Rhode Island 2023 Regular Session

Rhode Island House Bill H5210 Compare Versions

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

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5	5	2023 -- H 5210
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7	7	LC000208
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9	9	S T A T E O F R H O D E I S L A N D
10	10	IN GENERAL ASSEMBLY
11	11	JANUARY SESSION, A.D. 2023
12	12	____________
13	13
14	14	A N A C T
15	15	RELATING TO HEALTH AND SAFETY -- LILA MANFIELD SAPINSLEY
16	16	COMPASSIONATE CARE A CT
17	17	Introduced By: Representatives Ajello, Tanzi, Knight, Finkelman, Dawson, Craven,
18	18	McEntee, Donovan, Speakman, and Handy
19	19	Date Introduced: January 19, 2023
20	20	Referred To: House Judiciary
21	21
22	22
23	23	It is enacted by the General Assembly as follows:
24	24	SECTION 1. Title 23 of the General Laws entitled "HEALTH AND SAFETY" is hereby 1
25	25	amended by adding thereto the following chapter: 2
26	26	CHAPTER 4.15 3
27	27	LILA MANFIELD SAPINSLEY COMPASSIONATE CARE ACT 4
28	28	23-4.15-1. Short title. 5
29	29	This chapter shall be known and may be cited as the "Lila Manfield Sapinsley 6
30	30	Compassionate Care Act". 7
31	31	23-4.15-2. Definitions. 8
32	32	As used in this chapter: 9
33	33	(1) "Bona fide physician-patient relationship" means a treating or consulting relationship 10
34	34	in the course of which a physician has completed a full assessment of the patient's medical history 11
35	35	and current medical condition, including a personal physical examination. 12
36	36	(2) "Capable" means that a patient has the ability to make and communicate health care 13
37	37	decisions to a physician, including communication through persons familiar with the patient's 14
38	38	manner of communicating if those persons are available. 15
39	39	(3) "Healthcare facility" shall have the same meaning as in § 23-17-2. 16
40	40	(4) "Healthcare provider" means a person, partnership, corporation, facility, or institution, 17
41	41	licensed or certified or authorized by law to administer health care or dispense medication in the 18
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43	43
44	44	LC000208 - Page 2 of 8
45	45	ordinary course of business or practice of a profession. 1
46	46	(5) "Impaired judgment" means that a person does not sufficiently understand or appreciate 2
47	47	the relevant facts necessary to make an informed decision. 3
48	48	(6) "Interested person" means: 4
49	49	(i) The patient's physician; 5
50	50	(ii) A person who knows that they are a relative of the patient by blood, civil marriage, 6
51	51	civil union, or adoption; 7
52	52	(iii) A person who knows that they would be entitled, upon the patient's death, to any 8
53	53	portion of the estate or assets of the patient under any will or trust, by operation of law, or by 9
54	54	contract; or 10
55	55	(iv) An owner, operator, or employee of a healthcare facility, nursing home, or residential 11
56	56	care facility where the patient is receiving medical treatment or is a resident. 12
57	57	(7) "Palliative care" shall have the same definition as in § 23-89-3. 13
58	58	(8) "Patient" means a person who is eighteen (18) years of age or older, a resident of Rhode 14
59	59	Island, and under the care of a physician. 15
60	60	(9) "Physician" means an individual licensed to engage in the practice of medicine as 16
61	61	defined in § 5-37-1. 17
62	62	(10) "Terminal condition" means an incurable and irreversible disease which would, within 18
63	63	reasonable medical judgment, result in death within six (6) months or less. 19
64	64	23-4.15-3. Requirements for prescription and documentation - Immunity. 20
65	65	(a) A physician shall not be subject to any civil or criminal liability or professional 21
66	66	disciplinary action if the physician prescribes to a patient with a terminal condition medication to 22
67	67	be self-administered for the purpose of hastening the patient's death and the physician affirms by 23
68	68	documenting in the patient's medical record that all of the following occurred: 24
69	69	(1) The patient made an oral request to the physician in the physician's physical presence 25
70	70	to be prescribed medication to be self-administered for the purpose of hastening the patient's death. 26
71	71	(2) No fewer than fifteen (15) days after the first oral request, the patient made a second 27
72	72	oral request to the physician in the physician's physical presence to be prescribed medication to be 28
73	73	self-administered for the purpose of hastening the patient's death. 29
74	74	(3) At the time of the second oral request, the physician offered the patient an opportunity 30
75	75	to rescind the request. 31
76	76	(4) The patient made a written request to be prescribed medication to be self-administered 32
77	77	for the purpose of hastening the patient's death that was signed by the patient in the presence of two 33
78	78	(2) or more subscribing witnesses at least one of whom is not an interested person as defined in § 34
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81	81	LC000208 - Page 3 of 8
82	82	23-4.15-2, who were at least eighteen (18) years of age, and who subscribed and attested that the 1
83	83	patient appeared to understand the nature of the document and to be free from duress or undue 2
84	84	influence at the time the request was signed. 3
85	85	(5) The physician determined that the patient: 4
86	86	(i) Was suffering a terminal condition, based on the physician's physical examination of 5
87	87	the patient and the physician's review of the patient's relevant medical records; 6
88	88	(ii) Was capable; 7
89	89	(iii) Was making an informed decision; 8
90	90	(iv) Had made a voluntary request for medication to hasten their death; and 9
91	91	(v) Was a Rhode Island resident. 10
92	92	(6) The physician informed the patient in person, both verbally and in writing, of all the 11
93	93	following: 12
94	94	(i) The patient's medical diagnosis; 13
95	95	(ii) The patient's prognosis, including an acknowledgement that the physician's prediction 14
96	96	of the patient's life expectancy was an estimate based on the physician's best medical judgment and 15
97	97	was not a guarantee of the actual time remaining in the patient's life, and that the patient could live 16
98	98	longer than the time predicted; 17
99	99	(iii) The range of treatment options appropriate for the patient and the patient's diagnosis; 18
100	100	(iv) If the patient was not enrolled or participating in hospice care, all feasible end-of-life 19
101	101	services, including palliative care, comfort care, hospice care, and pain control; 20
102	102	(v) The range of possible results, including potential risks associated with taking the 21
103	103	medication to be prescribed; and 22
104	104	(vi) The probable result of taking the medication to be prescribed. 23
105	105	(7) The physician referred the patient to a second physician for medical confirmation of 24
106	106	the diagnosis, prognosis, and a determination that the patient was capable, was acting voluntarily, 25
107	107	and had made an informed decision. 26
108	108	(8) The physician either verified that the patient did not have impaired judgment or referred 27
109	109	the patient for an evaluation by a psychiatrist, psychologist, or clinical social worker, licensed in 28
110	110	Rhode Island, for confirmation that the patient was capable and did not have impaired judgment. 29
111	111	(9) If applicable, the physician consulted with the patient's primary care physician with the 30
112	112	patient's consent. 31
113	113	(10) The physician informed the patient that the patient may rescind the request at any time 32
114	114	and in any manner and offered the patient an opportunity to rescind after the patient's second oral 33
115	115	request. 34
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119	119	(11) The physician ensured that all required steps were carried out in accordance with this 1
120	120	section and confirmed, immediately prior to writing the prescription for medication, that the patient 2
121	121	was making an informed decision. 3
122	122	(12) The physician wrote the prescription no fewer than forty-eight (48) hours after the last 4
123	123	to occur of the following events: 5
124	124	(i) The patient's written request for medication to hasten their death; 6
125	125	(ii) The patient's second oral request; or 7
126	126	(iii) The physician's offering the patient an opportunity to rescind the request. 8
127	127	(13) The physician either: 9
128	128	(i) Dispensed the medication directly; provided, that at the time the physician dispensed 10
129	129	the medication, the physician was licensed to dispense medication in Rhode Island, had a current 11
130	130	Drug Enforcement Administration certificate, and complied with any applicable administrative 12
131	131	rules; or 13
132	132	(ii) With the patient's written consent: 14
133	133	(A) Contacted a pharmacist and informed the pharmacist of the prescription; and 15
134	134	(B) Delivered the written prescription personally or by mail or electronically to the 16
135	135	pharmacist, who dispensed the medication to the patient, the physician, or an expressly identified 17
136	136	agent of the patient. 18
137	137	(14) The physician recorded and filed the following in the patient's medical record: 19
138	138	(i) The date, time and detailed description of all oral requests of the patient for medication 20
139	139	to hasten their death; 21
140	140	(ii) All written requests by the patient for medication to hasten their death; 22
141	141	(iii) The physician's diagnosis, prognosis, and basis for the determination that the patient 23
142	142	was capable, was acting voluntarily, and had made an informed decision; 24
143	143	(iv) The second physician's diagnosis, prognosis, and verification that the patient was 25
144	144	capable, was acting voluntarily, and had made an informed decision; 26
145	145	(v) The physician's attestation that the patient was enrolled in hospice care at the time of 27
146	146	the patient's oral and written requests for medication to hasten their death or that the physician 28
147	147	informed the patient of all feasible end-of-life services; 29
148	148	(vi) The physician's verification that the patient either did not have impaired judgment or 30
149	149	that the physician referred the patient for an evaluation and the person conducting the evaluation 31
150	150	has determined that the patient did not have impaired judgment; 32
151	151	(vii) A report of the outcome and determinations made during any evaluation which the 33
152	152	patient may have received; 34
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156	156	(viii) The date, time, and detailed description of the physician's offer to the patient to 1
157	157	rescind the request for medication at the time of the patient's second oral request; and 2
158	158	(ix) A note by the physician indicating that all requirements under this section were 3
159	159	satisfied and describing all of the steps taken to carry out the request, including a notation of the 4
160	160	medication prescribed. 5
161	161	(15) After writing the prescription, the physician promptly filed a report with the 6
162	162	department of health documenting completion of all of the requirements under this section. 7
163	163	(b) This section shall not be construed to limit civil or criminal liability for gross 8
164	164	negligence, recklessness, or intentional misconduct. 9
165	165	23-4.15-4. No duty to aid. 10
166	166	A patient with a terminal condition who self-administers a lethal dose of medication shall 11
167	167	not be considered to be a person exposed to grave physical harm under § 11-56-1, and no person 12
168	168	shall be subject to civil or criminal liability solely for being present when a patient with a terminal 13
169	169	condition self-administers a lethal dose of medication pursuant to this chapter, or for not acting to 14
170	170	prevent the patient from self-administering a lethal dose of medication pursuant to this chapter, or 15
171	171	for not rendering aid to a patient who has self-administered medication pursuant to this chapter. 16
172	172	23-4.15-5. Limitations on actions. 17
173	173	(a) A physician, nurse, pharmacist, or other person shall not be under any duty, by law or 18
174	174	contract, to participate in the provision of a lethal dose of medication to a patient. 19
175	175	(b) A healthcare facility or healthcare provider shall not subject a physician, nurse, 20
176	176	pharmacist, or other person to discipline, suspension, loss of license, loss of privileges, or other 21
177	177	penalty for actions taken in good faith reliance on the provisions of this chapter or refusals to act 22
178	178	under this chapter. 23
179	179	(c) Except as otherwise provided in this chapter herein, nothing in this chapter shall be 24
180	180	construed to limit liability for civil damages resulting from negligent conduct or intentional 25
181	181	misconduct by any person. 26
182	182	23-4.15-6. Healthcare facility exception. 27
183	183	A healthcare facility may prohibit a physician from writing a prescription for a dose of 28
184	184	medication intended to be lethal for a patient who is a resident in its facility and intends to use the 29
185	185	medication on the facility's premises, provided the facility has notified the physician in writing of 30
186	186	its policy with regard to the said prescriptions. Notwithstanding the provisions of § 23-4.15-5(b), 31
187	187	any physician who violates a policy established by a healthcare facility under this section may be 32
188	188	subject to sanctions otherwise allowable under law or contract. 33
189	189	23-4.15-7. Insurance policies -- Prohibitions. 34
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192	192	LC000208 - Page 6 of 8
193	193	(a) A person and their beneficiaries shall not be denied benefits under any life insurance 1
194	194	policy, as defined in § 27-4-0.1, for actions taken in accordance with this chapter. 2
195	195	(b) The sale, procurement, or issue of any medical malpractice insurance policy or the rate 3
196	196	charged for the policy shall not be conditioned upon or affected by whether the physician is willing 4
197	197	or unwilling to participate in the provisions of this chapter. 5
198	198	23-4.15-8. No effect on palliative sedation. 6
199	199	This chapter shall not limit or otherwise affect the provision, administration, or receipt of 7
200	200	palliative sedation consistent with accepted medical standards. 8
201	201	23-4.15-9. Protection of patient choice at end-of-life. 9
202	202	A physician with a bona fide physician-patient relationship with a patient with a terminal 10
203	203	condition shall not be considered to have engaged in unprofessional conduct under § 5-37-5.1 if: 11
204	204	(1) The physician determines that the patient is capable and does not have impaired 12
205	205	judgment; 13
206	206	(2) The physician informs the patient of all feasible end-of-life services, including 14
207	207	palliative care, comfort care, hospice care, and pain control; 15
208	208	(3) The physician prescribes a dose of medication that may be lethal to the patient; 16
209	209	(4) The physician advises the patient of all foreseeable risks related to the prescription; and 17
210	210	(5) The patient makes an independent decision to self-administer a lethal dose of the 18
211	211	medication. 19
212	212	23-4.15-10. Immunity for physicians. 20
213	213	A physician shall be immune from any civil or criminal liability or professional disciplinary 21
214	214	action for actions performed in good faith compliance with the provisions of this chapter. 22
215	215	23-4.15-11. Safe disposal of unused medications. 23
216	216	The department of health shall adopt rules and regulations providing for the safe disposal 24
217	217	of unused medications prescribed under this chapter. 25
218	218	23-4.15-12. Statutory construction. 26
219	219	Nothing in this chapter shall be construed to authorize a physician or any other person to 27
220	220	end a patient's life by lethal injection, mercy killing, or active euthanasia. Action taken in 28
221	221	accordance with this chapter shall not be construed for any purpose to constitute suicide, assisted 29
222	222	suicide, mercy killing, or homicide under the law. This section shall not be construed to conflict 30
223	223	with section 1553 of the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, as 31
224	224	amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152. 32
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227	227	LC000208 - Page 7 of 8
228	228	SECTION 2. This act shall take effect upon passage. 1
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230	230	LC000208
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234	234	LC000208 - Page 8 of 8
235	235	EXPLANATION
236	236	BY THE LEGISLATIVE COUNCIL
237	237	OF
238	238	A N A C T
239	239	RELATING TO HEALTH AND SAFETY -- LILA MANFIELD SAPINSLEY
240	240	COMPASSIONATE CARE A CT
241	241	***
242	242	This act would establish the process to provide a legal mechanism whereby a terminally ill 1
243	243	patient may choose to end their life using medications prescribed by a physician. 2
244	244	This act would take effect upon passage. 3
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246	246	LC000208
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