Amended in Assembly September 3, 2015

Amended in Assembly September 3, 2015

California Legislature—2015–16 Second Extraordinary Session

Assembly BillNo. 15


Introduced by Assembly Members Eggman, Alejo, and Mark Stone

(Principal coauthor: Assembly Member Bonta)

(Principal coauthors: Senators Monning and Wolk)

(Coauthors: Assembly Members Atkins, Burke, Chiu, Chu, Cooper, Frazier, Cristina Garcia, Jones-Sawyer, Low, McCarty, Perea, Quirk, and Rendon)

(Coauthors: Senators Allen, Block, De León, Glazer, Hall, Hancock, Hernandez, Hertzberg, Hill, Jackson, Leno, McGuire, Mitchell, and Wieckowski)

August 17, 2015


An act to addbegin insert and repealend insert Part 1.85 (commencing with Section 443)begin delete toend deletebegin insert ofend insert Division 1 of the Health and Safety Code, relating to end of life.

LEGISLATIVE COUNSEL’S DIGEST

AB 15, as amended, Eggman. End of life.

Existing law authorizes an adult to give an individual health care instruction and to appoint an attorney to make health care decisions for that individual in the event of his or her incapacity pursuant to a power of attorney for health care.

This billbegin insert, until January 1, 2026,end insert would enact the End of Life Option Act authorizing an adult who meets certain qualifications, and who has been determined by his or her attending physician to be suffering from a terminal disease, as defined, to make a request for a drug prescribed pursuant to these provisions for the purpose of ending his or her life. The bill would establish the procedures for making these requests. The bill would also establishbegin delete theend deletebegin insert specifiedend insert forms to request an aid-in-dying drugbegin delete andend delete, under specified circumstances, an interpreter declaration to be signed subject to penalty of perjury, thereby creating a crime and imposing a state-mandated local programbegin insert, and a final attestation for an aid-in-dying drugend insert. This bill would require specified information to be documented in the individual’s medical record, including, among other things, all oral and written requests for an aid-in-dying drug.

This bill would prohibit a provision in a contract, will, or other agreement from being conditioned upon, or affected by, a person making or rescinding a request for the above-described drug. The bill would prohibit the sale, procurement, or issuance of any life, health, or annuity policy, health care service plan contract, or health benefit plan, or the rate charged for any policy or plan contract, from being conditioned upon or affected by the request. The bill would prohibit an insurance carrier from providing any information in communications made to an individual about the availability of an aid-in-dying drug absent a request by the individual or his or her attending physician at the behest of the individual. The bill would also prohibit any communication from containing both the denial of treatment and information as to the availability of aid-in-dying drug coverage.

This bill would providebegin insert a person, except as provided,end insert immunity frombegin delete civil, criminal, administrative, employment, or contractual liability or professional disciplinary action for participating in good faith compliance with the act,end deletebegin insert civil or criminal liability solely because the person was present when the qualified individual self-administered the drug, or the person assisted the qualified individual by preparing the aid-in-dying drug so long as the person did not assist with the ingestion of the drug,end insert and would specify that the immunities and prohibitions on sanctions of a health care provider are solely reserved for conductbegin insert of a health care providerend insert provided for by the bill. The bill would make participation in activities authorized pursuant to its provisions voluntary, and would make health care providers immune from liability for refusing to engage in activities authorized pursuant to its provisions. The bill would also authorize a health care provider to prohibit its employees, independent contractors, or other persons or entities, including other health care providers, from participating in activities under the act while on the premises owned or under the management or direct control of that prohibiting health care provider, or while acting within the course and scope of any employment by, or contract with, the prohibiting health care provider.

This bill would make it a felony to knowingly alter or forge a request for drugs to end an individual’s life without his or her authorization or to conceal or destroy a withdrawal or rescission of a request for a drug, if it is done with the intent or effect of causing the individual’s death. The bill would make it a felony to knowingly coerce or exert undue influence on an individual to request a drug for the purpose of ending his or herbegin delete life orend deletebegin insert life,end insert to destroy a withdrawal or rescission of abegin delete request.end deletebegin insert request, or to administer an aid-in-dying drug to an individual without their knowledge or consent.end insert By creating a new crime, the bill would impose a state-mandated local program. The bill would provide that nothing in its provisions is to be construed to authorize ending a patient’s life by lethal injection, mercy killing, or active euthanasia, and would provide that action taken in accordance with the act shall not constitute, among other things, suicide or homicide.

This bill would require physicians to submit specified forms and information to the State Department of Public Health after writing a prescription for an aid-in-dying drug and after the death of an individual who requested an aid-in-dying drug. The bill would authorize the Medical Board of California to update those forms and would require the State Department of Public Health to publish the forms on its Internet Web site. The bill would require the department to annually review a sample of certain information and records, make a statistical report of the information collected, and post that report to its Internet Web site.

Existing constitutional provisions require that a statute that limits the right of access to the meetings of public bodies or the writings of public officials and agencies be adopted with findings demonstrating the interest protected by the limitation and the need for protecting that interest.

This bill would make legislative findings to that effect.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: yes.

The people of the State of California do enact as follows:

P4    1

SECTION 1.  

Part 1.85 (commencing with Section 443) is
2added to Division 1 of the Health and Safety Code, to read:

3 

4PART 1.85.  End of Life Option Act

5

 

6

443.  

This part shall be known and may be cited as the End of
7Life Option Act.

8

443.1.  

As used in this part, the following definitions shall apply:

9(a) “Adult” means an individual 18 years of age or older.

10(b) “Aid-in-dying drug” means a drug determined and prescribed
11by a physician for a qualified individual, which the qualified
12individual may choose to self-administer to bring about his or her
13death due to a terminal disease.

14(c) “Attending physician” means the physician who has primary
15responsibility for the health care of an individual and treatment of
16the individual’s terminal disease.

17(d) “Attending physician checklist and compliance form” means
18a form, as described in Section 443.22, identifying each and every
19requirement that must be fulfilled by an attending physician to be
20in good faith compliance with this part should the attending
21physician choose to participate.

22(e) “Capacity to make medical decisions” means that, in the
23opinion of an individual’s attending physician, consulting
24physician, psychiatrist, or psychologist, pursuant to Section 4609
25of the Probate Code, the individual has the ability to understand
26the nature and consequences of a health care decision, the ability
27to understand its significant benefits, risks, and alternatives, and
28the ability to make and communicate an informed decision to health
29care begin delete providers, including communication through a person familiar
30with the individual’s manner of communicating, if that person is
31available.end delete
begin insert providers.end insert

32(f) “Consulting physician” means a physician who is
33independent from the attending physician and who is qualified by
34specialty or experience to make a professional diagnosis and
35prognosis regarding an individual’s terminal disease.

36(g) “Department” means the State Department of Public Health.

37(h) “Health care provider” or “provider of health care” means
38any person licensed or certified pursuant to Division 2
P5    1(commencing with Section 500) of the Business and Professions
2Code; any person licensed pursuant to the Osteopathic Initiative
3Act or the Chiropractic Initiative Act; any person certified pursuant
4to Division 2.5 (commencing with Section 1797) of this code; and
5any clinic, health dispensary, or health facility licensed pursuant
6to Division 2 (commencing with Section 1200) of this code.

7(i) “Informed decision” means a decision by an individual with
8a terminal disease to request and obtain a prescription for a drug
9that the individual may self-administer to end the individual’s life,
10that is based on an understanding and acknowledgment of the
11relevant facts, and that is made after being fully informed by the
12attending physician of all of the following:

13(1) The individual’s medical diagnosis and prognosis.

14(2) The potential risks associated with taking the drug to be
15 prescribed.

16(3) The probable result of taking the drug to be prescribed.

17(4) The possibility that the individual may choose not to obtain
18the drug or may obtain the drug but may decide not to ingest it.

19(5) The feasible alternatives or additional treatment
20opportunities, including, but not limited to, comfort care, hospice
21care, palliative care, and pain control.

22(j) “Medically confirmed” means the medical diagnosis and
23prognosis of the attending physician has been confirmed by a
24consulting physician who has examined the individual and the
25individual’s relevant medical records.

26(k) “Mental health specialist assessment” means one or more
27consultations between an individual and a mental health specialist
28for the purpose of determining that the individual has the capacity
29to make medical decisions and is not suffering from impaired
30judgment due to a mental disorder.

31(l) “Mental health specialist” means a psychiatrist or a licensed
32psychologist.

33(m) “Physician” means a doctor of medicine or osteopathy
34currently licensed to practice medicine in this state.

35(n) “Public place” means any street, alley, park, public building,
36any place of business or assembly open to or frequented by the
37public, and any other place that is open to the public view, or to
38which the public has access.

39(o) “Qualified individual” means an adult who has the capacity
40to make medical decisions, is a resident of California, and has
P6    1satisfied the requirements of this part in order to obtain a
2prescription for a drug to end his or her life.

3(p) “Self-administer” means a qualified individual’s affirmative,
4conscious, and physical act of administering and ingesting the
5aid-in-dying drug to bring about his or her own death.

6(q) “Terminal disease” means an incurable and irreversible
7disease that has been medically confirmed and will, within
8reasonable medical judgment, result in death within six months.

9

443.2.  

(a) An individual who is an adult with the capacity to
10make medical decisions and with a terminal disease may make a
11request to receive a prescription for an aid-in-dying drug if all of
12the following conditions are satisfied:

13(1) The individual’s attending physician has diagnosed the
14individual with a terminal disease.

15(2) The individual has voluntarily expressed the wish to receive
16a prescription for an aid-in-dying drug.

17(3) The individual is a resident of California and is able to
18establish residency through any of the following means:

19(A) Possession of a California driver license or other
20identification issued by the State of California.

21(B) Registration to vote in California.

22(C) Evidence that the person owns or leases property in
23California.

24(D) Filing of a California tax return for the most recent tax year.

25(4) The individual documents his or her request pursuant to the
26requirements set forth in Section 443.3.

27(5) The individual has the physical and mental ability to
28self-administer the aid-in-dying drug.

29(b) A person shall not be considered a “qualified individual”
30under the provisions of this part solely because of age or disability.

31(c) A request for a prescription for an aid-in-dying drug under
32this part shall be made solely and directly by the individual
33diagnosed with the terminal disease and shall not be made on behalf
34of the patient, including, but not limited to, through a power of
35attorney, an advance health care directive, a conservator, health
36care agent, surrogate, or any other legally recognized health care
37decisionmaker.

38

443.3.  

(a) An individual seeking to obtain a prescription for
39an aid-in-dying drug pursuant to this part shall submit two oral
40requests, a minimum of 15 days apart, and a written request to his
P7    1or her attending physician. The attending physician shall directly,
2and not through a designee, receive all three requests required
3pursuant to this section.

4(b) A valid written request for an aid-in-dying drug under
5subdivision (a) shall meet all of the following conditions:

6(1) The request shall be in the form described in Section 443.11.

7(2) The request shall be signed and dated, in the presence of
8two witnesses, by the individual seeking the aid-in-dying drug.

9(3) The request shall be witnessed by at least two other adult
10persons who, in the presence of the individual, shall attest that to
11the best of their knowledge and belief the individual is all of the
12following:

13(A) An individual who is personally known to them or has
14provided proof of identity.

15(B) An individual who voluntarily signed this request in their
16presence.

17(C) An individual whom they believe to be of sound mind and
18not under duress, fraud, or undue influence.

19(D) Not an individual for whom either of them is the attending
20physician, consulting physician, or mental health specialist.

21(c) Only one of the two witnesses at the time the written request
22is signed may:

23(1) Be related to the qualified individual by blood, marriage,
24registered domestic partnership, or adoption or be entitled to a
25portion of the individual’s estate upon death.

26(2) Own, operate, or be employed at a health care facility where
27the individual is receiving medical treatment or resides.

28(d) The attending physician, consulting physician, or mental
29health specialist of the individual shall not be one of the witnesses
30required pursuant to paragraph (3) of subdivision (b).

31

443.4.  

(a) An individual may at any time withdraw or rescind
32his or her request for an aid-in-dying drug, or decide not to ingest
33an aid-in-dying drug, without regard to the individual’s mental
34state.

35(b) A prescription for an aid-in-dying drug provided under this
36part may not be written without the attending physician directly,
37and not through a designee, offering the individual an opportunity
38to withdraw or rescind the request.

39

443.5.  

(a) Before prescribing an aid-in-dying drug, the
40attending physician shall do all of the following:

P8    1(1) Make the initial determination of all of the following:

2(A) (i) Whether the requesting adult has the capacity to make
3medical decisions.

4(ii) If there are indications of a mental disorder, the physician
5shall refer the individual for a mental health specialist assessment.

6(iii) If a mental health specialist assessment referral is made,
7no aid-in-dying drugs shall be prescribed until the mental health
8specialist determines that the individual has the capacity to make
9medical decisions and is not suffering from impaired judgment
10due to a mental disorder.

11(B) Whether the requesting adult has a terminal disease.

12(C) Whether the requesting adult has voluntarily made the
13request for an aid-in-dying drug pursuant to Sections 443.2 and
14443.3.

15(D) Whether the requesting adult is a qualified individual
16pursuant to subdivision (o) of Section 443.1.

17(2) Confirm that the individual is making an informed decision
18by discussing with him or her all of the following:

19(A) His or her medical diagnosis and prognosis.

20(B) The potential risks associated with ingesting the requested
21aid-in-dying drug.

22(C) The probable result of ingesting the aid-in-dying drug.

23(D) The possibility that he or she may choose to obtain the
24aid-in-dying drug but not take it.

25(E) The feasible alternatives or additional treatment options,
26including, but not limited to, comfort care, hospice care, palliative
27care, and pain control.

28(3) Refer the individual to a consulting physician for medical
29confirmation of the diagnosis and prognosis, and for a
30determination that the individual has the capacity to make medical
31decisions and has complied with the provisions of this part.

32 (4) Confirm that the qualified individual’s request does not arise
33from coercion or undue influence by another person by discussing
34with the qualified individual, outside of the presence of any other
35persons, except for an interpreter as required pursuant to this part,
36whether or not the qualified individual is feeling coerced or unduly
37influenced by another person.

38(5) Counsel the qualified individual about the importance of all
39of the following:

P9    1(A) Having another person present when he or she ingests the
2aid-in-dying drug prescribed pursuant to this part.

3(B) Not ingesting the aid-in-dying drug in a public place.

4(C) Notifying the next of kin of his or her request for an
5aid-in-dying drug. A qualified individual who declines or is unable
6to notify next of kin shall not have his or her request denied for
7that reason.

8(D) Participating in a hospice program.

9(E) Maintaining the aid-in-dying drug in a safe and secure
10location until the time that the qualified individual will ingest it.

11(6) Inform the individual that he or she may withdraw or rescind
12the request for an aid-in-dying drug at any time and in any manner.

13(7) Offer the individual an opportunity to withdraw or rescind
14the request for an aid-in-dying drug before prescribing the
15aid-in-dying drug.

16(8) Verify, immediately before writing the prescription for an
17aid-in-dying drug, that the qualified individual is making an
18informed decision.

19 (9) Confirm that all requirements are met and all appropriate
20steps are carried out in accordance with this part before writing a
21prescription for an aid-in-dying drug.

22(10) Fulfill the record documentation required under Sections
23443.8 and 443.19.

24(11) Complete the attending physician checklist and compliance
25form, as described in Section 443.22, include it and the consulting
26 physician compliance form in the individual’s medical record, and
27submit both forms to the State Department of Public Health.

begin insert

28(12) Give the qualified individual the final attestation form,
29with the instruction that the form be filled out and executed by the
30qualified individual within 48 hours prior to the qualified
31individual choosing to self-administer the aid-in-dying drug.

end insert

32(b) If the conditions set forth in subdivision (a) are satisfied,
33the attending physician may deliver the aid-in-dying drug in any
34of the following ways:

35(1) Dispensing the aid-in-dying drug directly, including ancillary
36medication intended to minimize the qualified individual’s
37discomfort, if the attending physician meets all of the following
38 criteria:

39(A) Is authorized to dispense medicine under California law.

P10   1(B) Has a current United States Drug Enforcement
2Administration (USDEA) certificate.

3(C) Complies with any applicable administrative rule or
4regulation.

5(2) With the qualified individual’s written consent, contacting
6a pharmacist, informing the pharmacist of the prescriptions, and
7delivering the written prescriptions personally, by mail, or
8electronically to the pharmacist, who may dispense the drug to the
9qualified individual, the attending physician, or a person expressly
10designated by the qualified individual and with the designation
11delivered to the pharmacist in writing or verbally.

12(c) Delivery of the dispensed drug to the qualified individual,
13the attending physician, or a person expressly designated by the
14qualified individual may be made by personal delivery, or, with a
15signature required on delivery, by United Parcel Service, United
16States Postal Service, Federal Express, or by messenger service.

17

443.6.  

Before a qualified individual obtains an aid-in-dying
18drug from the attending physician, the consulting physician shall
19perform all of the following:

20(a) Examine the individual and his or her relevant medical
21records.

22(b) Confirm in writing the attending physician’s diagnosis and
23prognosis.

24(c) Determine that the individual has the capacity to make
25medical decisions, is acting voluntarily, and has made an informed
26decision.

27(d) If there are indications of a mental disorder, refer the
28individual for a mental health specialist assessment.

29(e) Fulfill the record documentation required under this part.

30(f) Submit the compliance form to the attending physician.

31

443.7.  

Upon referral from the attending or consulting physician
32pursuant to this part, the mental health specialist shall:

33(a) Examine the qualified individual and his or her relevant
34medical records.

35(b) Determine that the individual has the mental capacity to
36make medical decisions, act voluntarily, and make an informed
37decision.

38(c) Determine that the individual is not suffering from impaired
39judgment due to a mental disorder.

40(d) Fulfill the record documentation requirements of this part.

P11   1

443.8.  

All of the following shall be documented in the
2individual’s medical record:

3(a) All oral requests for aid-in-dying drugs.

4(b) All written requests for aid-in-dying drugs.

5(c) The attending physician’s diagnosis and prognosis, and the
6determination that a qualified individual has the capacity to make
7medical decisions, is acting voluntarily, and has made an informed
8decision, or that the attending physician has determined that the
9individual is not a qualified individual.

10(d) The consulting physician’s diagnosis and prognosis, and
11verification that the qualified individual has the capacity to make
12medical decisions, is acting voluntarily, and has made an informed
13decision, or that the consulting physician has determined that the
14individual is not a qualified individual.

15(e) A report of the outcome and determinations made during a
16mental health specialist’s assessment, if performed.

17(f) The attending physician’s offer to the qualified individual
18to withdraw or rescind his or her request at the time of the
19individual’s second oral request.

20(g) A note by the attending physician indicating that all
21requirements under Sections 443.5 and 443.6 have been met and
22indicating the steps taken to carry out the request, including a
23 notation of the aid-in-dying drug prescribed.

24

443.9.  

(a) Within 30 calendar days of writing a prescription
25for an aid-in-dying drug, the attending physician shall submit to
26the State Department of Public Health a copy of the qualifying
27patient’s written request, the attending physician checklist and
28compliance form, and the consulting physician compliance form.

29(b) Within 30 calendar days following the qualified individual’s
30death from ingesting the aid-in-dying drug, or any other cause, the
31attending physician shall submit the attending physician followup
32form to the State Department of Public Health.

33

443.10.  

A qualified individual may not receive a prescription
34for an aid-in-dying drug pursuant to this part unless he or she has
35made an informed decision. Immediately before writing a
36prescription for an aid-in-dying drug under this part, the attending
37physician shall verify that the individual is making an informed
38decision.

39

443.11.  

(a) A request for an aid-in-dying drug as authorized
40by this part shall be in the following form:


P13   6

 

REQUEST FOR AN AID-IN-DYING DRUG TO END MY LIFE IN A HUMANE AND DIGNIFIED MANNER I, ......................................................, am an adult of sound mind and a resident of the State of California.
I am suffering from ................, which my attending physician has determined is in its terminal phase and which has been medically confirmed.
I have been fully informed of my diagnosis and prognosis, the nature of the aid-in-dying drug to be prescribed and potential associated risks, the expected result, and the feasible alternatives or additional treatment options, including comfort care, hospice care, palliative care, and pain control.
I request that my attending physician prescribe an aid-in-dying drug that will end my life in a humane and dignified manner if I choose to take it, and I authorize my attending physician to contact any pharmacist about my request.
INITIAL ONE:
............ I have informed one or more members of my family of my decision and taken their opinions into consideration.
............ I have decided not to inform my family of my decision.
............ I have no family to inform of my decision.
I understand that I have the right to withdraw or rescind this request at any time.
I understand the full import of this request and I expect to die if I take the aid-in-dying drug to be prescribed. My attending physician has counseled me about the possibility that my death may not be immediately upon the consumption of the drug.
I make this request voluntarily, without reservation, and without being coerced.
 
Signed:..............................................
Dated:...............................................
 
 
DECLARATION OF WITNESSES
We declare that the person signing this request:
(a) is personally known to us or has provided proof of identity;
(b) voluntarily signed this request in our presence;
(c) is an individual whom we believe to be of sound mind and not under duress, fraud, or undue influence; and
(d) is not an individual for whom either of us is the attending physician, consulting physician, or mental health specialist.
............................Witness 1/Date
............................Witness 2/Date
NOTE: Only one of the two witnesses may be a relative (by blood, marriage, registered domestic partnership, or adoption) of the person signing this request or be entitled to a portion of the person’s estate upon death. Only one of the two witnesses may own, operate, or be employed at a health care facility where the person is a patient or resident.
18P13  35

 

7(b) (1) The written language of the request shall be written in
8the same translated language as any conversations, consultations,
9or interpreted conversations or consultations between a patient and
10his or her attending or consulting physicians.

11(2) Notwithstanding paragraph (1), the written request may be
12prepared in English even when the conversations or consultations
13or interpreted conversations or consultations were conducted in a
14language other than English if the English language form includes
15an attached interpreter’s declaration that is signed under penalty
16 of perjury. The interpreter’s declaration shall state words to the
17effect that:

 

I, (INSERT NAME OF INTERPRETER), am fluent in English and (INSERT TARGET LANGUAGE).

On (insert date) at approximately (insert time), I read the “Request for an Aid-In-Dying Drug to End My Life” to (insert name of individual/patient) in (insert target language).

Mr./Ms. (insert name of patient/qualified individual) affirmed to me that he/she understood the content of this form and affirmed his/her desire to sign this form under his/her own power and volition and that the request to sign the form followed consultations with an attending and consulting physician.

I declare that I am fluent in English and (insert target language) and further declare under penalty of perjury that the foregoing is true and correct.

Executed at (insert city, county, and state) on this (insert day of month) of (insert month), (insert year).

X______Interpreter signature

X______Interpreter printed name

X______Interpreter address

P13  35

 

36(3) An interpreter whose services are provided pursuant to
37paragraph (2) shall not be related to the qualified individual by
38blood, marriage, registered domestic partnership, or adoption or
39be entitled to a portion of the person’s estate upon death. An
40interpreter whose services are provided pursuant to paragraph (2)
P14   1shall meet the standards promulgated by the California Healthcare
2Interpreting Association or the National Council on Interpreting
3in Health Care or other standards deemed acceptable by the
4department for health care providers in California.

begin insert

5(c) The final attestation form given by the attending physician
6to the qualified individual at the time the attending physician writes
7the prescription shall appear in the following form:
8

 

begin insertFINAL ATTESTATION FOR AN AID-IN-DYING DRUG TO END MY LIFE IN A HUMANE AND DIGNIFIED MANNER I, ......................................................, am an adult of sound mind and a resident of the State of California.end insert
begin insertI am suffering from ................, which my attending physician has determined is in its terminal phase and which has been medically confirmed.end insert
begin insertI have been fully informed of my diagnosis and prognosis, the nature of the aid-in-dying drug to be prescribed and potential associated risks, the expected result, and the feasible alternatives or additional treatment options, including comfort care, hospice care, palliative care, and pain control.end insert
begin insertI have received the aid-in-dying drug and am fully aware that this aid-in-dying drug will end my life in a humane and dignified manner.end insert
begin insertINITIAL ONE:end insert
begin insert............ I have informed one or more members of my family of my decision and taken their opinions into consideration.end insert
begin insert............ I have decided not to inform my family of my decision.end insert
begin insert............ I have no family to inform of my decision.end insert
begin insertMy attending physician has counseled me about the possibility that my death may not be immediately upon the consumption of the drug.end insert
begin insertI make this decision to ingest the aid-in-dying drug to end my life in a humane and dignified manner. I understand I still may choose not to ingest the drug and by signing this form I am under no obligation to ingest the drug. I understand I may rescind this request at any time.end insert
begin insert end insert
begin insert end insert
begin insertSigned:..............................................end insert
begin insertDated:...............................................end insert
begin insertTime:.................................................end insert
begin insert end insert
begin insert end insert
begin insert end insert
begin insert end insert
begin insert end insert
begin insert end insert
begin insert end insert
begin insert end insert
begin insert end insert
begin insert end insert
P15   7

 

end insert
begin insert

8(1) Within 48 hours prior to the individual self-administering
9the aid-in-dying drug, the individual shall complete the final
10attestation form. If aid-in-dying medication is not returned or
11relinquished upon the patient’s death as required in Section 443.20,
12the completed form shall be delivered by the individual’s health
13care provider, family member, or other representative to the
14attending physician to be included in the patient’s medical record.

end insert
begin insert

15(2) Upon receiving the final attestation form the attending
16physician shall add this form to the medical records of the qualified
17individual.

end insert
18

443.12.  

(a) A provision in a contract, will, or other agreement
19executed on or after January 1, 2016, whether written or oral, to
20the extent the provision would affect whether a person may make,
21withdraw, or rescind a request for an aid-in-dying drug is not valid.

22(b) An obligation owing under any contract executed on or after
23January 1, 2016, may not be conditioned or affected by a qualified
24individual making, withdrawing, or rescinding a request for an
25aid-in-dying drug.

26

443.13.  

(a) (1) The sale, procurement, or issuance of a life,
27health, or annuity policy, health care service plan contract, or health
28benefit plan, or the rate charged for a policy or plan contract may
29not be conditioned upon or affected by a person making or
30rescinding a request for an aid-in-dying drug.

31(2) Pursuant to Section 443.18, death resulting from the
32self-administration of an aid-in-dying drug is not suicide, and
33therefore health and insurance coverage shall not be exempted on
34that basis.

35(b) Notwithstanding any other law, a qualified individual’s act
36of self-administering an aid-in-dying drug shall not have an effect
37upon a life, health, or annuity policy other than that of a natural
38death from the underlying disease.

39(c) An insurance carrier shall not provide any information in
40communications made to an individual about the availability of
P16   1an aid-in-dying drug absent a request by the individual or his or
2her attending physician at the behest of the individual. Any
3communication shall not include both the denial of treatment and
4information as to the availability of aid-in-dying drug coverage.
5For the purposes of this subdivision, “insurance carrier” means a
6health care service plan as defined in Section 1345 of this code or
7a carrier of health insurance as defined in Section 106 of the
8Insurance Code.

9

443.14.  

(a) Notwithstanding any other law, a person shall not
10be subject tobegin delete civil, criminal, administrative, employment, or
11contractual liability or professional disciplinary action for
12participating in good faith compliance with this part, including an
13individual who is present when a qualified individual
14self-administers the prescribed aid-in-dying drug.end delete
begin insert civil or criminal
15liability solely because the person was present when the qualified
16individual self-administers the prescribed aid-in-dying drug. A
17person who is present may, without civil or criminal liability, assist
18the qualified individual by preparing the aid-in-dying drug so long
19as the person does not assist the qualified person in ingesting the
20aid-in-dying drug.end insert

21(b) A health care provider or professional organization or
22association shall not subject an individual to censure, discipline,
23suspension, loss of license, loss of privileges, loss of membership,
24or other penalty for participating in good faith compliance with
25this part or for refusing to participate in accordance with
26subdivision (e).

27(c) Notwithstanding any other law, a health care provider shall
28not be subject to civil, criminal, administrative, disciplinary,
29employment, credentialing, professional discipline, contractual
30liability, or medical staff action, sanction, or penalty or other
31liability for participating in this part, including, but not limited to,
32determining the diagnosis or prognosis of an individual,
33determining the capacity of an individual for purposes of qualifying
34for the act, providing information to an individual regarding this
35part, and providing a referral to a physician who participates in
36this part.begin insert Nothing in this subdivision shall be construed to limit
37the application of, or provide immunity from, Section 443.16 or
38443.17.end insert

39(d) (1) A request by a qualified individual to an attending
40physician to provide an aid-in-dying drug in good faith compliance
P17   1with the provisions of this part shall not provide the sole basis for
2the appointment of a guardian or conservator.

3(2) No actions taken in compliance with the provisions of this
4part shall constitute or provide the basis for any claim of neglect
5or elder abuse for any purpose of law.

6(e) (1) Participation in activities authorized pursuant to this
7part shall be voluntary. Notwithstanding Sections 442 to 442.7,
8inclusive, a person or entity that elects, for reasons of conscience,
9morality, or ethics, not to engage in activities authorized pursuant
10to this part is not required to take any action in support of an
11individual’s decision under this part.

12(2) Notwithstanding any other law, a health care provider is not
13subject to civil, criminal, administrative, disciplinary, employment,
14credentialing, professional discipline, contractual liability, or
15medical staff action, sanction, or penalty or other liability for
16refusing to participate in activities authorized under this part,
17 including, but not limited to, refusing to inform a patient regarding
18his or her rights under this part, and not referring an individual to
19a physician who participates in activities authorized under this
20part.

21(3) If a health care provider is unable or unwilling to carry out
22a qualified individual’s request under this part and the qualified
23individual transfers care to a new health care provider, the
24individual may request a copy of his or her medical records
25pursuant to law.

26

443.15.  

(a) Subject to subdivision (b), notwithstanding any
27other law, a health care provider may prohibit its employees,
28independent contractors, or other persons or entities, including
29other health care providers, from participating in activities under
30this part while on premises owned or under the management or
31direct control of that prohibiting health care provider or while
32acting within the course and scope of any employment by, or
33contract with, the prohibiting health care provider.

34(b) A health care provider that elects to prohibit its employees,
35independent contractors, or other persons or entities, including
36health care providers, from participating in activities under this
37part, as described in subdivision (a), shall first give notice of the
38 policy prohibiting participation under this part to the individual or
39entity. A health care provider that fails to provide notice to an
P18   1individual or entity in compliance with this subdivision shall not
2be entitled to enforce such a policy against that individual or entity.

3(c) Subject to compliance with subdivision (b), the prohibiting
4health care provider may take action, including, but not limited
5to, the following, as applicable, against any individual or entity
6that violates this policy:

7(1) Loss of privileges, loss of membership, or other action
8authorized by the bylaws or rules and regulations of the medical
9staff.

10(2) Suspension, loss of employment, or other action authorized
11by the policies and practices of the prohibiting health care provider.

12(3) Termination of any lease or other contract between the
13prohibiting health care provider and the individual or entity that
14violates the policy.

15(4) Imposition of any other nonmonetary remedy provided for
16in any lease or contract between the prohibiting health care provider
17and the individual or entity in violation of the policy.

18(d) Nothing in this section shall be construed to prevent, or to
19allow a prohibiting health care provider to prohibit, any other
20health care provider, employee, independent contractor, or other
21person or entity from any of the following:

22(1) Participating, or entering into an agreement to participate,
23in activities under this part, while on premises that are not owned
24or under the management or direct control of the prohibiting
25provider or while acting outside the course and scope of the
26participant’s duties as an employee of, or an independent contractor
27for, the prohibiting health care provider.

28(2) Participating, or entering into an agreement to participate,
29in activities under this part as an attending physician or consulting
30physician while on premises that are not owned or under the
31management or direct control of the prohibiting provider.

32(e) In taking actions pursuant to subdivision (c), a health care
33provider shall comply with all procedures required by law, its own
34policies or procedures, and any contract with the individual or
35entity in violation of the policy, as applicable.

36(f) For purposes of this section:

37(1) “Notice” means a separate statement in writing advising of
38the prohibiting health care provider policy with respect to
39participating in activities under this part.

P19   1(2) “Participating, or entering into an agreement to participate,
2in activities under this part” means doing or entering into an
3agreement to do any one or more of the following:

4(A) Performing the duties of an attending physician as specified
5in Section 443.5.

6(B) Performing the duties of a consulting physician as specified
7in Section 443.6.

8(C) Performing the duties of a mental health specialist, in the
9circumstance that a referral to one is made.

10(D) Delivering the prescription for, dispensing, or delivering
11the dispensed aid-in-dying drug pursuant to paragraph (2) of
12subdivision (b) of, and subdivision (c) of, Section 443.5.

13(E) Being present when the qualified individual takes the
14aid-in-dying drug prescribed pursuant to this part.

15(3) “Participating, or entering into an agreement to participate,
16in activities under this part” does not include doing, or entering
17into an agreement to do, any of the following:

18(A) Diagnosing whether a patient has a terminal disease,
19informing the patient of the medical prognosis, or determining
20whether a patient has the capacity to make decisions.

21(B) Providing information to a patient about this part.

22(C) Providing a patient, upon the patient’s request, with a referral
23to another health care provider for the purposes of participating in
24the activities authorized by this part.

25(g) Any action taken by a prohibiting provider pursuant to this
26section shall not be reportable under Sections 800 to 809.9,
27inclusive, of the Business and Professions Code. The fact that a
28health care provider participates in activities under this part shall
29not be the sole basis for a complaint or report by another health
30care provider of unprofessional or dishonorable conduct under
31Sections 800 to 809.9, inclusive, of the Business and Professions
32Code.

33(h) Nothing in this part shall prevent a health care provider from
34providing an individual with health care services that do not
35constitute participation in this part.

36

443.16.  

(a) A health care provider may not be sanctioned for
37any of the following:

38(1) Making an initial determination pursuant to the standard of
39care that an individual has a terminal disease and informing him
40or her of the medical prognosis.

P20   1(2) Providing information about the End of Life Option Act to
2a patient upon the request of the individual.

3(3) Providing an individual, upon request, with a referral to
4another physician.

5(b) A health care provider that prohibits activities under this
6part in accordance with Section 443.15 shall not sanction an
7 individual health care provider for contracting with a qualified
8individual to engage in activities authorized by this part if the
9individual health care provider is acting outside of the course and
10scope of his or her capacity as an employee or independent
11contractor of the prohibiting health care provider.

12(c) Notwithstanding any contrary provision in this section, the
13immunities and prohibitions on sanctions of a health care provider
14are solely reserved for actionsbegin insert of a health care providerend insert taken
15pursuant to thisbegin delete part, and those healthend deletebegin insert part. Notwithstanding any
16contrary provision in this part, healthend insert
care providers may be
17sanctionedbegin insert by their licensing board or agencyend insert for conduct and
18actionsbegin delete not included and provided for in this part if the conduct
19and actions do not comply with the standards and practices set
20forth by the Medical Board of California.end delete
begin insert constituting
21unprofessional conduct, including failure to comply in good faith
22with this part.end insert

23

443.17.  

(a) Knowingly altering or forging a request for an
24aid-in-dying drug to end an individual’s life without his or her
25authorization or concealing or destroying a withdrawal or rescission
26of a request for an aid-in-dying drug is punishable as a felony if
27the act is done with the intent or effect of causing the individual’s
28death.

29(b) Knowingly coercing or exerting undue influence on an
30individual to requestbegin insert or ingestend insert an aid-in-dying drug for the purpose
31of ending his or her life or to destroy a withdrawal or rescission
32of abegin delete requestend deletebegin insert request, or to administer an aid-in-dying drug to an
33individual without his or her knowledge or consent,end insert
is punishable
34as a felony.

35(c) For purposes of this section, “knowingly” has the meaning
36provided in Section 7 of the Penal Code.

begin insert

37(d) The attending physician, consulting physician, or mental
38health specialist shall not be related to the individual by blood,
39marriage, registered domestic partnership, or adoption, or be
40entitled to a portion of the individual’s estate upon death.

end insert
begin delete

P21   1(d)

end delete

2begin insert(e)end insert Nothing in this section shall be construed to limit civil
3liability.

begin delete

4(e)

end delete

5begin insert(f)end insert The penalties in this section do not preclude criminal
6penalties applicable under any law for conduct inconsistent with
7the provisions of this section.

8

443.18.  

Nothing in this part may be construed to authorize a
9physician or any other person to end an individual’s life by lethal
10injection, mercy killing, or active euthanasia. Actions taken in
11accordance with this part shall not, for any purposes, constitute
12suicide, assisted suicide, homicide, or elder abuse under the law.

13

443.19.  

(a) The State Department of Public Health shall collect
14and review the information submitted pursuant to Section 443.9.
15The information collected shall be confidential and shall be
16collected in a manner that protects the privacy of the patient, the
17patient’s family, and any medical provider or pharmacist involved
18with the patient under the provisions of this part. The information
19shall not be disclosed, discoverable, or compelled to be produced
20in any civil, criminal, administrative, or other proceeding.

21(b) On or before July 1, 2017, and each year thereafter, based
22on the information collected in the previous year, the department
23shall create a report with the information collected from the
24attending physician followup form and post that report to its
25Internet Web site. The report shall include, but not be limited to,
26all of the following based on the information that is provided to
27the department and on the department’s access to vital statistics:

28(1) The number of people for whom an aid-in-dying prescription
29was written.

30(2) The number of known individuals who died each year for
31whom aid-in-dying prescriptions were written, and the cause of
32death of those individuals.

33(3) For the period commencing January 1, 2016, to and including
34the previous year, cumulatively, the total number of aid-in-dying
35prescriptions written, the number of people who died due to use
36of aid-in-dying drugs, and the number of those people who died
37who were enrolled in hospice or other palliative care programs at
38the time of death.

39(4) The number of known deaths in California from using
40aid-in-dying drugs per 10,000 deaths in California.

P22   1(5) The number of physicians who wrote prescriptions for
2aid-in-dying drugs.

3(6) Of people who died due to using an aid-in-dying drug,
4demographic percentages organized by the following
5characteristics:

6(A) Age at death.

7(B) Education level.

8(C) Race.

9(D) Sex.

10(E) Type of insurance, including whether or not they had
11insurance.

12(F) Underlying illness.

13(c) The State Department of Public Health shall make available
14the attending physician checklist and compliance form, the
15consulting physician compliance form, and the attending physician
16followup form, as described in Section 443.22, by posting them
17on its Internet Web site.

18

443.20.  

A person who has custody or control of any unused
19aid-in-dying drugs prescribed pursuant to this part after the death
20of the patient shall personally deliver the unused aid-in-dying drugs
21for disposal by delivering it to the nearest qualified facility that
22properly disposes of controlled substances, or if none is available,
23shall dispose of it by lawful means in accordance with guidelines
24promulgated by the California State Board of Pharmacy or a federal
25Drug Enforcement Administration approved take-back program.

26

443.21.  

Any governmental entity that incurs costs resulting
27from a qualified individual terminating his or her life pursuant to
28the provisions of this part in a public place shall have a claim
29against the estate of the qualified individual to recover those costs
30and reasonable attorney fees related to enforcing the claim.

begin insert
31

begin insert443.215.end insert  

This part shall remain in effect only until January 1,
322026, and as of that date is repealed, unless a later enacted statute,
33that is enacted before January 1, 2026, deletes or extends that
34date.

end insert
35

443.22.  

(a) The Medical Board of California may update the
36attending physician checklist and compliance form, the consulting
37physician compliance form, and the attending physician followup
38form, based on those provided in subdivision (b). Upon completion,
39the State Department of Public Health shall publish the updated
40forms on its Internet Web site.

P23   1(b) Unless and until updated by the Medical Board of California
2pursuant to this section, the attending physician checklist and
3compliance form, the consulting physician compliance form, and
4the attending physician followup form shall be in the following
5form:

P24   1PRINTER PLEASE NOTE: TIP-IN MATERIAL TO BE
2INSERTED

[8 pages]

P32   1

SEC. 2.  

The Legislature finds and declares that Section 1 of
2this act, which adds Section 443.19 to the Health and Safety Code,
3imposes a limitation on the public’s right of access to the meetings
4of public bodies or the writings of public officials and agencies
5within the meaning of Section 3 of Article I of the California
6Constitution. Pursuant to that constitutional provision, the
7Legislature makes the following findings to demonstrate the interest
8protected by this limitation and the need for protecting that interest:

9(a) Any limitation to public access to personally identifiable
10patient data collected pursuant to Section 443.19 of the Health and
11 Safety Code as proposed to be added by this act is necessary to
12protect the privacy rights of the patient and his or her family.

13(b) The interests in protecting the privacy rights of the patient
14and his or her family in this situation strongly outweigh the public
15interest in having access to personally identifiable data relating to
16services.

17(c) The statistical report to be made available to the public
18pursuant to subdivision (b) of Section 443.19 of the Health and
19Safety Code is sufficient to satisfy the public’s right to access.

20

SEC. 3.  

The provisions of this part are severable. If any
21provision of this part or its application is held invalid, that
22invalidity shall not affect other provisions or applications that can
23be given effect without the invalid provision or application.

24

SEC. 4.  

No reimbursement is required by this act pursuant to
25Section 6 of Article XIII B of the California Constitution because
26the only costs that may be incurred by a local agency or school
27district will be incurred because this act creates a new crime or
28infraction, eliminates a crime or infraction, or changes the penalty
29for a crime or infraction, within the meaning of Section 17556 of
30the Government Code, or changes the definition of a crime within
31the meaning of Section 6 of Article XIII B of the California
32Constitution.



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