Chief Sponsor: Rebecca Chavez-Houck

Senate Sponsor: ____________


8     General Description:
9          This bill amends the Utah Uniform Probate Code to enact the End of Life Options Act.
10     Highlighted Provisions:
11          This bill:
12          ▸     defines terms;
13          ▸     designates when an individual may make a request for medication;
14          ▸     establishes attending physician responsibilities;
15          ▸     requires a consulting physician confirmation;
16          ▸     provides for a counseling referral when needed;
17          ▸     requires an informed decision;
18          ▸     encourages family notification;
19          ▸     requires written and oral requests and ability to rescind the request at any time;
20          ▸     requires waiting periods;
21          ▸     includes:
22               •     documentation and reporting requirements; and
23               •     a requirement that the patient be a resident of the state;
24          ▸     establishes the effect of the decision to end an individual's life on wills, contracts,
25     and insurance or annuity contracts;
26          ▸     provides limited immunities and procedures for permissible sanctions;
27          ▸     prohibits euthanasia or mercy killing;

28          ▸     establishes criminal penalties for certain actions; and
29          ▸     provides a uniform form for patient consent.
30     Money Appropriated in this Bill:
31          None
32     Other Special Clauses:
33          This bill provides a special effective date.
34     Utah Code Sections Affected:
35     ENACTS:
36          75-2c-101, Utah Code Annotated 1953
37          75-2c-102, Utah Code Annotated 1953
38          75-2c-103, Utah Code Annotated 1953
39          75-2c-104, Utah Code Annotated 1953
40          75-2c-105, Utah Code Annotated 1953
41          75-2c-106, Utah Code Annotated 1953
42          75-2c-107, Utah Code Annotated 1953
43          75-2c-108, Utah Code Annotated 1953
44          75-2c-109, Utah Code Annotated 1953
45          75-2c-110, Utah Code Annotated 1953
46          75-2c-111, Utah Code Annotated 1953
47          75-2c-112, Utah Code Annotated 1953
48          75-2c-113, Utah Code Annotated 1953
49          75-2c-114, Utah Code Annotated 1953
50          75-2c-115, Utah Code Annotated 1953
51          75-2c-116, Utah Code Annotated 1953
52          75-2c-117, Utah Code Annotated 1953
53          75-2c-118, Utah Code Annotated 1953
54          75-2c-119, Utah Code Annotated 1953
55          75-2c-120, Utah Code Annotated 1953
56          75-2c-121, Utah Code Annotated 1953
57          75-2c-122, Utah Code Annotated 1953

59     Be it enacted by the Legislature of the state of Utah:
60          Section 1. Section 75-2c-101 is enacted to read:

62          75-2c-101. Title.
63          This chapter is known as the "End of Life Options Act."
64          Section 2. Section 75-2c-102 is enacted to read:
65          75-2c-102. Definitions.
66          As used in this chapter:
67          (1) "Adult" means an individual who is 18 years of age or older.
68          (2) "Attending physician" means the physician who has primary responsibility for the
69     care of the patient and treatment of the patient's terminal disease.
70          (3) "Capable" means that in the opinion of the patient's attending physician or
71     consulting physician, psychiatrist, or psychologist, a patient has the ability to make and
72     communicate health care decisions to health care providers, including communication through
73     individuals familiar with the patient's manner of communicating if those individuals are
74     available.
75          (4) "Consulting physician" means a physician who is qualified by specialty or
76     experience to make a professional diagnosis and prognosis regarding the patient's disease.
77          (5) "Counseling" means one or more consultations as necessary between a state
78     licensed psychiatrist or psychologist and a patient for the purpose of determining that the
79     patient is capable.
80          (6) "Health care provider" means a person licensed, certified, or otherwise authorized
81     or permitted by the law of this state to administer health care or dispense medication in the
82     ordinary course of business or practice of a profession and includes a health care facility.
83          (7) "Informed decision" means a decision by a qualified patient to request and obtain a
84     prescription to end the patient's life in a humane and dignified manner that is based on an
85     appreciation of the relevant facts and after being fully informed by the attending physician of:
86          (a) the patient's medical diagnosis;
87          (b) the patient's prognosis;
88          (c) the potential risks associated with taking the medication to be prescribed;
89          (d) the probable result of taking the medication to be prescribed; and

90          (e) the feasible alternatives, including palliative care, comfort care, hospice care,
91     disability resources available in the community, and pain control.
92          (8) "Medically confirmed" means the medical opinion of the attending physician has
93     been confirmed by a consulting physician who has examined the patient and the patient's
94     relevant medical records.
95          (9) "Patient" means an individual who is under the care of a physician.
96          (10) "Physician" means a doctor of medicine or osteopathy licensed to practice
97     medicine in the state.
98          (11) "Qualified patient" means a capable adult who is a resident of Utah and has
99     satisfied the requirements of this chapter to obtain a prescription for medication to end the
100     patient's life in a humane and dignified manner.
101          (12) "Self administer" means a qualified individual's affirmative, conscious act of using
102     the medication to bring about the individual's own peaceful and humane death.
103          (13) "Terminal disease" means an incurable and irreversible disease that has been
104     medically confirmed and will, within reasonable medical judgment, produce death within six
105     months.
106          Section 3. Section 75-2c-103 is enacted to read:
107          75-2c-103. Initiation of written request for medication.
108          (1) An individual may make a written request for medication for the purpose of ending
109     the individual's life in a humane and dignified manner in accordance with this chapter if the
110     individual:
111          (a) is an adult;
112          (b) is capable;
113          (c) is a resident of Utah;
114          (d) has been determined by the attending physician and consulting physician to be
115     suffering from a terminal disease; and
116          (e) has voluntarily expressed a wish to die.
117          (2) An individual may not qualify under the provisions of Subsection (1) solely
118     because of age or disability.
119          Section 4. Section 75-2c-104 is enacted to read:
120          75-2c-104. Form of the written request.

121          (1) A valid request for medication under this chapter shall be in substantially the form
122     described in Section 75-2c-122, signed and dated by the patient, and witnessed by at least two
123     individuals who, in the presence of the patient, attest that to the best of their knowledge and
124     belief the patient is capable, is acting voluntarily, and is not being coerced to sign the request.
125          (2) One of the witnesses shall be an individual who is not:
126          (a) a relative of the patient by blood, marriage, or adoption;
127          (b) an individual who at the time the request is signed would be entitled to any portion
128     of the estate of the qualified patient upon death under any will or by operation of law; or
129          (c) an owner, operator, or employee of a health care facility where the qualified patient
130     is receiving medical treatment or is a resident.
131          (3) The patient's attending physician at the time the request is signed shall not be a
132     witness.
133          Section 5. Section 75-2c-105 is enacted to read:
134          75-2c-105. Attending physician responsibilities.
135          (1) The attending physician shall:
136          (a) make the initial determination of whether a patient:
137          (i) has a terminal disease;
138          (ii) is capable; and
139          (iii) has made the request voluntarily;
140          (b) request that the patient attest to Utah residency pursuant to Section 75-2c-113;
141          (c) ensure that the patient is making an informed decision, by informing the patient of:
142          (i) the patient's medical diagnosis;
143          (ii) the patient's prognosis;
144          (iii) the potential risks associated with taking the medication to be prescribed;
145          (iv) the probable result of taking the medication to be prescribed; and
146          (v) the feasible alternatives, including palliative care, comfort care, hospice care,
147     disability resources available in the community, and pain control;
148          (d) refer the patient to a consulting physician for medical confirmation of the diagnosis
149     and for a determination that the patient is capable and acting voluntarily;
150          (e) refer the patient for counseling if appropriate pursuant to Section 75-2c-107;
151          (f) recommend that the patient notify next of kin;

152          (g) counsel the patient about the importance of having another individual present when
153     the patient takes the medication prescribed pursuant to this chapter and of not taking the
154     medication in a public place;
155          (h) inform the patient that the patient has an opportunity to rescind the request at any
156     time and in any manner, and offer the patient an opportunity to rescind at the end of the 15-day
157     waiting period required by Section 75-2c-111;
158          (i) verify, immediately prior to writing the prescription for medication under this
159     chapter, that the patient is making an informed decision;
160          (j) fulfill the medical record documentation requirements of Section 75-2c-112;
161          (k) ensure that all appropriate steps are carried out in accordance with this chapter prior
162     to writing a prescription for medication to enable a qualified patient to end the patient's life in a
163     humane and dignified manner;
164          (l) with the patient's consent:
165          (i) contact a pharmacist and inform the pharmacist of the prescription; and
166          (ii) deliver the written prescription personally or electronically to the pharmacist, who
167     will dispense the medications to either the patient, the attending physician, or an expressly
168     identified agent of the patient; and
169          (m) inform the Department of Health of the prescription written for the patient,
170     including the name of any drugs prescribed.
171          (2) Notwithstanding any other provision of law, the attending physician may sign the
172     patient's death certificate.
173          Section 6. Section 75-2c-106 is enacted to read:
174          75-2c-106. Consulting physician confirmation.
175          Before a patient is qualified under this chapter, a consulting physician shall examine the
176     patient and the patient's relevant medical records and confirm, in writing, the attending
177     physician's diagnosis that the patient is suffering from a terminal disease and verify that the
178     patient is capable, is acting voluntarily, and has made an informed decision.
179          Section 7. Section 75-2c-107 is enacted to read:
180          75-2c-107. Counseling referral.
181          If in the opinion of the attending physician or the consulting physician a patient may be
182     suffering from a psychiatric or psychological disorder or depression causing impaired

183     judgment, either physician shall refer the patient for counseling. No medication to end a
184     patient's life in a humane and dignified manner shall be prescribed until the person performing
185     the counseling determines that the patient is capable, is acting voluntarily, and has made an
186     informed decision.
187          Section 8. Section 75-2c-108 is enacted to read:
188          75-2c-108. Informed decision.
189          A patient shall not receive a prescription for medication to end the patient's life in a
190     humane and dignified manner unless the patient has made an informed decision as defined in
191     Section 75-2c-102. Immediately before writing a prescription for medication under this
192     chapter, the attending physician shall verify that the patient is making an informed decision.
193          Section 9. Section 75-2c-109 is enacted to read:
194          75-2c-109. Family notification.
195          The attending physician shall recommend that the patient notify the next of kin of the
196     patient's request for medication pursuant to this chapter. A patient who declines or is unable to
197     notify next of kin shall not have the patient's request denied for that reason.
198          Section 10. Section 75-2c-110 is enacted to read:
199          75-2c-110. Written and oral requests -- Opportunity to rescind.
200          (1) In order to receive a prescription for medication to end a patient's life in a humane
201     and dignified manner, a qualified patient shall:
202          (a) make an oral request for medication;
203          (b) make a written request for medication; and
204          (c) repeat the oral request to the patient's attending physician no less than 15 days after
205     making the initial oral request.
206          (2) At the time the qualified patient makes the second oral request, the attending
207     physician shall offer the patient an opportunity to rescind the request.
208          (3) A patient may rescind the patient's request at any time and in any manner without
209     regard to the patient's mental state. A prescription for medication under this chapter shall not
210     be written without the attending physician offering the qualified patient an opportunity to
211     rescind the request.
212          Section 11. Section 75-2c-111 is enacted to read:
213          75-2c-111. Waiting periods.

214          A physician shall not write a prescription under this chapter until:
215          (1) no less than 15 days have elapsed between the patient's initial oral request and the
216     writing of a prescription; and
217          (2) no less than 48 hours have elapsed between the patient's written request and the
218     writing of a prescription.
219          Section 12. Section 75-2c-112 is enacted to read:
220          75-2c-112. Medical record documentation requirements.
221          The following shall be documented or filed in the patient's medical record:
222          (1) all oral requests by the patient for medication to end the patient's life in a humane
223     and dignified manner;
224          (2) all written requests by the patient for medication to end the patient's life in a
225     humane and dignified manner;
226          (3) the attending physician's diagnosis, prognosis, and determination that the patient is
227     capable, is acting voluntarily, and has made an informed decision;
228          (4) the consulting physician's diagnosis, prognosis, and verification that the patient is
229     capable, is acting voluntarily, and has made an informed decision;
230          (5) a report of the outcome and determinations made during counseling, if performed;
231          (6) the attending physician's offer to the patient to rescind the patient's request at the
232     time of the patient's second oral request; and
233          (7) a note by the attending physician indicating that all requirements under this chapter
234     have been met and indicating the steps taken to carry out the request, including a notation of
235     the medication prescribed.
236          Section 13. Section 75-2c-113 is enacted to read:
237          75-2c-113. Residency requirement.
238          (1) An attending physician may rely on a patient's attestation of meeting the
239     requirements for being a resident of Utah if the attestation complies with Subsections (2) and
240     (3).
241          (2) A patient shall attest to the attending physician that the patient is a resident of the
242     state, and that the patient:
243          (a) possesses a Utah driver license or Utah identification card;
244          (b) is registered to vote in Utah;

245          (c) owns or leases property in Utah;
246          (d) filed a Utah tax return for the most recent tax year; or
247          (e) has some other indication of residency that is recognized by state law.
248          (3) A patient who relies on Subsection (2)(e) to attest to residency in Utah shall
249     specifically describe the factors that the patient is relying upon in the attestation to the
250     attending physician.
251          Section 14. Section 75-2c-114 is enacted to read:
252          75-2c-114. Reporting requirements.
253          (1) A health care provider who dispenses a medication pursuant to this chapter shall
254     file a copy of the dispensing record with the Department of Health in the manner required by
255     the department.
256          (2) (a) The Department of Health may review a sample of the medical records of
257     patients who receive a medication under this chapter.
258          (b) Except as otherwise required by law, the information collected under Subsections
259     (1) and (2)(a) shall not be a public record and may not be made available for inspection by the
260     public.
261          (3) The Department of Health shall:
262          (a) generate and make available to the public an annual statistical report of
263     de-identified information collected under this section;
264          (b) make rules under Title 63G, Chapter 3, Utah Administrative Rulemaking Act, to
265     facilitate the collection of information regarding compliance with this chapter; and
266          (c) provide an annual report to the Legislature's Health and Human Services Interim
267     Committee regarding the statistical report in Subsection (3)(a).
268          Section 15. Section 75-2c-115 is enacted to read:
269          75-2c-115. Effect on construction of wills, contracts, and statutes.
270          (1) No provision in a contract, will, or other agreement, whether written or oral, to the
271     extent the provision would affect whether an individual may make or rescind a request for
272     medication to end the individual's life in a humane and dignified manner, shall be valid.
273          (2) No obligation owing under any currently existing contract shall be conditioned or
274     affected by the making or rescinding of a request, by an individual, for medication to end the
275     individual's life in a humane and dignified manner.

276          Section 16. Section 75-2c-116 is enacted to read:
277          75-2c-116. Insurance or annuity policies.
278          A qualified patient's act of ingesting medication to end the patient's life in a humane
279     and dignified manner does not affect a life, health, or accident insurance or annuity policy.
280          Section 17. Section 75-2c-117 is enacted to read:
281          75-2c-117. Construction of chapter.
282          Nothing in this chapter shall be construed to authorize a physician or any other person
283     to end a patient's life by lethal injection, mercy killing, or active euthanasia. Actions taken in
284     accordance with this chapter shall not, for any purpose, constitute suicide, assisted suicide,
285     mercy killing, or homicide, under the law.
286          Section 18. Section 75-2c-118 is enacted to read:
287          75-2c-118. Immunities -- Basis for prohibiting health care provider from
288     participation -- Notification -- Permissible sanctions.
289          (1) Except as provided in Section 75-2c-119, the provisions of this section apply to this
290     chapter.
291          (2) A person shall not be subject to civil or criminal liability or professional
292     disciplinary action for participating in good faith compliance with this chapter, including being
293     present when a qualified patient takes the prescribed medication to end the qualified patient's
294     life in a humane and dignified manner.
295          (3) A professional organization or association, or health care provider, may not subject
296     a person to censure, discipline, suspension, loss of license, loss of privileges, loss of
297     membership, or other penalty for participating or refusing to participate in good faith
298     compliance with this chapter.
299          (4) A request by a patient for, or provision by an attending physician of, medication in
300     good faith compliance with the provisions of this chapter shall not constitute neglect for any
301     purpose of law or provide the sole basis for the appointment of a guardian or conservator.
302          (5) A health care provider shall not be under any duty, whether by contract, by statute,
303     or by any other legal requirement, to participate in the provision to a qualified patient of
304     medication to end the patient's life in a humane and dignified manner. If a health care provider
305     is unable or unwilling to carry out a patient's request under this chapter, and the patient
306     transfers the patient's care to a new health care provider, the prior health care provider shall

307     transfer, upon request, a copy of the patient's relevant medical records to the new health care
308     provider.
309          (6) (a) Notwithstanding any other provision of law, a health care provider may prohibit
310     another health care provider from participating in this chapter on the premises of the
311     prohibiting health care provider if the prohibiting health care provider notifies the health care
312     provider of the prohibiting provider's policy regarding participating in this chapter. Nothing in
313     this Subsection (6)(a) prevents a health care provider from providing health care services to a
314     patient that do not constitute participation in this chapter.
315          (b) Notwithstanding the provisions of Subsections (2) through (5), a health care
316     provider may subject another health care provider to the sanctions stated in this Subsection
317     (6)(b) if the sanctioning health care provider has notified the sanctioned provider before
318     participation in this chapter that the sanctioning health care provider prohibits participation in
319     this chapter. The sanctions may include:
320          (i) loss of privileges, loss of membership, or other sanction provided pursuant to the
321     medical staff bylaws, policies, and procedures of the sanctioning health care provider, if the
322     sanctioned provider is a member of the sanctioning provider's medical staff and participates in
323     this chapter while on the health care facility premises of the sanctioning health care provider,
324     but not including the private medical office of a physician or other provider;
325          (ii) termination of lease or other property contract or other nonmonetary remedies
326     provided by lease contract, not including loss or restriction of medical staff privileges or
327     exclusion from a provider panel, if the sanctioned provider participates in this chapter while on
328     the premises of the sanctioning health care provider or on property that is owned by or under
329     the direct control of the sanctioning health care provider; and
330          (iii) termination of contract or other nonmonetary remedies provided by contract if the
331     sanctioned provider participates in this chapter while acting in the course and scope of the
332     sanctioned provider's capacity as an employee or independent contractor of the sanctioning
333     health care provider.
334          (c) Nothing in Subsections (6)(a) and (b) shall be construed to prevent:
335          (i) a health care provider from participating in this chapter while acting outside the
336     course and scope of the provider's capacity as an employee or independent contractor of the
337     sanctioning health care provider; or

338          (ii) a patient from contracting with the patient's attending physician and consulting
339     physician to act outside the course and scope of the provider's capacity as an employee or
340     independent contractor of the sanctioning health care provider.
341          (7) A health care provider that imposes sanctions pursuant to Subsection (6)(b) shall
342     follow all due process and other procedures the sanctioning health care provider may have that
343     are related to the imposition of sanctions on another health care provider.
344          (8) For purposes of this section:
345          (a) "Notify" means a separate statement in writing to the health care provider
346     specifically informing the health care provider before the provider's participation in this chapter
347     of the sanctioning health care provider's policy about participation in activities covered by this
348     chapter.
349          (b) "Participate in this chapter":
350          (i) means to perform the duties of an attending physician pursuant to Section
351     75-2c-105, the consulting physician function pursuant to Section 75-2c-106, or the counseling
352     function pursuant to Section 75-2c-107; and
353          (ii) does not include:
354          (A) making an initial determination that a patient has a terminal disease and informing
355     the patient of the medical prognosis;
356          (B) providing information to a patient, upon the request of the patient, about the End of
357     Life Options Act;
358          (C) providing a patient, upon the request of the patient, with a referral to another
359     physician; or
360          (D) a patient contracting with the patient's attending physician and consulting physician
361     to act outside of the course and scope of the provider's capacity as an employee or independent
362     contractor of the sanctioning health care provider.
363          (9) Suspension or termination of staff membership or privileges under Subsection (6) is
364     not reportable under Title 58, Occupations and Professions. Action taken pursuant to Section
365     75-2c-118 shall not be the sole basis for a report of unprofessional conduct to a licensing board
366     under Title 58, Occupations and Professions.
367          (10) This chapter shall not be construed to allow a lower standard of care for patients
368     in the community where the patient is treated or a similar community.

369          Section 19. Section 75-2c-119 is enacted to read:
370          75-2c-119. Liabilities.
371          (1) A person who, without authorization of the patient, willfully alters or forges a
372     request for medication or conceals or destroys a rescission of that request with the intent or
373     effect of causing the patient's death shall be guilty of a first degree felony.
374          (2) A person who coerces or exerts undue influence on a patient to request medication
375     for the purpose of ending the patient's life, or to destroy a rescission of such a request, shall be
376     guilty of a first degree felony.
377          (3) Nothing in this chapter limits further liability for civil damages resulting from other
378     negligent conduct or intentional misconduct by any person.
379          (4) The penalties in this chapter do not preclude criminal penalties applicable under
380     other law for conduct that is inconsistent with the provisions of this chapter.
381          Section 20. Section 75-2c-120 is enacted to read:
382          75-2c-120. Claims by governmental entity for costs incurred.
383          A governmental entity that incurs costs resulting from an individual terminating the
384     individual's life pursuant to the provisions of this chapter in a public place shall have a claim
385     against the estate of the individual to recover the costs and reasonable attorney fees related to
386     enforcing the claim.
387          Section 21. Section 75-2c-121 is enacted to read:
388          75-2c-121. Severability.
389          Any section of this chapter that is held invalid as to any person or circumstance shall
390     not affect the application of any other section of this chapter that can be given full effect
391     without the invalid section or application.
392          Section 22. Section 75-2c-122 is enacted to read:
393          75-2c-122. Form of the request.
394          A request for a medication as authorized by this chapter shall be in substantially the
395     following form:_______________________________________________________________
399          I, ______________________, am an adult of sound mind.

400          I am suffering from _________, which my attending physician has determined is a
401     terminal disease and which has been medically confirmed by a consulting physician.
402          I have been fully informed of my diagnosis, prognosis, the nature of medication to be
403     prescribed, and potential associated risks, the expected result, and the feasible alternatives,
404     including palliative care, comfort care, hospice care, disability resources available in the
405     community, and pain control.
406          I request that my attending physician prescribe medication that will end my life in a
407     humane and dignified manner.
408          INITIAL ONE:
409          ______ I have informed my family of my decision and taken their opinions into
410          consideration.
411          ______ I have decided not to inform my family of my decision.
412          ______ I have no family to inform of my decision.
413          I understand that I have the right to rescind this request at any time.
414          I understand the full import of this request and I expect to die when I take the
415     medication to be prescribed. I further understand that although most deaths occur within three
416     hours, my death may take longer and my physician has counseled me about this possibility.
417          I make this request voluntarily and without reservation, and I accept full moral
418     responsibility for my actions.
419          Signed: _______________
420          Dated: _______________
422          We declare that the individual signing this request:
423          (a) is personally known to us or has provided proof of identity;
424          (b) signed this request in our presence;
425          (c) appears to be of sound mind and not under duress, fraud, or undue influence; and
426          (d) is not a patient for whom either of us is the attending physician.
427          ______________Witness 1/Date
428          ______________Witness 2/Date
429          NOTE: One witness shall not be a relative (by blood, marriage, or adoption) of the
430     person signing this request, shall not be entitled to any portion of the individual's estate upon

431     death, and shall not own, operate, or be employed at a health care facility where the individual
432     is a patient or resident. If the patient is an inpatient at a health care facility, one of the
433     witnesses shall be an individual designated by the facility.
434          Section 23. Effective date.
435          This bill takes effect on July 1, 2017.

Legislative Review Note
Office of Legislative Research and General Counsel