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