Amended in Senate April 14, 2015

Amended in Senate March 17, 2015

Senate Bill No. 128

Introduced by Senators Wolk and Monning

(Principal coauthors: Senators Jackson and Leno)

(Principal begin delete coauthor: Assembly Member Eggman end delete begin insert coauthors: Assembly Members Alejo and Eggman end insert )

(Coauthors: Senators Block, Hall, Hancock, Hernandez, Hill, McGuire, and Wieckowski)

(Coauthors: Assembly Members Chu, Cooper, Frazier, Cristina Garcia, Quirk, 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 begin delete illness, end delete begin insert disease, end insert 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 and end delete begin insert and, end insert under specified begin delete circumstances end delete begin insert circumstances, end insert 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 begin insert agreement end insert 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, begin insert health care service plan, contract, or health benefit plan, end insert or the rate charged for any begin delete policy, end delete begin insert policy or plan contract, end insert from being conditioned upon or affected by the request. begin insert The bill would prohibit an insurance carrier from providing any information in communications made to an individual about the availability of aid-in-dying medication absent a request by the individual, his or her attending physician at the behest of the individual, or the individual’s designee. The bill would also prohibit any communication from containing both the denial of treatment and information as to the availability of aid-in-dying medication coverage. end insert

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. begin insert 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 this 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. end insert

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 of end delete Public Health begin insert Officer end insert to adopt regulations begin delete regarding the collection of information end delete begin insert establishing additional reporting requirements for physicians and pharmacists end insert to determine the use begin delete of end delete begin insert of, end insert and compliance begin delete with end delete begin insert with, end insert the act, and would require the begin delete department end delete begin insert state Public Health Officer end insert to annually review a sample of certain records and begin insert the State Department of Public Health to end insert make a statistical report of the information collected.

begin insert

This bill would require specified information to be documented in the individual’s medical record, including, among other things, all oral and written requests for aid-in-dying medication.

end insert

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

This bill would make legislative findings to that effect.

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

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

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

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

SECTION 1.  

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

 

PART 1.85.  End of Life Option Act

 

443.  

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

443.1.  

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

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

(b) “Aid-in-dying 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 begin delete illness. end delete begin insert disease. end insert

(c) “Attending physician” means the physician who has primary
responsibility for the health care of an individual and treatment of
the individual’s terminal begin delete illness. end delete begin insert disease. end insert

(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 begin delete illness. end delete begin insert terminal disease. end insert

(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 begin delete a terminally ill
individual end delete begin insert an individual with a terminal disease end insert 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
be prescribed.

(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 take it.

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

(j) “Medically confirmed” means the medical opinion of the
attending physician has been confirmed by a consulting physician
who has examined the individual and the individual’s relevant
medical records.

(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
her life.

(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 begin delete illness” end delete begin insert disease” end insert means an incurable and
irreversible begin delete illness end delete begin insert disease end insert 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 begin delete a
terminally ill adult end delete begin insert an adult with a terminal disease end insert may make a
request to receive a prescription for aid-in-dying medication if all
of the following conditions are satisfied:

(1) The qualified individual’s attending physician has
determined the individual to be suffering from a terminal begin delete illness. end delete
begin insert disease. end insert

(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 or other
identification issued by the State of California.

(B) Registration to vote in California.

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

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

(4) The 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. begin insert The attending physician
must receive all three requests required pursuant to this section. end insert

(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
Section 443.9.

(2) The request shall be signed and begin delete dated end delete begin insert dated, in the presence
of two witnesses in accordance with paragraph (3), end insert 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:

(A) Competent.

(B) Acting voluntarily.

(C) Not being coerced to sign the request.

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

(1) Be related to the qualified individual by blood, marriage, or
adoption or be entitled to a portion of the person’s estate upon
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
subdivision (b).

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 begin delete illness. end delete begin insert disease. end insert

(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 be prescribed.

(D) The possibility that he or she may choose to obtain the
begin insert aid-in-dying end insert 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 begin delete diagnosis, end delete begin insert diagnosis and end insert 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.
begin insert No aid-in-dying medication shall be prescribed until the person
performing the counseling determines that the patient is not
suffering from a psychiatric or psychological disorder or
depression causing impaired judgment. end insert

(5) Ensure that the qualified individual’s request does not arise
from coercion or undue influence by another begin delete person. end delete begin insert person by
discussing with the qualified individual, outside of the presence
of any other persons, whether or not the qualified individual is
feeling coerced or unduly influenced by another person. end insert

(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.

begin insert

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

end insert begin insert

(D) Participating in a hospice program.

end insert

(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 begin insert aid-in-dying end insert medication before prescribing the
aid-in-dying medication.

(9) Verify, immediately prior to writing the prescription for
begin insert aid-in-dying end insert medication, that the qualified individual is making
an informed decision.

(10) Ensure that all appropriate steps are carried out in
accordance with this part before writing a prescription for
aid-in-dying medication.

(11) Fulfill the record documentation begin delete that may be end delete required under
begin delete Section 443.16. end delete begin insert Sections 443.16 and 443.19. end insert

(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
criteria:

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

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

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

(2) With the qualified individual’s written consent, 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 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 begin delete service. end delete begin insert service with a signature
required at delivery. end insert

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
medical records.

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

(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 begin delete that may be end delete required under
begin delete Section 443.16. end delete begin insert Sections 443.16 and 443.19. end insert

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 begin delete an individual’s death certificate
who uses aid-in-dying medication end delete begin insert the death certificate of an
individual who uses aid-in-dying medication end insert shall be the underlying
terminal begin delete illness. end delete begin insert disease. end insert

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 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.

INITIAL ONE:

............ I have informed one or more members of my family of my decision and taken their opinions into consideration.

............ I have decided not to inform my family of my decision.

............ I have no family to inform of my decision.

I understand that I have the right to 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.

Signed:..............................................

Dated:...............................................

DECLARATION OF WITNESSES

We declare that the person signing this request:

(a) is personally known to us or has provided proof of identity;

(b) 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.

............................Witness 1/Date

............................Witness 2/Date

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
effect that:

 

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

On (insert date) at approximately (insert time), I read the “Request for 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 signature

X______Interpreter printed name

X______Interpreter address

 

(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 begin delete 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. end delete begin insert meet
the standards promulgated by the California Healthcare
Interpreters Association or the National Council on Interpreting
in Healthcare or other standards deemed acceptable for health
care providers in California. end insert

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 contract in effect on begin insert or after end insert
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 begin delete illness. end delete
begin insert disease. end insert

begin insert

(c) An insurance carrier shall not provide any information in
communications made to an individual about the availability of
aid-in-dying medication absent a request by the individual, his or
her attending physician at the behest of the individual, or the
individual’s designee. Any communication shall not include both
the denial of treatment and information as to the availability of
aid-in-dying medication coverage. For the purposes of this
subdivision, “insurance carrier” means a health care service plan
pursuant to Section 1345 or a health insurer pursuant to Section
106 of the Insurance Code.

end insert

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 begin delete may end delete begin insert shall end insert not subject an individual to censure,
discipline, suspension, loss of license, loss of privileges, loss of
membership, or other penalty begin delete for participating or refusing to
participate in good faith compliance with this part. end delete begin insert for participating
in good faith compliance with this part or for refusing to
participate in accordance with subdivision (d). end insert

begin delete

(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.

end delete begin insert

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

end insert begin insert

(2) A request by an individual to a pharmacist to dispense
aid-in-dying medication in good faith compliance with the
provisions of this part shall not constitute neglect or elder abuse
for any purpose of law.

end insert

(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
begin delete otherwise required by law. end delete begin insert required by Sections 442 through 442.7,
inclusive. end insert

(2) If a health care provider is unable or unwilling to carry out
begin delete an end delete begin insert a qualified end insert individual’s request under this part and the begin insert qualified end insert
individual transfers care to a new health care provider, the prior
health care provider shall transfer, upon request, a copy of the
begin insert qualified end insert individual’s relevant medical records to the new health
care provider.

begin insert

(e) (1) Subject to paragraph (2), notwithstanding any other
law, a health care provider may prohibit its employees,
independent contractors, or other persons or entities, including
other health care providers, from participating in activities under
this part while on premises owned or under the management or
direct control of that prohibiting health care provider or while
acting within the course and scope of any employment by, or
contract with, the prohibiting health care provider.

end insert begin insert

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

end insert begin insert

(3) Subject to compliance with paragraph (2), the prohibiting
health care provider may take action, including, but not limited
to, the following, as applicable, against any individual or entity
that violates this policy:

end insert begin insert

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

end insert begin insert

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

end insert begin insert

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

end insert begin insert

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

end insert begin insert

(4) Nothing in this subdivision shall be construed to prevent,
or to allow a prohibiting health care provider to prohibit any other
health care provider, employee, independent contractor, or other
person or entity from any of the following:

end insert begin insert

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

end insert begin insert

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

end insert begin insert

(5) In taking actions pursuant to paragraph (3), a health care
provider shall comply with all procedures required by law, its own
policies or procedures, and any contract with the individual or
entity in violation of the policy, as applicable.

end insert begin insert

(6) For purposes of this subdivision:

end insert begin insert

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

end insert begin insert

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

end insert begin insert

(i) Performing the duties of an attending physician specified in
Section 443.5.

end insert begin insert

(ii) Performing the duties of a consulting physician specified in
Section 443.6.

end insert begin insert

(iii) Delivering the prescription for, dispensing, or delivering
the dispensed aid-in-dying medication pursuant to paragraph (2)
of subdivision (b) of, and subdivision (c) of, Section 443.5.

end insert begin insert

(iv) Being present when the qualified individual takes the
aid-in-dying medication prescribed pursuant to this part.

end insert begin insert

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

end insert begin insert

(i) Making an initial determination that a patient has a terminal
illness and informing the patient of the medical prognosis.

end insert begin insert

(ii) Providing information to a patient about the End of Life
Option Act.

end insert begin insert

(iii) Providing a patient, upon the patient’s request, with a
referral to another health care provider for the purposes of
participating in the activities authorized by the End of Life Option
Act.

end insert begin insert

(7) Any action taken by a prohibiting provider pursuant to this
subdivision shall not be reportable under Sections 800 through
809.9, inclusive, of the Business and Professions Code. The fact
that a health care provider participates in activities under this
part shall not be the sole basis for a complaint or report by another
health care provider of unprofessional or dishonorable conduct
under Sections 800 through 809.9, inclusive, of the Business and
Professions Code.

end insert begin delete

(e)

end delete

begin insert (f) end insert  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.  

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

begin delete

(a)

end delete

begin insert (1) end insert  Making an initial determination pursuant to the standard of
care that an individual has a terminal begin delete illness end delete begin insert disease end insert and informing
him or her of the medical prognosis.

begin delete

(b)

end delete

begin insert (2) end insert  Providing information about the End of Life Option Act to
a patient upon the request of the individual.

begin delete

(c)

end delete

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

begin delete

(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
this part.

end delete begin insert

(b) A health care provider that prohibits activities under this
part in accordance with subdivision (e) of Section 443.12 shall
not sanction an individual health care provider for contracting
with a qualified individual to engage in activities authorized by
this part if the individual health care provider is acting outside of
the course and scope of his or her capacity as an employee or
independent contractor of the prohibiting health care provider.

end insert begin delete

(e)

end delete

begin insert (c) end insert  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
begin insert aid-in-dying end insert medication to end an individual’s life without his or
her authorization or concealing or destroying a rescission of a
request for begin insert aid-in-dying end insert 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 begin insert aid-in-dying end insert medication for the purpose of
ending his or her life or to destroy a rescission of a request is
punishable as a felony.

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

(d) Nothing in this section begin delete limits further liability for civil
damages resulting from other negligent conduct or intentional
misconduct by any person. end delete begin insert shall be construed to limit civil liability. end insert

(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 begin delete Officer, in consultation
with the State Department of Social Services, end delete begin insert Officer shall annually
review a sample of records maintained pursuant to Section 443.19
and end insert shall adopt regulations establishing begin insert additional end insert 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.

begin insert

begin insert 443.19. end insert   

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

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

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

(c) The attending physician’s diagnosis and prognosis,
determination that a qualified individual is competent, acting
voluntarily, and has made an informed decision, or that the
attending physician has determined that the individual is not a
qualified individual.

(d) The consulting physician’s diagnosis and prognosis, and
verification that the qualified individual is competent, acting
voluntarily, and has made an informed decision, or that the
consulting physician has determined that the individual is not a
qualified individual.

(e) A report of the outcome and determinations made during
counseling, if performed.

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

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

end insert

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 interest:

(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
services.

(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
Constitution.