PRINTER'S NO. 1841
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No.
1225
Session of
2020
INTRODUCED BY LEACH, BOSCOLA AND TARTAGLIONE, JULY 10, 2020
REFERRED TO JUDICIARY, JULY 10, 2020
AN ACT
Amending Title 20 (Decedents, Estates and Fiduciaries) of the
Pennsylvania Consolidated Statutes, providing for end of life
options, for duties of attending physicians, for duties of
consulting physicians and for insurance or annuity policies;
imposing duties on the Department of Health; providing for
immunities; and imposing penalties.
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
END OF LIFE OPTIONS
Sec.
54B01. Short title of chapter.
54B02. Definitions.
54B03. Requests for medication.
54B04. Form of written request.
54B05. Attending physician responsibilities.
54B06. Pharmacist authorization.
54B07. Consulting physician confirmation.
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54B08. Counseling referral.
54B09. Right to rescind request.
54B10. Waiting periods.
54B11. Medical record documentation requirements.
54B12. Reporting requirements.
54B13. Effect on construction of wills and contracts.
54B14. Insurance or annuity policies.
54B15. Disposal of unused medication.
54B16. Use of interpreters.
54B17. Construction.
54B18. Immunities.
54B19. Health care provider participation; notification;
permissible sanctions.
54B20. Liabilities.
54B21. Instrument.
54B22. Penalties for mishandling instrument.
54B23. Severability.
§ 54B01. Short title of chapter.
This chapter shall be known and may be cited as the End of
Life Options Act.
§ 54B02. 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 at least 18 years of age.
"Attending physician." A physician:
(1) Who has primary responsibility for the care of a
patient and treatment of the patient's terminal illness.
(2) Who provides medical care to patients with advanced
and terminal illness in the normal course of the physician's
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medical practice.
(3) Whose treatment is not limited to or primarily
comprised of providing medical aid in dying.
"Capable." An opinion of an attending physician, consulting
physician, psychiatrist, psychologist or licensed clinical
social worker who has the ability to make and communicate health
care decisions to direct health care providers in the course of
a patient's treatment.
"Coercion or undue influence." A willful attempt, whether by
deception, intimidation or any other means:
(1) to cause an individual to request, obtain or self-
administer medication under this chapter with the intent to
cause bodily harm or death of the individual; or
(2) to prevent a terminally ill individual from
requesting, obtaining or from self-administering medication
under this chapter against the individual's wishes.
"Consulting physician." A physician who is qualified by
specialty or experience to make a professional diagnosis and
prognosis regarding a patient's terminal illness.
"Counseling." One or more consultations as necessary between
a patient and licensed psychiatrist, psychologist or licensed
clinical social worker for the purpose of determining that the
patient is capable and not suffering from 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.
"Informed decision." A decision by a terminally ill
individual to obtain a prescription for medication under this
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chapter that the patient may self-administer to end the
patient's life.
"Interpreter." A person who:
(1) For purposes of 42 Pa.C.S. Ch. 44 Subch. B (relating
to court interpreters for persons with limited English
proficiency):
(i) is readily able to interpret; and
(ii) has read, understands and agrees to abide by
the code of professional conduct for court interpreters
for persons with limited English proficiency as
established by the court administrator in accordance with
42 Pa.C.S. Ch. 44 Subch. B.
(2) For purposes of 42 Pa.C.S. Ch. 44 Subch. C (relating
to court interpreters for persons who are deaf):
(i) is readily able to interpret;
(ii) is certified by the National Association of the
Deaf, the Registry of Interpreters for the Deaf or
similar registry; and
(iii) has read, understands and agrees to abide by
the code of professional conduct for court interpreters
for persons who are deaf as established by the court
administrator in accordance with 42 Pa.C.S. Ch. 44 Subch.
C.
"Medication." Medication prescribed by an attending
physician in compliance with this chapter to bring about a
qualified patient's death.
"Patient." A person who is under the care of a physician.
"Pharmacist." An individual duly licensed by the State Board
of Pharmacy to engage in the practice of pharmacy.
"Physician." A doctor of medicine or osteopathy licensed to
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practice by the State Board of Medicine or State Board of
Osteopathy.
"Qualified patient." A capable adult who has satisfied the
requirements of this chapter in order to obtain a prescription
for medication that the qualified patient may self-administer to
end the qualified patient's life. No person may be qualified as
a "qualified patient" under this chapter solely because of
advanced age or disability.
"Self-administer." An affirmative, conscious, voluntary act
by an individual to ingest medication prescribed in compliance
with this chapter to bring about an individual's death. The term
does not include administration via injection or intravenous
infusion.
"Terminal illness." A disease or condition that, without
life-sustaining procedures, will soon result in death or a state
of permanent unconsciousness from which recovery is unlikely.
"Terminally ill individual." An individual with a terminal
illness.
§ 54B03. Requests for medication.
(a) General rule.--In order to receive medication, a
qualified patient must, in the following order:
(1) make an oral request;
(2) make a written request; and
(3) reiterate the oral request.
(b) Time.--No less than seven days shall elapse between the
qualified patient's initial oral request and the physician
writing the prescription.
(c) Opportunity to rescind.--At the time the qualified
patient reiterates the second oral request, the attending
physician shall offer the patient an opportunity to rescind the
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request.
(d) Requester.--Oral and written requests for medication
under this chapter must be made by a terminally ill qualified
patient and may not be made by any other individual, including a
terminally ill individual's qualified power of attorney,
attorney-in-fact for health care or via advance health care
directive.
§ 54B04. Form of written request.
(a) Signature, date and attestation.--A valid written
request for medication under this chapter must be in
substantially the form described in section 54B21 (relating to
instrument), signed and dated by the qualified patient and
witnessed by at least two individuals who, in the presence of
the qualified patient, attest that to the best of their
knowledge and belief the qualified patient is capable, acting
voluntarily and not being coerced to sign the request.
(b) Ineligible witnesses.--One of the witnesses must be a
person who is not:
(1) a relative of the qualified patient by blood,
marriage or adoption;
(2) at the time the request is signed, entitled to any
portion of the estate of the patient upon death under a will
or by operation of law; or
(3) an owner, operator or employee of a health care
facility where the patient receives medical treatment or is a
resident.
(c) Prohibition.--The qualified patient's attending
physician at the time the request is signed may not be a
witness.
(d) Long-term care patient.--If the qualified patient lives
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in a long-term care facility at the time the written request is
made, one of the witnesses must be an individual who is
designated by the facility and meets the qualifications
specified by regulation of the department.
§ 54B05. Attending physician responsibilities.
(a) General rule.--The attending physician shall:
(1) Make the initial determination of whether a patient
has a terminal illness, is capable and has made the request
voluntarily.
(2) Attempt to confirm that the patient's request does
not arise from coercion or undue influence by another
individual by discussing with the patient, outside the
presence of other individuals, except for an interpreter as
necessary, whether the patient feels coerced or unduly
influenced by another individual.
(3) Ensure that the patient is making an informed
decision by informing the patient of:
(i) Feasible alternatives, concurrent or additional
treatment opportunities for the patient's terminal
illness, including, but not limited to, comfort care,
palliative care, hospice care or pain control and the
potential risks and benefits of each.
(ii) The potential risks, benefits and probable
result of self-administering the medication prescribed to
bring about a death.
(iii) The choices available to the patient that
reflect the patient's self-determination, including that
the patient is under no obligation to fill the
prescription once provided nor self-administer the
medication if it is obtained.
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(iv) The right to rescind the request for medication
under this chapter at any time and in any manner.
(v) The benefits of notifying family of the
patient's decision to request medication under this
chapter as an end of life care option.
(4) Provide the patient with a .referral for comfort
care, palliative care, hospice care, pain control or other
end of life treatment opportunities as clinically indicated.
(5) Refer the patient to another consulting physician
for medical confirmation of the diagnosis and for a
determination that the patient is capable and acting
voluntarily.
(6) Refer the patient for counseling if appropriate
under section 54B08 (relating to counseling referral).
(7) Counsel the patient about:
(i) The recommended methods for self-administering
the medication to be prescribed.
(ii) The safe-keeping and proper disposal of unused
medication in accordance with Federal Drug Administration
and department guidelines.
(iii) The importance of having another person
present when the patient self-administers the medication
prescribed under this chapter.
(8) Inform the patient that the patient has an
opportunity to rescind a written or oral request for
medication at any time and in any manner under section 54B09
(relating to right to rescind request) and offer the patient
an opportunity to rescind a written or oral request for
medication at the end of the seven-day waiting period under
section 54B10 (relating to waiting periods).
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(9) Fulfill the medical record documentation
requirements of section 54B11 (relating to medical record
documentation requirements).
(10) Either:
(i) dispense medications directly, including
ancillary medications intended to facilitate the desired
effect to minimize the patient's discomfort, provided the
attending physician is:
(A) authorized to do so in this Commonwealth;
(B) has a current Drug Enforcement
Administration certificate;
(C) complies with any applicable administrative
regulation; or
(ii) with the patient's consent:
(A) contact a pharmacist and inform the
pharmacist of the prescription; and
(B) deliver the written prescription personally,
by mail or electronically to the pharmacist, who
shall dispense the medication to either the qualified
patient, the attending physician or an expressly
identified agent of the patient.
(b) Death certificate.--
(1) Notwithstanding any other provision of law, the
attending physician may sign the qualified patient's death
certificate. When a death has occurred in accordance with
this chapter, the attending physician shall record the cause
of death as the underlying terminal illness.
(2) A qualified patient's act of self-administering
medication prescribed under this chapter shall not be
indicated on the death certificate.
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§ 54B06. Pharmacist authorization.
A pharmacist may dispense the medication after receiving a
written prescription from the attending physician for a
qualified patient.
§ 54B07. Consulting physician confirmation.
(a) General rule.--Before an patient becomes a qualified
patient under this chapter, a consulting physician shall
evaluate the patient and the patient's relevant medical records
to confirm the attending physician's diagnosis that the patient
has a terminal illness. The confirmation shall be in writing.
(b) Requirements.--The consulting physician must also verify
the patient:
(1) is capable;
(2) is acting voluntarily; and
(3) has made an informed decision.
§ 54B08. Counseling referral.
If the opinion of the attending physician or the consulting
physician is that the patient may be suffering from impaired
judgment, either physician shall refer the patient for
counseling. No medication to end a patient's life may be
prescribed until the person performing the counseling determines
that the patient is not suffering from impaired judgment.
§ 54B09. Right to rescind request.
A qualified patient may rescind a request for medication at
any time and in any manner without regard to mental state. No
prescription for medication under this chapter may be written
before the attending physician has offered the qualified patient
an opportunity to rescind the request for medication.
§ 54B10. Waiting periods.
(a) General rule.--
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(1) No less than seven days shall elapse between the
qualified patient's initial oral request and the writing of a
prescription under this chapter.
(2) No less than 48 hours shall elapse between the
patient's written request and the writing of a prescription
under this chapter.
(b) Waiver of waiting period.--Notwithstanding subsection
(a)(1), if the terminally ill patient's attending physician
attests that the terminally ill patient will, within reasonable
medical judgment, die within seven days after making the initial
oral request under this section, the terminally ill patient may
reiterate the oral request to the attending physician at any
time after making the initial oral request in order to waive the
seven day waiting period.
§ 54B11. Medical record documentation requirements.
The following shall be documented or filed in a patient's
medical record:
(1) All oral requests by the patient for medication
under this chapter.
(2) All written requests by the patient for medication
under this chapter.
(3) The attending physician's diagnosis, prognosis and
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 counseling, if performed.
(6) The attending physician's offer to the patient to
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rescind the request at the time of the patient's second oral
request.
(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.
§ 54B12. Reporting requirements.
The department shall generate and make available to the
public an annual statistical report of information collected
under this chapter.
§ 54B13. Effect on construction of wills and contracts.
(a) Effect on existing agreements.--A provision in a
contract, will or other agreement, whether written or oral, that
affects whether a person may self-administer medication or make
or rescind a request for medication under this chapter is
invalid and unenforceable.
(b) Obligations under an existing contract.--No obligation
under an existing contract may be conditioned or affected by a
qualified patient's self-administering medication or making or
rescinding of a request for medication to end the qualified
patient's life under this chapter.
§ 54B14. Insurance or annuity policies.
(a) Restrictions.--
(1) The sale, procurement or issuance of life, health or
accident insurance or an annuity policy or the rate charged
for a policy shall not be conditioned upon or affected by the
making or rescinding of a request by an individual for
medication to end the individual's life.
(2) A qualified patient's act of ingesting medication to
end the patient's life may not be a cause for the patient's
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life, health or accident insurance or annuity policy to deny
benefits under the policy.
(b) Health insurance.--A patient with a terminal illness who
is a covered beneficiary of a health insurance plan may not be
denied benefits or have the individual's benefits altered based
on access to end of life options, the availability of
medication, the individual's request for medication under this
chapter or absent a request for medication under this chapter.
(c) Medial assistance.--A terminally ill individual who is a
recipient of medical assistance under Subarticle (f) of Article
IV of the act of June 13, 1967 (P.L.31, No.21), known as the
Human Services Code, may not be denied benefits or have benefits
altered based on the individual's access to end of life options,
the availability of medication, the individual's request for
medication under this chapter or absent a request for medication
under this chapter.
§ 54B15. Disposal of unused medication.
An individual who has custody or control of medication
prescribed and dispensed under this chapter that remains unused
after the terminally ill individual's death shall dispose of the
medication by lawful means in accordance with Federal and State
guidelines.
§ 54B16. Use of interpreters.
A terminally ill individual who requests information or
services under this chapter may request an interpreter. An
interpreter used under this chapter may not be related to the
terminally ill individual by blood, marriage, registered
domestic partnership, or adoption or be entitled to a portion of
the terminally ill individual's estate upon death.
§ 54B17. Construction.
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Nothing in this chapter shall be construed to authorize a
physician or other person to end a patient's life by any means
not authorized by this chapter. Conduct in accordance with this
chapter shall not constitute suicide, assisted suicide, mercy
killing or homicide under law.
§ 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 acting in
accordance with this chapter, including being present when a
qualified patient self-administers the prescribed medication
to end the qualified patient's life.
(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 acting in accordance
with this chapter.
(3) No request by a patient for medication in good faith
compliance with this chapter may constitute negligence or
provide the sole basis for the appointment of a guardian or
conservator.
(4) No issuance by an attending physician of medication
in good faith with this chapter may constitute negligence or
provide the sole basis for the appointment of a guardian or
conservator.
§ 54B19. Health care provider participation; notification;
permissible sanctions.
(a) Participation not required.--
(1) No health care provider may be under a duty, whether
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by contract, by statute or by any other legal requirement, to
participate in the issuance to a qualified patient of
medication to end the patient's life under this chapter.
(2) If a health care provider is unable or unwilling to
carry out a patient's request under this chapter and, as a
result, the patient transfers 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.
(b) Unprofessional or dishonorable conduct reports.--Action
taken under section 54B04 (relating to form of written request),
54B05 (relating to attending physician responsibilities), 54B07
(relating to consulting physician confirmation) or 54B08
(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.
(c) Standard of care.--No provision of this chapter may be
construed to allow a lower standard of care for a patient in the
community where the patient is treated or a similar community.
§ 54B20. Liabilities.
(a) Mishandling instrument.--A person who, without
authorization from a patient, willfully alters or forges a
request for medication or conceals or destroys the rescission of
the request with the intent or effect of proximately causing the
patient's death shall not be immune from criminal liability
under section 54B18 (relating to immunities).
(b) Undue influence.--A person who for the purpose of ending
a patient's life coerces or exerts undue influence on the
patient to request medication or to destroy a rescission of the
request shall not be immune from criminal liability under
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section 54B18.
(c) Civil damages.--Nothing under this chapter limits
liability for civil damages resulting from negligent or
intentional misconduct by any person.
§ 54B21. Instrument.
A written request for a medication as authorized under this
chapter shall be in substantially the following form:
REQUEST FOR MEDICATION
TO PEACEFULLY 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 illness.
I have been fully informed of my diagnosis and prognosis, the
feasible alternatives, concurrent or additional treatment
opportunities for my terminal illness, including, but not
limited to, comfort care, palliative care, hospice care or pain
control and the potential risks and benefits of each. I have
been offered resources or referrals to pursue these
alternatives.
I request that my attending physician prescribe medication
that I may self-administer to bring a peaceful end to my life in
a humane and dignified manner.
I understand that I have the right to rescind this request at
any time.
I understand the full importance of this request and I expect
to die when I take the medication to be prescribed.
I make this request voluntarily and without reservation.
Signed:
Date:
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DECLARATION OF WITNESS
I declare that the person signing this request:
(1) Is personally known to me or has provided proof of
identity.
(2) Signed this request in my presence.
(3) Appears to be of sound mind and not under duress, fraud
or undue influence.
(4) Is not a patient for whom I am a physician.
Date:
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 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.
§ 54B22. Penalties for mishandling instrument.
(a) Intent to hasten death.--A person who without
authorization of a qualified patient willfully alters, forges,
conceals or destroys a written or oral request, the
reinstatement or revocation of a written or oral request or any
other evidence or document reflecting the qualified patient'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 qualified patient commits a felony of the first
degree.
(b) Intent to affect health care decision.--Except as
provided in subsection (a), a person who without authorization
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of a qualified patient willfully alters, forges, conceals or
destroys a written or oral request, the reinstatement or
revocation of a written or oral request or any other evidence or
document reflecting the qualified patient's desires and
interests with the intent or effect of affecting a health care
decision commits a misdemeanor of the first degree.
§ 54B23. Severability.
If a part of this chapter is invalid, all valid parts that
are severable from the invalid part remain in effect. If a part
of this chapter is invalid in one or more of its applications,
the part remains in effect in all valid applications that are
severable from the invalid applications.
Section 2. This act shall take effect in 60 days.
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