BILL NUMBER: SB 128 AMENDED
AMENDED IN SENATE MARCH 17, 2015
INTRODUCED BY Senators Wolk and Monning
(Principal coauthors: Senators Jackson and Leno)
(Principal coauthor: Assembly Member Eggman)
(Coauthors: Senators Block, Hall, Hancock, Hernandez, Hill,
McGuire, and Wieckowski)
(Coauthors: Assembly Members Chu, Cooper,
Frazier, Cristina Garcia, Quirk,
and Mark Stone
Rendon, and Mark Stone )
JANUARY 20, 2015
An act to add Part 1.85 (commencing with Section 443) to Division
1 of the Health and Safety Code, relating to end of life.
LEGISLATIVE COUNSEL'S DIGEST
SB 128, as amended, Wolk. 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
illness, as defined, to make a request for medication 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
aid-in-dying medication and under specified circumstances an
interpreter declaration to be signed subject to penalty of perjury,
thereby imposing a crime and state-mandated local program.
This bill would prohibit a provision in a contract, will, or other
agreement, or in a health care service plan contract, or health
benefit plan contract, from being conditioned upon or affected by a
person making or rescinding a request for the above-described
medication. The bill would prohibit the sale, procurement, or
issuance of any life, health, or accident insurance or annuity
policy, or the rate charged for any policy, from being conditioned
upon or affected by the request.
This bill would provide immunity from civil or criminal liability
or professional disciplinary action for participating in good faith
compliance with the act. 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 provide that participation in
activities authorized pursuant to this bill shall be voluntary.
This bill would make it a felony to knowingly alter or forge a
request for medication to end an individual's life without his or her
authorization or to conceal or destroy a rescission of a request for
medication, 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
medication for the purpose of ending his or her life or to destroy a
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 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 others, suicide or homicide.
This bill would require the State Department of Public Health to
adopt regulations regarding the collection of information to
determine the use of and compliance with the act, and would require
the department to annually review a sample of certain records and
make a statistical report of the information collected.
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
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
443.1. As used in this part, the following definitions shall
(a) "Adult" means an individual 18 years of age or older.
(b) "Aid-in-dying medication" means medication 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 illness.
(c) "Attending physician" means the physician who has primary
responsibility for the health care of an individual and treatment of
the individual's terminal illness.
(d) "Competent" means that, in the opinion of a court or in the
opinion of an individual's attending physician, consulting physician,
psychiatrist, or psychologist, the individual has 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.
(e) "Consulting physician" means a physician who is qualified by
specialty or experience to make a professional diagnosis and
prognosis regarding an individual's illness.
(f) "Counseling" means one or more consultations, as necessary,
between an individual and a psychiatrist or psychologist licensed in
this state for the purpose of determining that the individual is
competent and is not suffering from a psychiatric or psychological
disorder or depression causing impaired judgment.
(g) "Department" means the State Department of Public Health.
(h) "Health care provider" or "provider" means a person licensed,
certified, or otherwise authorized or permitted by law to administer
health care or dispense medication in the ordinary course of business
or practice of a profession, including, but not limited to,
physicians, doctors of osteopathy, and pharmacists. "Health care
provider" or "provider" includes a health care facility as identified
in Section 1250.
(i) "Informed decision" means a decision by a terminally ill
individual to request and obtain a prescription for medication 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 medication to
(3) The probable result of taking the medication to be prescribed.
(4) The possibility that the individual may choose not to obtain
the medication or may obtain the medication but may decide not to
(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 opinion of the
attending physician has been confirmed by a consulting physician who
has examined the individual and the individual's relevant medical
(k) "Physician" means a doctor of medicine or osteopathy
currently licensed to practice medicine in this state.
(l) "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.
(m) "Qualified individual" means a competent adult who is a
resident of California and has satisfied the requirements of this
part in order to obtain a prescription for medication to end his or
(n) "Self-administer" means a qualified individual's affirmative,
conscious, and physical act of using the medication to bring about
his or her own death.
(o) "Terminal illness" means an incurable and irreversible illness
that has been medically confirmed and will, within reasonable
medical judgment, result in death within six months.
443.2. (a) A competent, qualified individual who is a terminally
ill adult may make a request to receive a prescription for
aid-in-dying medication if all of the following conditions are
(1) The qualified individual's attending physician has determined
the individual to be suffering from a terminal illness.
(2) The qualified individual has voluntarily expressed the wish to
receive a prescription for aid-in-dying medication.
(3) The qualified 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.
license or other identification issued by the State of
(B) Registration to vote in California.
(C) Evidence that the person owns or leases property in
(D) Filing of a California tax return for the most recent tax
(4) The qualified individual documents his or her request pursuant
to the requirements set forth in Section 443.3.
(b) A person may not qualify under the provisions of this part
solely because of age or disability.
(c) A request for a prescription for aid-in-dying medication under
this part shall not be made on behalf of the patient through a power
of attorney, an advance health care directive, or a conservator.
443.3. (a) A qualified individual wishing to receive a
prescription for aid-in-dying medication 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.
(b) A valid written request for aid-in-dying medication under
subdivision (a) shall meet all of the following conditions:
(1) The request shall be in substantially the form described in
(2) The request shall be signed and dated by the qualified
individual seeking the medication.
(3) The request shall be witnessed by at least two other adult
persons who, in the presence of the qualified individual, shall
attest that to the best of their knowledge and belief the qualified
individual is all of the following:
(B) Acting voluntarily.
(C) Not being coerced to sign the request.
(c) At most, 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, or
adoption or be entitled to a portion of the person's estate upon
death, but not both. death.
(2) Own, operate, or be employed at a health care facility where
the qualified individual is receiving medical treatment or resides.
(d) The attending physician of the qualified individual shall not
be one of the witnesses required pursuant to paragraph (3) of
443.4. (a) A qualified individual may at any time rescind his or
her request for aid-in-dying medication without regard to the
qualified individual's mental state.
(b) A prescription for aid-in-dying medication provided under this
part may not be written without the attending physician offering the
qualified individual an opportunity to rescind the request.
443.5. (a) Before prescribing aid-in-dying medication, the
attending physician shall do all of the following:
(1) Make the initial determination of all of the following:
(A) Whether the requesting adult is competent.
(B) Whether the requesting adult has a terminal illness.
(C) Whether the requesting adult has voluntarily made the request
for aid-in-dying medication pursuant to Sections 443.2 and 443.3.
(D) Whether the requesting adult is a qualified individual
pursuant to subdivision (m) of Section 443.1.
(2) Ensure the qualified 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 taking the aid-in-dying
medication to be prescribed.
(C) The probable result of taking the aid-in-dying medication to
(D) The possibility that he or she may choose to obtain the
medication but not take it.
(E) The feasible alternatives or additional treatment
opportunities, including, but not limited to, comfort care, hospice
care, palliative care, and pain control.
(3) Refer the qualified individual to a consulting physician for
medical confirmation of the diagnosis, prognosis, and for a
determination that the qualified individual is competent and has
complied with the provisions of this part.
(4) Refer the qualified individual for counseling if appropriate.
(5) Ensure that the qualified individual's request does not arise
from coercion or undue influence by another person.
(6) Counsel the qualified individual about the importance of all
of the following:
(A) Having another person present when he or she takes the
aid-in-dying medication prescribed pursuant to this part.
(B) Not taking the aid-in-dying medication in a public place.
(7) Inform the qualified individual that he or she may rescind the
request for aid-in-dying medication at any time and in any manner.
(8) Offer the qualified individual an opportunity to rescind the
request for medication before prescribing the aid-in-dying
(9) Verify, immediately prior to writing the prescription for
medication, that the qualified individual is making an informed
(10) Ensure that all appropriate steps are carried out in
accordance with this part before writing a prescription for
(11) Fulfill the record documentation that may be required under
(b) If the conditions set forth in subdivision (a) are satisfied,
the attending physician may deliver the aid-in-dying medication in
any of the following ways:
(1) Dispense aid-in-dying medications directly, including
ancillary medication intended to minimize the qualified individual's
discomfort, if the attending physician meets all of the following
(A) Is registered as a dispensing physician with the
Medical Board of California. Is authorized
to dispense medicine under California law.
(B) Has a current United States Drug Enforcement Administration
(C) Complies with any applicable administrative rule or
(2) With the qualified individual's written consent, the attending
physician may contact a pharmacist, inform the pharmacist of the
prescriptions, and deliver the written prescriptions personally, by
mail, or electronically to the pharmacist, who shall
may dispense the medications 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 medication to the qualified
individual, the attending physician, or a person expressly designated
by the qualified individual may be made by: personal delivery,
United Parcel Service, United States Postal Service, Federal Express,
or by messenger service.
443.6. Prior to a qualified individual obtaining aid-in-dying
medication from the attending physician, the consulting physician
shall perform all of the following:
(a) Examine the qualified individual and his or her relevant
(b) Confirm in writing the attending physician's diagnosis and
(c) Verify, in the opinion of the consulting physician, that the
qualified individual is competent, acting voluntarily, and has made
an informed decision.
(d) Fulfill the record documentation that may be required under
443.7. (a) Unless otherwise prohibited by law, the attending
physician may sign the qualified individual's death certificate.
(b) The cause of death listed on an individual's death certificate
who uses aid-in-dying medication shall be the underlying terminal
443.8. A qualified individual may not receive a prescription for
aid-in-dying medication pursuant to this part, unless he or she has
made an informed decision. Immediately before writing a prescription
for aid-in-dying medication under this part, the attending physician
shall verify that the individual is making an informed decision.
443.9. (a) A request for aid-in-dying medication as authorized by
this part shall be in substantially the following form:
REQUEST FOR MEDICATION TO END MY LIFE IN A
HUMANE AND DIGNIFIED MANNER I,
....., am an adult of sound mind and a resident
of the s S tate of California.
I am suffering from ................, which my
attending physician has determined is in
its terminal phase and which has been medically
I have been fully informed of my diagnosis and
prognosis, the nature of the aid-in-dying
medication to be prescribed and potential
associated risks, the expected result, and the
feasible alternatives or additional treatment
opportunities, including comfort care, hospice
care, palliative care, and pain control.
I request that my attending physician prescribe
medication 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
I understand that I have the right to 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
medication to be prescribed. I further
understand that although most deaths occur
within three hours, my death may take longer,
and my attending physician has counseled me
medication to be prescribed. My attending
physician has counseled me about th is
that my death may not be immediately upon the
consumption of the medication.
I make this request voluntarily , and
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) 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
(d) is not an individual for whom either of us
is the attending physician.
NOTE: Only one of the two witnesses may be a
relative (by blood, marriage, 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 where the conversations or consultations or
interpreted conversations or consultations where 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
I (INSERT NAME OF INTERPRETER), am fluent in
English and (INSERT TARGET LANGUAGE).
On (insert date) at approximately ( I i
I read the ""Request for Medication to End My
Life'' to (insert name of individual/patient) in
(insert target language).
Mr./Ms. ( I i nsert name of
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),
X______Interpreter printed name
(3) An interpreter provided by paragraph (2) shall not be related
to the qualified individual by blood, marriage, or adoption or be
entitled to a portion of the person's estate upon death. An
interpreter provided by paragraph (2) shall be qualified as described
in subparagraph (H) of paragraph (2) of subdivision (c) of Section
1300.67.04 of Title 28 of the California Code of Regulations.
443.10. (a) A provision in a contract, will, or other agreement,
whether written or oral, to the extent the provision would affect
whether a person may make or rescind a request for aid-in-dying
medication, is not valid.
(b) An obligation owing under any currently existing
contract in effect on January 1 , 2016,
may not be conditioned or affected by a qualified individual
making or rescinding a request for aid-in-dying medication.
443.11. (a) The sale, procurement, or issuance of a life, health,
accident insurance 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 aid-in-dying medication.
(b) Notwithstanding any other law, a qualified individual's act of
self-administering aid-in-dying medication may not have an effect
upon a life, health, or accident insurance or annuity policy other
than that of a natural death from the underlying illness.
443.12. (a) Notwithstanding any other law, a person shall not be
subject to civil or criminal 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 medication.
(b) A health care provider or professional organization or
association may not subject an individual to censure, discipline,
suspension, loss of license, loss of privileges, loss of membership,
or other penalty for participating or refusing to participate in good
faith compliance with this part.
(c) A request by an individual to an attending physician or to a
pharmacist to dispense aid-in-dying medication or provide
aid-in-dying medication in good faith compliance with the provisions
of this part does not constitute neglect or elder abuse for any
purpose of law or provide the sole basis for the appointment of a
guardian or conservator.
(d) (1) Participation in activities authorized pursuant to this
part shall be voluntary. 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 a patient's decision under this part, except as
otherwise required by law.
(2) If a health care provider is unable or unwilling to carry out
an individual's request under this part and the individual transfers
care to a new health care provider, the prior health care provider
shall transfer, upon request, a copy of the individual's relevant
medical records to the new health care provider.
(e) 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.
443.13. A health care provider may not be sanctioned for any of
(a) Making an initial determination pursuant to the standard
of care that an individual has a terminal illness and informing
him or her of the medical prognosis.
(b) Providing information about the End of Life Option Act to a
patient upon the request of the individual.
(c) Providing an individual, upon request, with a referral to
(d) Contracting with an individual to act outside the course and
scope of the provider's capacity as an employee or independent
contractor of a health care provider that prohibits activities under
(e) Notwithstanding any contrary provision in this section, the
immunities and prohibitions on sanctions of a health care provider
are solely reserved for actions taken pursuant to this part and those
health care providers may be sanctioned 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.
443.14. (a) Knowingly altering or forging a request for
medication to end an individual's life without his or her
authorization or concealing or destroying a rescission of a request
for medication 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 medication for the purpose of ending his or her
life or to destroy a rescission of a request is punishable as a
(c) For purposes of this section, "knowingly" has the meaning
provided in Section 7 of the Penal Code.
(d) Nothing in this section limits further liability for civil
damages resulting from other negligent conduct or intentional
misconduct by any person.
(e) The penalties in this section do not preclude criminal
penalties applicable under any law for conduct inconsistent with the
provisions of this part.
443.15. 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, mercy killing, homicide, or elder abuse
under the law.
443.16. (a) The State Public Health Officer, in consultation with
the State Department of Social Services, shall adopt regulations
establishing reporting requirements for physicians and pharmacists
pursuant to this part.
(b) The reporting requirements shall be designed to collect
information to determine utilization and compliance with this part.
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.
(c) Based on the information collected, the department shall
provide an annual compliance and utilization statistical report
aggregated by age, gender, race, ethnicity, and primary language
spoken at home and other data the department may determine relevant.
The department shall make the report public within 30 days of
completion of each annual report.
443.17. A person who has custody or control of any unused
aid-in-dying medication prescribed pursuant to this part after the
death of the patient shall personally deliver the unused aid-in-dying
medication 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.
443.18. 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.
SEC. 2. The Legislature finds and declares that Section 1 of this
act, which adds Section 443.16 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
(a) Any limitation to public access to personally identifiable
patient data collected pursuant to Section 443.16 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
(c) The statistical report to be made available to the public
pursuant to subdivision (c) of Section 443.16 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