suicide for any purpose, including, but not limited 320
to, a criminal prosecution under section 53a-56 of the general statutes. 321
Sec. 13. (NEW) (Effective October 1, 2019) (a) As used in this section, 322
"participate in the provision of medication" means to perform the 323
duties of an attending physician or consulting physician, a psychiatrist, 324
psychologist or pharmacist in accordance with the provisions of 325
sections 2 to 10, inclusive, of this act. "Participate in the provision of 326
medication" does not include: (1) Making an initial diagnosis of a 327
patient's terminal illness; (2) informing a patient of his or her medical 328
diagnosis or prognosis; (3) informing a patient concerning the 329
provisions of this section, sections 1 to 12, inclusive, of this act and 330
sections 16 to 19, inclusive, of this act, upon the patient's request; or (4) 331
referring a patient to another health care provider for aid in dying. 332
(b) Participation in any act described in sections 1 to 12, inclusive, of 333
this act and sections 16 to 19, inclusive, of this act by a patient, health 334
care provider or any other person shall be voluntary. Each health care 335
provider shall individually and affirmatively determine whether to 336
participate in the provision of medication to a qualified patient for aid 337
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in dying. A health care facility shall not require a health care provider 338
to participate in the provision of medication to a qualified patient for 339
aid in dying, but may prohibit such participation in accordance with 340
subsection (d) of this section. 341
(c) If a health care provider or health care facility chooses not to 342
participate in the provision of medication to a qualified patient for aid 343
in dying, upon request of a qualified patient, such health care provider 344
or health care facility shall transfer all relevant medical records to any 345
health care provider or health care facility, as directed by a qualified 346
patient. 347
(d) A health care facility may adopt written policies prohibiting a 348
health care provider associated with such health care facility from 349
participating in the provision of medication to a patient for aid in 350
dying, provided such facility provides written notice of such policy 351
and any sanctions for violation of such policy to such health care 352
provider. Notwithstanding the provisions of this subsection or any 353
policies adopted in accordance with this subsection, a health care 354
provider may: (1) Diagnose a patient with a terminal illness; (2) inform 355
a patient of his or her medical prognosis; (3) provide a patient with 356
information concerning the provisions of this section, sections 1 to 12, 357
inclusive, of this act and sections 16 to 19, inclusive, of this act, upon a 358
patient's request; (4) refer a patient to another health care facility or 359
health care provider; (5) transfer a patient's medical records to a health 360
care provider or health care facility, as requested by a patient; or (6) 361
participate in the provision of medication for aid in dying when such 362
health care provider is acting outside the scope of his or her 363
employment or contract with a health care facility that prohibits 364
participation in the provision of such medication. 365
(e) Except as provided in a policy adopted in accordance with 366
subsection (d) of this section, no health care facility may subject an 367
employee or other person who provides services under contract with 368
the health care facility to disciplinary action, loss of privileges, loss of 369
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membership or any other penalty for participating, or refusing to 370
participate, in the provision of medication or related activities in good 371
faith compliance with the provisions of this section, sections 1 to 12, 372
inclusive, of this act and sections 16 to 19, inclusive, of this act. 373
Sec. 14. (NEW) (Effective October 1, 2019) (a) A person is guilty of 374
murder when such person, without authorization of a patient, wilfully 375
alters or forges a request for aid in dying, as described in sections 3 376
and 4 of this act, or conceals or destroys a rescission of such a request 377
for aid in dying with the intent or effect of causing the patient's death. 378
(b) A person is guilty of murder when such person coerces or exerts 379
undue influence on a patient to complete a request for aid in dying, as 380
described in sections 3 and 4 of this act, or coerces or exerts undue 381
influence on a patient to destroy a rescission of such request with the 382
intent or effect of causing the patient's death. 383
Sec. 15. (NEW) (Effective October 1, 2019) (a) Nothing in sections 1 to 384
14, inclusive, of this act or sections 16 to 19, inclusive, of this act 385
authorizes a physician or any other person to end another person's life 386
by lethal injection, mercy killing, assisting a suicide or any other active 387
euthanasia. 388
(b) No action taken in accordance with sections 1 to 14, inclusive, of 389
this act or sections 16 to 19, inclusive, of this act shall constitute 390
causing or assisting another person to commit suicide in violation of 391
section 53a-54a or 53a-56 of the general statutes. 392
(c) No person shall be subject to civil or criminal liability or 393
professional disciplinary action, including, but not limited to, 394
revocation of such person's professional license, for (1) participating in 395
the provision of medication or related activities in good faith 396
compliance with the provisions of sections 1 to 14, inclusive, of this act 397
and sections 16 to 19, inclusive, of this act, or (2) being present at the 398
time a qualified patient self-administers medication dispensed or 399
prescribed for aid in dying. 400
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(d) An attending physician's dispensing of, or issuance of a 401
prescription for medication for aid in dying or a patient's request for 402
aid in dying, in good faith compliance with the provisions of sections 1 403
to 19, inclusive, of this act shall not constitute neglect for the purpose 404
of any law or provide the sole basis for appointment of a guardian or 405
conservator for such patient. 406
Sec. 16. (NEW) (Effective October 1, 2019) Sections 1 to 15, inclusive, 407
of this act or sections 17 to 19, inclusive, of this act do not limit liability 408
for civil damages resulting from negligent conduct or intentional 409
misconduct by any person. 410
Sec. 17. (NEW) (Effective October 1, 2019) (a) Any person who 411
knowingly possesses, sells or delivers medication dispensed or 412
prescribed for aid in dying for any purpose other than delivering such 413
medication to a qualified patient, or returning such medication in 414
accordance with section 11 of this act, shall be guilty of a class D 415
felony. 416
(b) Nothing in sections 1 to 16, inclusive, of this act or section 18 or 417
19 of this act shall preclude criminal prosecution under any provision 418
of law for conduct that is inconsistent with said sections. 419
Sec. 18. (NEW) (Effective October 1, 2019) Nothing in sections 1 to 17, 420
inclusive, of this act or section 19 of this act shall limit the jurisdiction 421
or authority of the nonprofit entity designated by the Governor to 422
serve as the Connecticut protection and advocacy system under 423
chapter 813 of the general statutes. 424
Sec. 19. (NEW) (Effective October 1, 2019) No person who serves as an 425
attending physician, consulting physician or a witness as described in 426
section 3 of this act, or otherwise participates in the provision of 427
medication for aid in dying to a qualified patient, shall inherit or 428
receive any part of the estate of such qualified patient, whether under 429
the provisions of law relating to intestate succession or as a devisee or 430
legatee, or otherwise under the will of such qualified patient, or receive 431
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any property as beneficiary or survivor of such qualified patient after 432
such qualified patient has self-administered medication dispensed or 433
prescribed for aid in dying. 434
This act shall take effect as follows and shall amend the following
sections:
Section 1 October 1, 2019 New section
Sec. 2 October 1, 2019 New section
Sec. 3 October 1, 2019 New section
Sec. 4 October 1, 2019 New section
Sec. 5 October 1, 2019 New section
Sec. 6 October 1, 2019 New section
Sec. 7 October 1, 2019 New section
Sec. 8 October 1, 2019 New section
Sec. 9 October 1, 2019 New section
Sec. 10 October 1, 2019 New section
Sec. 11 October 1, 2019 New section
Sec. 12 October 1, 2019 New section
Sec. 13 October 1, 2019 New section
Sec. 14 October 1, 2019 New section
Sec. 15 October 1, 2019 New section
Sec. 16 October 1, 2019 New section
Sec. 17 October 1, 2019 New section
Sec. 18 October 1, 2019 New section
Sec. 19 October 1, 2019 New section
Statement of Purpose:
To provide aid in dying to terminally ill patients.
[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.]
Co-Sponsors: REP. STEINBERG, 136th Dist.; REP. GRESKO, 121st Dist.
H.B. 5898