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 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 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 state-mandated local program. 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
begin delete uponend delete or affected begin delete byend delete 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 begin delete plan,end delete 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 immunity from civil, criminal, administrative, employment, or contractual liability or professional disciplinary action for participating in good faith compliance with the act, and would specify that the immunities and prohibitions on sanctions of a health care provider are solely reserved for conduct 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 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 to destroy a withdrawal or rescission of a request. 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
begin delete requireend delete the Medical Board of California to update those forms begin delete on or before January 1, 2019,end delete and 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 begin delete records and toend delete make a statistical report of the information begin delete collected.end delete
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:
Part 1.85 (commencing with Section 443) is
2added to Division 1 of the Health and Safety Code, to read:
This part shall be known and may be cited as the End of
7Life Option Act.
As used in this part, the following definitions shall apply:
2(a) “Adult” means an individual 18 years of age or older.
3(b) “Aid-in-dying drug” means a drug determined and prescribed
4by a physician for a qualified individual, which the qualified
5individual may choose to self-administer to bring about his or her
6death due to a terminal disease.
7(c) “Attending physician” means the physician who has primary
8responsibility for the health care of an individual and treatment of
9the individual’s terminal disease.
10(d) “Attending physician checklist and compliance form” means
11a form, as described in Section 443.22, identifying each and every
12requirement that must be fulfilled by an attending physician to be
13in good faith compliance with this part should the attending
14physician choose to participate.
15(e) “Capacity to make medical decisions” means that, in the
16opinion of an individual’s attending physician, consulting
17physician, psychiatrist, or psychologist, pursuant to Section 4609
18of the Probate Code, the individual has the ability to understand
19the nature and consequences of a health care decision, the ability
20to understand its significant benefits, risks, and alternatives, and
21the ability to make and communicate an informed decision to health
22care providers, including communication through a person familiar
23with the individual’s manner of communicating, if that person is
25(f) “Consulting physician” means a physician who is
26independent from the attending physician and who is qualified by
27specialty or experience to make a professional diagnosis and
28prognosis regarding an individual’s terminal disease.
29(g) “Department” means the State Department of Public Health.
30(h) “Health care provider” or “provider of health care” means
31any person licensed or certified pursuant to Division 2
32(commencing with Section 500) of the Business and Professions
33Code; any person licensed pursuant to the Osteopathic Initiative
34Act or the Chiropractic Initiative Act; any person certified pursuant
35to Division 2.5 (commencing with Section 1797) of this code; and
36any clinic, health dispensary, or health facility licensed pursuant
37to Division 2 (commencing with Section 1200) of this code.
38(i) “Informed decision” means a decision by an individual with
39a terminal disease to request and obtain a prescription for a drug
40that the individual may self-administer to end the individual’s life,
P5 1that is based on an understanding and acknowledgment of the
2relevant facts, and that is made after being fully informed by the
3attending physician of all of the following:
4(1) The individual’s medical diagnosis and prognosis.
5(2) The potential risks associated with taking the drug to be
7(3) The probable result of taking the drug to be prescribed.
8(4) The possibility that the individual may choose not to obtain
9the drug or may obtain the drug but may decide not to ingest it.
10(5) The feasible alternatives or additional treatment
11opportunities, including, but not limited to, comfort care, hospice
12care, palliative care, and pain control.
13(j) “Medically confirmed” means the medical diagnosis and
14prognosis of the attending physician has been confirmed by a
15consulting physician who has examined the individual and the
16individual’s relevant medical records.
17(k) “Mental health specialist assessment” means one or more
18consultations between an individual and a mental health specialist
19for the purpose of determining that the individual has the capacity
20to make medical decisions and is not suffering from impaired
21judgment due to a mental disorder.
22(l) “Mental health specialist” means a psychiatrist or a licensed
24(m) “Physician” means a doctor of medicine or osteopathy
25currently licensed to practice medicine in this state.
26(n) “Public place” means any street, alley, park, public building,
27any place of business or assembly open to or frequented by the
28public, and any other place that is open to the public view, or to
29which the public has access.
30(o) “Qualified individual” means an adult who has the capacity
31to make medical decisions, is a resident of California, and has
32satisfied the requirements of this part in order to obtain a
33prescription for a drug to end his or her life.
34(p) “Self-administer” means a qualified individual’s affirmative,
35conscious, and physical act of administering and ingesting the
36aid-in-dying drug to bring about his or her own death.
37(q) “Terminal disease” means an incurable and irreversible
38disease that has been medically confirmed and will, within
39reasonable medical judgment, result in death within six months.
(a) An individual who is an adult with the capacity to
2make medical decisions and with a terminal disease may make a
3request to receive a prescription for an aid-in-dying drug if all of
4the following conditions are satisfied:
5(1) The individual’s attending physician has diagnosed the
6individual with a terminal disease.
7(2) The individual has voluntarily expressed the wish to receive
8a prescription for an aid-in-dying drug.
9(3) The individual is a resident of California and is able to
10establish residency through any of the following means:
11(A) Possession of a California driver license or other
12identification issued by the State of California.
13(B) Registration to vote in California.
14(C) Evidence that the person owns or leases property in
16(D) Filing of a California tax return for the most recent tax year.
17(4) The individual documents his or her request pursuant to the
18requirements set forth in Section 443.3.
19(5) The individual has the physical and mental ability to
20self-administer the aid-in-dying drug.
21(b) A person shall not be considered a “qualified individual”
22under the provisions of this part solely because of age or disability.
23(c) A request for a prescription for an aid-in-dying drug under
24this part shall be made solely and directly by the individual
25diagnosed with the terminal disease and shall not be made on behalf
26of the patient, including, but not limited to, through a power of
27attorney, an advance health care directive, a conservator, health
28care agent, surrogate, or any other legally recognized health care
(a) An individual seeking to obtain a prescription for
31an aid-in-dying drug pursuant to this part shall submit two oral
32requests, a minimum of 15 days apart, and a written request to his
33or her attending physician. The attending physician shall directly,
34and not through a designee, receive all three requests required
35pursuant to this section.
36(b) A valid written request for an aid-in-dying drug under
37subdivision (a) shall meet all of the following conditions:
38(1) The request shall be in the form described in Section 443.11.
39(2) The request shall be
signed and dated, in the presence of
40two witnesses, by the individual seeking the aid-in-dying drug.
P7 1(3) The request shall be witnessed by at least two other adult
2persons who, in the presence of the individual, shall attest that to
3the best of their knowledge and belief the individual is all of the
5(A) An individual who is personally known to them or has
6provided proof of identity.
7(B) An individual who voluntarily signed this request in their
9(C) An individual whom they believe to be of sound mind and
10not under duress, fraud, or undue influence.
11(D) Not an individual for
whom either of them is the attending
12physician, consulting physician, or mental health specialist.
13(c) Only one of the two witnesses at the time the written request
14is signed may:
15(1) Be related to the qualified individual by blood, marriage,
16registered domestic partnership, or adoption or be entitled to a
17portion of the individual’s estate upon death.
18(2) Own, operate, or be employed at a health care facility where
19the individual is receiving medical treatment or resides.
20(d) The attending physician, consulting physician, or mental
21health specialist of the individual shall not be one of the witnesses
22required pursuant to paragraph (3) of subdivision (b).
(a) An individual may at any time withdraw or rescind
24his or her request for an aid-in-dying drug, or decide not to ingest
25an aid-in-dying drug, without regard to the individual’s mental
27(b) A prescription for an aid-in-dying drug provided under this
28part may not be written without the attending physician directly,
29and not through a designee, offering the individual an opportunity
30to withdraw or rescind the request.
(a) Before prescribing an aid-in-dying drug, the
32attending physician shall do all of the following:
33(1) Make the initial determination of all of the following:
34(A) (i) Whether the requesting adult has the capacity to make
36(ii) If there are indications of a mental disorder, the physician
37shall refer the individual for a mental health specialist assessment.
38(iii) If a mental health specialist assessment referral is made,
39no aid-in-dying drugs shall be prescribed until the mental health
40specialist determines that the individual has the capacity to make
P8 1medical decisions and is not suffering from impaired judgment
2due to a mental disorder.
3(B) Whether the requesting adult has a terminal disease.
4(C) Whether the requesting adult has voluntarily made the
5request for an aid-in-dying drug pursuant to Sections 443.2 and
7(D) Whether the requesting adult is a qualified individual
8pursuant to subdivision (o) of Section 443.1.
9(2) Confirm that the individual is making an informed decision
10by discussing with him or her all of the following:
11(A) His or her medical diagnosis and prognosis.
12(B) The potential risks associated with ingesting the requested
14(C) The probable result of ingesting the aid-in-dying drug.
15(D) The possibility that he or she may choose to obtain the
16aid-in-dying drug but not take it.
17(E) The feasible alternatives or additional treatment options,
18including, but not limited to, comfort care, hospice care, palliative
19care, and pain control.
20(3) Refer the individual to a consulting physician for medical
21confirmation of the diagnosis and prognosis, and for a
22determination that the individual has the capacity to make medical
23decisions and has complied with the provisions of this part.
24 (4) Confirm that the qualified individual’s request does not arise
25from coercion or undue influence by another person by discussing
26with the qualified individual, outside of the presence of any other
27persons, except for an interpreter as required pursuant to this part,
28whether or not the qualified individual is feeling coerced or unduly
29influenced by another person.
30(5) Counsel the qualified individual about the importance of all
31of the following:
32(A) Having another person present when he or she ingests the
33aid-in-dying drug prescribed pursuant to this part.
34(B) Not ingesting the aid-in-dying drug in a public place.
35(C) Notifying the next of kin of his or her request for an
36aid-in-dying drug. A qualified individual who declines or is unable
37to notify next of kin shall not have his or her request denied for
39(D) Participating in a hospice program.
P9 1(E) Maintaining the aid-in-dying drug in a safe and secure
2location until the time that the qualified individual will ingest it.
3(6) Inform the individual that he or she may withdraw or rescind
4the request for an aid-in-dying drug at any time and in any manner.
5(7) Offer the individual an opportunity to withdraw or rescind
6the request for an aid-in-dying drug before prescribing the
8(8) Verify, immediately before writing the prescription for an
9aid-in-dying drug, that the qualified individual is making an
11 (9) Confirm that all requirements are met and all appropriate
12steps are carried out in accordance with this part before writing a
13prescription for an aid-in-dying drug.
14(10) Fulfill the record documentation required under Sections
15443.8 and 443.19.
16(11) Complete the attending physician checklist and compliance
17form, as described in Section 443.22, include it in the individual’s medical record, and
begin delete itend delete to the State Department of Public Health.
20(b) If the conditions set forth in subdivision (a) are satisfied,
21the attending physician may deliver the aid-in-dying drug in any
22of the following ways:
23(1) Dispensing the aid-in-dying drug directly, including ancillary
24medication intended to minimize the qualified individual’s
25discomfort, if the attending physician meets all of the following
27(A) Is authorized to dispense medicine under California law.
28(B) Has a current United States Drug Enforcement
29Administration (USDEA) certificate.
30(C) Complies with any applicable administrative rule or
32(2) With the qualified individual’s written consent, contacting
33a pharmacist, informing the pharmacist of the prescriptions, and
34delivering the written prescriptions personally, by mail, or
35electronically to the pharmacist, who may dispense the drug to the
36qualified individual, the attending physician, or a person expressly
37designated by the qualified individual and with the designation
38delivered to the pharmacist in writing or verbally.
39(c) Delivery of the dispensed drug to the qualified individual,
40the attending physician, or a person expressly designated by the
P10 1qualified individual may be made by personal delivery, or, with a
2signature required on delivery, by United Parcel Service, United
3States Postal Service, Federal Express, or by messenger service.
Before a qualified individual obtains an aid-in-dying
5drug from the attending physician, the consulting physician shall
6perform all of the following:
7(a) Examine the individual and his or her relevant medical
9(b) Confirm in writing the attending physician’s diagnosis and
11(c) Determine that the individual has the capacity to make
12medical decisions, is acting voluntarily, and has made an informed
14(d) If there are indications of a mental disorder, refer the
15individual for a mental health specialist assessment.
16(e) Fulfill the record documentation required under this part.
Upon referral from the attending or consulting physician
19pursuant to this part, the mental health specialist shall:
20(a) Examine the qualified individual and his or her relevant
22(b) Determine that the individual has the mental capacity to
23make medical decisions, act voluntarily, and make an informed
25(c) Determine that the individual is not suffering from impaired
26judgment due to a mental disorder.
27(d) Fulfill the record documentation requirements of this part.
All of the following shall be documented in the
29individual’s medical record:
30(a) All oral requests for aid-in-dying drugs.
31(b) All written requests for aid-in-dying drugs.
32(c) The attending physician’s diagnosis and prognosis, and the
33determination that a qualified individual has the capacity to make
34medical decisions, is acting voluntarily, and has made an informed
35decision, or that the attending physician has determined that the
36individual is not a qualified individual.
37(d) The consulting physician’s
diagnosis and prognosis, and
38verification that the qualified individual has the capacity to make
39medical decisions, is acting voluntarily, and has made an informed
P11 1decision, or that the consulting physician has determined that the
2individual is not a qualified individual.
3(e) A report of the outcome and determinations made during a
4mental health specialist’s assessment, if performed.
5(f) The attending physician’s offer to the qualified individual
6to withdraw or rescind his or her request at the time of the
7individual’s second oral request.
8(g) A note by the attending physician indicating that all
9requirements under Sections 443.5 and 443.6 have been met and
10indicating the steps taken to carry out the request, including a
11 notation of the aid-in-dying drug prescribed.
(a) Within 30 calendar days of writing a prescription
13for an aid-in-dying drug, the attending physician shall submit to
14the State Department of Public Health a copy of the qualifying
15patient’s written request, the attending physician
16 compliance form, and the consulting physician compliance form.
17(b) Within 30 calendar days following the qualified individual’s
18death from ingesting the aid-in-dying drug, or any other cause, the
19attending physician shall submit the attending physician followup
20form to the State Department of Public Health.
A qualified individual may not receive a prescription
22for an aid-in-dying drug pursuant to this part unless he or she has
23made an informed decision. Immediately before writing a
24prescription for an aid-in-dying drug under this part, the attending
25physician shall verify that the individual is making an informed
(a) A request for an aid-in-dying drug as authorized
28by 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.|
|............ 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.|
|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.|
|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.|
37(b) (1) The written language of the request shall be written in
38the same translated language as any conversations, consultations,
39or interpreted conversations or consultations between a patient and
40his or her attending or consulting physicians.
P13 1(2) Notwithstanding paragraph (1), the written request may be
2prepared in English even when the conversations or consultations
3or interpreted conversations or consultations were conducted in a
4language other than English if the English language form includes
5an attached interpreter’s declaration that is signed under penalty
6 of perjury. The interpreter’s declaration shall state words to the
|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 printed name
26(3) An interpreter whose services are provided pursuant to
27paragraph (2) shall not be related to the qualified individual by
28blood, marriage, registered domestic partnership, or adoption or
29be entitled to a portion of the person’s estate upon death. An
30interpreter whose services are provided pursuant to paragraph (2)
31shall meet the standards promulgated by the California Healthcare
32Interpreting Association or the National Council on Interpreting
33in Health Care or other standards deemed acceptable by the
34department for health care providers in California.
(a) A provision in a contract, will, or other agreement
36executed on or after January 1, 2016, whether written or oral, to
37the extent the provision would affect whether a person may make,
38withdraw, or rescind a request for an aid-in-dying drug is not valid.
39(b) An obligation owing under any contract executed on or after
40January 1, 2016, may not be conditioned or affected by a qualified
P14 1individual making, withdrawing, or rescinding a request for an
(a) (1) The sale, procurement, or issuance of a life,
4health, or annuity policy, health care service plan contract, or health
5benefit plan, or the rate charged for a policy or plan contract may
6not be conditioned upon or affected by a person making or
7rescinding a request for an aid-in-dying drug.
8(2) Pursuant to Section 443.18, death resulting from the
9self-administration of an aid-in-dying drug is not suicide, and
10therefore health and insurance coverage shall not be exempted on
12(b) Notwithstanding any other law, a qualified individual’s act
13of self-administering an aid-in-dying drug shall not have an effect
14upon a life, health, or annuity policy other than that of a natural
15death from the underlying disease.
16(c) An insurance carrier shall not provide any information in
17communications made to an individual about the availability of
18an aid-in-dying drug absent a request by the individual or his or
19her attending physician at the behest of the individual. Any
20communication shall not include both the denial of treatment and
21information as to the availability of aid-in-dying drug coverage.
22For the purposes of this subdivision, “insurance carrier” means a
23health care service plan as defined in Section 1345 of this code or
24a carrier of health insurance as defined in Section 106 of the
(a) Notwithstanding any other law, a person shall not
27be subject to civil, criminal, administrative, employment, or
28contractual liability or professional disciplinary action for
29participating in good faith compliance with this part, including an
30individual who is present when a qualified individual
31self-administers the prescribed aid-in-dying drug.
32(b) A health care provider or professional organization or
33association shall not subject an individual to censure, discipline,
34suspension, loss of license, loss of privileges, loss of membership,
35or other penalty for participating in good faith compliance with
36this part or for refusing to participate in accordance with
38(c) Notwithstanding any other law, a health care provider shall
39not be subject to civil, criminal, administrative, disciplinary,
40employment, credentialing, professional discipline, contractual
P15 1liability, or medical staff action, sanction, or penalty or other
2liability for participating in this part, including, but not limited to,
3determining the diagnosis or prognosis of an individual,
4determining the capacity of an individual for purposes of qualifying
5for the act, providing information to an individual regarding this
6part, and providing a referral to a physician who participates in
8(d) (1) A request by a qualified individual to an attending
9physician to provide an aid-in-dying drug in good faith compliance
10with the provisions of this part shall not provide the sole basis for
11the appointment of a guardian or conservator.
12(2) No actions taken in compliance with the provisions of this
13part shall constitute or provide the basis for any claim of neglect
14or elder abuse for any purpose of law.
15(e) (1) Participation in activities authorized pursuant to this
16part shall be voluntary. Notwithstanding Sections 442 to 442.7,
17inclusive, a person or entity that elects, for reasons of conscience,
18morality, or ethics, not to engage in activities authorized pursuant
19to this part is not required to take any action in support of an
20individual’s decision under this part.
21(2) Notwithstanding any other law, a health care provider is not
22subject to civil, criminal, administrative, disciplinary, employment,
23credentialing, professional discipline, contractual liability, or
24medical staff action, sanction, or penalty or other liability for
25refusing to participate in activities authorized under this part,
26 including, but not limited to, refusing to inform a patient regarding
27his or her rights under this part, and not referring an individual to
28a physician who participates in activities authorized under this
30(3) If a health care provider is unable or unwilling to carry out
31a qualified individual’s request under this part and the qualified
32individual transfers care to a new health care provider, the
33individual may request a copy of his or her medical records
34pursuant to law.
(a) Subject to subdivision (b), notwithstanding any
36other law, a health care provider may prohibit its employees,
37independent contractors, or other persons or entities, including
38other health care providers, from participating in activities under
39this part while on premises owned or under the management or
40direct control of that prohibiting health care provider or while
P16 1acting within the course and scope of any employment by, or
2contract with, the prohibiting health care provider.
3(b) A health care provider that elects to prohibit its employees,
4independent contractors, or other persons or entities, including
5health care providers, from participating in activities under this
6part, as described in subdivision (a), shall first give notice of the
7 policy prohibiting participation under this part to the individual or
8entity. A health care provider that fails to provide notice to an
9individual or entity in compliance with this subdivision shall not
10be entitled to enforce such a policy against that individual or entity.
11(c) Subject to compliance with subdivision (b), the prohibiting
12health care provider may take action, including, but not limited
13to, the following, as applicable, against any individual or entity
14that violates this policy:
15(1) Loss of privileges, loss of membership, or other action
16authorized by the bylaws or rules and regulations of the medical
18(2) Suspension, loss of employment, or other action authorized
19by the policies and practices of the prohibiting health care provider.
20(3) Termination of any lease or other contract between the
21prohibiting health care provider and the individual or entity that
22violates the policy.
23(4) Imposition of any other nonmonetary remedy provided for
24in any lease or contract between the prohibiting health care provider
25and the individual or entity in violation of the policy.
26(d) Nothing in this section shall be construed to prevent, or to
27allow a prohibiting health care provider to prohibit, any other
28health care provider, employee, independent contractor, or other
29person or entity from any of the following:
30(1) Participating, or entering into an agreement to
31in activities under this part, while on premises that are not owned
32or under the management or direct control of the prohibiting
33provider or while acting outside the course and scope of the
34participant’s duties as an employee of, or an independent contractor
35for, the prohibiting health care provider.
36(2) Participating, or entering into an agreement to participate,
37in activities under this part as an attending physician or consulting
38physician while on premises that are not owned or under the
39management or direct control of the prohibiting provider.
P17 1(e) In taking actions pursuant to subdivision (c), a health care
2provider shall comply with all procedures required by law, its own
3policies or procedures, and any contract with the individual or
4entity in violation of the policy, as applicable.
5(f) For purposes of this section:
6(1) “Notice” means a separate statement in writing advising of
7the prohibiting health care provider policy with respect to
8participating in activities under this part.
9(2) “Participating, or entering into an agreement to participate,
10in activities under this part” means doing or entering into an
11agreement to do any one or more of the following:
12(A) Performing the duties of an attending physician as specified
13in Section 443.5.
14(B) Performing the duties of a consulting physician as specified
15in Section 443.6.
16(C) Performing the duties of a mental health specialist, in the
17circumstance that a referral to one is made.
18(D) Delivering the prescription for, dispensing, or delivering
19the dispensed aid-in-dying drug pursuant to paragraph (2) of
20subdivision (b) of, and subdivision (c) of, Section 443.5.
21(E) Being present when the qualified individual takes the
22aid-in-dying drug prescribed pursuant to this part.
23(3) “Participating, or entering into an agreement to participate,
24in activities under this part” does not include doing, or entering
25into an agreement to do, any of the following:
26(A) Diagnosing whether a
patient has a terminal disease,
27informing the patient of the medical prognosis, or determining
28whether a patient has the capacity to make decisions.
29(B) Providing information to a patient about this part.
30(C) Providing a patient, upon the patient’s request, with a referral
31to another health care provider for the purposes of participating in
32the activities authorized by this part.
33(g) Any action taken by a prohibiting provider pursuant to this
34section shall not be reportable under Sections 800 to 809.9,
35inclusive, of the Business and Professions Code. The fact that a
36health care provider participates in activities under this part shall
37not be the sole basis for a complaint or report by another health
38care provider of unprofessional or dishonorable conduct under
39Sections 800 to 809.9, inclusive, of the Business and Professions
P18 1(h) Nothing in this part shall prevent a health care provider from
2providing an individual with health care services that do not
3constitute participation in this part.
(a) A health care provider may not be sanctioned for
5any of the following:
6(1) Making an initial determination pursuant to the standard of
7care that an individual has a terminal disease and informing him
8or her of the medical prognosis.
9(2) Providing information about the End of Life Option Act to
10a patient upon the request of the individual.
11(3) Providing an individual, upon request, with a referral to
13(b) A health care provider that prohibits activities under this
14part in accordance with Section 443.15 shall not sanction an
15 individual health care provider for contracting with a qualified
16individual to engage in activities authorized by this part if the
17individual health care provider is acting outside of the course and
18scope of his or her capacity as an employee or independent
19contractor of the prohibiting health care provider.
20(c) Notwithstanding any contrary provision in this section, the
21immunities and prohibitions on sanctions of a health care provider
22are solely reserved for actions taken pursuant to this part, and those
23health care providers may be sanctioned for conduct and actions
24not included and provided for in this part if the conduct and actions
25do not comply with the standards and practices set forth by the
26Medical Board of California.
(a) Knowingly altering or forging a request for an
28aid-in-dying drug to end an individual’s life without his or her
29authorization or concealing or destroying a withdrawal or rescission
30of a request for an aid-in-dying drug is punishable as a felony if
31the act is done with the intent or effect of causing the individual’s
33(b) Knowingly coercing or exerting undue influence on an
34individual to request an aid-in-dying drug for the purpose of ending
35his or her life or to destroy a withdrawal or rescission of a request
36is punishable as a felony.
37(c) For purposes of this section, “knowingly” has the
38provided in Section 7 of the Penal Code.
39(d) Nothing in this section shall be construed to limit civil
P19 1(e) The penalties in this section do not preclude criminal
2penalties applicable under any law for conduct inconsistent with
3the provisions of this section.
Nothing in this part may be construed to authorize a
5physician or any other person to end an individual’s life by lethal
6injection, mercy killing, or active euthanasia. Actions taken in
7accordance with this part shall not, for any purposes, constitute
8suicide, assisted suicide, homicide, or elder abuse under the law.
(a) The State Department of Public Health shall collect
10and review the information submitted pursuant to Section 443.9.
11The information collected shall be confidential and shall be
12collected in a manner that protects the privacy of the patient, the
13patient’s family, and any medical provider or pharmacist involved
14with the patient under the provisions of this part. The information
15shall not be disclosed, discoverable, or compelled to be produced
16in any civil, criminal, administrative, or other proceeding.
17(b) On or before July 1, 2017, and each year thereafter, based
18on the information collected in the previous year, the department
begin delete reportend delete the information collected from
20the attending physician
begin delete follow-up form.end delete The report shall include, but
22not be limited to, all of the following based on the information that
23is provided to the department and on the department’s access to
25(1) The number of people for whom an aid-in-dying prescription
27(2) The number of known individuals who died each year for
28whom aid-in-dying prescriptions were written, and the cause of
29death of those individuals.
30(3) For the period commencing January 1, 2016, to and including
31the previous year, cumulatively, the total number of aid-in-dying
32prescriptions written, the number of people who died due to use
33of aid-in-dying drugs, and the number of those people who died
34who were enrolled in hospice or other palliative care programs at
35the time of death.
36(4) The number of known deaths in California from using
37aid-in-dying drugs per 10,000 deaths in California.
38(5) The number of physicians who wrote prescriptions for
P20 1(6) Of people who died due to using an aid-in-dying drug,
2demographic percentages organized by the following
4(A) Age at death.
5(B) Education level.
8(E) Type of insurance, including whether or not they had
10(F) Underlying illness.
11(c) The State Department of Public Health shall make available
12the attending physician checklist and compliance form, the
13consulting physician compliance form, and the attending physician
14followup form, as described in Section 443.22, by posting them
15on its Internet Web site.
A person who has custody or control of any unused
17aid-in-dying drugs prescribed pursuant to this part after the death
18of the patient shall personally deliver the unused aid-in-dying drugs
19for disposal by delivering it to the nearest qualified facility that
20properly disposes of controlled substances, or if none is available,
21shall dispose of it by lawful means in accordance with guidelines
22promulgated by the California State Board of Pharmacy or a federal
23Drug Enforcement Administration approved take-back program.
Any governmental entity that incurs costs resulting
25from a qualified individual terminating his or her life pursuant to
26the provisions of this part in a public place shall have a claim
27against the estate of the qualified individual to recover those costs
28and reasonable attorney fees related to enforcing the claim.
begin deleteOn or before January 1, 2019, the end delete Medical
30Board of California
begin delete shall develop, revise, andend delete update begin delete anend delete
31 attending physician checklist and compliance form,
begin delete aend delete consulting
32physician compliance form, and
begin delete anend delete attending physician
33followup form, based on those provided in subdivision (b). Upon
34completion, the State Department of Public Health shall publish
35the updated forms on its Internet Web
begin delete Site.end delete
begin deleteUntil the Medical Board of California develops and revises the attending physician
37forms pursuant to subdivision (a), or January 1, 2019, whichever
38is later, end delete
40checklist and compliance form, the consulting physician
P21 1compliance form, and the attending physician followup form shall
2be in the following form:
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
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.
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.
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