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7 LONG TITLE
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 ▸ establishes a procedure for an individual with a terminal disease to obtain a
14 prescription to end the individual's life;
15 ▸ designates when an individual may make a request for aid-in-dying medication;
16 ▸ establishes attending physician responsibilities;
17 ▸ requires a consulting physician confirmation;
18 ▸ provides for a counseling referral when needed;
19 ▸ requires an informed decision;
20 ▸ encourages family notification;
21 ▸ requires written and oral requests and the ability to rescind the request at any time;
22 ▸ requires waiting periods;
23 ▸ includes:
24 • documentation and reporting requirements; and
25 • a requirement that the patient be a resident of the state;
26 ▸ establishes the effect of the decision to utilize medical aid-in-dying on an
27 individual's wills, contracts, and insurance or annuity contracts;
28 ▸ provides limited immunities and procedures for permissible sanctions;
29 ▸ prohibits euthanasia or mercy killing;
30 ▸ establishes criminal penalties for certain actions; and
31 ▸ provides a uniform form for a patient's written request.
32 Money Appropriated in this Bill:
33 None
34 Other Special Clauses:
35 This bill provides a special effective date.
36 Utah Code Sections Affected:
37 ENACTS:
38 75-2c-101, Utah Code Annotated 1953
39 75-2c-102, Utah Code Annotated 1953
40 75-2c-103, Utah Code Annotated 1953
41 75-2c-104, Utah Code Annotated 1953
42 75-2c-105, Utah Code Annotated 1953
43 75-2c-106, Utah Code Annotated 1953
44 75-2c-107, Utah Code Annotated 1953
45 75-2c-108, Utah Code Annotated 1953
46 75-2c-109, Utah Code Annotated 1953
47 75-2c-110, Utah Code Annotated 1953
48 75-2c-111, Utah Code Annotated 1953
49 75-2c-112, Utah Code Annotated 1953
50 75-2c-113, Utah Code Annotated 1953
51 75-2c-114, Utah Code Annotated 1953
52 75-2c-115, Utah Code Annotated 1953
53 75-2c-116, Utah Code Annotated 1953
54 75-2c-117, Utah Code Annotated 1953
55 75-2c-118, Utah Code Annotated 1953
56 75-2c-119, Utah Code Annotated 1953
57 75-2c-120, Utah Code Annotated 1953
58 75-2c-121, Utah Code Annotated 1953
59 75-2c-122, Utah Code Annotated 1953
60 75-2c-123, Utah Code Annotated 1953
61 75-2c-124, Utah Code Annotated 1953
62 75-2c-125, Utah Code Annotated 1953
63
64 Be it enacted by the Legislature of the state of Utah:
65 Section 1. Section 75-2c-101 is enacted to read:
66
67 75-2c-101. Title.
68 This chapter is known as the "End of Life Options Act."
69 Section 2. Section 75-2c-102 is enacted to read:
70 75-2c-102. Definitions.
71 As used in this chapter:
72 (1) "Adult" means an individual who is 18 years of age or older.
73 (2) "Attending physician" means the physician who has primary responsibility for the
74 care of the patient and treatment of the patient's terminal disease.
75 (3) "Capable" means that in the opinion of the patient's attending physician, consulting
76 physician, and licensed mental health professional, if any, the patient has the ability to make
77 and communicate health care decisions to health care providers, including communication
78 through individuals familiar with the patient's manner of communicating if those individuals
79 are available.
80 (4) "Consulting physician" means a physician who is qualified by specialty or
81 experience to make a professional diagnosis and prognosis regarding the patient's disease.
82 (5) "Counseling" means one or more consultations as necessary between a licensed
83 mental health professional and a patient for the purpose of determining whether the patient is
84 capable.
85 (6) "Health care provider" means a person licensed, certified, or otherwise authorized
86 or permitted by the law of this state to administer health care or dispense medication in the
87 ordinary course of business or practice of a profession.
88 (7) "Informed decision" means a decision that is made by a patient to request and
89 obtain a medical aid-in-dying prescription to end the patient's life in a humane and dignified
90 manner and that is based on an appreciation of the relevant facts, after being fully informed by
91 the attending physician of:
92 (a) the patient's medical diagnosis;
93 (b) the patient's prognosis;
94 (c) the potential risks associated with taking the medication to be prescribed;
95 (d) the probable result of taking the medication to be prescribed; and
96 (e) the feasible alternatives, including concurrent or additional treatment alternatives,
97 palliative care, comfort care, hospice care, disability resources available in the community, and
98 pain control.
99 (8) "Medically confirmed" means the medical opinion of the attending physician has
100 been confirmed by a consulting physician who has examined the patient and the patient's
101 relevant medical records.
102 (9) "Patient" means an individual who is under the care of a physician.
103 (10) "Physician" means a doctor of medicine or osteopathy licensed to practice
104 medicine in the state.
105 (11) "Qualified patient" means a capable adult who has satisfied the requirements of
106 this chapter to obtain a prescription for medication to end the patient's life in a humane and
107 dignified manner.
108 (12) "Self-administer" means a qualified individual's affirmative, conscious act of
109 using the medication to bring about the individual's own peaceful and humane death.
110 (13) "Terminal disease" means an incurable and irreversible disease that has been
111 medically confirmed and will, within reasonable medical judgment, produce death within six
112 months.
113 Section 3. Section 75-2c-103 is enacted to read:
114 75-2c-103. Written and oral requests -- Opportunity to rescind.
115 (1) In order to receive a prescription for medication to end a patient's life in a humane
116 and dignified manner, a qualified patient shall:
117 (a) make an oral request for medication;
118 (b) make a written request for medication; and
119 (c) repeat the oral request to the patient's attending physician no less than 15 days after
120 making the initial oral request.
121 (2) At the time the patient makes the second oral request, the attending physician shall
122 offer the patient an opportunity to rescind the request.
123 (3) A patient may rescind the patient's request at any time and in any manner without
124 regard to the patient's mental state. An individual may not write a prescription for medication
125 under this chapter without the attending physician offering the patient an opportunity to rescind
126 the request.
127 Section 4. Section 75-2c-104 is enacted to read:
128 75-2c-104. Initiation of written request for medication.
129 (1) An individual may make a written request for medication for the purpose of ending
130 the individual's life in a humane and dignified manner in accordance with this chapter if the
131 individual:
132 (a) is an adult;
133 (b) is capable;
134 (c) is a resident of Utah;
135 (d) is suffering from a terminal disease; and
136 (e) has voluntarily expressed a wish to receive aid-in-dying medication.
137 (2) An individual may not qualify under the provisions of Subsection (1) solely
138 because of age or disability.
139 (3) A request for a medical aid-in-dying prescription shall be made by the terminally ill
140 individual and may not be made by any other means, including the terminally ill individual's
141 qualified power of attorney, durable medical power of attorney, or advanced health care
142 directive.
143 Section 5. Section 75-2c-105 is enacted to read:
144 75-2c-105. Form of the written request.
145 (1) A valid request for medication under this chapter shall be in substantially the form
146 described in Section 75-2c-122, signed and dated by the patient, and witnessed by at least two
147 individuals who, in the presence of the patient, attest that to the best of their knowledge and
148 belief the patient is capable, is acting voluntarily, and is not being coerced to sign the request.
149 (2) One of the witnesses shall be an individual who is not:
150 (a) a relative of the patient by blood, marriage, or adoption;
151 (b) an individual who at the time the request is signed would be entitled to any portion
152 of the estate of the qualified patient upon death under any will or by operation of law; or
153 (c) an owner, operator, or employee of a health care facility where the qualified patient
154 is receiving medical treatment or is a resident.
155 (3) The patient's attending physician at the time the request is signed may not be a
156 witness.
157 Section 6. Section 75-2c-106 is enacted to read:
158 75-2c-106. Attending physician responsibilities.
159 (1) The attending physician shall:
160 (a) make the initial determination of whether a patient:
161 (i) has a terminal disease;
162 (ii) is capable; and
163 (iii) has made the request voluntarily;
164 (b) request that the patient attest to Utah residency pursuant to Section 75-2c-113;
165 (c) ensure that the patient is making an informed decision, by informing the patient of:
166 (i) the patient's medical diagnosis;
167 (ii) the patient's prognosis;
168 (iii) the potential risks associated with taking the medication to be prescribed;
169 (iv) the probable result of taking the medication to be prescribed; and
170 (v) the feasible alternatives, including concurrent or additional treatments, palliative
171 care, comfort care, hospice care, disability resources available in the community, and pain
172 control;
173 (d) refer the patient to a consulting physician for medical confirmation of the diagnosis
174 and for a determination that the patient is capable and making an informed, voluntary decision;
175 (e) refer the patient for counseling if appropriate pursuant to Section 75-2c-108;
176 (f) recommend that the patient notify next of kin;
177 (g) counsel the patient about the importance of having another individual present when
178 the patient takes the medication prescribed pursuant to this chapter and of not taking the
179 medication in a public place;
180 (h) inform the patient that the patient has an opportunity to rescind the request at any
181 time and in any manner, and offer the patient an opportunity to rescind at the end of the 15-day
182 waiting period required by Section 75-2c-111;
183 (i) verify, immediately before writing the prescription for medication under this
184 chapter, that the patient is making an informed decision;
185 (j) fulfill the medical record documentation requirements of Section 75-2c-112;
186 (k) ensure that all appropriate steps are carried out in accordance with this chapter
187 before writing a prescription for medication to enable a qualified patient to end the patient's life
188 in a humane and dignified manner;
189 (l) with the patient's consent:
190 (i) contact a pharmacist and inform the pharmacist of the prescription; and
191 (ii) deliver the written prescription personally or electronically to the pharmacist, who
192 will dispense the medication to either the patient, the attending physician, or an expressly
193 identified agent of the patient; and
194 (m) inform the Department of Health of the prescription written for the patient,
195 including the name of any drugs prescribed.
196 (2) Notwithstanding any other provision of law, the attending physician may sign the
197 patient's death certificate.
198 Section 7. Section 75-2c-107 is enacted to read:
199 75-2c-107. Consulting physician confirmation.
200 Before a patient is qualified under this chapter, a consulting physician shall examine the
201 patient and the patient's relevant medical records and confirm, in writing, the attending
202 physician's diagnosis that the patient is suffering from a terminal disease and verify that the
203 patient is capable, is acting voluntarily, and has made an informed decision.
204 Section 8. Section 75-2c-108 is enacted to read:
205 75-2c-108. Counseling referral.
206 If in the opinion of the attending physician or the consulting physician a patient may be
207 suffering from impaired judgment, either physician shall refer the patient for counseling. No
208 medication to end a patient's life in a humane and dignified manner shall be prescribed until the
209 counselor determines that the patient is capable, is acting voluntarily, and has made an
210 informed decision.
211 Section 9. Section 75-2c-109 is enacted to read:
212 75-2c-109. Informed decision.
213 A patient may not receive a prescription for medication to end the patient's life in a
214 humane and dignified manner unless the patient has made an informed decision as defined in
215 Section 75-2c-102. Immediately before writing a prescription for medication under this
216 chapter, the attending physician shall verify that the patient is making an informed decision.
217 Section 10. Section 75-2c-110 is enacted to read:
218 75-2c-110. Family notification.
219 The attending physician shall recommend that the patient notify the next of kin of the
220 patient's request for medication under this chapter. The attending physician may not deny a
221 patient's request on the basis of a patient declining or being unable to notify the patient's next
222 of kin.
223 Section 11. Section 75-2c-111 is enacted to read:
224 75-2c-111. Waiting periods.
225 A physician may not write a prescription under this chapter until:
226 (1) no less than 15 days have elapsed between the patient's initial oral request and the
227 writing of a prescription; and
228 (2) no less than 48 hours have elapsed between the patient's written request and the
229 writing of a prescription.
230 Section 12. Section 75-2c-112 is enacted to read:
231 75-2c-112. Medical record documentation requirements.
232 The following shall be documented or filed in the patient's medical record:
233 (1) all oral requests by the patient for medication to end the patient's life in a humane
234 and dignified manner;
235 (2) all written requests by the patient for medication to end the patient's life in a
236 humane and dignified manner;
237 (3) the attending physician's diagnosis, prognosis, and determination that the patient is
238 capable, is acting voluntarily, and has made an informed decision;
239 (4) the consulting physician's diagnosis, prognosis, and verification that the patient is
240 capable, is acting voluntarily, and has made an informed decision;
241 (5) a report of the outcome and determinations made during counseling, if performed;
242 (6) the attending physician's offer to the patient to rescind the patient's request at the
243 time of the patient's second oral request; and
244 (7) a note by the attending physician indicating that all requirements under this chapter
245 have been met and indicating the steps taken to carry out the request, including a notation of
246 the medication prescribed.
247 Section 13. Section 75-2c-113 is enacted to read:
248 75-2c-113. Residency requirement.
249 (1) An attending physician may rely on a patient's attestation of meeting the
250 requirements for being a resident of Utah if the attestation complies with Subsections (2) and
251 (3).
252 (2) A patient shall attest to the attending physician that the patient is a resident of the
253 state, and that the patient:
254 (a) possesses a Utah driver license or Utah identification card;
255 (b) is registered to vote in Utah;
256 (c) owns or leases property in Utah;
257 (d) filed a Utah tax return for the most recent tax year, and did not file a Non and
258 Part-year Resident Schedule; or
259 (e) has some other indication of residency that is recognized by state law.
260 (3) A patient who relies on Subsection (2)(e) to attest to residency in Utah shall
261 specifically describe the factors that the patient is relying upon in the attestation to the
262 attending physician.
263 Section 14. Section 75-2c-114 is enacted to read:
264 75-2c-114. Reporting requirements.
265 (1) A health care provider who dispenses a medication pursuant to this chapter shall
266 file a copy of the dispensing record with the Department of Health in the manner required by
267 the department.
268 (2) (a) The Department of Health may review a sample of the medical records of
269 patients who receive medication under this chapter.
270 (b) Except as otherwise required by law, the information collected under Subsections
271 (1) and (2)(a) are not public records and are not available for inspection by the public.
272 (3) The Department of Health shall:
273 (a) generate and make available to the public an annual statistical report of
274 de-identified information collected under this section;
275 (b) make rules under Title 63G, Chapter 3, Utah Administrative Rulemaking Act, to
276 facilitate the collection of information regarding compliance with this chapter; and
277 (c) provide an annual report to the Legislature's Health and Human Services Interim
278 Committee regarding the statistical report in Subsection (3)(a).
279 Section 15. Section 75-2c-115 is enacted to read:
280 75-2c-115. Effect on construction of wills, contracts, and statutes.
281 (1) No provision in a contract, will, or other agreement, whether written or oral, to the
282 extent the provision would affect whether an individual may make or rescind a request for
283 aid-in-dying medication or self-administer aid-in-dying medication, is valid.
284 (2) No obligation owing under any currently existing contract shall be conditioned or
285 affected by the making or rescinding of a request, by an individual, for medication to end the
286 individual's life in a humane and dignified manner.
287 Section 16. Section 75-2c-116 is enacted to read:
288 75-2c-116. Insurance or annuity policies.
289 (1) A qualified patient's act of ingesting medication to end the patient's life in a humane
290 and dignified manner, in accordance with the provisions of this chapter, does not affect a life,
291 health, or accident insurance or annuity policy.
292 (2) An insurer may not deny or alter health care benefits otherwise available to an
293 individual with a terminal illness based on the availability of aid-in-dying medication or
294 otherwise attempt to coerce an individual to make a request for aid-in-dying medication.
295 Section 17. Section 75-2c-117 is enacted to read:
296 75-2c-117. Construction of chapter.
297 Nothing in this chapter shall be construed to authorize a physician or any other person
298 to end a patient's life by lethal injection, mercy killing, or euthanasia. Actions taken in
299 accordance with this chapter do not, for any purpose, constitute suicide, assisted suicide, mercy
300 killing, or homicide, under the law.
301 Section 18. Section 75-2c-118 is enacted to read:
302 75-2c-118. Immunity for action in good faith -- Prohibition against reprisal --
303 Acceptable prohibitions.
304 (1) A person is not subject to civil or criminal liability or professional disciplinary
305 action for actions resulting from good faith compliance with this chapter, including being
306 present when a qualified patient takes the prescribed medication to end the qualified patient's
307 life in a humane and dignified manner.
308 (2) A professional organization or association, or health care provider, may not subject
309 a person to censure, discipline, suspension, loss of license, loss of privileges, loss of
310 membership, or other penalty for participating or refusing to participate in good faith
311 compliance with this chapter.
312 (3) A request by a patient for, or provision by an attending physician of, medication in
313 good faith compliance with the provisions of this chapter does not constitute neglect for any
314 purpose of law or provide the sole basis for the appointment of a guardian or conservator.
315 (4) A health care facility may not prohibit a health care provider from providing
316 medical aid-in-dying care, except that the health care facility may prohibit the patient from
317 self-administration of the aid-in-dying medication on the premises of the facility.
318 (5) A health care facility may not prohibit the lawful self-administration of aid-in-dying
319 medication on the premises of the facility unless the health care facility provides written
320 notification of the prohibition to the attending physician and any qualified patient.
321 (6) If a health care facility prohibits the self-administration of aid-in-dying medication
322 under Subsection (5), the facility shall refer a qualified patient to a health care facility that does
323 not have a prohibition against the self-administration of aid-in-dying medication on the
324 premises.
325 Section 19. Section 75-2c-119 is enacted to read:
326 75-2c-119. Liabilities.
327 (1) A person who, without authorization of the patient, willfully alters or forges a
328 request for medication or conceals or destroys a rescission of that request with the intent or
329 effect of causing the patient's death is guilty of a first degree felony.
330 (2) A person who coerces or exerts undue influence on a patient to request medication
331 for the purpose of ending the patient's life, or to destroy a rescission of such a request, is guilty
332 of a first degree felony.
333 (3) Nothing in this chapter limits further liability for civil damages resulting from other
334 negligent conduct or intentional misconduct by any person.
335 (4) The penalties in this chapter do not preclude criminal penalties applicable under
336 other law for conduct that is inconsistent with the provisions of this chapter.
337 Section 20. Section 75-2c-120 is enacted to read:
338 75-2c-120. Claims by governmental entity for costs incurred.
339 A governmental entity that incurs costs resulting from an individual terminating the
340 individual's life pursuant to the provisions of this chapter in a public place shall have a claim
341 against the estate of the individual to recover the costs and reasonable attorney fees related to
342 enforcing the claim.
343 Section 21. Section 75-2c-121 is enacted to read:
344 75-2c-121. No duty to provide medical aid-in-dying care.
345 (1) A health care provider may choose whether to provide medical aid-in-dying care in
346 accordance with this chapter.
347 (2) If a health care provider is unwilling to provide medical aid-in-dying care to a
348 requesting, capable patient, the health care provider shall make reasonable efforts to transfer
349 the care of the patient to a health care provider who willingly provides medical aid-in-dying
350 care.
351 (3) When a health care provider transfers the care of a patient under Subsection (2), the
352 health care provider shall coordinate the transfer of the patient's medical records to the new
353 health care provider.
354 Section 22. Section 75-2c-122 is enacted to read:
355 75-2c-122. Death certificate.
356 (1) Unless otherwise prohibited, the attending physician or the hospice medical director
357 shall sign the death certificate of a qualified individual who obtained and self-administered
358 aid-in-dying medication.
359 (2) When a death has occurred in accordance with this chapter:
360 (a) the cause of death shall be listed on the death certificate as the underlying terminal
361 illness for which the individual qualified to obtain the aid-in-dying medication; and
362 (b) the manner of death may not be listed as suicide or homicide.
363 (3) Notwithstanding Section 26-4-7, a death that results in accordance with this chapter
364 may not form the sole basis for a postmortem investigation.
365 Section 23. Section 75-2c-123 is enacted to read:
366 75-2c-123. Safe disposal of unused aid-in-dying medication.
367 A person who has custody or control of aid-in-dying medication that is dispensed under
368 this chapter and that is unused after the qualified patient who obtained the aid-in-dying
369 medication has died shall dispose of the aid-in-dying medication by any lawful means,
370 including taking the unused aid-in-dying medication to:
371 (1) the attending physician who wrote the prescription for the aid-in-dying medication,
372 who shall dispose of the medication by lawful means;
373 (2) a federally approved medication take-back program; or
374 (3) a local take-back program supported by a law enforcement agency, pharmacy, or
375 health care provider.
376 Section 24. Section 75-2c-124 is enacted to read:
377 75-2c-124. Severability.
378 Any section of this chapter that is held invalid as to any person or circumstance does
379 not affect the application of any other section of this chapter that can be given full effect
380 without the invalid section or application.
381 Section 25. Section 75-2c-125 is enacted to read:
382 75-2c-125. Form of the request.
383 A request for a medication as authorized by this chapter shall be in substantially the
384 following form:_______________________________________________________________
385 REQUEST FOR MEDICATION
386 TO END MY LIFE IN A HUMANE
387 AND DIGNIFIED MANNER
388 I, ______________________, am an adult of sound mind.
389 I am suffering from _________, which my attending physician has determined is a
390 terminal disease and which has been medically confirmed by a consulting physician.
391 I have been fully informed of my diagnosis, prognosis, the nature of medication to be
392 prescribed, and potential associated risks, the expected result, and the feasible alternatives,
393 including palliative care, comfort care, hospice care, disability resources available in the
394 community, and pain control.
395 I request that my attending physician prescribe medication that will end my life in a
396 humane and dignified manner.
397 INITIAL ONE:
398 ______ I have informed my family of my decision and taken their opinions into
399 consideration.
400 ______ I have decided not to inform my family of my decision.
401 ______ I have no family to inform of my decision.
402 I understand that I have the right to rescind this request at any time.
403 I understand the full import of this request and I expect to die when I take the
404 medication to be prescribed. I further understand that although most deaths occur within three
405 hours, my death may take longer and my physician has counseled me about this possibility.
406 I make this request voluntarily and without reservation, and I accept full moral
407 responsibility for my actions.
408 Signed: _______________
409 Dated: _______________
410 DECLARATION OF WITNESSES
411 We declare that the individual signing this request:
412 (a) is personally known to us or has provided proof of identity;
413 (b) signed this request in our presence;
414 (c) appears to be of sound mind and not under duress, fraud, or undue influence; and
415 (d) is not a patient for whom either of us is the attending physician.
416 ______________Witness 1/Date
417 ______________Witness 2/Date
418 NOTE: One witness shall be an individual who is not a relative (by blood, marriage, or
419 adoption) of the individual signing this request, is not entitled to any portion of the requestor's
420 estate upon death, and does not own, operate, and is not employed at a health care facility
421 where the requestor is a patient or resident.
422 Section 26. Effective date.
423 This bill takes effect on July 1, 2018.
Legislative Review Note
Office of Legislative Research and General Counsel