FIRSTREGULARSESSION
HOUSEBILLNO.453
103RDGENERALASSEMBLY
INTRODUCEDBYREPRESENTATIVEMACKEY.
0343H.01I DANARADEMANMILLER,ChiefClerk
ANACT
Toamendchapters191and565,RSMo,byaddingtheretotwenty-sevennewsectionsrelating
topatient-directedcareattheendoflife.
BeitenactedbytheGeneralAssemblyofthestateofMissouri,asfollows:
SectionA.Chapters191and565,RSMo,areamendedbyaddingtheretotwenty-
2sevennewsections,tobeknownassections191.2400,191.2405,191.2410,191.2415,
3191.2420,191.2425,191.2430,191.2435,191.2440,191.2445,191.2450,191.2455,
4191.2460,191.2465,191.2470,191.2475,191.2480,191.2485,191.2490,191.2495,
5191.2496,191.2500,191.2505,191.2510,191.2515,191.2520,and565.017,toreadas
6follows:
191.2400.Sections191.2400to191.2520shallbeknownandmaybecitedasthe
2"MarilynTeitelbaumDeathwithDignityAct".
191.2405.Asusedinsections191.2400to191.2520,unlessthecontextotherwise
2indicates,thefollowingtermsmean:
3 (1)"Adult",apersonwhoiseighteenyearsofageorolder;
4 (2)"Attendingphysician",thephysicianwhohasprimaryresponsibilityforthe
5careofapatientandthetreatmentofthatpatient'sterminaldisease;
6 (3)"Competent",intheopinionofacourtorintheopinionofthepatient's
7attendingphysicianorconsultingphysician,psychiatrist,orpsychologist,apatienthas
8theabilitytomakeandcommunicateaninformeddecisiontohealthcareproviders,
9includingcommunicationthroughpersonsfamiliarwiththepatient'smannerof
10communicatingifthosepersonsareavailable;
EXPLANATION—Matterenclosedinbold-facedbrackets[thus] intheabovebillisnotenactedandis
intendedtobeomittedfromthelaw.Matterinbold-facetypeintheabovebillisproposedlanguage. 11 (4)"Consultingphysician",aphysicianwhoisqualifiedbyspecialtyor
12experiencetomakeaprofessionaldiagnosisandprognosisregardingapatient'sdisease;
13 (5)"Counseling",oneormoreconsultationsbetweenastate-licensed
14psychiatrist,state-licensedpsychologist,state-licensedclinicalsocialworker,orstate-
15licensedclinicalprofessionalcounselorandapatientforthepurposeofdeterminingthat
16thepatientiscompetentandnotsufferingfromapsychiatricorpsychologicaldisorder
17ordepressionthatsoimpairsjudgmentastopreventthepatient'sinformeddecision;
18 (6)"Healthcareprovider",thesamemeaninggiventotheterminsection
19376.1350andincludesanypersonlicensed,certified,orotherwisepermittedbylawto
20dispensemedicationintheordinarycourseofbusinessorpracticeofaprofession;
21 (7)"Informeddecision",adecisionbyaqualifiedpatienttorequestandobtaina
22prescriptionformedicationthatthequalifiedpatientmayself-administertoendthe
23qualifiedpatient'slifeinahumaneanddignifiedmannerthatisbasedonan
24appreciationoftherelevantfactsandthatismadeafterbeingfullyinformedbythe
25attendingphysicianof:
26 (a)Thequalifiedpatient'smedicaldiagnosis;
27 (b)Thequalifiedpatient'sprognosis;
28 (c)Thepotentialrisksassociatedwithtakingthemedicationtobeprescribed;
29 (d)Theprobableresultoftakingthemedicationtobeprescribed;and
30 (e)Thefeasiblealternativestotakingthemedicationtobeprescribed,including
31palliativecareandcomfortcare,hospicecare,paincontrol,anddisease-directed
32treatmentoptions;
33 (8)"Medicallyconfirmed",themedicalopinionofanattendingphysicianhas
34beenconfirmedbyaconsultingphysicianwhohasexaminedthepatientandthe
35patient'srelevantmedicalrecords;
36 (9)"Patient",anadultwhoisunderthecareofaphysician;
37 (10)"Physician",adoctorofmedicineorosteopathylicensedtopractice
38medicineinthisstate;
39 (11)"Qualifiedpatient",acompetentadultwhoisaresidentofthisstateand
40whohassatisfiedtherequirementsofsections191.2400to191.2520inordertoobtaina
41prescriptionformedicationthatthequalifiedpatientmayself-administertoendthe
42qualifiedpatient'slifeinahumaneanddignifiedmanner;
43 (12)"Self-administer",foraqualifiedpatient,tovoluntarilyandconsciously
44performthephysicalactofingestingorotherwiseadministeringtohimselforherselfthe
45medicationtoendthequalifiedpatient'sownlife;
HB453 2 46 (13)"Terminaldisease",anincurableandirreversiblediseasethathasbeen
47medicallyconfirmedandwill,withinreasonablemedicaljudgment,producedeath
48withinsixmonths.
191.2410.Apatienthasarighttoinformationregardingalltreatmentoptions
2reasonablyavailableforthecareofthepatient,including,butnotlimitedto,
3informationinresponsetospecificquestionsabouttheforeseeablerisksandbenefitsof
4medication,withoutaphysicianwithholdingrequestedinformationregardlessofthe
5purposeofthequestionsorthenatureoftheinformation.
191.2415.Anadultwhoiscompetent,isaresidentofthisstate,hasbeen
2determinedbyanattendingphysicianandaconsultingphysiciantobesufferingfroma
3terminaldisease,andhasvoluntarilyexpressedthewishtodiemaymakeawritten
4requestformedicationthattheadultmayself-administerinaccordancewithsections
5191.2400to191.2520.Anadultdoesnotqualifyundersections191.2400to191.2520
6solelybecauseofageordisability.
191.2420.1.Avalidrequestformedicationundersections191.2400to191.2520
2shallbesubstantiallyintheformdescribedinsection191.2515,signedanddatedbythe
3patient,andwitnessedbyatleasttwoindividualswho,inthepresenceofthepatient,
4attestthattothebestoftheirknowledgeandbeliefthepatientiscompetent,isacting
5voluntarily,andisnotbeingcoercedtosigntherequest.
6 2.(1)Thelanguageofawrittenrequestformedicationundersections191.2400
7to191.2520shallbethelanguageinwhichanyconversationsorconsultationsor
8interpretedconversationsorconsultationsbetweenapatientandthepatient'sattending
9physicianorconsultingphysicianareheld.
10 (2)Notwithstandingsubdivision(1)ofthissubsection,thelanguageofawritten
11requestformedicationundersections191.2400to191.2520maybeEnglishwhenthe
12conversationsorconsultationsorinterpretedconversationsorconsultationsbetweena
13patientandthepatient'sattendingphysicianorconsultingphysicianwereconductedin
14alanguageotherthanEnglishiftheformdescribedinsection191.2515containsthe
15attachmentdescribedinsection191.2520.
16 3.Atleastoneofthetwoormorewitnessesrequiredunderthissectionandany
17interpreterrequiredunderthissectionshallbeapersonwhoisnot:
18 (1)Arelativeofthepatientbyblood,marriage,oradoption;
19 (2)Apersonwhoatthetimetherequestissignedwouldbeentitledtoany
20portionoftheestateofthequalifiedpatientupondeath,underanywill,trust,transfer
21ondeathelection,beneficiarydesignation,orotherwisebyoperationofanylaw;or
22 (3)Anowner,operator,oremployeeofahealthcarefacilitywherethequalified
23patientisreceivingmedicaltreatmentorisaresident.
HB453 3 24 4.Thepatient'sattendingphysicianatthetimethewrittenrequestissigned
25shallnotbeawitness.
26 5.Ifthepatientisapatientinalong-termcarefacilityatthetimethepatient
27makesthewrittenrequest,oneofthewitnessesshallbeanindividualdesignatedbythe
28facilitywhohasthequalificationsspecifiedbythedepartmentofhealthandsenior
29servicesbyrule.
191.2425.Theattendingphysicianshall:
2 (1)Maketheinitialdeterminationofwhetherapatienthasaterminaldisease,is
3competent,andhasmadethewrittenrequestundersection191.2415voluntarily;
4 (2)Requestthatthepatientdemonstratestateresidencyasrequiredbysection
5191.2470;
6 (3)Toensurethatthepatientismakinganinformeddecision,informthepatient
7of:
8 (a)Thepatient'smedicaldiagnosis;
9 (b)Thepatient'sprognosis;
10 (c)Thepotentialrisksassociatedwithtakingthemedicationtobeprescribed;
11 (d)Theprobableresultoftakingthemedicationtobeprescribed;and
12 (e)Thefeasiblealternativestotakingthemedicationtobeprescribed,including
13palliativecareandcomfortcare,hospicecare,paincontrol,anddisease-directed
14treatmentoptions;
15 (4)Referthepatienttoaconsultingphysicianformedicalconfirmationofthe
16diagnosisandforadeterminationthatthepatientiscompetentandactingvoluntarily;
17 (5)Confirmthatthepatient'srequestdoesnotarisefromcoercionorundue
18influencebyanotherindividualbydiscussingwiththepatient,outsidethepresenceof
19anyotherindividual,exceptforaninterpreter,whetherthepatientisfeelingcoercedor
20undulyinfluenced;
21 (6)Referthepatientforcounseling,ifappropriate,asdescribedinsection
22191.2435;
23 (7)Recommendthatthepatientnotifythepatient'snextofkin;
24 (8)Counselthepatientabouttheimportanceofhavinganotherpersonpresent
25whenthepatienttakesthemedicationprescribedundersections191.2400to191.2520
26andcounselthepatientaboutnottakingthemedicationprescribedundersections
27191.2400to191.2520inapublicplace;
28 (9)Informthepatientthatthepatienthasanopportunitytorescindtherequest
29atanytimeandinanymannerandofferthepatientanopportunitytorescindthe
30requestattheendofthefifteen-daywaitingperiodinaccordancewithsection191.2450;
HB453 4 31 (10)Verify,immediatelybeforewritingtheprescriptionformedicationunder
32sections191.2400to191.2520,thatthepatientismakinganinformeddecision;
33 (11)Fulfillthemedicalrecorddocumentationrequirementsofsection191.2465;
34 (12)Ensurethatallappropriatestepsarecarriedoutinaccordancewithsections
35191.2400to191.2520beforewritingaprescriptionformedicationtoenableaqualified
36patienttoendthequalifiedpatient'slifeinahumaneanddignifiedmanner;and
37 (13)Dispensemedicationsdirectly,includingancillarymedicationsintendedto
38minimizethepatient'sdiscomfort,iftheattendingphysicianisauthorizedunderstate
39laworruletodispensemedicationsandhasacurrentDrugEnforcement
40Administrationcertificateor,withthepatient'swrittenconsent:
41 (a)Contactapharmacistandinformthepharmacistoftheprescription;and
42 (b)Deliverthewrittenprescriptionpersonally,bymail,orelectronicallytothe
43pharmacist,whomaydispensethemedicationsinpersontothepatient,theattending
44physician,oranexpresslyidentifiedagentofthepatient.
191.2430.Beforeapatientisdeterminedtobeaqualifiedpatientundersections
2191.2400to191.2520,aconsultingphysicianshallexaminethepatientandthepatient's
3relevantmedicalrecordsandconfirm,inwriting,theattendingphysician'sdiagnosis
4thatthepatientissufferingfromaterminaldiseaseandverifythatthepatientis
5competent,isactingvoluntarily,andhasmadeaninformeddecision.
191.2435.If,intheopinionoftheattendingphysicianortheconsulting
2physician,apatientmaybesufferingfromapsychiatricorpsychologicaldisorderor
3depressioncausingimpairedjudgment,thephysicianshallreferthepatientfor
4counseling.Medicationforthepatienttoself-administertoendthepatient'sownlifein
5ahumaneanddignifiedmannershallnotbeprescribeduntilthepersonperformingthe
6counselingdeterminesthatthepatientisnotsufferingfromapsychiatricor
7psychologicaldisorderordepressionthatsoimpairsjudgmentastopreventthe
8patient'sinformeddecision.
191.2440.Aqualifiedpatientshallnotreceiveaprescriptionformedication
2undersections191.2400to191.2520unlessthequalifiedpatienthasmadeaninformed
3decision.Immediatelybeforewritingaprescriptionformedicationundersections
4191.2400to191.2520,theattendingphysicianshallverifythatthequalifiedpatientis
5makinganinformeddecision.
191.2445.Apatientwhodeclinesorisunabletonotifythepatient'snextofkin
2shallnothavethepatient'srequestformedicationdeniedforthatreason.
191.2450.Toreceiveaprescriptionformedicationthatthequalifiedpatientmay
2self-administerundersections191.2400to191.2520,aqualifiedpatientshallmakean
3oralrequestandawrittenrequestandreiteratetheoralrequesttothequalified
HB453 5 4patient'sattendingphysicianatleastfifteendaysaftermakingtheinitialoralrequest.
5Atthetimethequalifiedpatientmakesthequalifiedpatient'ssecondoralrequest,the
6attendingphysicianshallofferthequalifiedpatientanopportunitytorescindthe
7request.
191.2455.Apatientmayrescindthepatient'srequestatanytimeandinany
2mannerwithoutregardtothepatient'smentalstate.Aprescriptionformedicationshall
3notbewrittenundersections191.2400to191.2520withouttheattendingphysician
4offeringthequalifiedpatientanopportunitytorescindtherequest.
191.2460.Atleastfifteendaysarerequiredtoelapsebetweenthepatient'sinitial
2oralrequestandthedatethepatientsignsthewrittenrequestundersection191.2450.
3Atleastforty-eighthoursarerequiredtoelapsebetweenthedatethepatientsignsthe
4writtenrequestandthewritingofaprescriptionundersections191.2400to191.2520.
191.2465.Thefollowingshallbedocumentedorfiledinapatient'smedical
2record:
3 (1)Alloralrequestsbythepatientformedicationtoendthatpatient'slifeina
4humaneanddignifiedmanner;
5 (2)Allwrittenrequestsbythepatientformedicationtoendthatpatient'slifein
6ahumaneanddignifiedmanner;
7 (3)Theattendingphysician'sdiagnosisandprognosisandtheattending
8physician'sdeterminationthatthepatientiscompetent,isactingvoluntarily,andhas
9madeaninformeddecision;
10 (4)Theconsultingphysician'sdiagnosisandprognosisandtheconsulting
11physician'sverificationthatthepatientiscompetent,isactingvoluntarily,andhasmade
12aninformeddecision;
13 (5)Areportoftheoutcomeanddeterminationsmadeduringcounseling,if
14counselingisprovidedasdescribedinsection191.2435;
15 (6)Theattendingphysician'soffertothepatienttorescindthepatient'srequest
16atthetimeofthepatient'ssecondoralrequestundersection191.2450;and
17 (7)Anotebytheattendingphysicianindicatingthatallrequirementsunder
18sections191.2400to191.2520havebeenmet,includingtherequirementsofsection
19191.2425,andindicatingthestepstakentocarryoutthepatient'srequest,includinga
20notationofthemedicationprescribed.
191.2470.Forpurposesofsections191.2400to191.2520,onlyrequestsmadeby
2residentsofthisstateshallbegranted.Theresidenceofapersonisthatplacewherethe
3personhasestablishedafixedandprincipalhometowhichtheperson,whenever
4temporarilyabsent,intendstoreturn.Thefollowingfactorsmaybeofferedin
HB453 6 5determiningaperson'sresidenceundersections191.2400to191.2520andneednotall
6bepresentinordertodetermineaperson'sresidence:
7 (1)Possessionofavaliddriver'slicenseissuedbythedepartmentofrevenue;
8 (2)Registrationtovoteinthisstate;
9 (3)Evidencethatthepersonownsorleasespropertyinthisstate;
10 (4)Thelocationofanydwellingcurrentlyoccupiedbytheperson;
11 (5)Theplacewhereanymotorvehicleownedbythepersonisregistered;
12 (6)Theresidenceaddress,notapostofficebox,shownonacurrentincometax
13return;
14 (7)Theresidenceaddress,notapostofficebox,atwhichtheperson'smailis
15received;
16 (8)Theresidenceaddress,notapostofficebox,shownonanycurrentresident
17huntingorfishinglicensesheldbytheperson;
18 (9)Theresidenceaddress,notapostofficebox,shownonanydriver'slicense
19heldbytheperson;
20 (10)Thereceiptofanypublicbenefitconditioneduponresidency,defined
21substantiallyasprovidedinthissection;or
22 (11)Anyotherobjectivefactstendingtoindicateaperson'splaceofresidence.
191.2475.Apersonwhohascustodyoforcontroloveranyunusedmedications
2prescribedinaccordancewithsections191.2400to191.2520afterthedeathofthe
3qualifiedpatientshallpersonallydelivertheunusedmedicationstothenearestfacility
4qualifiedtodisposeofcontrolledsubstancesor,ifsuchdeliveryisimpracticable,
5personallydisposeoftheunusedmedicationsbyanylawfulmeans,inaccordancewith
6anyguidelinesadoptedbythedepartmentofhealthandseniorservices.
191.2480.1.Thedepartmentofhealthandseniorservicesshallannuallyreview
2allrecordsmaintainedundersections191.2400to191.2520.
3 2.(1)Thedepartmentofhealthandseniorservicesshallrequireanyhealthcare
4provideruponwritingaprescriptionordispensingmedicationundersections191.2400
5to191.2520tofileacopyoftheprescriptionordispensingrecord,andother
6documentationrequiredundersection191.2465associatedwithwritingtheprescription
7ordispensingthemedication,withthedepartment.
8 (2)Documentationrequiredtobefiledunderthissubsectionshallbemailedor
9otherwisetransmittedasallowedbyrulesofthedepartmentnolaterthanthirty
10calendardaysafterthewritingoftheprescriptionorthedispensingofmedicationunder
11sections191.2400to191.2520,exceptthatalldocumentsrequiredtobefiledwiththe
12departmentbytheprescribingphysicianafterthedeathofthequalifiedpatientshallbe
HB453 7 13submittednolaterthanthirtycalendardaysafterthedateofthedeathofthequalified
14patient.
15 (3)Intheeventthatapersonrequiredundersections191.2400to191.2520to
16reportinformationtothedepartmentprovidesaninadequateorincompletereport,the
17departmentshallcontactthepersontorequestanadequateorcompletereport.
18 3.Thedepartmentofhealthandseniorservicesshallpromulgaterulesto
19facilitatethecollectionofinformationregardingcompliancewithsections191.2400to
20191.2520.Exceptasotherwiseprovidedbylaw,theinformationcollectedisconfidential,
21isnotapublicrecord,andshallnotbemadeavailableforinspectionbythepublic.
22 4.Thedepartmentofhealthandseniorservicesshallgenerateandmake
23availabletothepublicanannualstatisticalreportofinformationcollectedunderthis
24sectionandsubmitacopyofthereporttothestandingcommitteesofthehouseof
25representativesandthesenatehavingjurisdictionoverhealthmattersannuallyby
26Marchfirst.
27 5.Inadditiontotherulesrequiredtobepromulgatedunderthissection,the
28departmentofhealthandseniorservicesshallpromulgateallnecessaryrulesforthe
29administrationofsections191.2400to191.2520.Anyruleorportionofarule,asthat
30termisdefinedinsection536.010,thatiscreatedundertheauthoritydelegatedinthis
31sectionshallbecomeeffectiveonlyifitcomplieswithandissubjecttoallofthe
32provisionsofchapter536and,ifapplicable,section536.028.Thissectionandchapter
33536arenonseverableandifanyofthepowersvestedwiththegeneralassembly
34pursuanttochapter536toreview,todelaytheeffectivedate,ortodisapproveandannul
35arulearesubsequentlyheldunconstitutional,thenthegrantofrulemakingauthority
36andanyruleproposedoradoptedafterAugust28,2025,shallbeinvalidandvoid.
191.2485.Anyprovisioninacontract,will,orotheragreement,whetherwritten
2ororal,totheextenttheprovisionwouldaffectwhetherapersonmaymakeorrescinda
3requestformedicationtoendtheperson'slifeinahumaneanddignifiedmanner,isnot
4valid.Anyobligationowingunderanycurrentlyexistingcontractshallnotbe
5conditioneduponoraffectedbythemakingorrescindingofarequestbyapersonfor
6medicationtoendtheperson'slifeinahumaneanddignifiedmanner.
191.2490.Thesale,procurement,orissuanceofanylife,health,oraccident
2insuranceorannuitypolicyortheratechargedforanylife,health,oraccident
3insuranceorannuitypolicyshallnotbeconditioneduponoraffectedbythemakingor
4rescindingofarequestbyaqualifiedpatientformedicationthatthepatientmayself-
5administertoendthepatient'slifeinaccordancewithsections191.2400to191.2520.A
6qualifiedpatientwhoselifeisinsuredunderalifeinsurancepolicyissuedbyinsurers
7organizedunderchapter376andthebeneficiariesofthepolicyshallnotbedenied
HB453 8 8benefitsonthebasisofself-administrationofmedicationbythequalifiedpatientin
9accordancewithsections191.2400to191.2520.Therating,sale,procurement,or
10issuanceofanymedicalprofessionalliabilityinsurancepolicydeliveredorissuedfor
11deliveryinthisstateshallbeinaccordancewiththeinsurancelawsofthisstate.
191.2495.Sections191.2400to191.2520donotauthorizeaphysicianorany
2otherpersontoendapatient'slifebylethalinjection,mercykilling,oractive
3euthanasia.Actionstakeninaccordancewithsections191.2400to191.2520donot,for
4anypurpose,constitutesuicide,assistedsuicide,mercykilling,orhomicideunderthe
5law.Statereportsshallnotrefertoactscommittedundersections191.2400to191.2520
6as"suicide"or"assistedsuicide".Consistentwiththeprovisionsofsections191.2400to
7191.2520,statereportsshallrefertoactscommittedundersections191.2400to191.2520
8asobtainingandself-administeringlife-endingmedication.Nothingcontainedin
9sections191.2400to191.2520shallbeinterpretedtolowertheapplicablestandardof
10carefortheattendingphysician,theconsultingphysician,apsychiatrist,apsychologist,
11orotherhealthcareproviderprovidingservicesundersections191.2400to191.2520.
191.2496.1.Asusedinthissection,theterm"coveredindividual"meansa
2healthcareprovider,physician,psychiatrist,psychologist,clinicalsocialworker,
3professionalcounselor,pharmacist,pharmacist'sassistant,patient,witness,orfamily
4memberorfriendofapatient.
5 2.Anycoveredindividualwhoispresentduring,hasknowledgeof,performs,or
6engagesinanyoftheactivitiesdescribedinsections191.2400to191.2520shallnot,on
7accountofsuchactivities,besubjecttoanycivilorcriminalliability,professional
8discipline,orotherpenaltyofanynaturesolongassuchcoveredindividualisactingin
9goodfaithandisnotguiltyofwillfulmisconductorgrossnegligence.
191.2500.Nothinginsections191.2400to191.2520requiresahealthcare
2providertoprovidemedicationtoaqualifiedpatienttoendthequalifiedpatient'slife.
3Ifahealthcareproviderisunableorunwillingtocarryoutthequalifiedpatient's
4requestundersections191.2400to191.2520,thehealthcareprovidershalltransferany
5relevantmedicalrecordsforthepatienttoanewhealthcareprovideruponrequestby
6thepatient.
191.2505.1.Asusedinthissection,unlessthecontextotherwiseindicates,the
2followingtermsmean:
3 (1)"Notice",aseparatestatementinwritingadvisingoftheprohibitinghealth
4careprovider'spolicywithrespecttoparticipatinginactivitiesundersections191.2400
5to191.2520;
HB453 9 6 (2)"Participating,orenteringintoanagreementtoparticipate,inactivities
7undersections191.2400to191.2520",doingorenteringintoanagreementtodoanyone
8ormoreofthefollowing:
9 (a)Performingthedutiesofanattendingphysicianasspecifiedinsections
10191.2400to191.2520;
11 (b)Performingthedutiesofaconsultingphysicianasspecifiedinsections
12191.2400to191.2520;
13 (c)Performingthedutiesofastate-licensedpsychiatrist,state-licensed
14psychologist,state-licensedclinicalsocialworker,orstate-licensedclinicalprofessional
15counselor,inthecircumstancethatareferraltooneismadeundersection191.2435;
16 (d)Deliveringtheprescriptionfor,dispensing,ordeliveringthedispensed
17medicationinaccordancewithsections191.2400to191.2520;or
18 (e)Beingpresentwhenthequalifiedpatienttakesthemedicationprescribedin
19accordancewithsections191.2400to191.2520.
20
21"Participating,orenteringintoanagreementtoparticipate,inactivitiesundersections
22191.2400to191.2520"doesnotincludedoing,orenteringintoanagreementtodo,any
23ofthefollowing:diagnosingwhetherapatienthasaterminaldisease;informingthe
24patientofthemedicalprognosisordeterminingwhetherapatienthasthecapacityto
25makedecisions;providinginformationtoapatientaboutsections191.2400to191.2520;
26orprovidingapatient,uponthepatient'srequest,withareferraltoanotherhealthcare
27providerforthepurposesofparticipatingintheactivitiesauthorizedbysections
28191.2400to191.2520.
29 2.Theprovisionsofthissectiongovernthebasisforprohibitingpersonsor
30entitiesfromparticipatinginactivitiesundersections191.2400to191.2520,notification,
31penalties,andpermissibleactions.
32 3.Subjecttocompliancewithsubsection4ofthissectionandnotwithstanding
33anyotherlaw,ahealthcareprovidermayprohibititsemployees,independent
34contractors,orotherpersonsorentities,includingotherhealthcareproviders,from
35participatinginactivitiesundersections191.2400to191.2520whileonpremisesowned
36orunderthemanagementordirectcontrolofthatprohibitinghealthcareprovideror
37whileactingwithinthecourseandscopeofanyemploymentby,orcontractwith,the
38prohibitinghealthcareprovider.
39 4.Ahealthcareproviderthatelectstoprohibititsemployees,independent
40contractors,orotherpersonsorentities,includingotherhealthcareproviders,from
41participatinginactivitiesundersections191.2400to191.2520,asdescribedinsubsection
423ofthissection,shallfirstgivenoticeofthepolicyprohibitingparticipationunder
HB453 10 43sections191.2400to191.2520tothoseemployees,independentcontractors,orother
44personsorentities,includingotherhealthcareproviders.Ahealthcareproviderthat
45failstoprovidenoticetothoseemployees,independentcontractors,orotherpersonsor
46entities,includingotherhealthcareproviders,incompliancewiththissubsectionshall
47notenforcesuchapolicyagainstthoseemployees,independentcontractors,orother
48personsorentities,includingotherhealthcareproviders.
49 5.Subjecttocompliancewithsubsection4ofthissection,theprohibitinghealth
50careprovidermaytakeaction,including,butnotlimitedto,thefollowing,asapplicable,
51againstanemployee,independentcontractor,orotherpersonorentity,including
52anotherhealthcareprovider,thatviolatesthehealthcareprovider'spolicyprohibiting
53participationinactivitiesundersections191.2400to191.2520:
54 (1)Lossofprivileges,lossofmembership,orotheractionauthorizedbythe
55bylawsorrulesandregulationsofthemedicalstaff;
56 (2)Suspension,lossofemployment,orotheractionauthorizedbythepolicies
57andpracticesoftheprohibitinghealthcareprovider;
58 (3)Terminationofanyleaseorothercontractbetweentheprohibitinghealth
59careproviderandtheemployee,independentcontractor,orotherpersonorentity,
60includinganotherhealthcareprovider,thatviolatesthepolicy;or
61 (4)Impositionofanyothernonmonetaryremedyprovidedforinanyleaseor
62contractbetweentheprohibitinghealthcareproviderandtheemployee,independent
63contractor,orotherpersonorentity,includinganotherhealthcareprovider,inviolation
64ofthepolicy.
65 6.Nothinginthissectionshallbeconstruedtoprevent,ortoallowaprohibiting
66healthcareprovidertoprohibit,anemployee,independentcontractor,orotherperson
67orentity,includinganotherhealthcareprovider,fromanyofthefollowing:
68 (1)Participating,orenteringintoanagreementtoparticipate,inactivitiesunder
69sections191.2400to191.2520whileonpremisesthatarenotownedorunderthe
70managementordirectcontroloftheprohibitinghealthcareproviderorwhileacting
71outsidethecourseandscopeoftheparticipant'sdutiesasanemployeeof,oran
72independentcontractorfor,theprohibitinghealthcareprovider;or
73 (2)Participating,orenteringintoanagreementtoparticipate,inactivitiesunder
74sections191.2400to191.2520asanattendingphysicianorconsultingphysicianwhileon
75premisesthatarenotownedorunderthemanagementordirectcontrolofthe
76prohibitinghealthcareprovider.
77 7.Intakingactionsundersubsection5ofthissection,ahealthcareprovider
78shallcomplywithallproceduresrequiredbylaw,itsownpoliciesorprocedures,and
HB453 11 79anycontractwiththeemployee,independentcontractor,orotherpersonorentity,
80includinganotherhealthcareprovider,inviolationofthepolicy,asapplicable.
81 8.Anyactiontakenbyaprohibitinghealthcareproviderunderthissectionis
82notreportabletotheappropriatelicensingboardincluding,butnotlimitedto,thestate
83boardofregistrationforthehealingartsandthestateboardofpharmacy.Thefactthat
84ahealthcareproviderparticipatesinactivitiesundersections191.2400to191.2520shall
85notbethesolebasisforacomplaintorreportbyanotherhealthcareprovidertothe
86appropriatelicensingboardincluding,butnotlimitedto,thestateboardofregistration
87forthehealingartsandthestateboardofpharmacy.
191.2510.Anygovernmentalentitythatincurscostsresultingfromaperson
2endingtheperson'slifeundersections191.2400to191.2520inapublicplacehasaclaim
3againsttheestateofthepersontorecoverthecostsandreasonableattorney'sfees
4relatedtoenforcingtheclaim.
191.2515.Arequestformedicationasauthorizedbysections191.2400to
2191.2520shallbeinsubstantiallythefollowingform:
3 REQUESTFORMEDICATIONTOENDMYLIFEINA
4 HUMANEANDDIGNIFIEDMANNER
5 I,______,amanadultofsoundmind.Iamsufferingfrom_____
6 _,whichmyattendingphysicianhasdeterminedisaterminal
7 diseaseandwhichhasbeenmedicallyconfirmedbyaconsulting
8 physician.
9 Ihavebeenfullyinformedofmydiagnosisandprognosis,the
10 natureofmedicationtobeprescribedandpotentialassociated
11 risks,theexpectedresult,andfeasiblealternatives,including
12 palliativecareandcomfortcare,hospicecare,paincontrol,and
13 disease-directedtreatmentoptions.
14 IrequestthatmyattendingphysicianprescribemedicationthatI
15 mayself-administertoendmylifeinahumaneanddignified
16 mannerandcontactanypharmacisttofilltheprescription.
17 INITIALONE:
18 ______Ihaveinformedmyfamilyofmydecisionandtakentheir
19 opinionsintoconsideration.
20 ______Ihavedecidednottoinformmyfamilyofmydecision.
HB453 12 21 ______Ihavenofamilytoinformofmydecision.
22 IunderstandthatIhavetherighttorescindthisrequestatany
23 time.
24 Iunderstandthefullimportofthisrequest,andIexpecttodie
25 whenItakethemedicationtobeprescribed.Ifurther
26 understandthat,althoughmostdeathsoccurwithinthreehours,
27 mydeathmaytakelonger,andmyphysicianhascounseledme
28 aboutthispossibility.
29 Imakethisrequestvoluntarilyandwithoutreservation,andI
30 acceptfullmoralresponsibilityformyactions.
31 Signed:__________________
32 Dated:__________________
33 DECLARATIONOFWITNESSES
34 Byinitialingandsigningbelowonorafterthedatetheperson
35 namedabovesigns,wedeclarethatthepersonmakingand
36 signingtheaboverequest:
37 InitialsofWitness1:
38 ______1.Ispersonallyknowntousorhasprovidedproofof
39 identity;
40 ______2.Signedthisrequestinourpresenceonthedateofthe
41 person'ssignature;
42 ______3.Appearstobeofsoundmindandnotunderduress,
43 fraud,orundueinfluence;and
44 ______4.Isnotapatientforwhomeitherofusistheattending
45 physician.
46 PrintedNameofWitness1:__________________
47 SignatureofWitness1/Date:__________________
HB453 13 48 InitialsofWitness2:
49 ______1.Ispersonallyknowntousorhasprovidedproofof
50 identity;
51 ______2.Signedthisrequestinourpresenceonthedateofthe
52 person'ssignature;
53 ______3.Appearstobeofsoundmindandnotunderduress,
54 fraud,orundueinfluence;and
55 ______4.Isnotapatientforwhomeitherofusistheattending
56 physician.
57 PrintedNameofWitness2:__________________
58 SignatureofWitness2/Date:__________________
59 NOTE:Onewitnessmustbeapersonwhoisnotarelativeby
60 blood,marriage,oradoptionofthepersonsigningthisrequest,is
61 notentitledtoanyportionoftheperson'sestateupondeath,and
62 doesnotownoroperateorisnotemployedatahealthcare
63 facilitywherethepersonisapatientorresident.Theperson's
64 attendingphysicianatthetimetherequestissignedmaynotbea
65 witness.Ifthepersonisaninpatientatalong-termcarefacility,
66 oneofthewitnessesmustbeanindividualdesignatedbythe
67 facility.
191.2520.Theformofanattachmentforpurposesofprovidinginterpretive
2servicesasdescribedinsubsection2ofsection191.2420shallbeinsubstantiallythe
3followingform:
4 I,______,amfluentinEnglishand(languageofpatient).
5 On(date)atapproximately(time)Ireadthe"REQUESTFOR
6 MEDICATIONTOENDMYLIFEINAHUMANEAND
7 DIGNIFIEDMANNER"to(nameofpatient)in(languageof
8 patient).
9 Mr./Ms.(nameofpatient)affirmedtomethathe/sheunderstands
10 thecontentofthisform,thathe/shedesirestosignthisform
HB453 14 11 underhis/herownpowerandvolitionandthathe/sherequested
12 tosigntheformafterconsultationswithanattendingphysician
13 andaconsultingphysician.
14 Underpenaltyofperjury,IdeclarethatIamfluentinEnglish
15 and(languageofpatient)andthatthecontentsofthisform,tothe
16 bestofmyknowledge,aretrueandcorrect.
17 Executedat(nameofcity,county,andstate)on(date).
18 Interpreter'ssignature:__________________
19 Interpreter'sprintedname:__________________
20 Interpreter'saddress:__________________
565.017.Itshallbeanaffirmativedefensetoprosecutionsundersections
2565.020,565.021,and565.023thattheperson'sconductwasexpresslyauthorizedby
3sections191.2400to191.2520.
âś”
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