Researcher: JO Page 1 3/22/22
OLR Bill Analysis
sSB 88
AN ACT CONCERNING AID IN DYING FOR TERMINALLY ILL
PATIENTS.
SUMMARY
This bill allows terminally ill adults, under specified conditions, to
obtain and use prescriptions to self-administer lethal medications.
To be eligible, the patient must (1) be a competent adult (age 18 or
older) and Connecticut resident; (2) have a terminal illness, as
determined by his or her attending physician; (3) have voluntarily
expressed a wish to receive aid in dying; and (4) meet the bill’s other
requirements. To request aid in dying, the bill requires that a patient
submit two written requests (at least 15 days apart) to his or her
attending physician.
The attending physician must ensure that the patient is making an
informed decision by discussing certain issues with the patient,
including the diagnosis and prognosis and feasible alternative treatment
options. Also, a consulting physician must examine the patient and
confirm (1) the attending physician’s diagnosis and (2) that the patient
is competent, acting voluntarily, and making an informed decision. The
bill broadly prohibits attending and consulting physicians from
financially benefitting from a patient’s estate.
Under the bill, a “terminal illness” is the final stage of an incurable
and irreversible condition that the attending physician anticipates,
within reasonable medical judgment, will produce the patient’s death
within six months if the condition’s progression follows its typical
course.
Among other provisions, the bill:
1. requires two witnesses for a written request for aid in dying to be 2022SB-00088-R000064-BA.DOCX
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valid and limits who may serve as a witness;
2. allows only patients themselves, and not anyone acting on their
behalf (e.g., agents under a living will or conservators) to request
aid in dying;
3. requires the attending or consulting physician to refer the patient
for counseling if they determine that the patient may be suffering
from a psychological or psychiatric condition causing impaired
judgment;
4. establishes several procedural and recordkeeping requirements
for attending physicians when they receive an aid in dying
request and when they determine the patient qualifies;
5. allows patients to rescind an aid in dying request at any time and
in any manner;
6. prohibits health care facilities from requiring their providers to
participate in providing aid in dying medication; and
7. requires attending physicians to report on aid in dying
prescriptions and related deaths to the Department of Public
Health (DPH), and the department to annually report that
information to the Public Health Committee.
In authorizing aid in dying, the bill generally limits civil, criminal,
and professional liability for individuals involved, provided the bill’s
requirements are met. It makes corresponding changes invalidating
provisions of wills, annuities, life insurance, or other contracts impacted
by a patient requesting aid in dying or rescinding such a request.
EFFECTIVE DATE: October 1, 2022, except upon passage for the
provisions requiring DPH to create attending physician checklist and
follow-up forms (§ 18).
§§ 2-4 — REQUESTING AID IN DYING
Under the bill, “aid in dying” is the medical practice of a physician
prescribing medication to a terminally ill qualified patient, which the 2022SB-00088-R000064-BA.DOCX
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patient may self-administer to bring about his or her death. “Self-
administer” is a qualified patient’s voluntary, conscious, and
affirmative act of ingesting medication.
Eligibility (§ 2)
To request aid in dying, the bill requires that a patient voluntarily
express his or her wish to receive aid in dying and be:
1. an adult (i.e., age 18 or older);
2. a Connecticut resident;
3. competent (see below); and
4. determined by his or her attending physician to have a terminal
illness.
A “qualified patient” is one who meets these criteria and has satisfied
the bill’s other requirements.
An “attending physician” is a state-licensed physician with primary
responsibility for the patient’s medical care and treatment of the
patient’s terminal illness, and whose practice is not primarily comprised
of evaluating or qualifying patients for aid in dying or prescribing or
dispensing aid in dying medication.
Under the bill, a patient is “competent” if, in the opinion of his or her
attending or consulting physician (see below), psychiatrist,
psychologist, or licensed clinical social worker (LCSW), the patient has
the capacity to understand and acknowledge the nature and
consequences of health care decisions, including the benefits and
disadvantages of treatment, to make an informed decision (see below)
and to communicate that decision to a Connecticut licensed health care
provider. This includes communicating through a person familiar with
the patient’s manner of communicating.
The bill prohibits anyone from acting on a patient’s behalf for
purposes of the bill, including an agent under a living will, an attorney-
in-fact under a durable power of attorney, a guardian, or a conservator. 2022SB-00088-R000064-BA.DOCX
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Request Process (§ 3)
Before receiving aid in dying, a patient must submit two written
requests in a form the bill establishes to his or her attending physician,
at least 15 days apart.
Each written request must be signed and dated by the patient and
witnessed by at least two people in the patient’s presence. Each witness
must attest in writing, that to the best of the witness’s knowledge and
belief, the patient (1) appears to be of sound mind and (2) is acting
voluntarily and not being coerced to sign the request.
Each witness must also attest in writing, that to the best of the
witness’s knowledge and belief, he or she is not (1) related to the patient
by blood, marriage, or adoption; (2) entitled to any portion of the estate
upon the patient’s death, by will or operation of law; (3) an owner,
operator, or employee of a health care facility where the patient resides
or is receiving treatment; or (4) the patient’s attending physician when
the request was signed.
Under the bill, a patient’s act of requesting aid in dying, or a qualified
patient’s self-administration of aid in dying medication, must not
provide the sole basis for appointing a conservator or guardian for the
patient.
Form of Written Request (§ 4)
The bill requires written requests for aid in dying to be substantially
the same as the following form:
REQUEST FOR MEDICATION TO AID IN DYING
I, .…, am an adult of sound mind.
I am a resident of the State of Connecticut.
I am suffering from …., which my attending physician has
determined is an incurable and irreversible medical condition that will,
within reasonable medical judgment, result in death within six months
from the date on which this document is executed if the progression of 2022SB-00088-R000064-BA.DOCX
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such condition follows its typical course. This diagnosis of a terminal
illness has been medically confirmed by another physician.
I have been fully informed of my diagnosis, prognosis, the nature of
medication to be dispensed or prescribed to aid me in dying, the
potential associated risks, the expected result, feasible alternatives to aid
in dying and additional health care treatment options, including hospice
care and palliative care and the availability of counseling with a
psychologist, psychiatrist or licensed clinical social worker.
I request that my attending physician dispense or prescribe
medication that I may self-administer for aid in dying. I authorize my
attending physician to contact a pharmacist to fill the prescription for
such medication, upon my request.
INITIAL ONE:
…. I have informed my family of my decision and taken family
opinions into consideration.
…. I have decided not to inform my family of my decision.
…. I have no family to inform of my decision.
I understand that I have the right to rescind this request at any time.
I understand the full import of this request and I expect to die if and
when I take the medication to be dispensed or prescribed. I further
understand that although most deaths occur within one hour, my death
may take longer and my attending physician has counseled me about
this possibility.
I make this request voluntarily and without reservation, and I accept
full responsibility for my decision to request aid in dying.
Signed: ….
Dated: ….
DECLARATION OF WITNESSES 2022SB-00088-R000064-BA.DOCX
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By initialing and signing below on the date the person named above
signs, I declare that:
Witness 1 …. Witness 2 ….
Initials …. Initials ….
…. 1. The person making and signing the request is personally known
to me or has provided proof of identity;
…. 2. The person making and signing the request signed this request
in my presence on the date of the person's signature;
…. 3. The person making the request appears to be of sound mind
and not under duress, fraud or undue influence;
…. 4. I am not the attending physician for the person making the
request;
…. 5. The person making the request is not my relative by blood,
marriage or adoption;
…. 6. I am not entitled to any portion of the estate of the person
making the request upon such person's death under any will or by
operation of law; and
…. 7. I am not an owner, operator or employee of a health care facility
where the person making the request is a resident or receiving medical
treatment.
Printed Name of Witness 1 ….
Signature of Witness 1 …. Date ….
Printed Name of Witness 2 ….
Signature of Witness 2 …. Date ….
§ 5 — RESCISSION OF AID IN DYING REQUEST
The bill allows qualified patients to rescind aid in dying requests at 2022SB-00088-R000064-BA.DOCX
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any time and in any manner without regard to their mental state.
Under the bill, a qualified patient’s attending physician must offer
the patient an opportunity to rescind an aid in dying request when the
patient makes his or her second written request. The bill prohibits
attending physicians from dispensing or prescribing aid in dying
medication without first offering the patient a second opportunity to
rescind the request.
§§ 6-10 — PROCESS TO PRESCRIBE OR DISPENSE AID IN DYING
MEDICATION
Steps to Verify Eligibility (§ 6)
Under the bill, when an attending physician is presented with a
patient’s first written request for aid in dying, the physician must
determine that the patient is a competent adult, has a terminal illness,
and is voluntarily making the request. The physician cannot make this
determination solely based on the patient’s age, disability, or any
specific illness.
The physician must also require the patient to demonstrate
Connecticut residency by showing (1) a valid driver’s license, (2) a valid
voter registration card, or (3) any other valid government-issued
document that the physician reasonably believes demonstrates state
residency on the date the request is presented.
The physician must also ensure that the patient is making an
informed decision by informing the patient about (1) his or her
diagnosis and prognosis; (2) the potential risks and probable results of
self-administering the medication; (3) feasible alternatives and
treatment options, including hospice and palliative care; and (4) the
availability of counseling with a psychologist, psychiatrist, or LCSW.
The physician must fully inform the patient of these matters, and the
patient’s decision must be based on understanding and acknowledging
the relevant facts.
Consulting Physician (§§ 6 & 7)
The bill also requires the attending physician to refer the patient to a 2022SB-00088-R000064-BA.DOCX
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consulting physician qualified by specialty or experience to make a
diagnosis and prognosis about the terminal illness. In order for the
patient to be qualified for aid in dying, the consulting physician must:
1. examine the patient and the patient’s relevant medical records;
2. confirm the diagnosis; and
3. verify that the patient is competent, has made the request
voluntarily, and has made an informed decision.
The confirmation of the terminal diagnosis must be in writing.
Counseling Referral (§§ 7 & 8)
Under the bill, if either the attending or consulting physician believes
that the patient’s judgment may be impaired by a psychiatric or
psychological condition (including depression), then that physician
must refer the patient for counseling to determine whether he or she is
competent to request aid in dying.
In that case, the bill prohibits the attending physician from providing
the patient aid in dying until the counselor (a psychiatrist, psychologist,
or LCSW) determines that the patient is not suffering from a judgment-
impairing psychiatric or psychological condition.
Steps After Second Request (§ 9)
Under the bill, after both physicians determine that the patient is
qualified to obtain aid in dying and the patient submits a second written
request, the attending physician must:
1. recommend that the patient notify his or her next-of-kin of the
aid in dying request, but also inform the patient that it is not
required;
2. counsel the patient on the importance of (a) having someone else
there when the patient self-administers the medication and (b)
not taking it in public;
3. tell the patient that he or she may rescind the request at any time 2022SB-00088-R000064-BA.DOCX
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and in any manner;
4. verify that the patient is making an informed decision,
immediately before dispensing or prescribing the medication;
5. document specified information in the patient’s medical record
(see § 10 below); and
6. either dispense the medication directly to the patient, or upon the
patient’s request, deliver the prescription to a pharmacist so that
the pharmacist may dispense it to the patient (see below).
If the physician is authorized to dispense the medication and
dispenses it directly, he or she must also dispense ancillary medication
intended to minimize the patient’s discomfort.
Alternatively, if the patient provides written consent and requests it,
the physician must (1) contact a pharmacist who chooses to participate
in providing aid in dying medication and inform the pharmacist of the
prescription and (2) personally deliver the written prescription to the
pharmacist by mail, fax, or electronic transmission. The pharmacist then
may dispense the medication directly to the patient, the attending
physician, or the patient’s expressly identified agent.
Attending Physician Recordkeeping Requirements (§ 10)
The bill requires a qualified patient’s attending physician to ensure
that the following items are documented or filed in the patient’s medical
record:
1. the basis for determining that the patient is an adult and a state
resident;
2. the patient’s written requests for aid in dying medication;
3. the physician’s terminal diagnosis and the prognosis;
4. the physician’s determination that the patient is competent,
acting voluntarily, and has made an informed decision to request
aid in dying; 2022SB-00088-R000064-BA.DOCX
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5. the consulting physician’s confirmation of the information in
items 3 and 4;
6. a report of the outcome and determinations made during
counseling for patients with potentially impaired judgment;
7. documentation of the attending physician’s offer to the patient to
rescind his or her aid in dying request when the physician
dispensed or prescribed the medication; and
8. the physician’s statement indicating (a) that all of the bill’s
foregoing requirements have been met and (b) the steps that were
taken to carry out the patient’s request for aid in dying, including
the medication dispensed or prescribed.
§ 11 — MEDICATION RETURN
Under the bill, if anyone other than a qualified patient possesses
dispensed or prescribed aid in dying medication that the patient did not
use, that person must (1) destroy it a manner prescribed on the
Department of Consumer Protection’s website or (2) dispose of it at a
pharmacy or municipal police department that accepts and disposes of
unused medications under existing law.
§ 12 — EFFECT ON INSURANCE CONTRACTS, WILLS, AND OTHER
LAWS
The bill declares as invalid any contract provisions, including
contracts related to insurance policies and annuities, or will or codicil
provisions that are conditioned upon or affected by a patient making or
rescinding an aid in dying request.
Starting October 1, 2022, the bill prohibits the sale, procurement, or
issuance of life, health, or accident insurance or annuity policies, or
policy rates, that are conditioned upon or affected by the making or
rescinding of an aid in dying request.
The bill provides that a qualified patient’s act of requesting aid in
dying or self-administering the medication does not constitute suicide
for any purpose, including criminal prosecution for 2
nd
degree 2022SB-00088-R000064-BA.DOCX
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manslaughter.
§ 13 — VOLUNTARY NATURE OF PARTICIPATION BY PATIENT S
AND PROVIDERS
The bill provides that participation in any action under the bill is
voluntary, whether by a patient, health care provider, or anyone else. In
addition, health care providers must individually and affirmatively
determine whether to “participate in the provision of medication” to
qualified patients for aid in dying.
The bill prohibits health care facilities (i.e., hospitals, residential care
homes, nursing homes, or rest homes) from requiring providers to
participate. As further explained below, health care facilities may adopt
policies prohibiting associated providers from participating and, under
certain circumstances, they may impose sanctions on providers who fail
to comply with that policy. However, the bill allows these providers to
participate as long as they do so when acting outside the scope of their
employment contract.
For these purposes, to “participate in the provision of medication”
means to perform the duties of an attending or consulting physician,
psychiatrist, psychologist, or pharmacist under the bill. It does not
include (1) making an initial diagnosis of a patient’s terminal illness, (2)
informing a patient of his or her medical diagnosis or prognosis, (3)
informing a patient about the bill upon the patient’s request, or (4)
referring a patient to another health care provider for aid in dying.
Under the bill, if a health care provider or facility chooses not to
participate in providing medication for aid in dying, the provider or
facility must, upon a qualified patient’s request, transfer all relevant
medical records to another provider or facility as the patient directs.
Health Care Facility Policies
The bill allows health care facilities to adopt written policies
prohibiting associated providers from participating in providing
medication for aid in dying, as long as the facility gives them written
notice of the policy and any sanctions for violating it. 2022SB-00088-R000064-BA.DOCX
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The bill prohibits health care facilities, except as provided in such a
policy, from subjecting employees or contracted service providers to
disciplinary action, loss of privileges, loss of membership, or any other
penalty for participating, or refusing to participate, in the provision of
medication or related activities in good faith compliance with the bill.
Even if a facility adopts such a policy, the facility’s providers may:
1. diagnose patients with a terminal illness;
2. inform patients of their medical prognoses;
3. provide patients with information about the bill upon request;
4. refer patients to other health care facilities or providers;
5. transfer medical records to other health care facilities or
providers, as requested by the patient; or
6. participate in providing aid in dying medication when the
provider is acting outside the scope of his or her employment or
contract with the facility that prohibits the participation.
§§ 14 & 15 — UNAUTHORIZED ACTIONS, LIABILITY, AND
RELATED ISSUES
The bill specifies that it does not authorize a:
1. physician or anyone else to end someone else’s life by lethal
injection, mercy killing, assisting a suicide, or any other active
euthanasia; or
2. health care provider or anyone else, including a qualified patient,
to end the patient’s life by intravenous or other parenteral
injection or infusion, mercy killing, homicide, murder,
manslaughter, euthanasia, or any other criminal act.
The bill specifies that any actions taken under its aid in dying
procedures do not constitute suicide, assisted suicide, euthanasia, mercy
killing, homicide, murder, manslaughter, elder abuse or neglect, or any
other civil or criminal violation under law. It further specifies that these 2022SB-00088-R000064-BA.DOCX
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actions do not constitute causing or assisting suicide under existing laws
that make it (1) murder to intentionally cause someone to commit
suicide by force, duress, or deception (CGS § 53a-54a) and (2) 2
nd
degree
manslaughter to intentionally cause or aid someone to commit suicide
by other means (CGS § 53a-56).
The bill prohibits anyone from being subject to civil or criminal
liability or professional disciplinary action (including license
revocation) for (1) participating in the provision of medication or related
activities in good faith compliance with the bill or (2) being present
when a qualified patient self-administers aid in dying medication.
Under the bill, an attending physician’s dispensing or prescribing aid
in dying medication, a pharmacist’s dispensing of this medication, or a
patient’s aid in dying request, in good faith compliance with the bill
does not (1) constitute neglect under law or (2) provide the sole basis for
appointing a guardian or conservator for the patient.
However, the bill does not limit civil liability for damages resulting
from negligence or intentional misconduct.
§ 16 — PROTECTION AND ADVOCACY SYSTEM JURISDICTION
The bill specifies that it does not limit the jurisdiction or authority of
the nonprofit entity the governor designated to serve as the state’s
protection and advocacy system for individuals with disabilities (i.e.,
Disability Rights Connecticut).
§ 17 — LIMITATIONS ON PHYSICIANS’ INHERITANCE
The bill prohibits anyone who serves as an attending or consulting
physician under the bill from inheriting from or receiving any part of
the patient’s estate. This includes (1) receiving part of the estate under
the intestate succession laws, as a devisee or legatee, or otherwise under
the patient’s will, or (2) receiving any property as the patient’s
beneficiary or survivor, after the patient has self-administered aid in
dying medication.
§§ 18 & 19 — ATTENDING PHYSICIAN CHECKLIST AND FOLLOW-
UP FORMS; REPORTING 2022SB-00088-R000064-BA.DOCX
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The bill requires attending physicians, within 30 days after
prescribing aid in dying medication to a qualified patient, to submit a
checklist form to DPH. These physicians must also submit a follow-up
form to DPH within 60 days after they are notified that a qualified
patient died from self-administration of this medication. By October 1,
2022, DPH must (1) create these forms to facilitate collecting the
required information and (2) post the forms on its website.
Both forms must include the qualified patient’s name and date of
birth. The first form must also include (1) the qualified patient’s
diagnosis and prognosis and (2) a statement by the attending physician
indicating that all of the bill’s applicable requirements have been met
and that the physician has prescribed medication pursuant to the bill.
The follow-up form must include (1) the date of the qualified patient’s
death and (2) whether the patient was provided hospice care at the time
of death.
Under the bill, starting by January 1, 2023, DPH must (1) annually
review the submitted forms to ensure compliance with the bill’s
reporting requirements and (2) report to the Public Health Committee.
The department’s annual reports to the committee must include the
number of (1) aid in dying prescriptions written for qualified patients
and (2) such patients who died following self-administration of this
medication. The reports must not contain identifying information about
qualified patients or health care providers.
The bill excludes any data DPH collects under these provisions from
disclosure under the Freedom of Information Act.
COMMITTEE ACTION
Public Health Committee
Joint Favorable Substitute
Yea 22 Nay 9 (03/08/2022)