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General Assembly Raised Bill No. 6425
January Session, 2021
LCO No. 3247
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, 2021) 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 licensed 12
clinical social worker, that a patient has the capacity to understand and 13 Raised Bill No. 6425
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acknowledge the nature and consequences of health care decisions, 14
including the benefits and disadvantages of treatment, to make an 15
informed decision and to communicate such decision to a health care 16
provider, including communicating through a person familiar with a 17
patient's manner of communicating; 18
(5) "Consulting physician" means a physician other than a patient's 19
attending physician who is qualified by specialty or experience to make 20
a professional diagnosis and prognosis regarding a patient's terminal 21
illness; 22
(6) "Counseling" means one or more consultations as necessary 23
between a psychiatrist, psychologist or licensed clinical social worker 24
and a patient for the purpose of determining that a patient is competent 25
and not suffering from depression or any other psychiatric or 26
psychological disorder that causes impaired judgment; 27
(7) "Health care provider" means a person licensed, certified or 28
otherwise authorized or permitted by the laws of this state to administer 29
health care or dispense medication in the ordinary course of business or 30
practice of a profession, including, but not limited to, a physician, 31
psychiatrist, psychologist or pharmacist; 32
(8) "Health care facility" means a hospital, residential care home, 33
nursing home or rest home, as such terms are defined in section 19a-490 34
of the general statutes; 35
(9) "Informed decision" means a decision by a qualified patient to 36
request and obtain a prescription for medication that the qualified 37
patient may self-administer for aid in dying, that is based on an 38
understanding and acknowledgment of the relevant facts and after 39
being fully informed by the attending physician of: (A) The qualified 40
patient's medical diagnosis and prognosis; (B) the potential risks 41
associated with self-administering the medication to be prescribed; (C) 42
the probable result of taking the medication to be dispensed or 43
prescribed; and (D) the feasible alternatives to aid in dying and health 44
care treatment options, including, but not limited to, palliative care; 45 Raised Bill No. 6425
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(10) "Licensed clinical social worker" means a person who has been 46
licensed as a clinical social worker pursuant to chapter 383b of the 47
general statutes; 48
(11) "Medically confirmed" means the medical opinion of the 49
attending physician has been confirmed by a consulting physician who 50
has examined the patient and the patient's relevant medical records; 51
(12) "Palliative care" means health care centered on a seriously ill 52
patient and such patient's family that (A) optimizes a patient's quality 53
of life by anticipating, preventing and treating a patient's suffering 54
throughout the continuum of a patient's terminal illness, (B) addresses 55
the physical, emotional, social and spiritual needs of a patient, (C) 56
facilitates patient autonomy, patient access to information and patient 57
choice, and (D) includes, but is not limited to, discussions between a 58
patient and a health care provider concerning a patient's goals for 59
treatment and appropriate treatment options available to a patient, 60
including hospice care and comprehensive pain and symptom 61
management; 62
(13) "Patient" means a person who is under the care of a physician; 63
(14) "Pharmacist" means a person licensed to practice pharmacy 64
pursuant to chapter 400j of the general statutes; 65
(15) "Physician" means a person licensed to practice medicine and 66
surgery pursuant to chapter 370 of the general statutes; 67
(16) "Psychiatrist" means a physician specializing in psychiatry and 68
licensed pursuant to chapter 370 of the general statutes; 69
(17) "Psychologist" means a person licensed to practice psychology 70
pursuant to chapter 383 of the general statutes; 71
(18) "Qualified patient" means a competent adult who is a resident of 72
this state, has a terminal illness and has satisfied the requirements of this 73
section and sections 2 to 9, inclusive, of this act, in order to obtain aid in 74
dying; 75 Raised Bill No. 6425
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(19) "Self-administer" means a qualified patient's voluntary, 76
conscious and affirmative act of ingesting medication; and 77
(20) "Terminal illness" means the final stage of an incurable and 78
irreversible medical condition that an attending physician anticipates, 79
within reasonable medical judgment, will produce a patient's death 80
within six months. 81
Sec. 2. (NEW) (Effective October 1, 2021) (a) A patient who (1) is an 82
adult, (2) is competent, (3) is a resident of this state, (4) has been 83
determined by such patient's attending physician to have a terminal 84
illness, and (5) has voluntarily expressed his or her wish to receive aid 85
in dying, may request aid in dying by making two oral requests and one 86
written request to such patient's attending physician pursuant to 87
sections 3 and 4 of this act. 88
(b) No person, including, but not limited to, an agent under a living 89
will, an attorney-in-fact under a durable power of attorney, a guardian, 90
or a conservator, may act on behalf of a patient for purposes of this 91
section, section 1 or sections 3 to 19, inclusive, of this act. 92
Sec. 3. (NEW) (Effective October 1, 2021) (a) A patient wishing to 93
receive aid in dying shall make two oral requests and one written 94
request to such patient's attending physician. A patient's second oral 95
request for aid in dying shall be made not earlier than fifteen days after 96
the date on which a patient makes the first oral request. A valid written 97
request for aid in dying under sections 1 and 2 of this act and sections 4 98
to 19, inclusive, of this act shall be in substantially the form set forth in 99
section 4 of this act and shall be signed and dated by the patient. A 100
written request shall be witnessed by at least two persons in the 101
presence of the patient. Each person serving as a witness shall attest, in 102
writing, that to the best of his or her knowledge and belief (1) the patient 103
appears to be of sound mind, and (2) the patient is acting voluntarily 104
and not being coerced to sign the request. 105
(b) Any patient's act of requesting aid in dying or a qualified patient's 106
self-administration of medication prescribed for aid in dying shall not 107 Raised Bill No. 6425
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provide the sole basis for appointment of a conservator or guardian for 108
such patient or qualified patient. 109
Sec. 4. (NEW) (Effective October 1, 2021) A written request for aid in 110
dying as authorized by this section, sections 1 to 3, inclusive, of this act 111
and sections 5 to 19, inclusive, of this act shall be in substantially the 112
following form: 113
REQUEST FOR MEDICATION TO AID IN DYING 114
I, .…, am an adult of sound mind. 115
I am a resident of the State of Connecticut. 116
I am suffering from …., which my attending physician has 117
determined is an incurable and irreversible medical condition that will, 118
within reasonable medical judgment, result in death within six months 119
from the date on which this document is executed. This diagnosis of a 120
terminal illness has been medically confirmed by another physician. 121
I have been fully informed of my diagnosis, prognosis, the nature of 122
medication to be dispensed or prescribed to aid me in dying, the 123
potential associated risks, the expected result, feasible alternatives to aid 124
in dying and additional health care treatment options, including 125
palliative care and the availability of counseling with a psychologist, 126
psychiatrist or licensed clinical social worker. 127
I request that my attending physician dispense or prescribe 128
medication that I may self-administer for aid in dying. I authorize my 129
attending physician to contact a pharmacist to fill the prescription for 130
such medication, upon my request. 131
INITIAL ONE: 132
…. I have informed my family of my decision and taken family 133
opinions into consideration. 134
…. I have decided not to inform my family of my decision. 135 Raised Bill No. 6425
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…. I have no family to inform of my decision. 136
I understand that I have the right to rescind this request at any time. 137
I understand the full import of this request and I expect to die if and 138
when I take the medication to be dispensed or prescribed. I further 139
understand that although most deaths occur within one hour, my death 140
may take longer and my attending physician has counseled me about 141
this possibility. 142
I make this request voluntarily and without reservation, and I accept 143
full responsibility for my decision to request aid in dying. 144
Signed: …. 145
Dated: …. 146
DECLARATION OF WITNESSES 147
By initialing and signing below on the date the person named above 148
signs, I declare that: 149
Witness 1 …. Witness 2 …. 150
Initials …. Initials …. 151
…. 1. The person making and signing the request is personally known 152
to me or has provided proof of identity; 153
…. 2. The person making and signing the request signed this request 154
in my presence on the date of the person's signature; 155
…. 3. The person making the request appears to be of sound mind 156
and not under duress, fraud or undue influence. 157
Printed Name of Witness 1 …. 158
Signature of Witness 1 …. Date …. 159
Printed Name of Witness 2 …. 160 Raised Bill No. 6425
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Signature of Witness 2 …. Date …. 161
Sec. 5. (NEW) (Effective October 1, 2021) (a) A qualified patient may 162
rescind his or her request for aid in dying at any time and in any manner 163
without regard to his or her mental state. 164
(b) An attending physician shall offer a qualified patient an 165
opportunity to rescind his or her request for aid in dying at the time 166
such patient makes a second oral request for aid in dying to the 167
attending physician. 168
(c) No attending physician shall dispense or prescribe medication for 169
aid in dying without the attending physician first offering the qualified 170
patient a second opportunity to rescind his or her request for aid in 171
dying. 172
Sec. 6. (NEW) (Effective October 1, 2021) When an attending physician 173
receives a patient's first oral request for aid in dying made pursuant to 174
sections 2 to 4, inclusive, of this act, the attending physician shall: 175
(1) Make a determination that the patient (A) is an adult, (B) has a 176
terminal illness, (C) is competent, and (D) has voluntarily requested aid 177
in dying. Such determination shall not be made solely on the basis of 178
age, disability or any specific illness; 179
(2) Require the patient to demonstrate residency in this state by 180
presenting: (A) A Connecticut driver's license; (B) a valid voter 181
registration record authorizing the patient to vote in this state; or (C) 182
any other government-issued document that the attending physician 183
reasonably believes demonstrates that the patient is a current resident 184
of this state; 185
(3) Ensure that the patient is making an informed decision by 186
informing the patient of: (A) The patient's medical diagnosis; (B) the 187
patient's prognosis; (C) the potential risks associated with self-188
administering the medication to be dispensed or prescribed for aid in 189
dying; (D) the probable result of self-administering the medication to be 190 Raised Bill No. 6425
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dispensed or prescribed for aid in dying; (E) the feasible alternatives to 191
aid in dying and health care treatment options including, but not limited 192
to, palliative care; and (F) the availability of counseling with a 193
psychologist, psychiatrist or licensed clinical social worker; and 194
(4) Refer the patient to a consulting physician for medical 195
confirmation of the attending physician's diagnosis of the patient's 196
terminal illness, the patient's prognosis and for a determination that the 197
patient is competent and acting voluntarily in requesting aid in dying. 198
Sec. 7. (NEW) (Effective October 1, 2021) In order for a patient to be 199
found to be a qualified patient for the purposes of this section, sections 200
1 to 6, inclusive, of this act and sections 8 to 19, inclusive, of this act, a 201
consulting physician shall: (1) Examine the patient and the patient's 202
relevant medical records; (2) confirm, in writing, the attending 203
physician's diagnosis that the patient has a terminal illness; (3) verify 204
that the patient is competent, is acting voluntarily and has made an 205
informed decision to request aid in dying; and (4) refer the patient for 206
counseling, if required in accordance with section 8 of this act. 207
Sec. 8. (NEW) (Effective October 1, 2021) (a) If, in the medical opinion 208
of the attending physician or the consulting physician, a patient may be 209
suffering from a psychiatric or psychological condition including, but 210
not limited to, depression, that is causing impaired judgment, either the 211
attending or consulting physician shall refer the patient for counseling 212
to determine whether the patient is competent to request aid in dying. 213
(b) An attending physician shall not provide the patient aid in dying 214
until the person providing such counseling determines that the patient 215
is not suffering a psychiatric or psychological condition including, but 216
not limited to, depression, that is causing impaired judgment. 217
Sec. 9. (NEW) (Effective October 1, 2021) (a) After an attending 218
physician and a consulting physician determine that a patient is a 219
qualified patient, in accordance with sections 6 to 8, inclusive, of this act 220
and after such qualified patient makes a second oral request for aid in 221
dying in accordance with section 3 of this act, the attending physician 222 Raised Bill No. 6425
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shall: 223
(1) Recommend to the qualified patient that he or she notify his or her 224
next of kin of the qualified patient's request for aid in dying and inform 225
the qualified patient that a failure to do so shall not be a basis for the 226
denial of such request; 227
(2) Counsel the qualified patient concerning the importance of: (A) 228
Having another person present when the qualified patient self-229
administers the medication dispensed or prescribed for aid in dying; 230
and (B) not taking the medication in a public place; 231
(3) Inform the qualified patient that he or she may rescind his or her 232
request for aid in dying at any time and in any manner; 233
(4) Verify, immediately before dispensing or prescribing medication 234
for aid in dying, that the qualified patient is making an informed 235
decision; 236
(5) Fulfill the medical record documentation requirements set forth 237
in section 10 of this act; and 238
(6) (A) Dispense such medication, including ancillary medication 239
intended to facilitate the desired effect to minimize the qualified 240
patient's discomfort, if the attending physician is authorized to dispense 241
such medication, to the qualified patient; or (B) upon the qualified 242
patient's request and with the qualified patient's written consent (i) 243
contact a pharmacist and inform the pharmacist of the prescription, and 244
(ii) personally deliver the written prescription, by mail, facsimile or 245
electronic transmission to the pharmacist, who shall dispense such 246
medication directly to the qualified patient, the attending physician or 247
an expressly identified agent of the qualified patient. 248
(b) The person signing the qualified patient's death certificate shall 249
list the underlying terminal illness as the cause of death. 250
Sec. 10. (NEW) (Effective October 1, 2021) The attending physician shall 251
ensure that the following items are documented or filed in a qualified 252 Raised Bill No. 6425
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patient's medical record: 253
(1) The basis for determining that a qualified patient is an adult and 254
a resident of the state; 255
(2) All oral requests by a qualified patient for medication for aid in 256
dying; 257
(3) All written requests by a qualified patient for medication for aid 258
in dying; 259
(4) The attending physician's diagnosis of a qualified patient's 260
terminal illness and prognosis, and a determination that a qualified 261
patient is competent, is acting voluntarily and has made an informed 262
decision to request aid in dying; 263
(5) The consulting physician's confirmation of a qualified patient's 264
diagnosis and prognosis, confirmation that a qualified patient is 265
competent, is acting voluntarily and has made an informed decision to 266
request aid in dying; 267
(6) A report of the outcome and determinations made during 268
counseling, if counseling was recommended and provided in 269
accordance with section 8 of this act; 270
(7) Documentation of the attending physician's offer to a qualified 271
patient to rescind his or her request for aid in dying at the time the 272
attending physician dispenses or prescribes medication for aid in dying; 273
and 274
(8) A statement by the attending physician indicating that (A) all 275
requirements under this section and sections 1 to 9, inclusive, of this act 276
have been met, and (B) the steps taken to carry out a qualified patient's 277
request for aid in dying, including the medication dispensed or 278
prescribed. 279
Sec. 11. (NEW) (Effective October 1, 2021) Any person, other than a 280
qualified patient, in possession of medication dispensed or prescribed 281 Raised Bill No. 6425
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for aid in dying that has not been self-administered shall return such 282
medication to the attending physician or the Commissioner of 283
Consumer Protection in accordance with section 21a-252 of the general 284
statutes. 285
Sec. 12. (NEW) (Effective October 1, 2021) (a) Any provision of a 286
contract, including, but not limited to, a contract related to an insurance 287
policy or annuity, conditioned on or affected by the making or 288
rescinding of a request for aid in dying shall not be valid. 289
(b) Any provision of a will or codicil conditioned on or affected by 290
the making or rescinding of a request for aid in dying shall not be valid. 291
(c) On and after October 1, 2021, the sale, procurement or issuance of 292
any life, health or accident insurance or annuity policy or the rate 293
charged for any such policy shall not be conditioned upon or affected 294
by the making or rescinding of a request for aid in dying. 295
(d) A qualified patient's act of requesting aid in dying or self-296
administering medication dispensed or prescribed for aid in dying shall 297
not constitute suicide for any purpose, including, but not limited to, a 298
criminal prosecution under section 53a-56 of the general statutes. 299
Sec. 13. (NEW) (Effective October 1, 2021) (a) As used in this section, 300
"participate in the provision of medication" means to perform the duties 301
of an attending physician or consulting physician, a psychiatrist, 302
psychologist or pharmacist in accordance with the provisions of sections 303
2 to 10, inclusive, of this act. "Participate in the provision of medication" 304
does not include: (1) Making an initial diagnosis of a patient's terminal 305
illness; (2) informing a patient of his or her medical diagnosis or 306
prognosis; (3) informing a patient concerning the provisions of this 307
section, sections 1 to 12, inclusive, of this act and sections 16 to 19, 308
inclusive, of this act, upon the patient's request; or (4) referring a patient 309
to another health care provider for aid in dying. 310
(b) Participation in any act described in sections 1 to 12, inclusive, of 311
this act and sections 16 to 19, inclusive, of this act by a patient, health 312 Raised Bill No. 6425
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care provider or any other person shall be voluntary. Each health care 313
provider shall individually and affirmatively determine whether to 314
participate in the provision of medication to a qualified patient for aid 315
in dying. A health care facility shall not require a health care provider 316
to participate in the provision of medication to a qualified patient for aid 317
in dying, but may prohibit such participation in accordance with 318
subsection (d) of this section. 319
(c) If a health care provider or health care facility chooses not to 320
participate in the provision of medication to a qualified patient for aid 321
in dying, upon request of a qualified patient, such health care provider 322
or health care facility shall transfer all relevant medical records to any 323
health care provider or health care facility, as directed by a qualified 324
patient. 325
(d) A health care facility may adopt written policies prohibiting a 326
health care provider associated with such health care facility from 327
participating in the provision of medication to a patient for aid in dying, 328
provided such facility provides written notice of such policy and any 329
sanctions for violation of such policy to such health care provider. 330
Notwithstanding the provisions of this subsection or any policies 331
adopted in accordance with this subsection, a health care provider may: 332
(1) Diagnose a patient with a terminal illness; (2) inform a patient of his 333
or her medical prognosis; (3) provide a patient with information 334
concerning the provisions of this section, sections 1 to 12, inclusive, of 335
this act and sections 16 to 19, inclusive, of this act, upon a patient's 336
request; (4) refer a patient to another health care facility or health care 337
provider; (5) transfer a patient's medical records to a health care 338
provider or health care facility, as requested by a patient; or (6) 339
participate in the provision of medication for aid in dying when such 340
health care provider is acting outside the scope of his or her employment 341
or contract with a health care facility that prohibits participation in the 342
provision of such medication. 343
(e) Except as provided in a policy adopted in accordance with 344
subsection (d) of this section, no health care facility may subject an 345 Raised Bill No. 6425
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employee or other person who provides services under contract with 346
the health care facility to disciplinary action, loss of privileges, loss of 347
membership or any other penalty for participating, or refusing to 348
participate, in the provision of medication or related activities in good 349
faith compliance with the provisions of this section, sections 1 to 12, 350
inclusive, of this act and sections 16 to 19, inclusive, of this act. 351
Sec. 14. (NEW) (Effective October 1, 2021) (a) A person is guilty of 352
murder when such person, without authorization of a patient, wilfully 353
alters or forges a request for aid in dying, as described in sections 3 and 354
4 of this act, or conceals or destroys a rescission of such a request for aid 355
in dying with the intent or effect of causing the patient's death. 356
(b) A person is guilty of murder when such person coerces or exerts 357
undue influence on a patient to complete a request for aid in dying, as 358
described in sections 3 and 4 of this act, or coerces or exerts undue 359
influence on a patient to destroy a rescission of such request with the 360
intent or effect of causing the patient's death. 361
Sec. 15. (NEW) (Effective October 1, 2021) (a) Nothing in sections 1 to 362
14, inclusive, of this act or sections 16 to 19, inclusive, of this act 363
authorizes a physician or any other person to end another person's life 364
by lethal injection, mercy killing, assisting a suicide or any other active 365
euthanasia. 366
(b) Nothing in sections 1 to 14, inclusive, of this act or section 16 to 367
19, inclusive, of this act authorizes a health care provider or any person, 368
including a qualified patient, to end the qualified patient's life by 369
intravenous or other parenteral injection or infusion, mercy killing, 370
homicide, murder, manslaughter, euthanasia, or any other criminal act. 371
(c) Any actions taken in accordance with sections 1 to 14, inclusive, of 372
this act or sections 16 to 19, inclusive, of this act, do not, for any 373
purposes, constitute suicide, assisted suicide, euthanasia, mercy killing, 374
homicide, murder, manslaughter, elder abuse or neglect or any other 375
civil or criminal violation under the general statutes. 376 Raised Bill No. 6425
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(d) No action taken in accordance with sections 1 to 14, inclusive, of 377
this act or sections 16 to 19, inclusive, of this act shall constitute causing 378
or assisting another person to commit suicide in violation of section 53a-379
54a or 53a-56 of the general statutes. 380
(e) No person shall be subject to civil or criminal liability or 381
professional disciplinary action, including, but not limited to, 382
revocation of such person's professional license, for (1) participating in 383
the provision of medication or related activities in good faith 384
compliance with the provisions of sections 1 to 14, inclusive, of this act 385
and sections 16 to 19, inclusive, of this act, or (2) being present at the 386
time a qualified patient self-administers medication dispensed or 387
prescribed for aid in dying. 388
(f) An attending physician's dispensing of, or issuance of a 389
prescription for medication for aid in dying or a patient's request for aid 390
in dying, in good faith compliance with the provisions of sections 1 to 391
19, inclusive, of this act shall not constitute neglect for the purpose of 392
any law or provide the sole basis for appointment of a guardian or 393
conservator for such patient. 394
Sec. 16. (NEW) (Effective October 1, 2021) Sections 1 to 15, inclusive, of 395
this act or sections 17 to 19, inclusive, of this act do not limit liability for 396
civil damages resulting from negligent conduct or intentional 397
misconduct by any person. 398
Sec. 17. (NEW) (Effective October 1, 2021) (a) Any person who 399
knowingly possesses, sells or delivers medication dispensed or 400
prescribed for aid in dying for any purpose other than delivering such 401
medication to a qualified patient, or returning such medication in 402
accordance with section 11 of this act, shall be guilty of a class D felony. 403
(b) Nothing in sections 1 to 16, inclusive, of this act or section 18 or 19 404
of this act shall preclude criminal prosecution under any provision of 405
law for conduct that is inconsistent with said sections. 406
Sec. 18. (NEW) (Effective October 1, 2021) Nothing in sections 1 to 17, 407 Raised Bill No. 6425
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inclusive, of this act or section 19 of this act shall limit the jurisdiction or 408
authority of the nonprofit entity designated by the Governor to serve as 409
the Connecticut protection and advocacy system under section 46a-10b 410
of the general statutes. 411
Sec. 19. (NEW) (Effective October 1, 2021) No person who serves as an 412
attending physician or consulting physician shall inherit or receive any 413
part of the estate of such qualified patient, whether under the provisions 414
of law relating to intestate succession or as a devisee or legatee, or 415
otherwise under the will of such qualified patient, or receive any 416
property as beneficiary or survivor of such qualified patient after such 417
qualified patient has self-administered medication dispensed or 418
prescribed for aid in dying. 419
This act shall take effect as follows and shall amend the following
sections:
Section 1 October 1, 2021 New section
Sec. 2 October 1, 2021 New section
Sec. 3 October 1, 2021 New section
Sec. 4 October 1, 2021 New section
Sec. 5 October 1, 2021 New section
Sec. 6 October 1, 2021 New section
Sec. 7 October 1, 2021 New section
Sec. 8 October 1, 2021 New section
Sec. 9 October 1, 2021 New section
Sec. 10 October 1, 2021 New section
Sec. 11 October 1, 2021 New section
Sec. 12 October 1, 2021 New section
Sec. 13 October 1, 2021 New section
Sec. 14 October 1, 2021 New section
Sec. 15 October 1, 2021 New section
Sec. 16 October 1, 2021 New section
Sec. 17 October 1, 2021 New section
Sec. 18 October 1, 2021 New section
Sec. 19 October 1, 2021 New section
Statement of Purpose:
To provide aid in dying to terminally ill patients. Raised Bill No. 6425
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[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.]