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
begin delete illness,end delete 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 begin delete andend delete under specified begin delete circumstancesend delete 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
begin delete agreement, or in a health care service plan contract, or health benefit plan contract,end delete
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 begin delete policy,end delete 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, 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
begin delete Department ofend delete Public Health to adopt regulations begin delete regarding the collection of informationend delete to determine the use begin delete ofend delete and compliance begin delete withend delete the act, and would require the begin delete departmentend delete 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 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:
9(a) “Adult” means an individual 18 years of age or older.
10(b) “Aid-in-dying medication” means medication determined
11and prescribed by a physician for a qualified individual, which the
P4 1qualified individual may choose to self-administer to bring about
2his or her death due to a terminal
begin delete illness.end delete
3(c) “Attending physician” means the physician
who has primary
4responsibility for the health care of an individual and treatment of
5the individual’s terminal
begin delete illness.end delete
6(d) “Competent” means that, in the opinion of a court or in the
7opinion of an individual’s attending physician, consulting
8physician, psychiatrist, or psychologist, the individual has the
9ability to make and communicate an informed decision to health
10care providers, including communication through a person familiar
11with the individual’s manner of communicating, if that person is
13(e) “Consulting physician” means a physician who is qualified
14by specialty or experience to make a professional diagnosis and
15prognosis regarding an individual’s
begin delete illness.end delete
16(f) “Counseling” means one or more consultations, as necessary,
17between an individual and a psychiatrist or psychologist licensed
18in this state for the purpose of determining that the individual is
19competent and is not suffering from a psychiatric or psychological
20disorder or depression causing impaired judgment.
21(g) “Department” means the State Department of Public Health.
22(h) “Health care provider” or “provider” means a person
23licensed, certified, or otherwise authorized or permitted by law to
24administer health care or dispense medication in the ordinary
25course of business or practice of a profession, including, but not
26limited to, physicians, doctors of osteopathy, and pharmacists.
27“Health care provider” or “provider” includes a health care facility
28as identified in Section 1250.
29(i) “Informed decision” means a decision by
begin delete a terminally ill to request and
31obtain a prescription for medication that the individual may
32self-administer to end the individual’s life, that is based on an
33understanding and acknowledgment of the relevant facts, and that
34is made after being fully informed by the attending physician of
35all of the following:
36(1) The individual’s medical diagnosis and prognosis.
37(2) The potential risks associated with taking the medication to
39(3) The probable result of taking the medication to be prescribed.
P5 1(4) The possibility that the individual may choose not to obtain
2the medication or may obtain the medication but may decide not
3to take it.
4(5) The feasible alternatives or additional treatment
5opportunities, including, but not limited to, comfort care, hospice
6care, palliative care, and pain control.
7(j) “Medically confirmed” means the medical opinion of the
8attending physician has been confirmed by a consulting physician
9who has examined the individual and the individual’s relevant
11(k) “Physician” means a doctor of medicine or osteopathy
12currently licensed to practice medicine in this state.
13(l) “Public place” means any street, alley, park, public building,
14any place of business or assembly open to or frequented by the
15public, and any other place that is open to the public view, or to
16which the public has access.
17(m) “Qualified individual” means a competent adult who is a
18resident of California and has satisfied the requirements of this
19part in order to obtain a prescription for medication to end his or
21(n) “Self-administer” means a qualified individual’s affirmative,
22conscious, and physical act of using the medication to bring about
23his or her own death.
begin delete illness”end delete means an incurable and
begin delete illnessend delete that has been medically confirmed and
26will, within reasonable medical judgment, result in death within
(a) A competent, qualified individual who is
begin delete a may make a
29terminally ill adultend delete
30request to receive a prescription for aid-in-dying medication if all
31of the following conditions are satisfied:
32(1) The qualified individual’s attending physician has
33determined the individual to be suffering from a terminal
begin delete illness.end delete
35(2) The qualified individual has voluntarily expressed the wish
36to receive a prescription for aid-in-dying medication.
37(3) The qualified individual is a resident of California and is
38able to establish residency through any of the following means:
39(A) Possession of a California driver license or other
40identification issued by the State of California.
P6 1(B) Registration to vote in California.
2(C) Evidence that the person owns or leases property in
4(D) Filing of a California tax return for the most recent tax year.
5(4) The qualified individual documents his or her request
6pursuant to the requirements set forth in Section 443.3.
7(b) A person may not qualify under the provisions of this part
8solely because of age or disability.
9(c) A request for a prescription for aid-in-dying medication
10under this part shall not be made on behalf of the patient through
11a power of attorney, an advance health care directive, or a
(a) A qualified individual wishing to receive a
14prescription for aid-in-dying medication pursuant to this part shall
15submit two oral requests, a minimum of 15 days apart, and a written
16request to his or her attending physician.
18(b) A valid written request for aid-in-dying medication under
19subdivision (a) shall meet all of the following conditions:
20(1) The request shall be in substantially the form described in
22(2) The request shall be signed and
begin delete datedend delete by the qualified
24individual seeking the medication.
25(3) The request shall be witnessed by at least two other adult
26persons who, in the presence of the qualified individual, shall attest
27that to the best of their knowledge and belief the qualified
28individual is all of the following:
30(B) Acting voluntarily.
31(C) Not being coerced to sign the request.
32(c) Only one of the two witnesses at the time the written request
33is signed may:
34(1) Be related to the qualified individual by blood, marriage, or
35adoption or be entitled to a portion of the person’s estate upon
37(2) Own, operate, or be employed at a health care facility where
38the qualified individual is receiving medical treatment or resides.
P7 1(d) The attending physician of the qualified individual shall not
2be one of the witnesses required pursuant to paragraph (3) of
(a) A qualified individual may at any time rescind his
5or her request for aid-in-dying medication without regard to the
6qualified individual’s mental state.
7(b) A prescription for aid-in-dying medication provided under
8this part may not be written without the attending physician
9offering the qualified individual an opportunity to rescind the
(a) Before prescribing aid-in-dying medication, the
12attending physician shall do all of the following:
13(1) Make the initial determination of all of the following:
14(A) Whether the requesting adult is competent.
15(B) Whether the requesting adult has a terminal
begin delete illness.end delete
16(C) Whether the requesting adult has voluntarily made
17request for aid-in-dying medication pursuant to Sections 443.2
19(D) Whether the requesting adult is a qualified individual
20pursuant to subdivision (m) of Section 443.1.
21(2) Ensure the qualified individual is making an informed
22decision by discussing with him or her all of the following:
23(A) His or her medical diagnosis and prognosis.
24(B) The potential risks associated with taking the aid-in-dying
25medication to be prescribed.
26(C) The probable result of taking the aid-in-dying medication
27to be prescribed.
possibility that he or she may choose to obtain the
29 medication but not take it.
30(E) The feasible alternatives or additional treatment
31opportunities, including, but not limited to, comfort care, hospice
32care, palliative care, and pain control.
33(3) Refer the qualified individual to a consulting physician for
34medical confirmation of the
begin delete diagnosis,end delete prognosis,
35and for a determination that the qualified individual is competent
36and has complied with the provisions of this part.
37(4) Refer the qualified individual for counseling if appropriate.
3(5) Ensure that the qualified individual’s request does not arise
4from coercion or undue influence by another
begin delete person.end delete
8(6) Counsel the qualified individual about the importance of all
9of the following:
10(A) Having another person present when he or she takes the
11aid-in-dying medication prescribed pursuant to this part.
12(B) Not taking the aid-in-dying medication in a public place.
18(7) Inform the qualified individual that he or she may rescind
19the request for aid-in-dying medication at any time and in any
21(8) Offer the qualified individual an opportunity to rescind the
22request for medication before prescribing the
24(9) Verify, immediately prior to writing the prescription for
25 medication, that the qualified individual is making
26an informed decision.
27(10) Ensure that all appropriate steps are carried out in
28accordance with this part before writing a prescription for
30(11) Fulfill the record documentation
begin delete that may beend delete required under
begin delete Section 443.16.end delete
32(b) If the conditions set forth in subdivision (a) are satisfied,
33the attending physician may deliver the aid-in-dying medication
34in any of the following ways:
35(1) Dispense aid-in-dying medications directly, including
36ancillary medication intended to minimize the qualified individual’s
37discomfort, if the attending physician meets all of the following
39(A) Is authorized to dispense medicine under California law.
P9 1(B) Has a current United States Drug Enforcement
2Administration (USDEA) certificate.
3(C) Complies with any applicable administrative rule or
5(2) With the qualified individual’s written consent, the attending
6physician may contact a pharmacist, inform the pharmacist of the
7prescriptions, and deliver the written prescriptions personally, by
8mail, or electronically to the pharmacist, who may dispense the
9medications to the qualified individual, the attending physician,
10or a person expressly designated by the qualified individual and
11with the designation delivered to the pharmacist in writing or
13(c) Delivery of the dispensed medication to the qualified
14individual, the attending physician, or a person expressly
15designated by the qualified individual may be made by: personal
16delivery, United Parcel Service, United States Postal Service,
17Federal Express, or by messenger
begin delete service.end delete
Prior to a qualified individual obtaining aid-in-dying
20medication from the attending physician, the consulting physician
21shall perform all of the following:
22(a) Examine the qualified individual and his or her relevant
24(b) Confirm in writing the attending physician’s diagnosis and
26(c) Verify, in the opinion of the consulting physician, that the
27qualified individual is competent, acting voluntarily, and has made
28an informed decision.
29(d) Fulfill the record documentation
begin delete that
may beend delete
begin delete Section 443.16.end delete
(a) Unless otherwise prohibited by law, the attending
32physician may sign the qualified individual’s death certificate.
33(b) The cause of death listed on
begin delete an individual’s death certificate shall be the underlying
34who uses aid-in-dying medicationend delete
begin delete illness. end delete
A qualified individual may not receive a prescription
38for aid-in-dying medication pursuant to this part, unless he or she
39has made an informed decision. Immediately before writing a
40prescription for aid-in-dying medication under this part, the
P10 1attending physician shall verify that the individual is making an
(a) A request for aid-in-dying medication as authorized
4by 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 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 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 decision.|
|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. My attending physician has counseled me about the possibility that my death may not be immediately upon the consumption of the medication.|
|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) 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.|
|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.|
9(b) (1) The written language of the request shall be written in
10the same translated language as any conversations, consultations,
11or interpreted conversations or consultations between a patient and
12his or her attending or consulting physicians.
13(2) Notwithstanding paragraph (1), the written request may be
14prepared in English even where the conversations or consultations
15or interpreted conversations or consultations where conducted in
16a language other than English if the English language form includes
17an attached interpreter’s declaration that is signed under penalty
18of 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 Medication 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
38(3) An interpreter provided by paragraph (2) shall not be related
39to the qualified individual by blood, marriage, or adoption or be
40entitled to a portion of the person’s estate upon death. An
P12 1interpreter provided by paragraph (2) shall
begin delete be qualified as described
2in subparagraph (H) of paragraph (2) of subdivision (c) of Section
31300.67.04 of Title 28 of the California Code of Regulations.end delete
(a) A provision in a contract, will, or other agreement,
9whether written or oral, to the extent the provision would affect
10whether a person may make or rescind a request for aid-in-dying
11medication, is not valid.
12(b) An obligation owing under any contract in effect on
13 January 1, 2016, may not be conditioned or affected by a qualified
14individual making or rescinding a request for aid-in-dying
(a) The sale, procurement, or issuance of a life, health,
17accident insurance or annuity policy, health care service plan
18contract, or health benefit plan, or the rate charged for a policy or
19plan contract may not be conditioned upon or affected by a person
20making or rescinding a request for aid-in-dying medication.
21(b) Notwithstanding any other law, a qualified individual’s act
22of self-administering aid-in-dying medication may not have an
23effect upon a life, health, or accident insurance or annuity policy
24other than that of a natural death from the underlying
begin delete illness.end delete
(a) Notwithstanding any other law, a person shall not
37be subject to civil or criminal liability or professional disciplinary
38action for participating in good faith compliance with this part,
39including an individual who is present when a qualified individual
40self-administers the prescribed aid-in-dying medication.
P13 1(b) A health care provider or professional organization or
begin delete mayend delete not subject an individual to censure,
3discipline, suspension, loss of license, loss of privileges, loss of
4 membership, or other penalty
begin delete for participating or refusing to
5participate in good faith compliance with this part.end delete
8(c) A request by an individual to an attending physician or to a
9pharmacist to dispense aid-in-dying medication or provide
10aid-in-dying medication in good faith compliance with the
11provisions of this part does not constitute neglect or elder abuse
12for any purpose of law or provide the sole basis for the appointment
13of a guardian or conservator.
22(d) (1) Participation in activities authorized pursuant to this
23part shall be voluntary. A person or entity that elects, for reasons
24of conscience, morality, or ethics, not to engage in activities
25authorized pursuant to this part is not required to take any action
26in support of a patient’s decision under this part, except as
begin delete otherwise required by law.end delete
29(2) If a health care provider is unable or unwilling to carry out
begin delete anend delete individual’s request under this part and the
31 individual transfers care to a new health care provider, the prior
32health care provider shall transfer, upon request, a copy of the
33 individual’s relevant medical records to the new health
P16 1 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 health care provider may not be sanctioned for
5any of the following:
7 Making an initial determination pursuant to the standard of
8care that an individual has a terminal
begin delete illnessend delete and informing
9him or her of the medical prognosis.
11 Providing information about the End of Life Option Act to
12a patient upon the request of the individual.
14 Providing an individual, upon request, with a referral to
16(d) Contracting with an individual to act outside the course and
17scope of the provider’s capacity as an employee or independent
18contractor of a health care provider that prohibits activities under
28 Notwithstanding any contrary provision in this section, the
29immunities and prohibitions on sanctions of a health care provider
30are solely reserved for actions taken pursuant to this part and those
31health care providers may be sanctioned for conduct and actions
32not included and provided for in this part if the conduct and actions
33do not comply with the standards and practices set forth by the
34Medical Board of California.
(a) Knowingly altering or forging a request for
36 medication to end an individual’s life without his or
37her authorization or concealing or destroying a rescission of a
38request for medication is punishable as a felony if the
39act is done with the intent or effect of causing the individual’s
P17 1(b) Knowingly coercing or exerting undue influence on an
2individual to request medication for the purpose of
3ending his or her life or to destroy a rescission of a request is
4punishable as a felony.
5(c) For purposes of this section, “knowingly” has the meaning
6provided in Section 7 of the Penal Code.
7(d) Nothing in this section
begin delete limits further liability for civil
8damages resulting from other negligent conduct or intentional
9misconduct by any person.end delete
10(e) The penalties in this section do not preclude criminal
11penalties applicable under any law for conduct inconsistent with
12the provisions of this part.
Nothing in this part may be construed to authorize a
14physician or any other person to end an individual’s life by lethal
15injection, mercy killing, or active euthanasia. Actions taken in
16accordance with this part shall not, for any purposes, constitute
17suicide, assisted suicide, mercy killing, homicide, or elder abuse
18under the law.
(a) The State Public Health
begin delete Officer, in consultation shall adopt regulations establishing reporting
20with the State Department of Social Services,end delete
23requirements for physicians and pharmacists pursuant to this part.
24(b) The reporting requirements shall be designed to collect
25information to determine utilization and compliance with this part.
26The information collected shall be confidential and shall be
27collected in a manner that protects the privacy of the patient, the
28patient’s family, and any medical provider or pharmacist involved
29with the patient under the provisions of this part.
30(c) Based on the information collected, the department shall
31provide an annual compliance and utilization statistical report
32aggregated by age, gender, race, ethnicity, and primary language
33spoken at home and other data the department may determine
34relevant. The department shall make the report public within 30
35days of completion of each annual report.
A person who has custody or control of any unused
37aid-in-dying medication prescribed pursuant to this part after the
38death of the patient shall personally deliver the unused aid-in-dying
39medication for disposal by delivering it to the nearest qualified
P18 1facility that properly disposes of controlled substances, or if none
2is available, shall dispose of it by lawful means.
Any governmental entity that incurs costs resulting
4from a qualified individual terminating his or her life pursuant to
5the provisions of this part in a public place shall have a claim
6against the estate of the qualified individual to recover those costs
7and reasonable attorney fees related to enforcing the claim.
The Legislature finds and declares that Section 1 of
32this act, which adds Section 443.16 to the Health and Safety Code,
33imposes a limitation on the public’s right of access to the meetings
34of public bodies or the writings of public officials and agencies
35within the meaning of Section 3 of Article I of the California
36Constitution. Pursuant to that constitutional provision, the
37Legislature makes the following findings to demonstrate the interest
38protected by this limitation and the need for protecting that interest:
39(a) Any limitation to public access to personally identifiable
40patient data collected pursuant to Section 443.16 of the Health and
P19 1Safety Code as proposed to be added by this act is necessary to
2protect the privacy rights of the patient and his or her family.
3(b) The interests in protecting the privacy rights of the patient
4and his or her family in this situation strongly outweigh the public
5interest in having access to personally identifiable data relating to
7(c) The statistical report to be made available to the public
8pursuant to subdivision (c) of Section 443.16 of the Health and
9Safety Code is sufficient to satisfy the public’s right to access.
The provisions of this part are severable. If any
11provision of this part or its application is held invalid, that
12invalidity shall not affect other provisions or applications that can
13be given effect without the invalid provision or application.
No reimbursement is required by this act pursuant to
15Section 6 of Article XIII B of the California Constitution because
16the only costs that may be incurred by a local agency or school
17district will be incurred because this act creates a new crime or
18infraction, eliminates a crime or infraction, or changes the penalty
19for a crime or infraction, within the meaning of Section 17556 of
20the Government Code, or changes the definition of a crime within
21the meaning of Section 6 of Article XIII B of the California