Florida 2023 Regular Session

Florida House Bill H1231 Compare Versions

Only one version of the bill is available at this time.

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3	3	HB 1231 2023
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8	8	hb1231-00
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10	10	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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12	12
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14	14	A bill to be entitled 1
15	15	An act relating to end -of-life options; creating ch. 2
16	16	764, F.S., relating to personal autonomy; creating s. 3
17	17	764.101, F.S.; providing a short title; creating s. 4
18	18	764.102, F.S.; defining terms; creating s. 764.103, 5
19	19	F.S.; providing legislative findings and inte nt; 6
20	20	creating s. 764.104, F.S.; providing criteria for 7
21	21	qualified patients; providing factors to demonstrate 8
22	22	residency; requiring qualified patients to make oral 9
23	23	and written requests to obtain medication to end their 10
24	24	lives in a peaceful manner; requiring wai ting periods 11
25	25	before such requests may be made and such medication 12
26	26	may be prescribed; providing exceptions; providing a 13
27	27	form for written requests; specifying requirements for 14
28	28	the valid execution of such form; authorizing a 15
29	29	qualified patient to rescind a req uest at any time and 16
30	30	in any manner; creating s. 764.105, F.S.; specifying 17
31	31	responsibilities for attending physicians and 18
32	32	consulting physicians; providing that a qualified 19
33	33	patient's health care providers under the act may not 20
34	34	be related to the qualified pati ent or entitled to any 21
35	35	portion of the qualified patient's estate; specifying 22
36	36	recordkeeping requirements; requiring certain health 23
37	37	care providers to report specified information to the 24
38	38	Department of Health; requiring the department to 25
39	39
40	40	HB 1231 2023
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47	47	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
48	48
49	49
50	50
51	51	adopt rules; requiring the department annually publish 26
52	52	a specified report on its website; providing 27
53	53	requirements for the report; creating s. 764.106, 28
54	54	F.S.; requiring persons who have custody or control of 29
55	55	any unused medication prescribed under the act to 30
56	56	dispose of it in a spec ified manner; creating s. 31
57	57	764.107, F.S.; specifying requirements for the death 32
58	58	certificate of qualified patients who die by self -33
59	59	administration of medication prescribed in accordance 34
60	60	with the act; creating s. 764.108, F.S.; making 35
61	61	certain provisions of leg al instruments void and 36
62	62	unenforceable under certain circumstances; prohibiting 37
63	63	health insurers from denying or discriminating in 38
64	64	their provision of health benefits based on the 39
65	65	availability of medication prescribed under the act or 40
66	66	from attempting to influ ence a policyholder's decision 41
67	67	to make or rescind a request for such medication; 42
68	68	prohibiting an individual's participation under the 43
69	69	act from affecting the sale, procurement, or issuance 44
70	70	of certain insurance policies or the rates charged for 45
71	71	such policies; creating s. 764.109, F.S.; providing 46
72	72	criminal penalties and immunities; defining the terms 47
73	73	"notify" and "participation in this chapter"; 48
74	74	authorizing health care providers and health care 49
75	75	facilities to prohibit health care providers from 50
76	76
77	77	HB 1231 2023
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84	84	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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86	86
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88	88	participating under the act while on the premises of 51
89	89	facilities that they own or operate if they provided 52
90	90	prior notice of their policy; requiring such health 53
91	91	care providers and health care facilities to clearly 54
92	92	articulate this policy on websites they maintain and 55
93	93	in materials they provide to patients; requiring such 56
94	94	health care providers and health care facilities to 57
95	95	provide the policy in an easily accessible location on 58
96	96	their websites and in certain materials provided to 59
97	97	patients; authorizing health care providers and healt h 60
98	98	care facilities to impose sanctions against health 61
99	99	care providers who violate such policies; providing 62
100	100	that health care providers and health care facilities 63
101	101	may not prohibit their employees from participating 64
102	102	under the act off the premises or outside the course 65
103	103	and scope of their employment or impose sanctions 66
104	104	against them for doing so; requiring sanctioning 67
105	105	health care providers and health care facilities to 68
106	106	not be arbitrary or capricious in their sanctions and 69
107	107	to follow due process procedures when impos ing such 70
108	108	sanctions; providing that such sanctions may not be 71
109	109	considered a violation of the standard of care or as 72
110	110	unprofessional conduct for purposes of disciplinary 73
111	111	action against a health care provider's license; 74
112	112	creating s. 764.11, F.S.; authorizing cla ims for costs 75
113	113
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121	121	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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125	125	and attorney fees for governmental entities under 76
126	126	certain circumstances; creating s. 764.111, F.S.; 77
127	127	providing construction and severability; amending s. 78
128	128	782.08, F.S.; exempting persons acting in accordance 79
129	129	with the act from certain criminal p enalties; 80
130	130	providing an effective date. 81
131	131	82
132	132	Be It Enacted by the Legislature of the State of Florida: 83
133	133	84
134	134	Section 1. Chapter 764, Florida Statutes, consisting of 85
135	135	sections 764.101-764.111, Florida Statutes, is created and 86
136	136	entitled "Personal Autonomy." 87
137	137	Section 2. Section 764.101, Florida Statutes, is created 88
138	138	to read: 89
139	139	764.101 Short title. —Sections 764.101-764.111 may be cited 90
140	140	as the "Florida End-of-Life Options Act." 91
141	141	Section 3. Section 764.102, Florida Statutes, is created 92
142	142	to read: 93
143	143	764.102 Definitions.—As used in this chapter, the term: 94
144	144	(1) "Adult" means a resident of this state who is 18 years 95
145	145	of age or older. 96
146	146	(2) "Attending physician" means the physician who has 97
147	147	primary responsibility for the care of the patient and treatment 98
148	148	of the patient's terminal condition. 99
149	149	(3) "Capacity" or "mental capacity" means that a patient's 100
150	150
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158	158	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
159	159
160	160
161	161
162	162	attending physician, consulting physician, or treating mental 101
163	163	health professional has determined that, in accordance with the 102
164	164	relevant professional standards of care, the pat ient has the 103
165	165	ability to understand and appreciate health care options 104
166	166	available to him or her, including the significant benefits and 105
167	167	risks of such options, and to make and communicate health care 106
168	168	decisions to health care providers, including communication 107
169	169	through individuals familiar with the patient's manner of 108
170	170	communicating if those individuals are available. 109
171	171	(4) "Consulting physician" means a physician who is 110
172	172	qualified by specialty or experience to make a professional 111
173	173	diagnosis and prognosis regarding the patient's medical 112
174	174	condition. 113
175	175	(5) "Counseling" means one or more consultations as 114
176	176	necessary between a mental health professional and a patient for 115
177	177	the purpose of determining whether the patient has mental 116
178	178	capacity and whether the patient is suffering from a mental 117
179	179	health disorder or intellectual disability causing impaired 118
180	180	judgment that impacts his or her ability to make informed end -119
181	181	of-life decisions. 120
182	182	(6) "Department" means the Department of Health. 121
183	183	(7) "Health care facility" means a health care facility as 122
184	184	defined in s. 408.07 or another entity, other than a health care 123
185	185	provider, licensed or certified to provide health care services 124
186	186	in this state. 125
187	187
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195	195	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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199	199	(8) "Health care provider" means a health care 126
200	200	practitioner as defined in s. 456.001 or another in dividual 127
201	201	licensed or certified to provide health services in this state. 128
202	202	(9) "Informed decision" means a decision voluntarily made 129
203	203	by a qualified patient to request and obtain a prescription to 130
204	204	end his or her life after a sufficient explanation and 131
205	205	disclosure of the subject matter is given to enable the 132
206	206	qualified patient to understand and consider the relevant facts, 133
207	207	including the qualified patient's medical diagnosis and 134
208	208	prognosis, the potential risks associated with taking the 135
209	209	medication to be pres cribed, the probable results of taking the 136
210	210	medication, and the feasible alternatives to taking the 137
211	211	medication, and to make an informed health care decision without 138
212	212	coercion or undue influence. 139
213	213	(10) "Medically confirmed" means the medical opinion of 140
214	214	the attending physician has been confirmed by a consulting 141
215	215	physician who has examined the patient and the patient's 142
216	216	relevant medical records. 143
217	217	(11) "Medication" means a drug as defined in s. 499.003 144
218	218	which an attending physician prescribes to a qualified patien t 145
219	219	under this chapter to end his or her life in a peaceful manner. 146
220	220	(12) "Mental health professional" means a psychiatrist 147
221	221	licensed under chapter 458 or 459, a psychiatric nurse licensed 148
222	222	under part I of chapter 464, a psychologist licensed under 149
223	223	chapter 490, or a mental health counselor or clinical social 150
224	224
225	225	HB 1231 2023
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232	232	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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234	234
235	235
236	236	worker licensed under chapter 491. 151
237	237	(13) "Physician" means a person licensed to practice 152
238	238	medicine under chapter 458 or osteopathic medicine under chapter 153
239	239	459. 154
240	240	(14) "Public place" means any street, alley , park, or 155
241	241	public building; any place of business or assembly open to or 156
242	242	frequented by the public; and any other place open to the public 157
243	243	view or to which the public has access. The term does not 158
244	244	include a health care facility. 159
245	245	(15) "Qualified patient" m eans an individual who has 160
246	246	satisfied the requirements of this chapter to obtain a 161
247	247	prescription for medication to end his or her life in a peaceful 162
248	248	manner. 163
249	249	(16) "Self-administer" means to take an affirmative, 164
250	250	conscious, and voluntary action to ingest medi cation. 165
251	251	(17) "Telehealth" has the same meaning as provided in s. 166
252	252	456.47. 167
253	253	(18) "Terminal condition" means a medically confirmed 168
254	254	condition caused by an injury, an illness, or a disease which is 169
255	255	incurable and irreversible and which will, within reasonable 170
256	256	medical judgment, cause the patient's death within 6 months. 171
257	257	Section 4. Section 764.103, Florida Statutes, is created 172
258	258	to read: 173
259	259	764.103 Legislative findings and intent. —The Legislature 174
260	260	finds that every adult with mental capacity has the fundamental 175
261	261
262	262	HB 1231 2023
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269	269	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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271	271
272	272
273	273	right of self-determination regarding decisions pertaining to 176
274	274	his or her own health, and recognizes that for some faced with a 177
275	275	terminal condition, prolonging life may result in intolerable 178
276	276	pain and suffering. It is the intent of the Legislature to 179
277	277	establish a procedure to allow an individual with mental 180
278	278	capacity who has a terminal condition, and who makes a fully 181
279	279	informed decision that he or she no longer wants to live, to 182
280	280	obtain medication to end his or her life in a peaceful manner. 183
281	281	Section 5. Section 764.104, Florida Statutes, is created 184
282	282	to read: 185
283	283	764.104 Qualified patients; residency requirements; 186
284	284	written and oral requests for medication; waiting periods; form 187
285	285	requirements; right to rescind requests. — 188
286	286	(1)(a) An individual may request medication aut horized 189
287	287	under this chapter for the purpose of ending his or her life if 190
288	288	the individual: 191
289	289	1. Is 18 years of age or older; 192
290	290	2. Is a resident of Florida; 193
291	291	3. Has been clinically diagnosed with a terminal condition 194
292	292	by his or her attending physician which ha s been medically 195
293	293	confirmed by a consulting physician; 196
294	294	4. Has mental capacity; 197
295	295	5. Is making an informed decision; 198
296	296	6. Has voluntarily expressed his or her wish to die; and 199
297	297	7. Is able to self-administer the medication. 200
298	298
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306	306	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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310	310	(b) An individual may not qual ify for medication under 201
311	311	this chapter solely because of age or disability. 202
312	312	(2) Factors demonstrating Florida residency include, but 203
313	313	are not limited to: 204
314	314	(a) Possession of a Florida driver license; 205
315	315	(b) Registration to vote in Florida; 206
316	316	(c) Evidence that the individual owns or leases property 207
317	317	in Florida; or 208
318	318	(d) Filing of a federal tax return from the most recent 209
319	319	tax year which asserts that the individual's permanent residence 210
320	320	is in Florida. 211
321	321	(3) To obtain medication under this chapter to end his or 212
322	322	her life, a qualified patient must first make two oral requests, 213
323	323	and then one written request, for the medication to his or her 214
324	324	attending physician. 215
325	325	(a) A qualified patient may not make the second oral 216
326	326	request to his or her attending physician until at least 15 days 217
327	327	after making the first oral request. However, if the qualified 218
328	328	patient's attending physician has medically confirmed that the 219
329	329	qualified patient will, within reasonable medical judgment, die 220
330	330	within 15 days after making the first oral request, the 221
331	331	qualified patient may make the second oral request to his or her 222
332	332	attending physician at any time after making the first oral 223
333	333	request. 224
334	334	(b) After a qualified patient makes a second oral request, 225
335	335
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343	343	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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347	347	the attending physician must give the qualified patient an 226
348	348	opportunity to rescind the request. 227
349	349	(c) A qualified patient may make a written request for 228
350	350	medication under this chapter after he or she has made a second 229
351	351	oral request for the medication and has been offered the 230
352	352	opportunity to rescind the request. The written request must be 231
353	353	made by the qualified patient and may not be made by the 232
354	354	qualified patient's health care surrogate or proxy, attorney, or 233
355	355	representative or by an advance directive. 234
356	356	(d) An attending physician may not prescribe medication to 235
357	357	a qualified patient under this chapter until at least 48 hours 236
358	358	after the qualified patient makes a written request for the 237
359	359	medication. However, if the qualified patient's attending 238
360	360	physician has medically confirmed that the qualified patient 239
361	361	will, within reasonable medical judgment, die within the 48 -hour 240
362	362	waiting period, the attending physician may prescribe the 241
363	363	medication immediately after the qualified patient makes the 242
364	364	written request. 243
365	365	(e) A qualified patient may make the oral requests for 244
366	366	medication under this chapter through telehealth if the 245
367	367	attending physician deems it clinically appropriate under the 246
368	368	applicable standard of care for his or her profession. 247
369	369	(4)(a) A written request for medication under this chapter 248
370	370	must be in a form substantially similar to the following: 249
371	371	REQUEST FOR MEDICATION 250
372	372
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380	380	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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383	383
384	384	TO END MY LIFE IN A PEACEFUL MANNER 251
385	385	252
386	386	I, ...(name of qualified patient)..., am an adult of sound 253
387	387	mind. 254
388	388	255
389	389	I am suffering from ...(medical condition)..., which my 256
390	390	attending physician has determined is a terminal cond ition and 257
391	391	which has been medically confirmed by a consulting physician. 258
392	392	Both physicians agree that, within reasonable medical judgment, 259
393	393	my condition is incurable and irreversible and is likely to 260
394	394	cause my death within 6 months. ...(qualified patient's 261
395	395	initials)... 262
396	396	263
397	397	I have been fully informed of my diagnosis, prognosis, the 264
398	398	nature of the medication to be prescribed and potential 265
399	399	associated risks, the expected result of taking the medication, 266
400	400	and the feasible alternative, concurrent, or additional 267
401	401	treatment opportunities available to me, including hospice care 268
402	402	and palliative care focused on relieving symptoms and reducing 269
403	403	suffering. ...(qualified patient's initials)... 270
404	404	271
405	405	Pursuant to chapter 764, Florida Statutes, I request that 272
406	406	my attending physician prescrib e medication that will end my 273
407	407	life in a peaceful manner if I choose to self -administer it, and 274
408	408	I authorize my attending physician to contact a willing 275
409	409
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417	417	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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421	421	pharmacist to dispense such medication to me. ...(qualified 276
422	422	patient's initials)... 277
423	423	278
424	424	PURSUANT TO SECTION 764.104, FLORIDA STATUTES, I UNDERSTAND 279
425	425	THAT I HAVE THE RIGHT TO RESCIND THIS REQUEST AT ANY TIME AND IN 280
426	426	ANY MANNER, REGARDLESS OF MY MENTAL STATE. ...(qualified 281
427	427	patient's initials)... 282
428	428	283
429	429	I understand the full import of this request, and I expect 284
430	430	to die if I self-administer the medication to be prescribed. I 285
431	431	further understand that although most deaths occur within 3 286
432	432	hours, my death may take longer, and my attending physician has 287
433	433	counseled me about this possibility. ...(qualified patient's 288
434	434	initials)... 289
435	435	290
436	436	I make this request voluntarily and without reservation. 291
437	437	...(qualified patient's initials)... 292
438	438	293
439	439	Signed: ...(signature of qualified patient)... 294
440	440	Dated: ...(date)... Time: ...(time)... 295
441	441	296
442	442	DECLARATION OF WITNESSES 297
443	443	We declare that the person signing this request: 298
444	444	1. Is personally known to us or has provided proof of his 299
445	445	or her identity; 300
446	446
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454	454	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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458	458	2. Signed this request in our presence; 301
459	459	3. Appears to be of sound mind and not under duress, 302
460	460	fraud, or undue influence; and 303
461	461	4. Is not a patient for whom either of us is the attending 304
462	462	physician or other health care provider. 305
463	463	306
464	464	First witness Second witness 307
465	465	...(print name)... ...(print name)... 308
466	466	...(relation to patient)... ...(relation to 309
467	467	patient)... 310
468	468	...(signature)... ...(signature)... 311
469	469	...(date)... ...(date)... 312
470	470	313
471	471	NOTE: At least one witness must not be a relative (by 314
472	472	blood, marriage, registered domestic partnership, or adoption) 315
473	473	of the qualified person signing this request, must not be 316
474	474	entitled to any portion of the person's estate upon death, and 317
475	475	must not be an owner, operator, or employee of a health care 318
476	476	facility where the qualified patient is a patient or resident. 319
477	477	(b) To be valid, the written request must be signed by the 320
478	478	qualified patient and witnessed by at least two individuals who, 321
479	479	in the presence of th e qualified patient, attest that, to the 322
480	480	best of their knowledge and belief, the qualified patient has 323
481	481	mental capacity, is acting voluntarily, and is not being coerced 324
482	482	to sign the request. At least one of the witnesses must be a 325
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491	491	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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495	495	person who is not: 326
496	496	1. A relative of the qualified patient by blood, marriage, 327
497	497	registered domestic partnership, or adoption; 328
498	498	2. A person who at the time the request is signed would be 329
499	499	entitled to any portion of the estate of the qualified patient 330
500	500	upon death under any will or by o peration of law; or 331
501	501	3. An owner, operator, or employee of a health care 332
502	502	facility where the qualified patient is receiving medical 333
503	503	treatment or is a resident. 334
504	504	(c) The qualified patient's attending physician or other 335
505	505	health care provider at the time the request is signed may not 336
506	506	serve as a witness. 337
507	507	(5) A qualified patient may rescind his or her request at 338
508	508	any time and in any manner without regard to his or her mental 339
509	509	state. 340
510	510	Section 6. Section 764.105, Florida Statutes, is created 341
511	511	to read: 342
512	512	764.105 Attending physician responsibilities; consulting 343
513	513	physician responsibilities; recordkeeping and reporting 344
514	514	requirements; annual report. — 345
515	515	(1) ATTENDING PHYSICIAN RESPONSIBILITIES. —The attending 346
516	516	physician shall do all of the following before prescribing 347
517	517	medication to a qualified patient under this chapter: 348
518	518	(a) Make the initial determination of whether a patient 349
519	519	has a terminal condition, has mental capacity, has voluntarily 350
520	520
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528	528	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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532	532	made the request for medication to end his or her life without 351
533	533	coercion or undue infl uence by another person, and is able to 352
534	534	self-administer the medication to be prescribed. 353
535	535	(b) Refer the patient to a consulting physician for 354
536	536	medical confirmation of the diagnosis, and for a determination 355
537	537	that the patient has mental capacity and is acting voluntarily. 356
538	538	(c) Ensure that the patient is making an informed decision 357
539	539	by fully informing the patient of the facts relevant to all of 358
540	540	the following: 359
541	541	1. The patient's medical diagnosis and prognosis. 360
542	542	2. The potential risks associated with self-administering 361
543	543	the medication to be prescribed. 362
544	544	3. The probable result of self -administering the 363
545	545	medication to be prescribed. 364
546	546	4. The feasible alternative, concurrent, and additional 365
547	547	treatment options available to the patient, including, but not 366
548	548	limited to, palliative care, hospice care, and pain control. 367
549	549	5. The option to obtain the medication to end his or her 368
550	550	life but subsequently decide not to take it. 369
551	551	(d) Verify the patient's Florida residency. 370
552	552	(e) Refer the patient to a mental health professional with 371
553	553	the appropriate training and expertise for counseling if the 372
554	554	patient has a history of, or if the physician believes the 373
555	555	patient may be suffering from, a mental health disorder or 374
556	556	intellectual disability that may cause impaired judgment. The 375
557	557
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565	565	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
566	566
567	567
568	568
569	569	attending physician may not prescribe medication under this 376
570	570	chapter until the mental health professional counseling the 377
571	571	patient determines that the patient is not suffering from a 378
572	572	mental health disorder or intel lectual disability causing 379
573	573	impaired judgment that impacts his or her ability to make 380
574	574	informed end-of-life decisions. 381
575	575	(f) Inform the qualified patient that he or she has an 382
576	576	opportunity to rescind the request at any time and in any 383
577	577	manner, and offer the qu alified patient an opportunity to 384
578	578	rescind the request after the qualified patient's second oral 385
579	579	request in accordance with s. 764.104. 386
580	580	(g) Inform the qualified patient that there is no 387
581	581	obligation to fill the prescription or to self -administer the 388
582	582	medication prescribed under this chapter, even if obtained. 389
583	583	(h) Immediately before writing a prescription for 390
584	584	medication under this chapter, verify again that the qualified 391
585	585	patient is making an informed decision. 392
586	586	(i) Counsel the patient about the importance o f having 393
587	587	another person present when the patient self -administers the 394
588	588	medication prescribed under this chapter and of not self -395
589	589	administering the medication in a public place. 396
590	590	(j) Comply with the medical record documentation 397
591	591	requirements of this section. 398
592	592	(k) Ensure that all required steps are carried out in 399
593	593	accordance with this chapter before writing a prescription for 400
594	594
595	595	HB 1231 2023
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597	597
598	598
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602	602	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
603	603
604	604
605	605
606	606	medication to enable a qualified patient to end his or her life 401
607	607	in a peaceful manner. 402
608	608	(l)1. Dispense medications directly, including an cillary 403
609	609	medications intended to minimize the patient's discomfort, 404
610	610	provided the attending physician is registered as a dispensing 405
611	611	practitioner under s. 465.0276, has a current Drug Enforcement 406
612	612	Administration number, and complies with applicable laws and 407
613	613	rules; or 408
614	614	2. With the patient's written consent: 409
615	615	a. Contact a pharmacist and inform the pharmacist of the 410
616	616	prescription; and 411
617	617	b. Deliver the written prescription personally, 412
618	618	electronically, or by mail to the pharmacist, who will dispense 413
619	619	the medications to either the patient, the attending physician, 414
620	620	the patient's legal representative, or an individual whom the 415
621	621	patient designates in writing. 416
622	622	(2) CONSULTING PHYSICIAN RESPONSIBILITIES. —A consulting 417
623	623	physician shall examine the patient and his or her releva nt 418
624	624	medical records to confirm, in writing, whether the consulting 419
625	625	physician agrees with the attending physician's diagnosis that 420
626	626	the patient is suffering from a terminal condition, and verify 421
627	627	whether the patient has mental capacity, is acting voluntarily, 422
628	628	and has made an informed decision. A consulting physician must 423
629	629	refer the patient to a mental health professional for counseling 424
630	630	if the physician believes the patient may be suffering from a 425
631	631
632	632	HB 1231 2023
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639	639	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
640	640
641	641
642	642
643	643	mental health disorder or intellectual disability that may cause 426
644	644	impaired judgment and the attending physician has not already 427
645	645	referred the patient for such counseling. 428
646	646	(3) CONFLICT OF INTEREST. —The attending physician, 429
647	647	consulting physician, and mental health professional and 430
648	648	interpreter, if any, may not be related to the qualified patient 431
649	649	by blood, marriage, registered domestic partnership, or adoption 432
650	650	or be entitled to any portion of the qualified patient's estate. 433
651	651	(4) RECORDKEEPING.—An attending physician is responsible 434
652	652	for ensuring that all of the following is doc umented or filed in 435
653	653	the patient's medical record: 436
654	654	(a) All oral requests by a patient for medication under 437
655	655	this chapter. 438
656	656	(b) All written requests by a patient for medication under 439
657	657	this chapter. 440
658	658	(c) The attending physician's diagnosis, prognosis, and 441
659	659	determination that the patient has mental capacity, is acting 442
660	660	voluntarily, has made an informed decision, and is able to self -443
661	661	administer the medication to be prescribed. 444
662	662	(d) The consulting physician's diagnosis, prognosis, and 445
663	663	verification that the patien t has mental capacity, is acting 446
664	664	voluntarily, has made an informed decision, and is able to self -447
665	665	administer the medication to be prescribed. 448
666	666	(e) A report of the outcome and determinations made during 449
667	667	counseling, if performed. 450
668	668
669	669	HB 1231 2023
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671	671
672	672
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676	676	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
677	677
678	678
679	679
680	680	(f) The attending physicia n's offer to the patient to 451
681	681	rescind his or her request at the time of the patient's second 452
682	682	oral request. 453
683	683	(g) A note by the attending physician indicating that all 454
684	684	requirements under this chapter have been met and indicating the 455
685	685	steps taken to carry out t he request, including a notation of 456
686	686	the medication prescribed. 457
687	687	(5) REPORTING.—A health care provider who prescribes or 458
688	688	dispenses medication under this chapter must submit a report to 459
689	689	the department for each qualified patient for or to whom he or 460
690	690	she prescribes or dispenses such medication, as applicable. The 461
691	691	department shall adopt rules to establish timeframes and forms 462
692	692	for submitting such reports. The reports must be limited to all 463
693	693	of the following information: 464
694	694	(a) The qualified patient's age at death, if applicable. 465
695	695	(b) The qualified patient's gender, race, and ethnicity. 466
696	696	(c) Whether the qualified patient was enrolled in hospice 467
697	697	care at the time of death. 468
698	698	(d) The qualified patient's underlying terminal condition. 469
699	699	(e) Whether the qualified patie nt self-administered the 470
700	700	medication prescribed to end his or her life and, if so, the 471
701	701	date on which the death occurred. 472
702	702	(6) ANNUAL REPORT.—By January 15 of each year, the 473
703	703	department shall publish on its website an aggregated report of 474
704	704	all of the information submitted to the department under 475
705	705
706	706	HB 1231 2023
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708	708
709	709
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713	713	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
714	714
715	715
716	716
717	717	subsection (5) for the preceding year, including, but not 476
718	718	limited to, the total number of qualified patients who received 477
719	719	a prescription for medication under this chapter and the total 478
720	720	number of health care providers w ho prescribed such medication. 479
721	721	The report may not include any personal identifying information 480
722	722	for the qualified patients. 481
723	723	Section 7. Section 764.106, Florida Statutes, is created 482
724	724	to read: 483
725	725	764.106 Disposal of medication. —A person who has custody 484
726	726	or control of any unused medication prescribed under this 485
727	727	chapter after the death of the qualified patient must personally 486
728	728	deliver the unused medication to the nearest facility qualified 487
729	729	to dispose of controlled substances or must dispose of the 488
730	730	unused medications by any lawful means in accordance with the 489
731	731	rules of the Board of Pharmacy or a United States Drug 490
732	732	Enforcement Administration approved drug take back program. 491
733	733	Section 8. Section 764.107, Florida Statutes, is created 492
734	734	to read: 493
735	735	764.107 Death certif icates.—If a qualified patient dies by 494
736	736	self-administration of medication as authorized under this 495
737	737	chapter, the qualified patient's death certificate must list the 496
738	738	underlying terminal condition as the cause of death and not the 497
739	739	prescribed medication. 498
740	740	Section 9. Section 764.108, Florida Statutes, is created 499
741	741	to read: 500
742	742
743	743	HB 1231 2023
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745	745
746	746
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750	750	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
751	751
752	752
753	753
754	754	764.108 Effect on construction of wills, contracts, and 501
755	755	statutes; insurance or annuity policies. — 502
756	756	(1) A provision in a contract, will, or other agreement, 503
757	757	whether written or oral, to the e xtent the provision would 504
758	758	affect whether a person may make or rescind a request for 505
759	759	medication under this chapter, is void and unenforceable. 506
760	760	(2) An obligation owed under any existing contract may not 507
761	761	be conditioned or affected by a person making or resc inding a 508
762	762	request for medication under this chapter. 509
763	763	(3) A health insurer may not deny or discriminate in its 510
764	764	provision of health benefits to a policyholder based on the 511
765	765	availability of the medication authorized under this chapter to 512
766	766	end his or her life, nor may a health insurer attempt to 513
767	767	influence a policyholder's decision to make or rescind a request 514
768	768	for such medication. 515
769	769	(4) The sale, procurement, or issuance of any life, 516
770	770	health, or accident insurance or annuity policy, or the rate 517
771	771	charged for any policy, may not be conditioned upon or affected 518
772	772	by a person making or rescinding a request for medication under 519
773	773	this chapter. A qualified patient's act of self -administering 520
774	774	medication prescribed under this chapter may not affect a life, 521
775	775	health, or accident i nsurance or annuity policy. 522
776	776	Section 10. Section 764.109, Florida Statutes, is created 523
777	777	to read: 524
778	778	764.109 Penalties; liabilities; immunities; grounds for 525
779	779
780	780	HB 1231 2023
781	781
782	782
783	783
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787	787	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
788	788
789	789
790	790
791	791	prohibiting health care provider participation; notification; 526
792	792	permissible sanctions. — 527
793	793	(1) A person who: 528
794	794	(a) Without authorization of the patient, willfully alters 529
795	795	or forges a request for medication under this chapter or 530
796	796	conceals or destroys a rescission of that request with the 531
797	797	intent or effect of causing the patient's death commits a felony 532
798	798	of the first degree, punishable as provided in s. 775.082, s. 533
799	799	775.083, or s. 775.084. 534
800	800	(b) Coerces or exerts undue influence on a patient to 535
801	801	request medication under this chapter for the purpose of ending 536
802	802	the patient's life or to destroy a rescission of a medica tion 537
803	803	request commits a felony of the first degree, punishable as 538
804	804	provided in s. 775.082, s. 775.083, or s. 775.084. 539
805	805	(2) This chapter does not limit further liability for 540
806	806	civil damages resulting from other negligent conduct or 541
807	807	intentional misconduct by any person. 542
808	808	(3) The penalties in this chapter do not preclude criminal 543
809	809	penalties applicable under other law for conduct that is 544
810	810	inconsistent with this chapter. 545
811	811	(4) Except as provided in subsections (1) and (5): 546
812	812	(a) A person is not subject to civil or criminal liability 547
813	813	or professional disciplinary action for complying in good faith 548
814	814	with this chapter. This includes being present when a qualified 549
815	815	patient self-administers the medication prescribed under this 550
816	816
817	817	HB 1231 2023
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819	819
820	820
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824	824	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
825	825
826	826
827	827
828	828	chapter. 551
829	829	(b) A health care facility, a profe ssional organization or 552
830	830	association, or a health insurer may not subject a person to 553
831	831	censure, discipline, suspension; loss or denial of license, 554
832	832	credentials, privileges, or membership; or any other penalty 555
833	833	solely for refusing to participate in this chapter or for 556
834	834	complying in good faith with this chapter. 557
835	835	(c) A request by a patient for, or provision by an 558
836	836	attending physician of, medication in good faith compliance with 559
837	837	this chapter does not constitute evidence of neglect for any 560
838	838	purpose of law or provide the sole basis for the appointment of 561
839	839	a guardian or conservator. 562
840	840	(d) A health care provider is not under any duty, whether 563
841	841	by contract, by statute, or by any other legal requirement, to 564
842	842	participate in the provision of medication prescribed under this 565
843	843	chapter to a qualified patient. If a health care provider is 566
844	844	unable or unwilling to carry out a patient's request under this 567
845	845	chapter, the health care provider must inform the patient and 568
846	846	refer him or her to a health care provider willing to assist the 569
847	847	patient in the request for medication to end his or her life as 570
848	848	authorized under this chapter. If the patient transfers his or 571
849	849	her care to a new health care provider, the prior health care 572
850	850	provider must transfer, upon request, a copy of the patient's 573
851	851	relevant medical records to the new health care provider within 574
852	852	48 hours. 575
853	853
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856	856
857	857
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861	861	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
862	862
863	863
864	864
865	865	(5)(a) As used in this subsection, the term: 576
866	866	1. "Notify" means to make a separate written statement 577
867	867	specifically informing employees, before their participation in 578
868	868	this chapter, of the emplo ying health care provider's or health 579
869	869	care facility's policy sanctioning participation in activities 580
870	870	covered by this chapter. 581
871	871	2. "Participation in this chapter" means performing the 582
872	872	duties of an attending physician, the function of a consulting 583
873	873	physician, or the function of counseling pursuant to s. 764.105. 584
874	874	The term does not include: 585
875	875	a. Making an initial determination that a patient has a 586
876	876	terminal disease and informing the patient of the medical 587
877	877	prognosis; 588
878	878	b. Providing information about the Florida E nd-of-Life 589
879	879	Options Act to a patient upon the request of the patient; 590
880	880	c. Providing a patient, upon the request of the patient, 591
881	881	with a referral to another physician; or 592
882	882	d. A patient contracting with his or her attending 593
883	883	physician or consulting physician to act outside of the course 594
884	884	and scope of the provider's capacity as an employee or 595
885	885	independent contractor of the sanctioning health care provider. 596
886	886	(b) Notwithstanding any other law, an employing health 597
887	887	care provider or health care facility may prohibit participation 598
888	888	in this chapter on the premises of facilities that it owns or 599
889	889	operates if it first notifies the health care providers 600
890	890
891	891	HB 1231 2023
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893	893
894	894
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898	898	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
899	899
900	900
901	901
902	902	practicing in its facilities of its policy. This paragraph does 601
903	903	not prevent a health care provider or health care facility from 602
904	904	otherwise providing health care services to a patient which do 603
905	905	not constitute participation in this chapter. 604
906	906	(c) A health care provider or heal th care facility that 605
907	907	prohibits participation in this chapter on the premises of its 606
908	908	facilities shall clearly articulate this policy in an easily 607
909	909	accessible and appropriate location on any website maintained by 608
910	910	the provider or facility and in any applicabl e materials given 609
911	911	to patients. 610
912	912	(d) An employing health care provider or health care 611
913	913	facility may not prohibit a health care provider from, or 612
914	914	sanction a health care provider for, participation in this 613
915	915	chapter if done off premises of facilities that the e mploying 614
916	916	health care provider or health care facility owns or operates or 615
917	917	when the health care provider is acting outside the normal 616
918	918	course and scope of his or her employment with the health care 617
919	919	provider or health care facility. 618
920	920	(e) Notwithstanding subs ection (4), if an employing health 619
921	921	care provider or health care facility has a policy prohibiting 620
922	922	health care providers from participation in this chapter on the 621
923	923	premises of facilities that it owns or operates and has notified 622
924	924	them of the policy, the prohi biting health care provider or 623
925	925	health care facility may subject such health care providers to 624
926	926	sanctions for participating in this chapter in violation of that 625
927	927
928	928	HB 1231 2023
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930	930
931	931
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935	935	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
936	936
937	937
938	938
939	939	policy. 626
940	940	(f) An employing health care provider or health care 627
941	941	facility that imposes sanctions un der paragraph (e) may not be 628
942	942	arbitrary or capricious in its sanctions and must follow all due 629
943	943	process and other procedures the sanctioning health care 630
944	944	provider may have which are related to the imposition of 631
945	945	sanctions on another health care provider. 632
946	946	(6) Sanctions imposed under subsection (5) may not be 633
947	947	considered the imposition of a sanction based on a violation of 634
948	948	standard of care, and participation in this chapter may not be 635
949	949	deemed unprofessional conduct for the purpose of disciplinary 636
950	950	action against a health care provider's license. 637
951	951	Section 11. Section 764.11, Florida Statutes, is created 638
952	952	to read: 639
953	953	764.11 Claims by governmental entity for costs incurred. —640
954	954	Any governmental entity that incurs costs resulting from a 641
955	955	person terminating his or her life pursuant to this chapter in a 642
956	956	public place shall have a claim against the estate of the person 643
957	957	to recover the costs and reasonable attorney fees related to 644
958	958	enforcing the claim. 645
959	959	Section 12. Section 764.111, Florida Statutes, is created 646
960	960	to read: 647
961	961	764.111 Construction; severability. — 648
962	962	(1) This chapter may not be construed to authorize a 649
963	963	physician or any other person to end a patient's life by lethal 650
964	964
965	965	HB 1231 2023
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967	967
968	968
969	969	CODING: Words stricken are deletions; words underlined are additions.
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972	972	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
973	973
974	974
975	975
976	976	injection, mercy killing, or active euthanasia. Actions taken in 651
977	977	accordance with this chapter do not const itute suicide, assisted 652
978	978	suicide, mercy killing, euthanasia, adult abuse, or homicide for 653
979	979	any purpose under the law. 654
980	980	(2) Any section of this chapter being held invalid as to 655
981	981	any person or circumstance does not affect the application of 656
982	982	any other section of this chapter which can be given full effect 657
983	983	without the invalid section or application, and, to this end, 658
984	984	the provisions of this chapter are severable. 659
985	985	Section 13. Section 782.08, Florida Statutes, is amended 660
986	986	to read: 661
987	987	782.08 Assisting self -murder.—Every person deliberately 662
988	988	assisting another in the commission of self -murder shall be 663
989	989	guilty of manslaughter, a felony of the second degree, 664
990	990	punishable as provided in s. 775.082, s. 775.083, or s. 775.084. 665
991	991	Actions authorized under the Florida End -of-Life Options Act, 666
992	992	chapter 764, do not constitute assisting another in the 667
993	993	commission of self-murder, and a person acting within the scope 668
994	994	of and in accordance with chapter 764 may not be prosecuted 669
995	995	under this section for such acts. 670
996	996	Section 14. This act shall take effect July 1, 2023. 671