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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:
18 • a consulting physician confirmation;
19 • an informed decision;
20 • written and oral requests and the ability to rescind the request at any time;
21 • waiting periods; and
22 • that the patient be a resident of the state;
23 ▸ provides for a counseling referral when needed;
24 ▸ encourages family notification;
25 ▸ includes documentation and reporting requirements;
26 ▸ establishes the effect of the decision to utilize aid-in-dying medication on an
27 individual's wills, contracts, and insurance and annuity contracts;
28 ▸ provides limited immunities and procedures for permissible sanctions;
29 ▸ prohibits euthanasia or mercy killing;
30 ▸ establishes criminal penalties for certain actions;
31 ▸ provides a uniform form for a patient's written request; and
32 ▸ includes a severability clause.
33 Money Appropriated in this Bill:
34 None
35 Other Special Clauses:
36 This bill provides a special effective date.
37 Utah Code Sections Affected:
38 ENACTS:
39 75-2c-101, Utah Code Annotated 1953
40 75-2c-102, Utah Code Annotated 1953
41 75-2c-103, Utah Code Annotated 1953
42 75-2c-104, Utah Code Annotated 1953
43 75-2c-105, Utah Code Annotated 1953
44 75-2c-106, Utah Code Annotated 1953
45 75-2c-107, Utah Code Annotated 1953
46 75-2c-108, Utah Code Annotated 1953
47 75-2c-109, Utah Code Annotated 1953
48 75-2c-110, Utah Code Annotated 1953
49 75-2c-111, Utah Code Annotated 1953
50 75-2c-112, Utah Code Annotated 1953
51 75-2c-113, Utah Code Annotated 1953
52 75-2c-114, Utah Code Annotated 1953
53 75-2c-115, Utah Code Annotated 1953
54 75-2c-116, Utah Code Annotated 1953
55 75-2c-117, Utah Code Annotated 1953
56 75-2c-118, Utah Code Annotated 1953
57 75-2c-119, Utah Code Annotated 1953
58 75-2c-120, Utah Code Annotated 1953
59 75-2c-121, Utah Code Annotated 1953
60 75-2c-122, Utah Code Annotated 1953
61 75-2c-123, Utah Code Annotated 1953
62 75-2c-124, Utah Code Annotated 1953
63 75-2c-125, Utah Code Annotated 1953
64
65 Be it enacted by the Legislature of the state of Utah:
66 Section 1. Section 75-2c-101 is enacted to read:
67
68 75-2c-101. Title.
69 This chapter is known as the "End of Life Options Act."
70 Section 2. Section 75-2c-102 is enacted to read:
71 75-2c-102. Definitions.
72 As used in this chapter:
73 (1) "Adult" means an individual who is 18 years of age or older.
74 (2) "Attending physician" means the physician who has primary responsibility for the
75 care of the patient and treatment of the patient's terminal disease.
76 (3) "Capable" means that in the opinion of the patient's attending physician, consulting
77 physician, and licensed mental health professional, if any, the patient has the ability to make
78 and communicate health care decisions to health care providers, including communication
79 through individuals familiar with the patient's manner of communicating if those individuals
80 are available.
81 (4) "Consulting physician" means a physician who is qualified by specialty or
82 experience to make a professional diagnosis and prognosis regarding the patient's disease.
83 (5) "Counseling" means one or more consultations as necessary between a licensed
84 mental health professional and a patient for the purpose of determining whether the patient is
85 capable.
86 (6) "Health care provider" means a person licensed, certified, or otherwise authorized
87 or permitted by the law of this state to administer health care or dispense medication in the
88 ordinary course of business or practice of a profession.
89 (7) "Informed decision" means a decision that is made by a patient to request and
90 obtain a prescription for aid-in-dying medication to end the patient's life in a humane and
91 dignified manner and that is based on an appreciation of the relevant facts, after being fully
92 informed by the attending physician of:
93 (a) the patient's medical diagnosis;
94 (b) the patient's prognosis;
95 (c) the potential risks associated with taking the medication to be prescribed;
96 (d) the probable result of taking the medication to be prescribed; and
97 (e) the feasible alternatives, including concurrent or additional treatment alternatives,
98 palliative care, comfort care, hospice care, disability resources available in the community, and
99 pain control.
100 (8) "Medically confirmed" means the medical opinion of the attending physician has
101 been confirmed by a consulting physician who has examined the patient and the patient's
102 relevant medical records.
103 (9) "Patient" means an adult who is under the care of a physician.
104 (10) "Physician" means the same as that term is defined in Section 26-65-102.
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 patient's affirmative, conscious act of using
109 the medication to bring about the qualified patient's own death in a humane and dignified
110 manner.
111 (13) "Terminal disease" means an incurable and irreversible disease that has been
112 medically confirmed and will, within reasonable medical judgment, produce death within six
113 months.
114 Section 3. Section 75-2c-103 is enacted to read:
115 75-2c-103. Written and oral requests -- Opportunity to rescind.
116 (1) In order to receive a prescription for aid-in-dying medication to end a patient's life
117 in a humane and dignified manner, a patient shall:
118 (a) make an oral request for the aid-in-dying medication;
119 (b) make a written request for the aid-in-dying medication in accordance with this
120 chapter; and
121 (c) repeat the oral request to the patient's attending physician no less than 15 days after
122 the day on which the patient makes the initial oral request.
123 (2) At the time the patient makes the second oral request, the attending physician shall
124 offer the patient an opportunity to rescind the request.
125 (3) (a) A patient may rescind the patient's request at any time and in any manner
126 without regard to the patient's mental state.
127 (b) A physician may not write a prescription for medication under this chapter without
128 the attending physician offering the patient an opportunity to rescind the patient's request.
129 Section 4. Section 75-2c-104 is enacted to read:
130 75-2c-104. Initiation of written request for medication.
131 (1) A patient may make a written request for aid-in-dying medication for the purpose of
132 ending the patient's life in a humane and dignified manner if the patient:
133 (a) is suffering from a terminal disease;
134 (b) is capable;
135 (c) is a resident of Utah; and
136 (d) 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 prescription for aid-in-dying medication shall be made by a patient
140 described in Subsection (1), and may not be made by any other means, including the patient'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 written request for aid-in-dying medication under this chapter shall be in
146 substantially the form described in Section 75-2c-124, signed and dated by the patient, and
147 witnessed by at least two adults who, in the presence of the patient, attest that to the best of
148 each adult's knowledge and belief the patient:
149 (a) is capable;
150 (b) is acting voluntarily; and
151 (c) is not being coerced to sign the request.
152 (2) At least one witness may not:
153 (a) be a relative of the patient by blood, marriage, or adoption;
154 (b) at the time the request is signed, be entitled to any portion of the estate of the
155 patient upon death under any will or by operation of law; or
156 (c) an owner, operator, or employee of a health care facility where the patient is
157 receiving medical treatment or is a resident.
158 (3) The patient's attending physician at the time the patient's request is signed may not
159 be a witness.
160 Section 6. Section 75-2c-106 is enacted to read:
161 75-2c-106. Attending physician responsibilities.
162 (1) The attending physician for a patient who requests aid-in-dying medication for the
163 purpose of ending the patient's life in a humane and dignified manner, shall:
164 (a) make the initial determination of whether the patient:
165 (i) has a terminal disease;
166 (ii) is capable; and
167 (iii) is making the request voluntarily;
168 (b) request that the patient attest to Utah residency pursuant to Section 75-2c-113;
169 (c) ensure that the patient is making an informed decision, by informing the patient of:
170 (i) the patient's medical diagnosis;
171 (ii) the patient's prognosis;
172 (iii) the potential risks associated with taking the medication to be prescribed;
173 (iv) the probable result of taking the medication to be prescribed; and
174 (v) the feasible alternatives, including concurrent or additional treatments, palliative
175 care, comfort care, hospice care, disability resources available in the community, and pain
176 control;
177 (d) refer the patient to a consulting physician for medical confirmation of the diagnosis
178 and for a determination that the patient is capable, is acting voluntarily, and is making an
179 informed decision;
180 (e) refer the patient for counseling, if appropriate, as described in Section 75-2c-108;
181 (f) recommend that the patient notify the patient's next of kin;
182 (g) counsel the patient about the importance of having another individual present when
183 the patient takes the medication prescribed under this chapter and about not taking the
184 medication in a public place;
185 (h) inform the patient that the patient may rescind the request at any time and in any
186 manner;
187 (i) at the end of the 15-day waiting period described in Section 75-2c-111, offer the
188 patient an opportunity to rescind the patient's request;
189 (j) verify that the patient is making an informed decision in accordance with Section
190 75-2c-109; and
191 (k) fulfill the medical record documentation requirements of Section 75-2c-112.
192 (2) (a) The attending physician for the patient described in Subsection (1) shall ensure
193 that all appropriate steps are carried out in accordance with this chapter before:
194 (i) determining that the patient is a qualified patient; and
195 (ii) writing a prescription for aid-in-dying medication to enable the qualified patient to
196 end the qualified patient's life in a humane and dignified manner.
197 (b) With the qualified patient's consent, the attending physician for a qualified patient
198 shall:
199 (i) electronically contact a pharmacist and inform the pharmacist of the prescription for
200 the aid-in-dying medication described in Subsection (2)(a)(ii);
201 (ii) personally send an electronic prescription to the pharmacist for the aid-in-dying
202 medication; and
203 (iii) inform the Department of Health of the prescription for the aid-in-dying
204 medication, including the name of the medication prescribed.
205 (c) The pharmacist described in Subsection (2)(b) shall dispense the aid-in-dying
206 medication described in Subsection (2)(b) to:
207 (i) the qualified patient;
208 (ii) the attending physician; or
209 (iii) an expressly identified agent of the qualified patient.
210 (3) Notwithstanding any other provision of law, the attending physician may sign the
211 qualified patient's death certificate.
212 Section 7. Section 75-2c-107 is enacted to read:
213 75-2c-107. Consulting physician confirmation.
214 Before a patient is qualified under this chapter, a consulting physician shall examine the
215 patient and the patient's relevant medical records and confirm, in writing, the attending
216 physician's diagnosis that the patient is suffering from a terminal disease and verify that the
217 patient:
218 (1) is capable;
219 (2) is acting voluntarily; and
220 (3) is making an informed decision.
221 Section 8. Section 75-2c-108 is enacted to read:
222 75-2c-108. Counseling referral.
223 (1) If in the opinion of the attending physician or the consulting physician a patient
224 may be suffering from impaired judgment, the physician who holds that opinion shall refer the
225 patient for counseling.
226 (2) Aid-in-dying medication to end the life of a patient described in Subsection (1) in a
227 humane and dignified manner may not be prescribed until a counselor determines that the
228 patient:
229 (a) is capable;
230 (b) is acting voluntarily; and
231 (c) is making an informed decision.
232 Section 9. Section 75-2c-109 is enacted to read:
233 75-2c-109. Informed decision.
234 (1) A patient may not receive a prescription for aid-in-dying medication to end the
235 patient's life in a humane and dignified manner unless the patient has made an informed
236 decision.
237 (2) Immediately before prescribing the aid-in-dying medication described in
238 Subsection (1) in accordance with this chapter, the attending physician shall verify that the
239 patient is making an informed decision.
240 Section 10. Section 75-2c-110 is enacted to read:
241 75-2c-110. Family notification.
242 (1) The attending physician shall recommend that the patient notify the next of kin of
243 the patient's request for aid-in-dying medication under this chapter.
244 (2) The attending physician may not deny a patient's request for aid-in-dying
245 medication under this chapter on the basis of the patient's declination or inability to notify the
246 patient's next of kin.
247 Section 11. Section 75-2c-111 is enacted to read:
248 75-2c-111. Waiting periods.
249 A physician may not prescribe aid-in-dying medication to end a patient's life in a
250 humane and dignified manner until:
251 (1) no less than 15 days have elapsed since the day on which the patient made the first
252 oral request for a prescription for aid-in-dying medication to end the patient's life in a humane
253 and dignified manner;
254 (2) the patient made the second oral request described in Subsection 75-2c-103(1)(c);
255 and
256 (3) at least 48 hours have elapsed since the time at which the patient submitted to the
257 physician the patient's written request for a prescription for aid-in-dying medication to end the
258 patient's life in a humane and dignified manner.
259 Section 12. Section 75-2c-112 is enacted to read:
260 75-2c-112. Medical record documentation requirements.
261 The following shall be documented or filed in the medical record of a patient who
262 requests aid-in-dying medication for the purpose of ending the patient's life in a humane and
263 dignified manner:
264 (1) all oral requests by the patient for a prescription for aid-in-dying medication to end
265 the patient's life in a humane and dignified manner;
266 (2) all written requests by the patient for a prescription for aid-in-dying medication to
267 end the patient's life in a humane and dignified manner;
268 (3) the attending physician's diagnosis, prognosis, and determination whether the
269 patient:
270 (a) is capable;
271 (b) is acting voluntarily; and
272 (c) has made an informed decision;
273 (4) the consulting physician's diagnosis, prognosis, and determination whether the
274 patient:
275 (a) is capable;
276 (b) is acting voluntarily; and
277 (c) has made an informed decision;
278 (5) a report of the outcome and determinations made during counseling, if performed;
279 (6) the attending physician's offer to the patient to rescind the patient's request at the
280 time of the patient's second oral request under Subsection 75-2c-103(1)(c); and
281 (7) a note by the attending physician indicating that all requirements under this chapter
282 have been met and indicating the steps taken to carry out the request, including a notation of
283 the medication prescribed.
284 Section 13. Section 75-2c-113 is enacted to read:
285 75-2c-113. Residency requirement.
286 (1) An attending physician may rely on the patient's attestation of meeting the
287 requirements for being a resident of Utah if the attestation complies with Subsections (2) and
288 (3).
289 (2) A patient shall attest to the attending physician that the patient:
290 (a) is a resident of the state; and
291 (b) (i) possesses a Utah driver license or Utah identification card;
292 (ii) is registered to vote in Utah;
293 (iii) owns or leases property in Utah;
294 (iv) filed a Utah tax return for the most recent tax year, and did not file a Non and
295 Part-year Resident Schedule; or
296 (v) has some other indication of Utah residency that is recognized by state law.
297 (3) A patient who relies on Subsection (2)(b)(v) to attest to residency in Utah shall
298 specifically describe the factors that the patient is relying upon in the attestation to the
299 attending physician.
300 Section 14. Section 75-2c-114 is enacted to read:
301 75-2c-114. Reporting requirements.
302 (1) A health care provider who dispenses medication under this chapter shall file a
303 copy of the dispensing record with the Department of Health in the manner described in
304 Subsection (3).
305 (2) (a) The Department of Health may review a sample of the medical records of
306 patients who receive medication under this chapter.
307 (b) Except as otherwise required by law, the information collected under Subsections
308 (1) and (2)(a) are private records under Section 63G-2-302.
309 (3) The Department of Health shall:
310 (a) generate and make available to the public an annual statistical report of
311 de-identified information collected under this section;
312 (b) make rules under Title 63G, Chapter 3, Utah Administrative Rulemaking Act, to
313 facilitate the collection of information regarding compliance with this chapter; and
314 (c) provide an annual report to the Health and Human Services Interim Committee
315 regarding the statistical report described in Subsection (3)(a).
316 Section 15. Section 75-2c-115 is enacted to read:
317 75-2c-115. Effect on construction of wills, contracts, and statutes.
318 (1) No provision in a contract, will, or other agreement, whether written or oral, to the
319 extent the provision would affect whether an individual may make or rescind a request for
320 aid-in-dying medication, is valid.
321 (2) No obligation owing under any currently existing contract shall be conditioned or
322 affected by the making or rescinding of a request for aid-in-dying medication under this
323 chapter.
324 Section 16. Section 75-2c-116 is enacted to read:
325 75-2c-116. Insurance or annuity policies.
326 (1) A qualified patient's act of ingesting aid-in-dying medication to end the patient's
327 life in a humane and dignified manner, in accordance with this chapter, does not affect a life,
328 health, or accident insurance or annuity policy.
329 (2) An insurer may not:
330 (a) deny or alter health care benefits otherwise available to an individual with a
331 terminal illness based on the availability of aid-in-dying medication; or
332 (b) coerce or attempt to coerce an individual to make a request for aid-in-dying
333 medication.
334 Section 17. Section 75-2c-117 is enacted to read:
335 75-2c-117. Construction of chapter.
336 (1) Nothing in this chapter authorizes a physician or another person to end a patient's
337 life by lethal injection, mercy killing, or euthanasia.
338 (2) Actions taken in accordance with this chapter do not, for any purpose, constitute
339 suicide, assisted suicide, mercy killing, or homicide.
340 Section 18. Section 75-2c-118 is enacted to read:
341 75-2c-118. Immunity for action in good faith -- Prohibition against reprisal --
342 Acceptable prohibitions.
343 (1) A person is not subject to civil or criminal liability or professional disciplinary
344 action for actions resulting from good faith compliance with this chapter, including being
345 present when a qualified patient takes the prescribed aid-in-dying medication to end the
346 qualified patient's life in a humane and dignified manner.
347 (2) A professional organization or association, or health care provider, may not subject
348 a person to censure, discipline, suspension, loss of license, loss of privileges, loss of
349 membership, or other penalty for participating or refusing to participate in good faith
350 compliance with this chapter.
351 (3) A request by a patient for, or provision by an attending physician of, aid-in-dying
352 medication in good faith compliance with the provisions of this chapter is not neglect for any
353 purpose of law and may not form nor contribute to the basis for the appointment of a guardian
354 or conservator.
355 (4) A health care facility may not prohibit a health care provider from providing
356 medical aid-in-dying care, except that the health care facility may prohibit the patient from
357 self-administration of aid-in-dying medication on the premises of the facility.
358 (5) A health care facility may not prohibit the lawful self-administration of aid-in-dying
359 medication on the premises of the facility unless the health care facility provides written
360 notification of the prohibition to the attending physician and any qualified patient.
361 (6) If a health care facility prohibits the self-administration of aid-in-dying medication,
362 the facility shall refer a qualified patient to a health care facility that does not have a
363 prohibition against the self-administration of aid-in-dying medication on the premises.
364 Section 19. Section 75-2c-119 is enacted to read:
365 75-2c-119. Liabilities.
366 (1) A person may not:
367 (a) without authorization of the patient, willfully alter or forge a request for
368 aid-in-dying medication or conceal or destroy a rescission of the request with the intent or
369 effect of causing the patient's death; or
370 (b) coerce or exert undue influence on a patient to request aid-in-dying medication for
371 the purpose of ending the patient's life, or destroy a rescission of the request.
372 (2) A violation of Subsection (1) is a first degree felony.
373 (3) Nothing in this chapter limits further liability for civil damages resulting from other
374 negligent conduct or intentional misconduct by any person.
375 (4) The penalties in this chapter do not preclude criminal penalties applicable under
376 other law for conduct that is inconsistent with the provisions of this chapter.
377 Section 20. Section 75-2c-120 is enacted to read:
378 75-2c-120. Claims by governmental entity for costs incurred.
379 A governmental entity that incurs costs resulting from an individual terminating the
380 individual's life pursuant to the provisions of this chapter in a public place shall have a claim
381 against the estate of the individual to recover the costs and reasonable attorney fees related to
382 enforcing the claim.
383 Section 21. Section 75-2c-121 is enacted to read:
384 75-2c-121. No duty to provide medical aid-in-dying care.
385 (1) A health care provider may choose whether to provide medical aid-in-dying care in
386 accordance with this chapter.
387 (2) If a health care provider is unwilling to provide medical aid-in-dying care to a
388 requesting, capable patient, the health care provider shall make reasonable efforts to transfer
389 the care of the patient to a health care provider who willingly provides medical aid-in-dying
390 care.
391 (3) When a health care provider transfers the care of a patient under Subsection (2), the
392 health care provider shall coordinate the transfer of the patient's medical records to the new
393 health care provider.
394 Section 22. Section 75-2c-122 is enacted to read:
395 75-2c-122. Death certificate.
396 (1) Unless otherwise prohibited, the attending physician or the hospice medical director
397 shall sign the death certificate of a qualified patient who obtained and self-administered
398 aid-in-dying medication.
399 (2) When a death occurs as a result of aid-in-dying medication prescribed in
400 accordance with this chapter:
401 (a) the cause of death shall be listed on the death certificate as the underlying terminal
402 illness for which the individual qualified to obtain the aid-in-dying medication; and
403 (b) the manner of death may not be listed as suicide or homicide.
404 (3) Notwithstanding Section 26-4-7, a death that results in accordance with this chapter
405 may not form the sole basis for a postmortem investigation.
406 Section 23. Section 75-2c-123 is enacted to read:
407 75-2c-123. Safe disposal of unused aid-in-dying medication.
408 A person who has custody or control of aid-in-dying medication that is dispensed under
409 this chapter and that is unused after the qualified patient who obtained the aid-in-dying
410 medication has died shall dispose of the aid-in-dying medication by any lawful means,
411 including taking the unused aid-in-dying medication to:
412 (1) the attending physician who wrote the prescription for the aid-in-dying medication,
413 who shall dispose of the medication by lawful means;
414 (2) a federally approved medication take-back program; or
415 (3) a local take-back program supported by a law enforcement agency, pharmacy, or
416 health care provider.
417 Section 24. Section 75-2c-124 is enacted to read:
418 75-2c-124. Form of the request.
419 A request for aid-in-dying medication as authorized by this chapter shall be in
420 substantially the following form:__________________________________________________
421 REQUEST FOR MEDICATION
422 TO END MY LIFE IN A HUMANE
423 AND DIGNIFIED MANNER
424 I, ______________________, am an adult of sound mind.
425 I am suffering from _________, which my attending physician has determined is a
426 terminal disease and which has been medically confirmed by a consulting physician.
427 I have been fully informed of my diagnosis, prognosis, the nature of medication to be
428 prescribed, and potential associated risks, the expected result, and the feasible alternatives,
429 including palliative care, comfort care, hospice care, disability resources available in the
430 community, and pain control.
431 I request that my attending physician prescribe medication that will end my life in a
432 humane and dignified manner.
433 INITIAL ONE:
434 ______ I have informed my family of my decision and taken their opinions into
435 consideration.
436 ______ I have decided not to inform my family of my decision.
437 ______ I have no family to inform of my decision.
438 I understand that I have the right to rescind this request at any time.
439 I understand the full import of this request and I expect to die when I take the
440 medication to be prescribed. I further understand that although most deaths occur within three
441 hours, my death may take longer and my physician has counseled me about this possibility.
442 I make this request voluntarily and without reservation, and I accept full moral
443 responsibility for my actions.
444 Signed: _______________
445 Dated: _______________
446 DECLARATION OF WITNESSES
447 We declare that the individual signing this request:
448 (a) is personally known to us or has provided proof of identity;
449 (b) signed this request in our presence;
450 (c) appears to be of sound mind and not under duress, fraud, or undue influence; and
451 (d) is not a patient for whom either of us is the attending physician.
452 ______________Witness 1/Date
453 ______________Witness 2/Date
454 NOTE: At least one witness shall be an adult who is not a relative (by blood, marriage,
455 or adoption) of the individual signing this request, is not entitled to any portion of the
456 requestor's estate upon death, and does not own, operate, and is not employed at a health care
457 facility where the requestor is a patient or resident.
458 Section 25. Section 75-2c-125 is enacted to read:
459 75-2c-125. Severability.
460 (1) If a final decision of a court of competent jurisdiction holds invalid any provision
461 of this chapter or the application of any provision to any person or circumstance, the remaining
462 provisions of this chapter remain effective without the invalidated provision or application.
463 (2) The provisions of this chapter are severable.
464 Section 26. Effective date.
465 This bill takes effect on July 1, 2020.