BILL NUMBER: ABX2 15 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY SEPTEMBER 3, 2015
AMENDED IN ASSEMBLY SEPTEMBER 3, 2015
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 add and repeal Part 1.85 (commencing with
Section 443) to of 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 bill , until January 1, 2026, 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 establish
the specified forms to request an
aid-in-dying drug and , under specified
circumstances, an interpreter declaration to be signed subject to
penalty of perjury, thereby creating a crime and imposing a
state-mandated local program , and a final attestation for an
aid-in-dying drug . 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 provide a person, except as provided,
immunity from civil, criminal, administrative, employment,
or contractual liability or professional disciplinary action for
participating in good faith compliance with the act,
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, and would specify that the immunities
and prohibitions on sanctions of a health care provider are solely
reserved for conduct of a health care provider 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 her life or
life, to destroy a withdrawal or rescission of a
request. request, or to administer an
aid-in-dying drug to an individual without their knowledge or
consent. 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:
SECTION 1. Part 1.85 (commencing with Section 443) is added to
Division 1 of the Health and Safety Code, to read:
PART 1.85. End of Life Option Act
443. This part shall be known and may be cited as the End of Life
Option Act.
443.1. As used in this part, the following definitions shall
apply:
(a) "Adult" means an individual 18 years of age or older.
(b) "Aid-in-dying drug" means a drug determined and prescribed by
a physician for a qualified individual, which the qualified
individual may choose to self-administer to bring about his or her
death due to a terminal disease.
(c) "Attending physician" means the physician who has primary
responsibility for the health care of an individual and treatment of
the individual's terminal disease.
(d) "Attending physician checklist and compliance form" means a
form, as described in Section 443.22, identifying each and every
requirement that must be fulfilled by an attending physician to be in
good faith compliance with this part should the attending physician
choose to participate.
(e) "Capacity to make medical decisions" means that, in the
opinion of an individual's attending physician, consulting physician,
psychiatrist, or psychologist, pursuant to Section 4609 of the
Probate Code, the individual has the ability to understand the nature
and consequences of a health care decision, the ability to
understand its significant benefits, risks, and alternatives, and the
ability to make and communicate an informed decision to health care
providers, including communication through a person familiar
with the individual's manner of communicating, if that person is
available. providers.
(f) "Consulting physician" means a physician who is independent
from the attending physician and who is qualified by specialty or
experience to make a professional diagnosis and prognosis regarding
an individual's terminal disease.
(g) "Department" means the State Department of Public Health.
(h) "Health care provider" or "provider of health care" means any
person licensed or certified pursuant to Division 2 (commencing with
Section 500) of the Business and Professions Code; any person
licensed pursuant to the Osteopathic Initiative Act or the
Chiropractic Initiative Act; any person certified pursuant to
Division 2.5 (commencing with Section 1797) of this code; and any
clinic, health dispensary, or health facility licensed pursuant to
Division 2 (commencing with Section 1200) of this code.
(i) "Informed decision" means a decision by an individual with a
terminal disease to request and obtain a prescription for a drug that
the individual may self-administer to end the individual's life,
that is based on an understanding and acknowledgment of the relevant
facts, and that is made after being fully informed by the attending
physician of all of the following:
(1) The individual's medical diagnosis and prognosis.
(2) The potential risks associated with taking the drug to be
prescribed.
(3) The probable result of taking the drug to be prescribed.
(4) The possibility that the individual may choose not to obtain
the drug or may obtain the drug but may decide not to ingest it.
(5) The feasible alternatives or additional treatment
opportunities, including, but not limited to, comfort care, hospice
care, palliative care, and pain control.
(j) "Medically confirmed" means the medical diagnosis and
prognosis of the attending physician has been confirmed by a
consulting physician who has examined the individual and the
individual's relevant medical records.
(k) "Mental health specialist assessment" means one or more
consultations between an individual and a mental health specialist
for the purpose of determining that the individual has the capacity
to make medical decisions and is not suffering from impaired judgment
due to a mental disorder.
(l) "Mental health specialist" means a psychiatrist or a licensed
psychologist.
(m) "Physician" means a doctor of medicine or osteopathy currently
licensed to practice medicine in this state.
(n) "Public place" means any street, alley, park, public building,
any place of business or assembly open to or frequented by the
public, and any other place that is open to the public view, or to
which the public has access.
(o) "Qualified individual" means an adult who has the capacity to
make medical decisions, is a resident of California, and has
satisfied the requirements of this part in order to obtain a
prescription for a drug to end his or her life.
(p) "Self-administer" means a qualified individual's affirmative,
conscious, and physical act of administering and ingesting the
aid-in-dying drug to bring about his or her own death.
(q) "Terminal disease" means an incurable and irreversible disease
that has been medically confirmed and will, within reasonable
medical judgment, result in death within six months.
443.2. (a) An individual who is an adult with the capacity to
make medical decisions and with a terminal disease may make a request
to receive a prescription for an aid-in-dying drug if all of the
following conditions are satisfied:
(1) The individual's attending physician has diagnosed the
individual with a terminal disease.
(2) The individual has voluntarily expressed the wish to receive a
prescription for an aid-in-dying drug.
(3) The individual is a resident of California and is able to
establish residency through any of the following means:
(A) Possession of a California driver license or other
identification issued by the State of California.
(B) Registration to vote in California.
(C) Evidence that the person owns or leases property in
California.
(D) Filing of a California tax return for the most recent tax
year.
(4) The individual documents his or her request pursuant to the
requirements set forth in Section 443.3.
(5) The individual has the physical and mental ability to
self-administer the aid-in-dying drug.
(b) A person shall not be considered a "qualified individual"
under the provisions of this part solely because of age or
disability.
(c) A request for a prescription for an aid-in-dying drug under
this part shall be made solely and directly by the individual
diagnosed with the terminal disease and shall not be made on behalf
of the patient, including, but not limited to, through a power of
attorney, an advance health care directive, a conservator, health
care agent, surrogate, or any other legally recognized health care
decisionmaker.
443.3. (a) An individual seeking to obtain a prescription for an
aid-in-dying drug pursuant to this part shall submit two oral
requests, a minimum of 15 days apart, and a written request to his or
her attending physician. The attending physician shall directly, and
not through a designee, receive all three requests required pursuant
to this section.
(b) A valid written request for an aid-in-dying drug under
subdivision (a) shall meet all of the following conditions:
(1) The request shall be in the form described in Section 443.11.
(2) The request shall be signed and dated, in the presence of two
witnesses, by the individual seeking the aid-in-dying drug.
(3) The request shall be witnessed by at least two other adult
persons who, in the presence of the individual, shall attest that to
the best of their knowledge and belief the individual is all of the
following:
(A) An individual who is personally known to them or has provided
proof of identity.
(B) An individual who voluntarily signed this request in their
presence.
(C) An individual whom they believe to be of sound mind and not
under duress, fraud, or undue influence.
(D) Not an individual for whom either of them is the attending
physician, consulting physician, or mental health specialist.
(c) Only one of the two witnesses at the time the written request
is signed may:
(1) Be related to the qualified individual by blood, marriage,
registered domestic partnership, or adoption or be entitled to a
portion of the individual's estate upon death.
(2) Own, operate, or be employed at a health care facility where
the individual is receiving medical treatment or resides.
(d) The attending physician, consulting physician, or mental
health specialist of the individual shall not be one of the witnesses
required pursuant to paragraph (3) of subdivision (b).
443.4. (a) An individual may at any time withdraw or rescind his
or her request for an aid-in-dying drug, or decide not to ingest an
aid-in-dying drug, without regard to the individual's mental state.
(b) A prescription for an aid-in-dying drug provided under this
part may not be written without the attending physician directly, and
not through a designee, offering the individual an opportunity to
withdraw or rescind the request.
443.5. (a) Before prescribing an aid-in-dying drug, the attending
physician shall do all of the following:
(1) Make the initial determination of all of the following:
(A) (i) Whether the requesting adult has the capacity to make
medical decisions.
(ii) If there are indications of a mental disorder, the physician
shall refer the individual for a mental health specialist assessment.
(iii) If a mental health specialist assessment referral is made,
no aid-in-dying drugs shall be prescribed until the mental health
specialist determines that the individual has the capacity to make
medical decisions and is not suffering from impaired judgment due to
a mental disorder.
(B) Whether the requesting adult has a terminal disease.
(C) Whether the requesting adult has voluntarily made the request
for an aid-in-dying drug pursuant to Sections 443.2 and 443.3.
(D) Whether the requesting adult is a qualified individual
pursuant to subdivision (o) of Section 443.1.
(2) Confirm that the individual is making an informed decision by
discussing with him or her all of the following:
(A) His or her medical diagnosis and prognosis.
(B) The potential risks associated with ingesting the requested
aid-in-dying drug.
(C) The probable result of ingesting the aid-in-dying drug.
(D) The possibility that he or she may choose to obtain the
aid-in-dying drug but not take it.
(E) The feasible alternatives or additional treatment options,
including, but not limited to, comfort care, hospice care, palliative
care, and pain control.
(3) Refer the individual to a consulting physician for medical
confirmation of the diagnosis and prognosis, and for a determination
that the individual has the capacity to make medical decisions and
has complied with the provisions of this part.
(4) Confirm that the qualified individual's request does not
arise from coercion or undue influence by another person by
discussing with the qualified individual, outside of the presence of
any other persons, except for an interpreter as required pursuant to
this part, whether or not the qualified individual is feeling coerced
or unduly influenced by another person.
(5) Counsel the qualified individual about the importance of all
of the following:
(A) Having another person present when he or she ingests the
aid-in-dying drug prescribed pursuant to this part.
(B) Not ingesting the aid-in-dying drug in a public place.
(C) Notifying the next of kin of his or her request for an
aid-in-dying drug. A qualified individual who declines or is unable
to notify next of kin shall not have his or her request denied for
that reason.
(D) Participating in a hospice program.
(E) Maintaining the aid-in-dying drug in a safe and secure
location until the time that the qualified individual will ingest it.
(6) Inform the individual that he or she may withdraw or rescind
the request for an aid-in-dying drug at any time and in any manner.
(7) Offer the individual an opportunity to withdraw or rescind the
request for an aid-in-dying drug before prescribing the aid-in-dying
drug.
(8) Verify, immediately before writing the prescription for an
aid-in-dying drug, that the qualified individual is making an
informed decision.
(9) Confirm that all requirements are met and all appropriate
steps are carried out in accordance with this part before writing a
prescription for an aid-in-dying drug.
(10) Fulfill the record documentation required under Sections
443.8 and 443.19.
(11) Complete the attending physician checklist and compliance
form, as described in Section 443.22, include it and the consulting
physician compliance form in the individual's medical record, and
submit both forms to the State Department of Public Health.
(12) Give the qualified individual the final attestation form,
with the instruction that the form be filled out and executed by the
qualified individual within 48 hours prior to the qualified
individual choosing to self-administer the aid-in-dying drug.
(b) If the conditions set forth in subdivision (a) are satisfied,
the attending physician may deliver the aid-in-dying drug in any of
the following ways:
(1) Dispensing the aid-in-dying drug directly, including ancillary
medication intended to minimize the qualified individual's
discomfort, if the attending physician meets all of the following
criteria:
(A) Is authorized to dispense medicine under California law.
(B) Has a current United States Drug Enforcement Administration
(USDEA) certificate.
(C) Complies with any applicable administrative rule or
regulation.
(2) With the qualified individual's written consent, contacting a
pharmacist, informing the pharmacist of the prescriptions, and
delivering the written prescriptions personally, by mail, or
electronically to the pharmacist, who may dispense the drug to the
qualified individual, the attending physician, or a person expressly
designated by the qualified individual and with the designation
delivered to the pharmacist in writing or verbally.
(c) Delivery of the dispensed drug to the qualified individual,
the attending physician, or a person expressly designated by the
qualified individual may be made by personal delivery, or, with a
signature required on delivery, by United Parcel Service, United
States Postal Service, Federal Express, or by messenger service.
443.6. Before a qualified individual obtains an aid-in-dying drug
from the attending physician, the consulting physician shall perform
all of the following:
(a) Examine the individual and his or her relevant medical
records.
(b) Confirm in writing the attending physician's diagnosis and
prognosis.
(c) Determine that the individual has the capacity to make medical
decisions, is acting voluntarily, and has made an informed decision.
(d) If there are indications of a mental disorder, refer the
individual for a mental health specialist assessment.
(e) Fulfill the record documentation required under this part.
(f) Submit the compliance form to the attending physician.
443.7. Upon referral from the attending or consulting physician
pursuant to this part, the mental health specialist shall:
(a) Examine the qualified individual and his or her relevant
medical records.
(b) Determine that the individual has the mental capacity to make
medical decisions, act voluntarily, and make an informed decision.
(c) Determine that the individual is not suffering from impaired
judgment due to a mental disorder.
(d) Fulfill the record documentation requirements of this part.
443.8. All of the following shall be documented in the individual'
s medical record:
(a) All oral requests for aid-in-dying drugs.
(b) All written requests for aid-in-dying drugs.
(c) The attending physician's diagnosis and prognosis, and the
determination that a qualified individual has the capacity to make
medical decisions, is acting voluntarily, and has made an informed
decision, or that the attending physician has determined that the
individual is not a qualified individual.
(d) The consulting physician's diagnosis and prognosis, and
verification that the qualified individual has the capacity to make
medical decisions, is acting voluntarily, and has made an informed
decision, or that the consulting physician has determined that the
individual is not a qualified individual.
(e) A report of the outcome and determinations made during a
mental health specialist's assessment, if performed.
(f) The attending physician's offer to the qualified individual to
withdraw or rescind his or her request at the time of the individual'
s second oral request.
(g) A note by the attending physician indicating that all
requirements under Sections 443.5 and 443.6 have been met and
indicating the steps taken to carry out the request, including a
notation of the aid-in-dying drug prescribed.
443.9. (a) Within 30 calendar days of writing a prescription for
an aid-in-dying drug, the attending physician shall submit to the
State Department of Public Health a copy of the qualifying patient's
written request, the attending physician checklist and compliance
form, and the consulting physician compliance form.
(b) Within 30 calendar days following the qualified individual's
death from ingesting the aid-in-dying drug, or any other cause, the
attending physician shall submit the attending physician followup
form to the State Department of Public Health.
443.10. A qualified individual may not receive a prescription for
an aid-in-dying drug pursuant to this part unless he or she has made
an informed decision. Immediately before writing a prescription for
an aid-in-dying drug under this part, the attending physician shall
verify that the individual is making an informed decision.
443.11. (a) A request for an aid-in-dying drug as authorized by
this part shall be in the following form:
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.
(b) (1) The written language of the request shall be written in
the same translated language as any conversations, consultations, or
interpreted conversations or consultations between a patient and his
or her attending or consulting physicians.
(2) Notwithstanding paragraph (1), the written request may be
prepared in English even when the conversations or consultations or
interpreted conversations or consultations were conducted in a
language other than English if the English language form includes an
attached interpreter's declaration that is signed under penalty of
perjury. The interpreter's declaration shall state words to the
effect 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
(3) An interpreter whose services are provided pursuant to
paragraph (2) shall not be related to the qualified individual by
blood, marriage, registered domestic partnership, or adoption or be
entitled to a portion of the person's estate upon death. An
interpreter whose services are provided pursuant to paragraph (2)
shall meet the standards promulgated by the California Healthcare
Interpreting Association or the National Council on Interpreting in
Health Care or other standards deemed acceptable by the department
for health care providers in California.
(c) The final attestation form given by the attending physician to
the qualified individual at the time the attending physician writes
the prescription shall appear in the following form:
FINAL 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.
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 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.
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.
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 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.
Signed:..........................................
....
Dated:...........................................
....
Time:............................................
.....
(1) Within 48 hours prior to the individual self-administering the
aid-in-dying drug, the individual shall complete the final
attestation form. If aid-in-dying medication is not returned or
relinquished upon the patient's death as required in Section 443.20,
the completed form shall be delivered by the individual's health care
provider, family member, or other representative to the attending
physician to be included in the patient's medical record.
(2) Upon receiving the final attestation form the attending
physician shall add this form to the medical records of the qualified
individual.
443.12. (a) A provision in a contract, will, or other agreement
executed on or after January 1, 2016, whether written or oral, to the
extent the provision would affect whether a person may make,
withdraw, or rescind a request for an aid-in-dying drug is not valid.
(b) An obligation owing under any contract executed on or after
January 1, 2016, may not be conditioned or affected by a qualified
individual making, withdrawing, or rescinding a request for an
aid-in-dying drug.
443.13. (a) (1) The sale, procurement, or issuance of a life,
health, or annuity policy, health care service plan contract, or
health benefit plan, or the rate charged for a policy or plan
contract may not be conditioned upon or affected by a person making
or rescinding a request for an aid-in-dying drug.
(2) Pursuant to Section 443.18, death resulting from the
self-administration of an aid-in-dying drug is not suicide, and
therefore health and insurance coverage shall not be exempted on that
basis.
(b) Notwithstanding any other law, a qualified individual's act of
self-administering an aid-in-dying drug shall not have an effect
upon a life, health, or annuity policy other than that of a natural
death from the underlying disease.
(c) An insurance carrier shall not provide 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. Any communication shall not include both
the denial of treatment and information as to the availability of
aid-in-dying drug coverage. For the purposes of this subdivision,
"insurance carrier" means a health care service plan as defined in
Section 1345 of this code or a carrier of health insurance as defined
in Section 106 of the Insurance Code.
443.14. (a) Notwithstanding any other law, a person shall not be
subject to civil, criminal, administrative, employment, or
contractual liability or professional disciplinary action for
participating in good faith compliance with this part, including an
individual who is present when a qualified individual
self-administers the prescribed aid-in-dying drug.
civil or criminal liability solely because the person was present
when the qualified individual self-administers the prescribed
aid-in-dying drug. A person who is present may, without civil or
criminal liability, assist the qualified individual by
preparing the aid-in-dying drug so long as the person does not assist
the qualified person in ingesting the aid-in-dying drug.
(b) A health care provider or professional organization or
association shall not subject an individual to censure, discipline,
suspension, loss of license, loss of privileges, loss of membership,
or other penalty for participating in good faith compliance with this
part or for refusing to participate in accordance with subdivision
(e).
(c) Notwithstanding any other law, a health care provider shall
not be subject to civil, criminal, administrative, disciplinary,
employment, credentialing, professional discipline, contractual
liability, or medical staff action, sanction, or penalty or other
liability for participating in this part, including, but not limited
to, determining the diagnosis or prognosis of an individual,
determining the capacity of an individual for purposes of qualifying
for the act, providing information to an individual regarding this
part, and providing a referral to a physician who participates in
this part. Nothing in this subdivision shall be construed to
limit the application of, or provide immunity from, Section 443.16 or
443.17.
(d) (1) A request by a qualified individual to an attending
physician to provide an aid-in-dying drug in good faith compliance
with the provisions of this part shall not provide the sole basis for
the appointment of a guardian or conservator.
(2) No actions taken in compliance with the provisions of this
part shall constitute or provide the basis for any claim of neglect
or elder abuse for any purpose of law.
(e) (1) Participation in activities authorized pursuant to this
part shall be voluntary. Notwithstanding Sections 442 to 442.7,
inclusive, a person or entity that elects, for reasons of conscience,
morality, or ethics, not to engage in activities authorized pursuant
to this part is not required to take any action in support of an
individual's decision under this part.
(2) Notwithstanding any other law, a health care provider is not
subject to civil, criminal, administrative, disciplinary, employment,
credentialing, professional discipline, contractual liability, or
medical staff action, sanction, or penalty or other liability for
refusing to participate in activities authorized under this part,
including, but not limited to, refusing to inform a patient regarding
his or her rights under this part, and not referring an individual
to a physician who participates in activities authorized under this
part.
(3) If a health care provider is unable or unwilling to carry out
a qualified individual's request under this part and the qualified
individual transfers care to a new health care provider, the
individual may request a copy of his or her medical records pursuant
to law.
443.15. (a) Subject to subdivision (b), notwithstanding any other
law, a health care provider may prohibit its employees, independent
contractors, or other persons or entities, including other health
care providers, from participating in activities under this part
while on 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.
(b) A health care provider that elects to prohibit its employees,
independent contractors, or other persons or entities, including
health care providers, from participating in activities under this
part, as described in subdivision (a), shall first give notice of the
policy prohibiting participation under this part to the individual
or entity. A health care provider that fails to provide notice to an
individual or entity in compliance with this subdivision shall not be
entitled to enforce such a policy against that individual or entity.
(c) Subject to compliance with subdivision (b), the prohibiting
health care provider may take action, including, but not limited to,
the following, as applicable, against any individual or entity that
violates this policy:
(1) Loss of privileges, loss of membership, or other action
authorized by the bylaws or rules and regulations of the medical
staff.
(2) Suspension, loss of employment, or other action authorized by
the policies and practices of the prohibiting health care provider.
(3) Termination of any lease or other contract between the
prohibiting health care provider and the individual or entity that
violates the policy.
(4) Imposition of any other nonmonetary remedy provided for in any
lease or contract between the prohibiting health care provider and
the individual or entity in violation of the policy.
(d) Nothing in this section shall be construed to prevent, or to
allow a prohibiting health care provider to prohibit, any other
health care provider, employee, independent contractor, or other
person or entity from any of the following:
(1) Participating, or entering into an agreement to participate,
in activities under this part, while on premises that are not owned
or under the management or direct control of the prohibiting provider
or while acting outside the course and scope of the participant's
duties as an employee of, or an independent contractor for, the
prohibiting health care provider.
(2) Participating, or entering into an agreement to participate,
in activities under this part as an attending physician or consulting
physician while on premises that are not owned or under the
management or direct control of the prohibiting provider.
(e) In taking actions pursuant to subdivision (c), a health care
provider shall comply with all procedures required by law, its own
policies or procedures, and any contract with the individual or
entity in violation of the policy, as applicable.
(f) For purposes of this section:
(1) "Notice" means a separate statement in writing advising of the
prohibiting health care provider policy with respect to
participating in activities under this part.
(2) "Participating, or entering into an agreement to participate,
in activities under this part" means doing or entering into an
agreement to do any one or more of the following:
(A) Performing the duties of an attending physician as specified
in Section 443.5.
(B) Performing the duties of a consulting physician as specified
in Section 443.6.
(C) Performing the duties of a mental health specialist, in the
circumstance that a referral to one is made.
(D) Delivering the prescription for, dispensing, or delivering the
dispensed aid-in-dying drug pursuant to paragraph (2) of subdivision
(b) of, and subdivision (c) of, Section 443.5.
(E) Being present when the qualified individual takes the
aid-in-dying drug prescribed pursuant to this part.
(3) "Participating, or entering into an agreement to participate,
in activities under this part" does not include doing, or entering
into an agreement to do, any of the following:
(A) Diagnosing whether a patient has a terminal disease, informing
the patient of the medical prognosis, or determining whether a
patient has the capacity to make decisions.
(B) Providing information to a patient about this part.
(C) Providing a patient, upon the patient's request, with a
referral to another health care provider for the purposes of
participating in the activities authorized by this part.
(g) Any action taken by a prohibiting provider pursuant to this
section shall not be reportable under Sections 800 to 809.9,
inclusive, of the Business and Professions Code. The fact that a
health care provider participates in activities under this part shall
not be the sole basis for a complaint or report by another health
care provider of unprofessional or dishonorable conduct under
Sections 800 to 809.9, inclusive, of the Business and Professions
Code.
(h) Nothing in this part shall prevent a health care provider from
providing an individual with health care services that do not
constitute participation in this part.
443.16. (a) A health care provider may not be sanctioned for any
of the following:
(1) Making an initial determination pursuant to the standard of
care that an individual has a terminal disease and informing him or
her of the medical prognosis.
(2) Providing information about the End of Life Option Act to a
patient upon the request of the individual.
(3) Providing an individual, upon request, with a referral to
another physician.
(b) A health care provider that prohibits activities under this
part in accordance with Section 443.15 shall not sanction an
individual health care provider for contracting with a qualified
individual to engage in activities authorized by this part if the
individual health care provider is acting outside of the course and
scope of his or her capacity as an employee or independent contractor
of the prohibiting health care provider.
(c) Notwithstanding any contrary provision in this section, the
immunities and prohibitions on sanctions of a health care provider
are solely reserved for actions of a health care provider
taken pursuant to this part, and those health
part. Notwithstanding any contrary provision in this part, health
care providers may be sanctioned by their licensing board
or agency for conduct and actions not included and
provided for in this part if the conduct and actions do not comply
with the standards and practices set forth by the Medical Board of
California. constituting unprofessional conduct,
including failure to comply in good faith with this part.
443.17. (a) Knowingly altering or forging a request for an
aid-in-dying drug to end an individual's life without his or her
authorization or concealing or destroying a withdrawal or rescission
of a request for an aid-in-dying drug is punishable as a felony if
the act is done with the intent or effect of causing the individual's
death.
(b) Knowingly coercing or exerting undue influence on an
individual to request or ingest an aid-in-dying drug for
the purpose of ending his or her life or to destroy a withdrawal or
rescission of a request request,
or to administer an aid-in-dying drug to an individual without his or
her knowledge or consent, is punishable as a felony.
(c) For purposes of this section, "knowingly" has the meaning
provided in Section 7 of the Penal Code.
(d) The attending physician, consulting physician, or mental
health specialist shall not be related to the individual by blood,
marriage, registered domestic partnership, or adoption, or be
entitled to a portion of the individual's estate upon death.
(d)
(e) Nothing in this section shall be construed to limit
civil liability.
(e)
(f) The penalties in this section do not preclude
criminal penalties applicable under any law for conduct inconsistent
with the provisions of this section.
443.18. Nothing in this part may be construed to authorize a
physician or any other person to end an individual's life by lethal
injection, mercy killing, or active euthanasia. Actions taken in
accordance with this part shall not, for any purposes, constitute
suicide, assisted suicide, homicide, or elder abuse under the law.
443.19. (a) The State Department of Public Health shall collect
and review the information submitted pursuant to Section 443.9. The
information collected shall be confidential and shall be collected in
a manner that protects the privacy of the patient, the patient's
family, and any medical provider or pharmacist involved with the
patient under the provisions of this part. The information shall not
be disclosed, discoverable, or compelled to be produced in any civil,
criminal, administrative, or other proceeding.
(b) On or before July 1, 2017, and each year thereafter, based on
the information collected in the previous year, the department shall
create a report with the information collected from the attending
physician followup form and post that report to its Internet Web
site. The report shall include, but not be limited to, all of the
following based on the information that is provided to the department
and on the department's access to vital statistics:
(1) The number of people for whom an aid-in-dying prescription was
written.
(2) The number of known individuals who died each year for whom
aid-in-dying prescriptions were written, and the cause of death of
those individuals.
(3) For the period commencing January 1, 2016, to and including
the previous year, cumulatively, the total number of aid-in-dying
prescriptions written, the number of people who died due to use of
aid-in-dying drugs, and the number of those people who died who were
enrolled in hospice or other palliative care programs at the time of
death.
(4) The number of known deaths in California from using
aid-in-dying drugs per 10,000 deaths in California.
(5) The number of physicians who wrote prescriptions for
aid-in-dying drugs.
(6) Of people who died due to using an aid-in-dying drug,
demographic percentages organized by the following characteristics:
(A) Age at death.
(B) Education level.
(C) Race.
(D) Sex.
(E) Type of insurance, including whether or not they had
insurance.
(F) Underlying illness.
(c) The State Department of Public Health shall make available the
attending physician checklist and compliance form, the consulting
physician compliance form, and the attending physician followup form,
as described in Section 443.22, by posting them on its Internet Web
site.
443.20. A person who has custody or control of any unused
aid-in-dying drugs prescribed pursuant to this part after the death
of the patient shall personally deliver the unused aid-in-dying drugs
for disposal by delivering it to the nearest qualified facility that
properly disposes of controlled substances, or if none is available,
shall dispose of it by lawful means in accordance with guidelines
promulgated by the California State Board of Pharmacy or a federal
Drug Enforcement Administration approved take-back program.
443.21. Any governmental entity that incurs costs resulting from
a qualified individual terminating his or her life pursuant to the
provisions of this part in a public place shall have a claim against
the estate of the qualified individual to recover those costs and
reasonable attorney fees related to enforcing the claim.
443.215. This part shall remain in effect only until January 1,
2026, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2026, deletes or extends
that date.
443.22. (a) The Medical Board of California may update the
attending physician checklist and compliance form, the consulting
physician compliance form, and the attending physician followup form,
based on those provided in subdivision (b). Upon completion, the
State Department of Public Health shall publish the updated forms on
its Internet Web site.
(b) Unless and until updated by the Medical Board of California
pursuant to this section, the attending physician checklist and
compliance form, the consulting physician compliance form, and the
attending physician followup form shall be in the following form:
GRAPHIC INSERT HERE: SEE PRINTED VERSION OF THE BILL]
SEC. 2. The Legislature finds and declares that Section 1 of this
act, which adds Section 443.19 to the Health and Safety Code, imposes
a limitation on the public's right of access to the meetings of
public bodies or the writings of public officials and agencies within
the meaning of Section 3 of Article I of the California
Constitution. Pursuant to that constitutional provision, the
Legislature makes the following findings to demonstrate the interest
protected by this limitation and the need for protecting that
interest:
(a) Any limitation to public access to personally identifiable
patient data collected pursuant to Section 443.19 of the Health and
Safety Code as proposed to be added by this act is necessary to
protect the privacy rights of the patient and his or her family.
(b) The interests in protecting the privacy rights of the patient
and his or her family in this situation strongly outweigh the public
interest in having access to personally identifiable data relating to
services.
(c) The statistical report to be made available to the public
pursuant to subdivision (b) of Section 443.19 of the Health and
Safety Code is sufficient to satisfy the public's right to access.
SEC. 3. The provisions of this part are severable. If any
provision of this part or its application is held invalid, that
invalidity shall not affect other provisions or applications that can
be given effect without the invalid provision or application.
SEC. 4. No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of the
Government Code, or changes the definition of a crime within the
meaning of Section 6 of Article XIII B of the California
Constitution.