The Commonwealth of Massachusetts
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PRESENTED BY:
Louis L. Kafka, William C. Galvin (BY REQUEST)
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To the
Honorable Senate and House of Representatives of the Commonwealth of
Massachusetts in General
Court assembled:
The undersigned legislators and/or citizens respectfully petition for the passage of the accompanying bill:
An Act Relative to Death with Dignity.
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PETITION OF:
Name: |
District/Address: |
Mr. Albert E. Lipkind |
35 Lorraine Avenue |
The Commonwealth of
Massachusetts
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In the Year Two Thousand and Nine
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An Act Relative to Death with Dignity.
Be
it enacted by the Senate and House of Representatives in General Court
assembled, and by the authority of the same, as follows:
Section 1. Definitions
As used in this chapter, the following words shall, unless the context clearly indicates a different meaning, have the following meanings:
(1) "Adult" means an individual who is 18 years of age or older.
(2) (2) "Attending physician" means the physician who has primary responsibility for the care of the patient and treatment of the patient's terminal disease.
(3) (3) "Capable" means that in the opinion of a court or in the opinion of the patient's attending physician or consulting physician, psychiatrist or psychologist, a patient has the ability to make and communicate health care decisions to health care providers, including communication through persons familiar with the patient's manner of communicating if those persons are available.
(4) (4) "Consulting physician" means a physician who is qualified by specialty or experience to make a professional diagnosis and prognosis regarding the patient's disease.
(5) (5) "Counseling" means one or more consultations as necessary between a state licensed psychiatrist or psychologist and a patient for the purpose of determining that the patient is capable and not suffering from a psychiatric or psychological disorder or depression causing impaired judgment.
(6) (6) "Health care provider" means a person licensed, certified or otherwise authorized or permitted by the law of this state to administer health care or dispense medication in the ordinary course of business or practice of a profession, and includes a health care facility.
(7) (7) "Informed decision" means a decision by a qualified patient, to request and obtain a prescription to end his or her life in a humane and dignified manner, that is based on an appreciation of the relevant facts and after being fully informed by the attending physician of:
(8) (a) His or her medical diagnosis;
(b) His or her prognosis;
(c) The potential risks associated with taking the medication to be
prescribed;
(d) The probable result of taking the medication to be prescribed; and
(e) The feasible alternatives, including, but not limited to, comfort care, hospice care and pain control.
(8) "Medically confirmed" means the medical opinion of the attending physician has been confirmed by a consulting physician who has examined the patient and the patient's relevant medical records.
(9) "Patient" means a person who is under the care of a physician.
(10) "Physician" means a doctor of medicine or osteopathy licensed to practice medicine by the Board of Medical Examiners for the Commonwealth of Massachusetts.
(11) "Qualified patient" means a capable adult who is a resident of Massachusetts.
(12) "Terminal disease" means an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, produce death within six months.
Section 2. Who may initiate a written request for medication.
(1) An adult who is capable, is a resident of Massachusetts, and has been determined by the attending physician and consulting physician to be suffering from a terminal disease, and who has voluntarily expressed his or her wish to die, may make a written request for medication for the purpose of ending his or her life in a humane and dignified manner.
(2) No person shall qualify under the provisions of this act solely because of age or disability.
Section 3. Form of the written request.
(1) A valid request for medication under this act shall be in substantially the form described in Section 6, signed and dated by the patient and witnessed by at least two individuals who, in the presence of the patient, attest that to the best of their knowledge and belief the patient is capable, acting voluntarily, and is not being coerced to sign the request.
(2) (2) One of the witnesses shall be a person who is not:
(3) (a) A relative of the patient by blood, marriage or adoption;
(4) (b) A person who at the time the request is signed would be entitled to any portion of the estate of the qualified patient upon death under any will or by operation of law; or
(5) (c) An owner, operator or employee of a health care facility where the qualified patient is receiving medical treatment or is a resident.
(6) (3) The patient's attending physician at the time the
request is signed shall not be a witness.
(4) If the patient is a patient in a long term care facility at the time the
written request is made, one of the witnesses shall be an individual designated
by the facility.
(7) Section 3. Attending physician responsibilities.
(1) The attending physician shall:
(2) (a) Make the initial determination of whether a patient has a terminal disease, is capable, and has made the request voluntarily;
(3)
(b) Request that the
patient demonstrate Massachusetts residency;
(c) To ensure that the patient is making an informed decision,
inform the patient of:
(A) His or her medical diagnosis;
(B) His or her prognosis;
(C) The potential risks associated with taking the
medication to be prescribed;
(D) The probable result of taking the medication to be
prescribed; and
(E) The feasible alternatives, including, but not
limited to, comfort care, hospice care and pain control;
(d) Refer the patient to a consulting physician for medical
confirmation of the diagnosis, and for a determination that the patient is
capable and acting voluntarily;
(e) Refer the patient for counseling if appropriate pursuant to
Section 3B;
(f) Recommend that the patient notify next of kin;
(g) Counsel the patient about the importance of having another
person present when the patient takes the medication prescribed pursuant to
this act and of not taking the medication in a public place;
(h) Inform the patient that he or she has an opportunity to rescind
the request at any time and in any manner, and offer the patient an opportunity
to rescind at the end of the 15 day waiting period pursuant to Section 3E;
(i) Verify, immediately prior to writing the prescription for
medication under this act, that the patient is making an informed decision;
(j) Fulfill the medical record documentation requirements of
Section 3H;
(k) Ensure that all appropriate steps are carried out in accordance with this
act prior to writing a prescription for medication to enable a qualified
patient to end his or her life in a humane and dignified manner; and
(l)(A) Dispense medications directly, including
ancillary medications intended to facilitate the desired effect to minimize the
patient's discomfort, provided the attending physician is registered as a
dispensing physician with the Board of Medical Examiners, has a current Drug
Enforcement Administration certificate and complies with any applicable
administrative rule; or
(B) With the patient's written consent:
(i) Contact a pharmacist and inform the
pharmacist of the prescription; and
(ii) Deliver the written prescription
personally or by mail to the pharmacist, who will dispense the medications to
either the patient, the attending physician or an expressly identified agent of
the patient.
(2) Notwithstanding any other provision of law, the attending physician may
sign the patient's death certificate.
Section 3A. Consulting physician confirmation.
Before a
patient is qualified under this act, a consulting physician shall examine the
patient and his or her relevant medical records and confirm, in writing, the attending
physician's diagnosis that the patient is suffering from a terminal disease,
and verify that the patient is capable, is acting voluntarily and has made an
informed decision.
Section 3B. Counseling referral.
If in the opinion of the attending physician or the consulting physician a patient may be suffering from a psychiatric or psychological disorder or depression causing impaired judgment, either physician shall refer the patient for counseling. No medication to end a patient's life in a humane and dignified manner 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.
Section 3C. Informed decision.
No person
shall receive a prescription for medication to end his or her life in a humane
and dignified manner unless he or she has made an informed decision as defined
in Section 1 (7). Immediately prior to writing a prescription for medication
under this act, the attending physician shall verify that the patient is making
an informed decision.
Section 3D. Family notification.
The
attending physician shall recommend that the patient notify the next of kin of
his or her request for medication pursuant to this act. A patient who declines
or is unable to notify next of kin shall not have his or her request denied for
that reason.
Section 3E. Written and oral requests.
In order
to receive a prescription for medication to end his or her life in a humane and
dignified manner, a qualified patient shall have made an oral request and a
written request, and reiterate the oral request to his or her attending
physician no less than fifteen (15) days after making the initial oral request.
At the time the qualified patient makes his or her second oral request, the
attending physician shall offer the patient an opportunity to rescind the
request.
Section 3F. Right to rescind request.
A patient
may rescind his or her request at any time and in any manner without regard to
his or her mental state. No prescription for medication under this act may be
written without the attending physician offering the qualified patient an
opportunity to rescind the request.
Section 3G. Waiting periods.
No less
than fifteen (15) days shall elapse between the patient's initial oral request
and the writing of a prescription under this act. No less than 48 hours shall
elapse between the patient's written request and the writing of a prescription
under this act.
Section 3H. Medical record documentation requirements.
The
following shall be documented or filed in the patient's medical record:
(1) All oral requests by a patient for medication to end his or her life in a
humane and dignified manner;
(2) All written requests by a patient for medication to end his or her life in
a humane and dignified manner;
(3) The attending physician's diagnosis and prognosis, determination that the
patient is capable, acting voluntarily and has made an informed decision;
(4) The consulting physician's diagnosis and prognosis, and verification that
the patient is capable, acting voluntarily and has made an informed decision;
(5) A report of the outcome and determinations made during counseling, if
performed;
(6) The attending physician's offer to the patient to rescind his or her request
at the time of the patient's second oral request pursuant to Section 3E; and
(7) A note by the attending physician indicating that all requirements under
this act have been met and indicating the steps taken to carry out the request,
including a notation of the medication prescribed.
Section 3I. Residency requirement.
Only
requests made by Massachusetts residents under this act shall be granted.
Factors demonstrating Massachusetts residency include but are not limited to:
(1) Possession of a Massachusetts driver license;
(2) Registration to vote in Massachusetts;
(3) Evidence that the person owns or leases property in Massachusetts; or
(4) Filing of an Massachusetts tax return for the most recent tax year.
Section 3J. Reporting requirements.
(1)(a)
The Department of Public Health shall annually review a sample of records
maintained pursuant to this act.
(b) The department shall require any health care provider upon
dispensing medication pursuant to this act to file a copy of the dispensing
record with the division.
(2) The department shall make rules to facilitate the collection of information
regarding compliance with this act. Except as otherwise required by law, the
information collected shall not be a public record and may not be made
available for inspection by the public.
(3) The department shall generate and make available to the public an annual
statistical report of information collected under subsection (2) of this
section.
Section 3K. Effect on construction of wills, contracts and statutes.
(1) No
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 medication to end his or her life in a humane and dignified manner,
shall be valid.
(2) No obligation owing under any currently existing contract shall be
conditioned or affected by the making or rescinding of a request, by a person,
for medication to end his or her life in a humane and dignified manner.
Section 3L. Insurance or annuity policies.
The sale,
procurement, or issuance of any life, health, or accident insurance or annuity
policy or the rate charged for any policy shall not be conditioned upon or
affected by the making or rescinding of a request, by a person, for medication
to end his or her life in a humane and dignified manner. Neither shall a
qualified patient's act of ingesting medication to end his or her life in a
humane and dignified manner have an effect upon a life, health, or accident
insurance or annuity policy.
Section 3M. Construction of Act.
Nothing
in this act shall be construed to authorize a physician or any other person to
end a patient's life by lethal injection, mercy killing or active euthanasia.
Actions taken in accordance with this act shall not, for any purpose,
constitute suicide, assisted suicide, mercy killing or homicide, under the law.
Section 4. Immunities; basis for prohibiting health care
provider from participation; notification; permissible sanctions.
Except as
provided in Section 4B:
(1) No person shall be subject to civil or criminal liability or professional
disciplinary action for participating in good faith compliance with this act.
This includes being present when a qualified patient takes the prescribed
medication to end his or her life in a humane and dignified manner.
(2) No professional organization or association, or health care provider, may
subject a person 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 act.
(3) No request by a patient for or provision by an attending physician of
medication in good faith compliance with the provisions of this act shall
constitute neglect for any purpose of law or provide the sole basis for the
appointment of a guardian or conservator.
(4) No health care provider shall be under any duty, whether by contract, by
statute or by any other legal requirement to participate in the provision to a
qualified patient of medication to end his or her life in a humane and
dignified manner. If a health care provider is unable or unwilling to carry out
a patient's request under this act, and the patient transfers his or her care
to a new health care provider, the prior health care provider shall transfer,
upon request, a copy of the patient's relevant medical records to the new
health care provider.
(5)(a) Notwithstanding any other provision of law, a health care provider may
prohibit another health care provider from participating in this act on the
premises of the prohibiting provider if the prohibiting provider has notified
the health care provider of the prohibiting provider's policy regarding
participating in this act. Nothing in this paragraph prevents a health care
provider from providing health care services to a patient that do not
constitute participation in this act.
(b) Notwithstanding the provisions of subsections (1) to (4) of
this section, a health care provider may subject another health care provider
to the sanctions stated in this paragraph if the sanctioning health care
provider has notified the sanctioned provider prior to participation in this
act that it prohibits participation in this act:
(A) Loss of privileges, loss of membership or other
sanction provided pursuant to the medical staff bylaws, policies and procedures
of the sanctioning health care provider if the sanctioned provider is a member
of the sanctioning provider's medical staff and participates in this act while
on the health care facility premises, as defined in M.G.L. Ch. 111, S.25B, of
the sanctioning health care provider, but not including the private medical
office of a physician or other provider;
(B) Termination of lease or other property contract or
other nonmonetary remedies provided by lease contract, not including loss or
restriction of medical staff privileges or exclusion from a provider panel, if
the sanctioned provider participates in this act while on the premises of the
sanctioning health care provider or on property that is owned by or under the
direct control of the sanctioning health care provider; or
(C) Termination of contract or other nonmonetary
remedies provided by contract if the sanctioned provider participates in this
act while acting in the course and scope of the sanctioned provider's capacity
as an employee or independent contractor of the sanctioning health care
provider. Nothing in this subparagraph shall be construed to prevent:
(i) A health care provider from
participating in this act while acting outside the course and scope of the
provider's capacity as an employee or independent contractor; or
(ii) A patient from contracting with his or
her attending physician and consulting physician to act outside the course and
scope of the provider's capacity as an employee or independent contractor of
the sanctioning health care provider.
(c) A health care provider that imposes sanctions pursuant to
paragraph (b) of this subsection must follow all due process and other
procedures the sanctioning health care provider may have that are related to
the imposition of sanctions on another health care provider.
(d) For purposes of this subsection:
(A) "Notify" means a separate statement in
writing to the health care provider specifically informing the health care
provider prior to the provider's participation in this act of the sanctioning
health care provider's policy about participation in activities covered by this
act.
(B) "Participate in this act" means to
perform the duties of an attending physician pursuant to Section 3, the
consulting physician function pursuant to Section 3A or the counseling function
pursuant to Section 3B. "Participate in this act " does not include:
(i) Making an initial determination that a
patient has a terminal disease and informing the patient of the medical
prognosis;
(ii) Providing information about the
Massachusetts Death with Dignity Act to a patient upon the request of the
patient;
(iii) Providing a patient, upon the request
of the patient, with a referral to another physician; or
(iv) A patient contracting with his or her
attending physician and consulting physician to act outside of the course and
scope of the provider's capacity as an employee or independent contractor of
the sanctioning health care provider.
(6) Action taken pursuant to Sections 3, 3A, 3B, and 3C shall not be the sole
basis for a report of unprofessional or dishonorable conduct under M.G.L. Ch.
112, S. 5.
(7) No provision of this act shall be construed to allow a lower standard of
care for patients in the community where the patient is treated or a similar
community.
Section 4B. Liabilities.
(1) A
person who without authorization of the patient willfully alters or forges a
request for medication or conceals or destroys a rescission of that request
with the intent or effect of causing the patient's death shall be guilty of a
felony.
(2) A person who coerces or exerts undue influence on a patient to request
medication for the purpose of ending the patient's life, or to destroy a
rescission of such a request, shall be guilty of a felony.
(3) Nothing in this act limits further liability for civil damages resulting
from other negligent conduct or intentional misconduct by any person.
(4) The penalties in this act do not preclude criminal penalties applicable
under other law for conduct which is inconsistent with the provisions of this
act.
Section 4C. Claims by governmental entity for costs incurred.
Any
governmental entity that incurs costs resulting from a person terminating his
or her life pursuant to the provisions of this act in a public place shall have
a claim against the estate of the person to recover such costs and reasonable
attorney fees related to enforcing the claim.
Section 5. Severability.
Any
section of this act being held invalid as to any person or circumstance shall
not affect the application of any other section of this act which can be given
full effect without the invalid section or application.
Section 6. Form of the request.
A request for a medication as authorized by this act 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.
I am suffering from _______, which my attending physician has determined is a
terminal disease and which has been medically confirmed by a consulting
physician.
I have been fully informed of my diagnosis, prognosis, the nature of medication
to be prescribed and potential associated risks, the expected result, and the
feasible alternatives, including comfort care, hospice care and pain control.
I request that my attending physician prescribe medication that will end my
life in a humane and dignified manner.
INITIAL ONE:
_____ I have informed 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 when I take
the medication to be prescribed. I further understand that although most deaths
occur within three hours, my death may take longer and my physician has
counseled me about this possibility.
I make this request voluntarily and without reservation, and I accept full
moral responsibility for my actions.
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) Appears to be of sound mind and not under duress, fraud or undue influence;
(d) Is not a patient for whom either of us is attending physician.
__________ Witness 1/Date
__________ Witness 2/Date
NOTE: One witness shall not be a relative (by blood, marriage or adoption) of
the person signing this request, shall not be entitled to any portion of the
person's estate upon death and shall not own, operate or be employed at a
health care facility where the person is a patient or resident. If the patient
is an inpatient at a health care facility, one of the witnesses shall be an
individual designated by the facility.
Section 7. Penalties.
(1) It
shall be considered a felony for a person without authorization of the
principal to willfully alter, forge, conceal or destroy an instrument, the
reinstatement or revocation of an instrument or any other evidence or document
reflecting the principal's desires and interests, with the intent and effect of
causing a withholding or withdrawal of life-sustaining procedures or of
artificially administered nutrition and hydration which hastens the death of
the principal.
(2) Except as provided in subsection (1) of this section, it shall be
considered misdemeanor for a person without authorization of the principal to
willfully alter, forge, conceal or destroy an instrument, the reinstatement or
revocation of an instrument, or any other evidence or document reflecting the
principal's desires and interests with the intent or effect of affecting a
health care decision.