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General Assembly Raised Bill No. 5420
February Session, 2020
LCO No. 2340
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, 2020) As used in this section and 1
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, which 5
medication a qualified patient may self-administer to bring about his or 6
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
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nature and consequences of health care decisions, including the benefits 14
and disadvantages of treatment, to make an informed decision and to 15
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 administer 30
health care or dispense medication in the ordinary course of business or 31
practice of a profession, including, but not limited to, a physician, 32
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-490 35
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
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prescribed; and (D) the feasible alternatives to aid in dying and health 45
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 of 70
this state, has a terminal illness and has satisfied the requirements of this 71
section and sections 2 to 9, inclusive, of this act, in order to obtain aid in 72
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, 2020) (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, 2020) (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 this 93
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 under 96
sections 1 and 2 of this act and sections 4 to 19, inclusive, of this act shall 97
be signed and dated by the patient. Each request shall be witnessed by 98
at least two persons in the presence of the patient. Each person serving 99
as a witness shall attest, in writing, that to the best of his or her 100
knowledge and belief (1) the patient appears to be of sound mind, (2) 101
the patient is acting voluntarily and not being coerced to sign the 102
request, and (3) the witness is not: (A) A relative of the patient by blood, 103
marriage or adoption, (B) entitled to any portion of the estate of the 104
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patient upon the patient's death, under any will or by operation of law, 105
or (C) an owner, operator or employee of a health care facility where the 106
patient is a resident or receiving medical treatment. 107
(b) No person serving as a witness to a patient's request to receive aid 108
in dying shall be: (1) A relative of such patient by blood, marriage or 109
adoption; (2) at the time the request is signed, entitled to any portion of 110
the estate of the patient upon the patient's death, under any will or by 111
operation of law; (3) an owner, operator or employee of a health care 112
facility where the patient is a resident or receiving medical treatment; or 113
(4) such patient's attending physician at the time the request is signed. 114
(c) Any patient's act of requesting aid in dying or a qualified patient's 115
self-administration of medication prescribed for aid in dying shall not 116
provide the sole basis for appointment of a conservator or guardian for 117
such patient or qualified patient. 118
Sec. 4. (NEW) (Effective October 1, 2020) A request for aid in dying as 119
authorized by this section, sections 1 to 3, inclusive, of this act and 120
sections 5 to 19, inclusive, of this act shall be in substantially the 121
following form: 122
REQUEST FOR MEDICATION TO AID IN DYING 123
I, .…, am an adult of sound mind. 124
I am a resident of the State of Connecticut. 125
I am suffering from …., which my attending physician has 126
determined is an incurable and irreversible medical condition that will, 127
within reasonable medical judgment, result in death within six months 128
from the date on which this document is executed. This diagnosis of a 129
terminal illness has been medically confirmed by another physician. 130
I have been fully informed of my diagnosis, prognosis, the nature of 131
medication to be dispensed or prescribed to aid me in dying, the 132
potential associated risks, the expected result, feasible alternatives to aid 133
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in dying and additional health care treatment options, including 134
palliative care and the availability of counseling with a psychologist, 135
psychiatrist or licensed clinical social worker. 136
I request that my attending physician dispense or prescribe 137
medication that I may self-administer for aid in dying. I authorize my 138
attending physician to contact a pharmacist to fill the prescription for 139
such medication, upon my request. 140
INITIAL ONE: 141
…. I have informed my family of my decision and taken family 142
opinions into consideration. 143
…. I have decided not to inform my family of my decision. 144
…. I have no family to inform of my decision. 145
I understand that I have the right to rescind this request at any time. 146
I understand the full import of this request and I expect to die if and 147
when I take the medication to be dispensed or prescribed. I further 148
understand that although most deaths occur within three hours, my 149
death may take longer and my attending physician has counseled me 150
about this possibility. 151
I make this request voluntarily and without reservation, and I accept 152
full responsibility for my decision to request aid in dying. 153
Signed: …. 154
Dated: …. 155
DECLARATION OF WITNESSES 156
By initialing and signing below on the date the person named above 157
signs, I declare that: 158
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Witness 1 …. Witness 2 …. 159
Initials …. Initials …. 160
…. 1. The person making and signing the request is personally known 161
to me or has provided proof of identity; 162
…. 2. The person making and signing the request signed this request 163
in my presence on the date of the person's signature; 164
…. 3. The person making the request appears to be of sound mind 165
and not under duress, fraud or undue influence; 166
…. 4. I am not the attending physician for the person making the 167
request; 168
…. 5. The person making the request is not my relative by blood, 169
marriage or adoption; 170
…. 6. I am not entitled to any portion of the estate of the person 171
making the request upon such person's death under any will or by 172
operation of law; and 173
…. 7. I am not an owner, operator or employee of a health care facility 174
where the person making the request is a resident or receiving medical 175
treatment. 176
Printed Name of Witness 1 …. 177
Signature of Witness 1 …. Date …. 178
Printed Name of Witness 2 …. 179
Signature of Witness 2 …. Date …. 180
Sec. 5. (NEW) (Effective October 1, 2020) (a) A qualified patient may 181
rescind his or her request for aid in dying at any time and in any manner 182
without regard to his or her mental state. 183
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(b) An attending physician shall offer a qualified patient an 184
opportunity to rescind his or her request for aid in dying at the time 185
such patient submits a second written request for aid in dying to the 186
attending physician. 187
(c) No attending physician shall dispense or prescribe medication for 188
aid in dying without the attending physician first offering the qualified 189
patient a second opportunity to rescind his or her request for aid in 190
dying. 191
Sec. 6. (NEW) (Effective October 1, 2020) When an attending physician 192
is presented with a patient's first written request for aid in dying made 193
pursuant to sections 2 to 4, inclusive, of this act, the attending physician 194
shall: 195
(1) Make a determination that the patient (A) is an adult, (B) has a 196
terminal illness, (C) is competent, and (D) has voluntarily requested aid 197
in dying. Such determination shall not be made solely on the basis of 198
age, disability or any specific illness; 199
(2) Require the patient to demonstrate residency in this state by 200
presenting: (A) A Connecticut driver's license; (B) a valid voter 201
registration record authorizing the patient to vote in this state; or (C) 202
any other government-issued document that the attending physician 203
reasonably believes demonstrates that the patient is a current resident 204
of this state; 205
(3) Ensure that the patient is making an informed decision by 206
informing the patient of: (A) The patient's medical diagnosis; (B) the 207
patient's prognosis; (C) the potential risks associated with self-208
administering the medication to be dispensed or prescribed for aid in 209
dying; (D) the probable result of self-administering the medication to be 210
dispensed or prescribed for aid in dying; (E) the feasible alternatives to 211
aid in dying and health care treatment options including, but not limited 212
to, palliative care; and (F) the availability of counseling with a 213
psychologist, psychiatrist or licensed clinical social worker; and 214
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(4) Refer the patient to a consulting physician for medical 215
confirmation of the attending physician's diagnosis of the patient's 216
terminal illness, the patient's prognosis and for a determination that the 217
patient is competent and acting voluntarily in requesting aid in dying. 218
Sec. 7. (NEW) (Effective October 1, 2020) In order for a patient to be 219
found to be a qualified patient for the purposes of this section, sections 220
1 to 6, inclusive, of this act and sections 8 to 19, inclusive, of this act, a 221
consulting physician shall: (1) Examine the patient and the patient's 222
relevant medical records; (2) confirm, in writing, the attending 223
physician's diagnosis that the patient has a terminal illness; (3) verify 224
that the patient is competent, is acting voluntarily and has made an 225
informed decision to request aid in dying; and (4) refer the patient for 226
counseling, if required in accordance with section 8 of this act. 227
Sec. 8. (NEW) (Effective October 1, 2020) (a) If, in the medical opinion 228
of the attending physician or the consulting physician, a patient may be 229
suffering from a psychiatric or psychological condition including, but 230
not limited to, depression, that is causing impaired judgment, either the 231
attending or consulting physician shall refer the patient for counseling 232
to determine whether the patient is competent to request aid in dying. 233
(b) An attending physician shall not provide the patient aid in dying 234
until the person providing such counseling determines that the patient 235
is not suffering a psychiatric or psychological condition including, but 236
not limited to, depression, that is causing impaired judgment. 237
Sec. 9. (NEW) (Effective October 1, 2020) (a) After an attending 238
physician and a consulting physician determine that a patient is a 239
qualified patient, in accordance with sections 6 to 8, inclusive, of this act 240
and after such qualified patient submits a second request for aid in 241
dying in accordance with sections 3 and 4 of this act, the attending 242
physician shall: 243
(1) Recommend to the qualified patient that he or she notify his or her 244
next of kin of the qualified patient's request for aid in dying and inform 245
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the qualified patient that a failure to do so shall not be a basis for the 246
denial of such request; 247
(2) Counsel the qualified patient concerning the importance of: (A) 248
Having another person present when the qualified patient self-249
administers the medication dispensed or prescribed for aid in dying; 250
and (B) not taking the medication in a public place; 251
(3) Inform the qualified patient that he or she may rescind his or her 252
request for aid in dying at any time and in any manner; 253
(4) Verify, immediately before dispensing or prescribing medication 254
for aid in dying, that the qualified patient is making an informed 255
decision; 256
(5) Fulfill the medical record documentation requirements set forth 257
in section 10 of this act; and 258
(6) (A) Dispense such medication, including ancillary medication 259
intended to facilitate the desired effect to minimize the qualified 260
patient's discomfort, if the attending physician is authorized to dispense 261
such medication, to the qualified patient; or (B) upon the qualified 262
patient's request and with the qualified patient's written consent (i) 263
contact a pharmacist and inform the pharmacist of the prescription, and 264
(ii) personally deliver the written prescription, by mail, facsimile or 265
electronic transmission to the pharmacist, who shall dispense such 266
medication directly to the qualified patient, the attending physician or 267
an expressly identified agent of the qualified patient. 268
(b) The person signing the qualified patient's death certificate shall 269
list the underlying terminal illness as the cause of death. 270
Sec. 10. (NEW) (Effective October 1, 2020) The attending physician shall 271
ensure that the following items are documented or filed in a qualified 272
patient's medical record: 273
(1) The basis for determining that a qualified patient is an adult and 274
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a resident of the state; 275
(2) All oral requests by a qualified patient for medication for aid in 276
dying; 277
(3) All written requests by a qualified patient for medication for aid 278
in dying; 279
(4) The attending physician's diagnosis of a qualified patient's 280
terminal illness and prognosis, and a determination that a qualified 281
patient is competent, is acting voluntarily and has made an informed 282
decision to request aid in dying; 283
(5) The consulting physician's confirmation of a qualified patient's 284
diagnosis and prognosis, confirmation that a qualified patient is 285
competent, is acting voluntarily and has made an informed decision to 286
request aid in dying; 287
(6) A report of the outcome and determinations made during 288
counseling, if counseling was recommended and provided in 289
accordance with section 8 of this act; 290
(7) Documentation of the attending physician's offer to a qualified 291
patient to rescind his or her request for aid in dying at the time the 292
attending physician dispenses or prescribes medication for aid in dying; 293
and 294
(8) A statement by the attending physician indicating that (A) all 295
requirements under this section and sections 1 to 9, inclusive, of this act 296
have been met, and (B) the steps taken to carry out a qualified patient's 297
request for aid in dying, including the medication dispensed or 298
prescribed. 299
Sec. 11. (NEW) (Effective October 1, 2020) Any person, other than a 300
qualified patient, in possession of medication dispensed or prescribed 301
for aid in dying that has not been self-administered shall return such 302
medication to the attending physician or the Commissioner of 303
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Consumer Protection in accordance with section 21a-252 of the general 304
statutes. 305
Sec. 12. (NEW) (Effective October 1, 2020) (a) Any provision of a 306
contract, including, but not limited to, a contract related to an insurance 307
policy or annuity, conditioned on or affected by the making or 308
rescinding of a request for aid in dying shall not be valid. 309
(b) On and after October 1, 2020, the sale, procurement or issuance of 310
any life, health or accident insurance or annuity policy or the rate 311
charged for any such policy shall not be conditioned upon or affected 312
by the making or rescinding of a request for aid in dying. 313
(c) A qualified patient's act of requesting aid in dying or self-314
administering medication dispensed or prescribed for aid in dying shall 315
not constitute suicide for any purpose, including, but not limited to, a 316
criminal prosecution under section 53a-56 of the general statutes. 317
Sec. 13. (NEW) (Effective October 1, 2020) (a) As used in this section, 318
"participate in the provision of medication" means to perform the duties 319
of an attending physician or consulting physician, a psychiatrist, 320
psychologist or pharmacist in accordance with the provisions of sections 321
2 to 10, inclusive, of this act. "Participate in the provision of medication" 322
does not include: (1) Making an initial diagnosis of a patient's terminal 323
illness; (2) informing a patient of his or her medical diagnosis or 324
prognosis; (3) informing a patient concerning the provisions of this 325
section, sections 1 to 12, inclusive, of this act and sections 16 to 19, 326
inclusive, of this act, upon the patient's request; or (4) referring a patient 327
to another health care provider for aid in dying. 328
(b) Participation in any act described in sections 1 to 12, inclusive, of 329
this act and sections 16 to 19, inclusive, of this act by a patient, health 330
care provider or any other person shall be voluntary. Each health care 331
provider shall individually and affirmatively determine whether to 332
participate in the provision of medication to a qualified patient for aid 333
in dying. A health care facility shall not require a health care provider 334
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to participate in the provision of medication to a qualified patient for aid 335
in dying, but may prohibit such participation in accordance with 336
subsection (d) of this section. 337
(c) If a health care provider or health care facility chooses not to 338
participate in the provision of medication to a qualified patient for aid 339
in dying, upon request of a qualified patient, such health care provider 340
or health care facility shall transfer all relevant medical records to any 341
health care provider or health care facility, as directed by a qualified 342
patient. 343
(d) A health care facility may adopt written policies prohibiting a 344
health care provider associated with such health care facility from 345
participating in the provision of medication to a patient for aid in dying, 346
provided such facility provides written notice of such policy and any 347
sanctions for violation of such policy to such health care provider. 348
Notwithstanding the provisions of this subsection or any policies 349
adopted in accordance with this subsection, a health care provider may: 350
(1) Diagnose a patient with a terminal illness; (2) inform a patient of his 351
or her medical prognosis; (3) provide a patient with information 352
concerning the provisions of this section, sections 1 to 12, inclusive, of 353
this act and sections 16 to 19, inclusive, of this act, upon a patient's 354
request; (4) refer a patient to another health care facility or health care 355
provider; (5) transfer a patient's medical records to a health care 356
provider or health care facility, as requested by a patient; or (6) 357
participate in the provision of medication for aid in dying when such 358
health care provider is acting outside the scope of his or her employment 359
or contract with a health care facility that prohibits participation in the 360
provision of such medication. 361
(e) Except as provided in a policy adopted in accordance with 362
subsection (d) of this section, no health care facility may subject an 363
employee or other person who provides services under contract with 364
the health care facility to disciplinary action, loss of privileges, loss of 365
membership or any other penalty for participating, or refusing to 366
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participate, in the provision of medication or related activities in good 367
faith compliance with the provisions of this section, sections 1 to 12, 368
inclusive, of this act and sections 16 to 19, inclusive, of this act. 369
Sec. 14. (NEW) (Effective October 1, 2020) (a) A person is guilty of 370
murder when such person, without authorization of a patient, wilfully 371
alters or forges a request for aid in dying, as described in sections 3 and 372
4 of this act, or conceals or destroys a rescission of such a request for aid 373
in dying with the intent or effect of causing the patient's death. 374
(b) A person is guilty of murder when such person coerces or exerts 375
undue influence on a patient to complete a request for aid in dying, as 376
described in sections 3 and 4 of this act, or coerces or exerts undue 377
influence on a patient to destroy a rescission of such request with the 378
intent or effect of causing the patient's death. 379
Sec. 15. (NEW) (Effective October 1, 2020) (a) Nothing in sections 1 to 380
14, inclusive, of this act or sections 16 to 19, inclusive, of this act 381
authorizes a physician or any other person to end another person's life 382
by lethal injection, mercy killing, assisting a suicide or any other active 383
euthanasia. 384
(b) No action taken in accordance with sections 1 to 14, inclusive, of 385
this act or sections 16 to 19, inclusive, of this act shall constitute causing 386
or assisting another person to commit suicide in violation of section 53a-387
54a or 53a-56 of the general statutes. 388
(c) No person shall be subject to civil or criminal liability or 389
professional disciplinary action, including, but not limited to, 390
revocation of such person's professional license, for (1) participating in 391
the provision of medication or related activities in good faith 392
compliance with the provisions of sections 1 to 14, inclusive, of this act 393
and sections 16 to 19, inclusive, of this act, or (2) being present at the 394
time a qualified patient self-administers medication dispensed or 395
prescribed for aid in dying. 396
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(d) An attending physician's dispensing of, or issuance of a 397
prescription for medication for aid in dying or a patient's request for aid 398
in dying, in good faith compliance with the provisions of sections 1 to 399
19, inclusive, of this act shall not constitute neglect for the purpose of 400
any law or provide the sole basis for appointment of a guardian or 401
conservator for such patient. 402
Sec. 16. (NEW) (Effective October 1, 2020) Sections 1 to 15, inclusive, of 403
this act or sections 17 to 19, inclusive, of this act do not limit liability for 404
civil damages resulting from negligent conduct or intentional 405
misconduct by any person. 406
Sec. 17. (NEW) (Effective October 1, 2020) (a) Any person who 407
knowingly possesses, sells or delivers medication dispensed or 408
prescribed for aid in dying for any purpose other than delivering such 409
medication to a qualified patient, or returning such medication in 410
accordance with section 11 of this act, shall be guilty of a class D felony. 411
(b) Nothing in sections 1 to 16, inclusive, of this act or section 18 or 19 412
of this act shall preclude criminal prosecution under any provision of 413
law for conduct that is inconsistent with said sections. 414
Sec. 18. (NEW) (Effective October 1, 2020) Nothing in sections 1 to 17, 415
inclusive, of this act or section 19 of this act shall limit the jurisdiction or 416
authority of the nonprofit entity designated by the Governor to serve as 417
the Connecticut protection and advocacy system under chapter 813 of 418
the general statutes. 419
Sec. 19. (NEW) (Effective October 1, 2020) No person who serves as an 420
attending physician, consulting physician or a witness as described in 421
section 3 of this act, or otherwise participates in the provision of 422
medication for aid in dying to a qualified patient, shall inherit or receive 423
any part of the estate of such qualified patient, whether under the 424
provisions of law relating to intestate succession or as a devisee or 425
legatee, or otherwise under the will of such qualified patient, or receive 426
any property as beneficiary or survivor of such qualified patient after 427
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such qualified patient has self-administered medication dispensed or 428
prescribed for aid in dying. 429
This act shall take effect as follows and shall amend the following
sections:
Section 1 October 1, 2020 New section
Sec. 2 October 1, 2020 New section
Sec. 3 October 1, 2020 New section
Sec. 4 October 1, 2020 New section
Sec. 5 October 1, 2020 New section
Sec. 6 October 1, 2020 New section
Sec. 7 October 1, 2020 New section
Sec. 8 October 1, 2020 New section
Sec. 9 October 1, 2020 New section
Sec. 10 October 1, 2020 New section
Sec. 11 October 1, 2020 New section
Sec. 12 October 1, 2020 New section
Sec. 13 October 1, 2020 New section
Sec. 14 October 1, 2020 New section
Sec. 15 October 1, 2020 New section
Sec. 16 October 1, 2020 New section
Sec. 17 October 1, 2020 New section
Sec. 18 October 1, 2020 New section
Sec. 19 October 1, 2020 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.]