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S.112

Introduced by   Senator Lyons of Chittenden County, Senator Ayer of Addison County, Senator Condos of Chittenden County, Senator Dunne of Windsor County, Senator Miller of Chittenden County, Senator Scott of Washington County, Senator Snelling of Chittenden County and Senator White of Windham County

Referred to Committee on

Date:

Subject:  Health; death with dignity act

Statement of purpose:  This bill proposes to affirm and protect the rights of mentally competent patients to control end-of-life medical decisions when they are suffering from terminal illness and when they have no reasonable medical expectation of living longer than six months.  The bill protects the ability of such patients to preserve their dignity and privacy, to control intolerable suffering that may accompany terminal disease, and to control the taking of prescribed medication, even to the point of hastening their death, within a statutory framework of appropriate legal safeguards.

AN ACT RELATING TO THE VERMONT DEATH WITH DIGNITY ACT


It is hereby enacted by the General Assembly of the State of Vermont:

Sec. 1.  18 V.S.A. chapter 113 is added to read:

CHAPTER 113.  RIGHTS OF MENTALLY COMPETENT PATIENTS
SUFFERING A TERMINAL CONDITION

§ 5280.  DEFINITIONS

For purposes of this chapter:

(1)  “Attending physician” means the physician who has primary responsibility for the care of the patient.

(2)  “Consulting physician” means a physician who is qualified by specialty or experience to make a professional diagnosis and prognosis regarding the patient’s illness.

(3)  “Counseling” means a consultation between a psychiatrist or psychologist licensed in Vermont and a patient for the purpose of determining whether the patient is suffering from a psychiatric or psychological disorder or depression which causes the patient to have impaired judgment.

(4)  “Health care provider” means a person licensed, certified, or otherwise authorized or permitted by the law of this state to administer health care, and includes a health care facility.

(5)  “Incapable” means that in the opinion of a court or in the opinion of the patient’s attending physician or consulting physician, a patient lacks the ability to make and communicate health care decisions to health care providers, including communicating through persons familiar with the patient’s manner of communicating if those persons are available.  “Capable” means not incapable.

(6)  “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, and the decision is based on the patient’s understanding and appreciation of the relevant facts and was made after being fully informed by the attending physician of all the following:

(A)  The patient’s medical diagnosis.

(B)  The patient’s prognosis.

(C)  The potential risks associated with taking the medication to be prescribed.

(D)  The probable result of taking the medication to be prescribed.

(E)  All feasible alternatives, including comfort care, hospice care, and pain control.

(7)  “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.

(8)  “Patient” means a person who is 18 years of age or older, a resident of Vermont, and under the care of a physician.

(9)  “Physician” means a physician licensed pursuant to chapters 23 and 33 of Title 26.

(10)  “Qualified patient” means a capable patient who has satisfied the requirements of this chapter in order to obtain a prescription for medication to terminate his or her life in a humane and dignified manner.

(11)  “Terminal condition” means an incurable and irreversible disease which would, within reasonable medical judgment, produce death within six months.

§ 5281.  WRITTEN REQUEST FOR MEDICATION

(a)  A capable patient who has been determined by the attending physician and consulting physician to be suffering from a terminal condition and who has voluntarily expressed a 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 in accordance with this chapter.

(b)  A request for medication shall be 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 not being coerced to sign the request.  Neither witness shall be any of the following persons:

(1)  A relative of the patient by blood, marriage, or adoption.

(2)  A person who at the time the request is signed would be entitled to any portion of the estate of the qualified patient under any will or by operation of law.

(3)  An owner, operator, or employee of a health care facility where the qualified patient is receiving medical treatment or is a resident.

(4)  The patient’s attending physician.

§ 5282.  ATTENDING PHYSICIAN; DUTIES

The attending physician shall perform all the following:

(1)  Make the initial determination of whether a patient is suffering a terminal condition and whether the patient voluntarily made the request for medication.

(2)  Inform the patient of all the following:

(A)  The patient’s medical diagnosis.

(B)  The patient’s prognosis.

(C)  The potential risk associated with taking the medication to be prescribed.

(D)  The probable result of taking the medication to be prescribed.

(E)  All feasible alternatives, including comfort care, hospice care, and pain control.

(3)  Refer the patient to a consulting physician for medical confirmation of the diagnosis, prognosis, and a determination that the patient is capable and acting voluntarily.

(4)  Refer the patient for counseling if appropriate.

(5)  Request that the patient notify the next of kin.

(6)  Inform the patient that the patient 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.

(7)  Verify, immediately prior to writing the prescription for medication under this chapter, that the patient is making an informed decision.

(8)  Fulfill the medical record documentation requirements of section 5290 of this title.

(9)  Ensure that all appropriate steps are carried out in accordance with this chapter prior to writing a prescription for medication to enable a qualified patient to end his or her life in a humane and dignified manner.

§ 5283.  MEDICAL CONSULTATION REQUIRED

Before a patient is qualified under this chapter, a consulting physician shall examine the patient and the patient’s relevant medical records and confirm in writing the diagnosis of the attending physician that the patient is suffering from a terminal condition, that death is expected to occur within six months and verify that the patient is capable, is acting voluntarily, and has made an informed decision.

§ 5284.  COUNSELING REQUIRED

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 the patient’s life shall be prescribed until the person performing the counseling determines that the patient is not suffering from a psychiatric or psychological disorder or depression which causes the patient to have impaired judgment.

§ 5285.  INFORMED DECISION

No person shall receive a prescription for medication to end his or her life unless the patient has made an informed decision.  Immediately prior to writing a prescription for medication under this chapter, the attending physician shall verify that the patient is making an informed decision.

§ 5286.  FAMILY NOTIFICATION

The attending physician shall ask the patient to notify the patient’s next of kin of the patient’s request for medication under this chapter.  A patient who declines or is unable to notify next of kin shall not be refused medication under this chapter.


§ 5287.  WRITTEN AND ORAL REQUESTS

In order to receive a prescription for medication to end his or her life, a patient shall have made two oral requests and a written request.  The patient’s second oral request shall be at least 15 days after the first oral request.  The patient’s written request may be made at any time.

§ 5288.  RIGHT TO RESCIND

A patient may rescind the request at any time and in any manner without regard to the patient’s mental state.  No prescription for medication under this chapter may be written without the attending physician offering the qualified patient an opportunity to rescind the request.

§ 5289.  WAITING PERIOD

The attending physician shall write a prescription no less than 48 hours after the last to occur of all of the following events:

(1)  the patient’s written request to end his or her life;

(2)  the patient’s second oral request; or

(3)  the attending physician’s offering the patient an opportunity to rescind the request.

§ 5290.  MEDICAL RECORD DOCUMENTATION

The following shall be documented and filed in the patient’s medical record:

(1)  The date and wording of all oral requests of the patient for medication to end his or her life.

(2)  All written requests by a patient for medication to end his or her life.

(3)  The attending physician’s diagnosis, prognosis, and basis for the determination that the patient is capable, acting voluntarily, and has made an informed decision.

(4)  The consulting physician’s diagnosis, 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 any counseling which the patient may have received.

(6)  The date and wording of the attending physician’s offer to the patient to rescind the request for medication at the time of the patient’s second oral request.

(7)  A note by the attending physician indicating that all requirements under this chapter have been satisfied and all the steps that have been taken to carry out the request, including a notation of the medication prescribed.

§ 5291.  REPORTING

(a)  The department of health shall annually review the records of qualified patients who end their lives pursuant to this chapter.

(b)  The department of health shall make rules to facilitate the collection of information regarding compliance with this chapter.  The information collected shall not be public record and shall not be made available for inspection by the public.

(c)  The department of health shall generate and make available to the public an annual statistical report of information collected under subsection (b) of this section.

§ 5292.  PROHIBITIONS; CONTRACT CONSTRUCTION

(a)  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 under this chapter, shall be valid.

(b)  The sale, procurement, or issue 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 under this chapter or the act by a qualified patient to end his or her life pursuant to this chapter.  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 on a life, health, or accident insurance or annuity policy.


§ 5293.  IMMUNITIES

(a)  No person shall be subject to civil or criminal liability or professional disciplinary action for participating in good faith in compliance with this chapter.  This includes being present when a qualified patient takes the prescribed medication to end his or her life pursuant to this chapter.

(b)  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 chapter.

(c)  No request by a patient for or provision by an attending physician of medication in good faith compliance with the provisions of this chapter shall constitute neglect for any purpose of law or provide the sole basis for the appointment of a guardian or conservator.

(d)  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 under this chapter.  If a health care provider is unable or unwilling to carry out a patient’s request under this chapter and the patient transfers his or her care to a new health care provider, the previous health care provider shall transfer upon request a copy of the patient’s relevant medical records to the new health care provider.


§ 5294.  HEALTH CARE FACILITY EXCEPTION

Notwithstanding any other provision of law, a health care provider may prohibit an attending physician from writing a prescription for a patient who is resident on the prohibiting health care provider’s premises for medication for the purpose of ending his or her life in a humane and dignified manner on the premises of the prohibiting health care provider, if the prohibiting health care provider has notified the attending physician in writing of the prohibiting health care provider’s policy with regard to such prescriptions.

§ 5295.  FORM OF THE REQUEST

A request for medication as authorized by this chapter shall be substantially in 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:  Neither witness shall be a relative (by blood, marriage, or adoption) of the person signing this request, shall be entitled to any portion of the person’s estate upon death nor shall own, operate, or be employed at a health care facility where the person is a patient or resident.

Sec. 2.  CONSTRUCTION

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.  Action taken in accordance with this act shall not be construed for any purpose to constitute suicide, assisted suicide, mercy killing, or homicide under the law.



Published by:

The Vermont General Assembly
115 State Street
Montpelier, Vermont


www.leg.state.vt.us