PRINTER'S NO. 1162
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
943
Session of
2015
INTRODUCED BY ROZZI, THOMAS, STURLA, W. KELLER AND EVERETT,
APRIL 10, 2015
REFERRED TO COMMITTEE ON JUDICIARY, APRIL 10, 2015
AN ACT
Amending Title 20 (Decedents, Estates and Fiduciaries) of the
Pennsylvania Consolidated Statutes, providing for procedures
regarding the request and dispensation of lethal medication
to patients seeking to die in a dignified and humane manner,
for duties of attending physicians, for duties of consulting
physicians, for insurance or annuity policies; imposing
duties on the Department of Health; providing for immunities
and for attorney fees; and imposing penalties.
This act shall be referred to as the CARE Act.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Title 20 of the Pennsylvania Consolidated
Statutes is amended by adding a chapter to read:
CHAPTER 54B
COMPASSIONATE AUTONOMOUS RIGHT FOR
THE END OF LIFE
Sec.
54B01. Definitions.
54B02. Written request for medication.
54B03. Form of written request.
54B04. Attending physician responsibilities.
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54B05. Consulting physician confirmation.
54B06. Counseling referral.
54B07. Informed decision.
54B08. Family notification.
54B09. Written and oral requests.
54B10. Right to rescind request.
54B11. Waiting periods.
54B12. Medical record documentation requirements.
54B13. Residency requirement.
54B14. Reporting requirements.
54B15. Effect on construction of wills and contracts.
54B16. Insurance or annuity policies.
54B17. Construction.
54B18. Immunities.
54B19. Health care provider participation; notification;
permissible sanctions.
54B20. Liabilities.
54B21. Claims by governmental entity for costs incurred.
54B22. Instrument.
54B23. Penalties for mishandling instrument.
ยง 54B01. Definitions.
The following words and phrases when used in this chapter
shall have the meanings given to them in this section unless the
context clearly indicates otherwise:
" Adult. " An individual who is 18 years of age or older.
" Attending physician. " The physician who has primary
responsibility for the care of the patient and treatment of the
patient's terminal disease.
" Capable. " An opinion of either a court or a patient's
attending physician or consulting physician, psychiatrist,
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psychologist or clinical social worker that a patient has the
ability to make and communicate health care decisions to health
care providers, including communication through individuals
familiar with the patient's manner of communicating if those
individuals are available.
" Consulting physician. " A physician who is qualified by
specialty or experience to make a professional diagnosis and
prognosis regarding the patient's disease.
" Counseling. " One or more consultations as necessary between
a 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.
" Department. " The Department of Health of the Commonwealth.
" Health care provider. " A person licensed, certified or
otherwise authorized or permitted by the laws of this
Commonwealth to administer health care or dispense medication in
the ordinary course of business or practice of a profession. The
term includes a health care facility and institution.
" Informed decision. " A decision by a qualified patient to
request and obtain a prescription to end his or her life in a
humane and dignified manner, which decision is based on an
appreciation of the relevant facts and after being fully
informed by the attending physician of:
(1) His or her medical diagnosis.
(2) His or her prognosis.
(3) The potential risks associated with taking the
medication to be prescribed.
(4) The probable result of taking the medication to be
prescribed.
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(5) The feasible alternatives, including, but not
limited to, comfort care, hospice care and pain control.
" Medically confirmed. " 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.
" Participate under this chapter. " To perform the duties of
an attending physician under section 54B04 (relating to
attending physician responsibilities), the consulting physician
function under section 54B05 (relating to consulting physician
confirmation) or the consulting function under section 54B06
(relating to counseling referral). The term does not include:
(1) making an initial determination that a patient has a
terminal disease and informing the patient of the medical
prognosis;
(2) providing information about this chapter to a
patient upon his request;
(3) providing a patient, upon the request of the
patient, with a referral to another physician; or
(4) contracting by a patient 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.
" Patient. " An individual who is under the care of a
physician.
" Physician. " A doctor of medicine or osteopathy licensed to
practice by the State Board of Medicine or State Board of
Osteopathic Medicine.
" Qualified patient. " A capable adult who is a resident of
this Commonwealth and has satisfied the requirements of this
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chapter in order to obtain a prescription for medication to end
his or her life in a humane and dignified manner.
" Terminal disease. " An incurable and irreversible disease
that has been medically confirmed and will, within reasonable
medical judgment, produce death within six months.
ยง 54B02. Written request for medication.
An adult resident of this Commonwealth who is capable 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 in accordance with this
chapter. No individual may qualify to write a request for
medication under this section solely because of age or
disability.
ยง 54B03. Form of written request.
(a) Signature, date and attestation.--A valid request for
medication under this chapter shall be in substantially the form
described in section 54B22 (relating to instrument), 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.
(b) Witness.--One of the witnesses shall be an individual
who is not:
(1) a relative of the patient by blood, marriage or
adoption;
(2) someone with whom the patient has had a significant
relationship;
(3) an individual who, at the time the request is
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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
(4) an owner, operator or employee of a health care
facility where the qualified patient is receiving medical
treatment or is a resident.
(c) Prohibition.--The patient's attending physician,
consulting physician or an individual who has conducted an
evaluation of the patient at the time the request is signed
shall not be a witness.
(d) Long-term care patient.--If the patient is 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 and having the qualifications specified by the
department by rule.
ยง 54B04. Attending physician responsibilities.
(a) Responsibilities.--The attending physician shall:
(1) Make the initial determination of whether a patient
has a terminal disease, is capable and has made the request
voluntarily.
(2) Request that the patient demonstrate Commonwealth
residency under section 54B13 (relating to residency
requirement).
(3) Ensure that the patient is making an informed
decision and inform the patient of:
(i) His or her medical diagnosis.
(ii) His or her prognosis.
(iii) The potential risks associated with taking the
medication to be prescribed.
(iv) The probable result of taking the medication to
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be prescribed.
(v) The feasible alternatives, including, but not
limited to, comfort care, hospice care and pain control.
(4) 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.
(5) Refer the patient for counseling if appropriate
under section 54B06 (relating to counseling referral).
(6) Recommend the patient notify next of kin or someone
with whom the patient has a significant relationship.
(7) Counsel the patient about the importance of having
another individual present when the patient takes the
medication prescribed under this chapter and of not taking
the medication in a public place.
(8) Inform the patient that he or she has an opportunity
to rescind the request at any time and in any manner under
section 54B10 (relating to right to rescind request) and
offer the patient an opportunity to rescind at the end of the
15-day waiting period under section 54B11 (relating to
waiting periods).
(9) Immediately prior to writing a prescription for
medication under this chapter, verify the patient is making
an informed decision.
(10) Fulfill the medical record documentation
requirements of section 54B12 (relating to medical record
documentation requirements).
(11) Ensure the steps in this chapter are carried out
prior to writing a prescription for medication to enable a
qualified patient to end his or her life in a humane and
dignified manner.
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(12) (i) Dispense medications directly, including
ancillary medications intended to facilitate the desired
effect to minimize the patient's discomfort, provided the
attending physician is authorized to do so in this
Commonwealth, has a current Drug Enforcement
Administration certificate and complies with any
applicable administrative rule; or
(ii) with the patient's written consent:
(A) contact a pharmacist and inform the
pharmacist of the prescription; and
(B) deliver the written prescription personally,
by facsimile 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.
(b) Death certificate.--Notwithstanding any other provision
of law, the attending physician may sign the patient's death
certificate.
ยง 54B05. Consulting physician confirmation.
Before a patient is qualified under this chapter, a
consulting physician shall physically examine the patient and
the patient's relevant medical records to confirm the attending
physician's diagnosis that the patient is suffering from a
terminal disease. This confirmation shall be in writing. The
consulting physician must also verify the patient:
(1) Is capable.
(2) Is acting voluntarily.
(3) Has made an informed decision.
ยง 54B06. Counseling referral.
If the opinion of the attending physician or the consulting
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physician is that the patient may be suffering, at the time a
written request is made under section 54B02 (relating to written
request for medication), 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 may be
prescribed until the individual performing the counseling
determines that the patient is not suffering from a psychiatric
or psychological disorder or depression causing impaired
judgment.
ยง 54B07. Informed decision.
No individual may 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. Immediately prior to
writing a prescription for medication under this chapter, the
attending physician shall verify the patient is making an
informed decision.
ยง 54B08. Family notification.
The attending physician shall recommend that the patient
notify the next of kin or an individual with whom the patient
has a significant relationship of his or her request for
medication under this chapter. A patient who declines or is
unable to notify the next of kin or an individual with whom the
patient has a significant relationship shall not have his or her
request denied for that reason.
ยง 54B09. 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 shall make a second oral request to his or her attending
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physician no less than 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.
ยง 54B10. 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 chapter may be written
without the attending physician's offering the qualified patient
an opportunity to rescind the request.
ยง 54B11. Waiting periods.
No less than 15 days shall elapse between the patient's
initial oral request and the writing of a prescription under
this chapter. No less than 48 hours shall elapse between the
patient's written request and the writing of a prescription
under this chapter.
ยง 54B12. 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
and determination that the patient is capable and acting
voluntarily and has made an informed decision.
(4) The consulting physician's diagnosis and prognosis
and verification that the patient is capable and acting
voluntarily and has made an informed decision.
(5) A report of the outcome and determinations made
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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 under section 54B09 (relating to written
and oral requests).
(7) A note by the attending physician indicating the
requirements under this chapter have been met and the steps
taken to carry out the request, including a notation of the
medication prescribed.
ยง 54B13. Residency requirement.
Only requests made by Commonwealth residents under this
chapter shall be granted. Factors demonstrating residency
include, but are not limited to:
(1) Possession of a driver's license.
(2) Voter registration.
(3) Evidence the individual owns or leases property in
this Commonwealth.
(4) A tax return filed in the most recent year.
ยง 54B14. Reporting requirements.
(a) Review.--
(1) The department shall annually review a sample of
records maintained under this chapter.
(2) The department shall require any health care
provider to file a copy of the dispensing record with the
department upon dispensing medication under this chapter.
(b) Rulemaking.--The department shall promulgate rules to
facilitate the collection of information regarding compliance
with this chapter. Except as otherwise provided by law, the
information collected is not a public record and may not be made
available for inspection by the public.
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(c) Report.--The department shall generate and make
available to the public, to the extent doing so would not be
reasonably expected to violate the privacy of any individual, an
annual statistical report of information collected under
subsection (b).
ยง 54B15. Effect on construction of wills and contracts.
(a) Effect on existing agreements.--No provision in a
contract, will or other agreement, whether written or oral, may
be valid which affects whether an individual may make or rescind
a request for medication to end his or her life in a humane and
dignified manner.
(b) Obligations under an existing contract.--No obligation
under an existing contract may be conditioned or affected by an
individual's making or rescinding of a request for medication to
end his or her life in a humane and dignified manner.
ยง 54B16. Insurance or annuity policies.
The sale, procurement or issuance of life, health or accident
insurance or an 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 an individual, for medication to
end his or her life in a humane and dignified manner. A
qualified patient's act of ingesting medication to end his or
her life in a humane and dignified manner may not have an effect
upon a life, health or accident insurance or an annuity policy.
ยง 54B17. Construction.
Nothing under this chapter may be construed to authorize a
physician or any other individual to end a patient's life by
lethal injection, mercy killing or active euthanasia. Actions
taken in accordance with this chapter shall not constitute
suicide, assisted suicide, mercy killing or homicide under the
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law.
ยง 54B18. Immunities.
Except as provided in section 54B20 (relating to
liabilities):
(1) No person may be subject to civil or criminal
liability or professional disciplinary action for
participating in good faith compliance with this chapter.
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 in good
faith or refusing to participate under this chapter.
(3) No request by a patient for or provision by an
attending physician of medication in good faith compliance
with this chapter may constitute negligence for any purpose
of law or provide the sole basis for the appointment of a
guardian or conservator.
ยง 54B19. Health care provider participation; notification;
permissible sanctions.
(a) Participation not required.--No health care provider may
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 chapter
and the patient transfers his or her care to a new health care
provider, the prior health care provider shall transfer, upon
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request, a copy of the patient's relevant medical records to the
new health care provider.
(b) Prohibiting participation.--Notwithstanding any other
provision of law, a health care provider may prohibit another
health care provider from participating under this chapter 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 under this
chapter. Nothing in this subsection prevents a health care
provider from providing health care services to a patient that
does not constitute participation under this chapter.
(c) Health care facility.--Notwithstanding any other
provision of law to the contrary, a health care facility may
prohibit an attending physician from writing a prescription for
medication under this chapter for a patient who is a resident in
its facility and intends to use the medication on the facility's
premises, if the facility has notified the prescribing physician
in writing of its policy with regard to the prescriptions.
Notwithstanding section 54B18 (relating to immunities), any
health care provider who violates a policy established by a
health care facility under this section may be subject to
sanctions otherwise allowable under law or contract.
(d) Due process.--A health care provider that imposes
sanctions under subsection (c) 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.
(e) Unprofessional or dishonorable conduct reports.--Action
taken under section 54B03 (relating to form of written request),
54B04 (relating to attending physician responsibilities), 54B05
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(relating to consulting physician confirmation) or 54B06
(relating to counseling referral) may not be the sole basis for
a report of unprofessional or dishonorable conduct to the State
Board of Medicine or the State Board of Osteopathic Medicine.
(f) Standard of care.--No provision of this chapter may be
construed to allow a lower standard of care for patients in the
community where the patient is treated or a similar community.
(g) Definition.--As used in this section, the term " notify "
means a separate written statement to the health care provider
which sanctions its participation in activities covered by this
chapter before the participation occurs.
ยง 54B20. Liabilities.
(a) Civil action.--Except as provided under section 54B18
(relating to immunities), nothing in this chapter shall be
construed to limit liability for civil damages resulting from
negligent conduct or intentional misconduct by any person.
(b) Criminal action.--Except as provided under section
54B18, nothing in this chapter shall be construed to limit
criminal prosecution under any other provision of law.
(c) Disciplinary action.--A health care provider shall be
subject to review and disciplinary action by the appropriate
licensing entity for failing to act in accordance with this
chapter, if failure is not in good faith.
ยง 54B21. Claims by governmental entity for costs incurred.
A governmental entity that incurs costs resulting from an
individual terminating his or her life under the provisions of
this chapter in a public place shall have a claim against the
estate of the individual to recover those costs and reasonable
attorney fees related to enforcing the claim.
ยง 54B22. Instrument.
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A request for a medication as authorized under this chapter
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 and 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 or significant other of my
decision and have taken their opinions into consideration.
( ) I have decided not to inform my family or significant
other of my decision.
( ) I have no family or significant other to inform of my
decision.
I understand that I have the right to rescind this request at
any time.
I understand that this request will supersede any provision
of an advanced directive in conflict with the provisions of this
request.
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,
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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:
Date:
DECLARATION OF WITNESSES
We declare that the individual 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 an attending
physician.
Date:
Witness' signature:
Number and Street:
City, State and Zip Code:
Witness' signature:
Number and Street:
City, State and Zip Code:
NOTE: One witness shall not be a relative by blood, marriage
or adoption of the individual signing this request, shall not be
entitled to any portion of the individual's estate upon death
and shall not own, operate or be employed at a health care
facility where the individual 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.
ยง 54B23. Penalties for mishandling instrument.
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(a) Intent to hasten death.--An individual who without
authorization of the principal willfully alters, forges,
conceals or destroys 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 commits a
felony of the first degree.
(b) Intent to affect health care decision.--Except as
provided in subsection (a), an individual without authorization
of the principal who willfully alters, forges, conceals or
destroys 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 commits a misdemeanor of the
first degree.
Section 2. This act shall take effect in 60 days.
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