1Amending Title 20 (Decedents, Estates and Fiduciaries) of the
2Pennsylvania Consolidated Statutes, providing for procedures
3regarding the request and dispensation of lethal medication
4to patients seeking to die in a dignified and humane manner,
5for duties of attending physicians, for duties of consulting
6physicians, for insurance or annuity policies; imposing
7duties on the Department of Health; providing for immunities
8and for attorney fees; and imposing penalties.

9The General Assembly of the Commonwealth of Pennsylvania
10hereby enacts as follows:

11Section 1. Title 20 of the Pennsylvania Consolidated
12Statutes is amended by adding a chapter to read:

13CHAPTER 54B

14DEATH WITH DIGNITY

15Sec.

1654B01. Definitions.

1754B02. Written request for medication.

1854B03. Form of written request.

1954B04. Attending physician responsibilities.

2054B05. Consulting physician confirmation.

2154B06. Counseling referral.

154B07. Informed decision.

254B08. Family notification.

354B09. Written and oral requests.

454B10. Right to rescind request.

554B11. Waiting periods.

654B12. Medical record documentation requirements.

754B13. Residency requirement.

854B14. Reporting requirements.

954B15. Effect on construction of wills and contracts.

1054B16. Insurance or annuity policies.

1154B17. Construction.

1254B18. Immunities.

1354B19. Health care provider participation; notification;
14permissible sanctions.

1554B20. Liabilities.

1654B21. Claims by governmental entity for costs incurred.

1754B22. Instrument.

1854B23. Penalties for mishandling instrument.

19§ 54B01. Definitions.

20The following words and phrases when used in this chapter
21shall have the meanings given to them in this section unless the
22context clearly indicates otherwise:

23"Adult." An individual who is 18 years of age or older.

24"Attending physician." The physician who has primary 
25responsibility for the care of the patient and treatment of the 
26patient's terminal disease.

27"Capable." An opinion of either a court or a patient's 
28attending physician or consulting physician, psychiatrist or 
29psychologist that a patient has the ability to make and 
30communicate health care decisions to health care providers,
 

1including communication through persons familiar with the 
2patient's manner of communicating if those persons are 
3available.

4"Consulting physician." A physician who is qualified by 
5specialty or experience to make a professional diagnosis and 
6prognosis regarding the patient's disease.

7"Counseling." One or more consultations as necessary between 
8a licensed psychiatrist or psychologist and a patient for the 
9purpose of determining that the patient is capable and not 
10suffering from a psychiatric or psychological disorder or 
11depression causing impaired judgment.

12"Department." The Department of Health of the Commonwealth.

13"Health care provider." A person licensed, certified or 
14otherwise authorized or permitted by the laws of this 
15Commonwealth to administer health care or dispense medication in 
16the ordinary course of business or practice of a profession. The 
17term includes a health care facility.

18"Informed decision." A decision by a qualified patient to 
19request and obtain a prescription to end his or her life in a 
20humane and dignified manner, which decision is based on an 
21appreciation of the relevant facts and after being fully 
22informed by the attending physician of:

23(1) His or her medical diagnosis.

24(2) His or her prognosis.

25(3) The potential risks associated with taking the
26medication to be prescribed.

27(4) The probable result of taking the medication to be
28prescribed.

29(5) The feasible alternatives, including, but not
30limited to, comfort care, hospice care and pain control.

1"Medically confirmed." The medical opinion of the attending 
2physician has been confirmed by a consulting physician who has 
3examined the patient and the patient's relevant medical records.

4"Participate under this chapter." To perform the duties of 
5an attending physician under section 54B04 (relating to 
6attending physician responsibilities), the consulting physician 
7function under section 54B05 (relating to consulting physician 
8confirmation) or the consulting function under section 54B06 
9(relating to counseling referral). The term does not include:

10(1) making an initial determination that a patient has a
11terminal disease and informing the patient of the medical
12prognosis;

13(2) providing information about this chapter to a
14patient upon his request;

15(3) providing a patient, upon the request of the
16patient, with a referral to another physician; or

17(4) contracting by a patient with his or her attending
18physician and consulting physician to act outside of the
19course and scope of the provider's capacity as an employee or
20independent contractor of the sanctioning health care
21provider.

22"Patient." A person who is under the care of a physician.

23"Physician." A doctor of medicine or osteopathy licensed to 
24practice by the State Board of Medicine or State Board of 
25Osteopathy.

26"Qualified patient." A capable adult who is a resident of 
27this Commonwealth and has satisfied the requirements of this 
28chapter in order to obtain a prescription for medication to end 
29his or her life in a humane and dignified manner.

30"Terminal disease." An incurable and irreversible disease
 

1that has been medically confirmed and will, within reasonable 
2medical judgment, produce death within six months.

3§ 54B02. Written request for medication.

4An adult resident of this Commonwealth who is capable and has
5been determined by the attending physician and consulting
6physician to be suffering from a terminal disease, and who has
7voluntarily expressed his or her wish to die, may make a written
8request for medication for the purpose of ending his or her life
9in a humane and dignified manner in accordance with this
10chapter. No person may qualify to write a request for medication
11under this section solely because of age or disability.

12§ 54B03. Form of written request.

13(a) Signature, date and attestation.--A valid request for
14medication under this chapter shall be in substantially the form
15described in section 54B22 (relating to instrument), signed and
16dated by the patient and witnessed by at least two individuals
17who, in the presence of the patient, attest that to the best of
18their knowledge and belief the patient is capable, acting
19voluntarily and not being coerced to sign the request.

20(b) Witness.--One of the witnesses shall be a person who is
21not:

22(1) a relative of the patient by blood, marriage or
23adoption;

24(2) a person who, at the time the request is signed,
25would be entitled to any portion of the estate of the
26qualified patient upon death under any will or by operation
27of law; or

28(3) an owner, operator or employee of a health care
29facility where the qualified patient is receiving medical
30treatment or is a resident.

1(c) Prohibition.--The patient's attending physician at the
2time the request is signed shall not be a witness.

3(d) Long-term care patient.--If the patient is in a long-
4term care facility at the time the written request is made, one
5of the witnesses shall be an individual designated by the
6facility and having the qualifications specified by the
7department by rule.

8§ 54B04. Attending physician responsibilities.

9(a) Responsibilities.--The attending physician shall:

10(1) Make the initial determination of whether a patient
11has a terminal disease, is capable and has made the request
12voluntarily.

13(2) Request that the patient demonstrate Commonwealth
14residency under section 54B13 (relating to residency
15requirement).

16(3) Ensure that the patient is making an informed
17decision and inform the patient of:

18(i) His or her medical diagnosis.

19(ii) His or her prognosis.

20(iii) The potential risks associated with taking the
21medication to be prescribed.

22(iv) The probable result of taking the medication to
23be prescribed.

24(v) The feasible alternatives, including, but not
25limited to, comfort care, hospice care and pain control.

26(4) Refer the patient to a consulting physician for
27medical confirmation of the diagnosis and for a determination
28that the patient is capable and acting voluntarily.

29(5) Refer the patient for counseling if appropriate
30under section 54B06 (relating to counseling referral).

1(6) Recommend the patient notify next of kin.

2(7) Counsel the patient about the importance of having
3another person present when the patient takes the medication
4prescribed under this chapter and of not taking the
5medication in a public place.

6(8) Inform the patient that he or she has an opportunity
7to rescind the request at any time and in any manner under
8section 54B10 (relating to right to rescind request) and
9offer the patient an opportunity to rescind at the end of the
1015-day waiting period under section 54B11 (relating to
11waiting periods).

12(9) Immediately prior to writing a prescription for
13medication under this chapter, verify the patient is making
14an informed decision.

15(10) Fulfill the medical record documentation
16requirements of section 54B12 (relating to medical record
17documentation requirements).

18(11) Ensure the steps in this chapter are carried out
19prior to writing a prescription for medication to enable a
20qualified patient to end his or her life in a humane and
21dignified manner.

22(12) (i) Dispense medications directly, including
23ancillary medications intended to facilitate the desired
24effect to minimize the patient's discomfort, provided the
25attending physician is authorized to do so in this
26Commonwealth, has a current Drug Enforcement
27Administration certificate and complies with any
28applicable administrative rule; or

29(ii) with the patient's written consent:

30(A) contact a pharmacist and inform the

1pharmacist of the prescription; and

2(B) deliver the written prescription personally
3or by mail to the pharmacist, who will dispense the
4medications to either the patient, the attending
5physician or an expressly identified agent of the
6patient.

7(b) Death certificate.--Notwithstanding any other provision
8of law, the attending physician may sign the patient's death
9certificate.

10§ 54B05. Consulting physician confirmation.

11Before a patient is qualified under this chapter, a
12consulting physician shall examine the patient and the patient's
13relevant medical records to confirm the attending physician's
14diagnosis that the patient is suffering from a terminal disease.
15This confirmation shall be in writing. The consulting physician
16must also verify the patient:

17(1) Is capable.

18(2) Is acting voluntarily.

19(3) Has made an informed decision.

20§ 54B06. Counseling referral.

21If the opinion of the attending physician or the consulting
22physician is that the patient may be suffering from a
23psychiatric or psychological disorder or depression causing
24impaired judgment, either physician shall refer the patient for
25counseling. No medication to end a patient's life in a humane
26and dignified manner may be prescribed until the person
27performing the counseling determines that the patient is not
28suffering from a psychiatric or psychological disorder or
29depression causing impaired judgment.

30§ 54B07. Informed decision.

1No person may receive a prescription for medication to end
2his or her life in a humane and dignified manner unless he or
3she has made an informed decision. Immediately prior to writing
4a prescription for medication under this chapter, the attending
5physician shall verify the patient is making an informed
6decision.

7§ 54B08. Family notification.

8The attending physician shall recommend that the patient
9notify the next of kin of his or her request for medication
10under this chapter. A patient who declines or is unable to
11notify the next of kin shall not have his or her request denied
12for that reason.

13§ 54B09. Written and oral requests.

14In order to receive a prescription for medication to end his
15or her life in a humane and dignified manner, a qualified
16patient shall have made an oral request and a written request
17and shall reiterate the oral request to his or her attending
18physician no less than 15 days after making the initial oral
19request. At the time the qualified patient makes his or her
20second oral request, the attending physician shall offer the
21patient an opportunity to rescind the request.

22§ 54B10. Right to rescind request.

23A patient may rescind his or her request at any time and in
24any manner without regard to his or her mental state. No
25prescription for medication under this chapter may be written
26without the attending physician's offering the qualified patient
27an opportunity to rescind the request.

28§ 54B11. Waiting periods.

29No less than 15 days shall elapse between the patient's
30initial oral request and the writing of a prescription under

1this chapter. No less than 48 hours shall elapse between the
2patient's written request and the writing of a prescription
3under this chapter.

4§ 54B12. Medical record documentation requirements.

5The following shall be documented or filed in the patient's
6medical record:

7(1) All oral requests by a patient for medication to end
8his or her life in a humane and dignified manner.

9(2) All written requests by a patient for medication to
10end his or her life in a humane and dignified manner.

11(3) The attending physician's diagnosis and prognosis
12and determination that the patient is capable and acting
13voluntarily and has made an informed decision.

14(4) The consulting physician's diagnosis and prognosis
15and verification that the patient is capable and acting
16voluntarily and has made an informed decision.

17(5) A report of the outcome and determinations made
18during counseling, if performed.

19(6) The attending physician's offer to the patient to
20rescind his or her request at the time of the patient's
21second oral request under section 54B09 (relating to written
22and oral requests).

23(7) A note by the attending physician indicating the
24requirements under this chapter have been met and the steps
25taken to carry out the request, including a notation of the
26medication prescribed.

27§ 54B13. Residency requirement.

28Only requests made by Commonwealth residents under this
29chapter shall be granted. Factors demonstrating residency
30include, but are not limited to:

1(1) Possession of a driver's license.

2(2) Voter registration.

3(3) Evidence the person owns or leases property in this
4Commonwealth.

5(4) A tax return filed in the most recent year.

6§ 54B14. Reporting requirements.

7(a) Review.--

8(1) The department shall annually review a sample of
9records maintained under this chapter.

10(2) The department shall require any health care
11provider to file a copy of the dispensing record with the
12department upon dispensing medication under this chapter.

13(b) Rulemaking.--The department shall promulgate rules to
14facilitate the collection of information regarding compliance
15with this chapter. Except as otherwise provided by law, the
16information collected is not a public record and may not be made
17available for inspection by the public.

18(c) Report.--The department shall generate and make
19available to the public an annual statistical report of
20information collected under subsection (b).

21§ 54B15. Effect on construction of wills and contracts.

22(a) Effect on existing agreements.--No provision in a
23contract, will or other agreement, whether written or oral, may
24be valid which affects whether a person may make or rescind a
25request for medication to end his or her life in a humane and
26dignified manner.

27(b) Obligations under an existing contract.--No obligation
28under an existing contract may be conditioned or affected by a
29person's making or rescinding of a request for medication to end
30his or her life in a humane and dignified manner.

1§ 54B16. Insurance or annuity policies.

2The sale, procurement or issuance of life, health or accident
3insurance or an annuity policy or the rate charged for any
4policy shall not be conditioned upon or affected by the making
5or rescinding of a request, by a person, for medication to end
6his or her life in a humane and dignified manner. A qualified
7patient's act of ingesting medication to end his or her life in
8a humane and dignified manner may not have an effect upon a
9life, health or accident insurance or an annuity policy.

10§ 54B17. Construction.

11Nothing under this chapter may be construed to authorize a
12physician or any other person to end a patient's life by lethal
13injection, mercy killing or active euthanasia. Actions taken in
14accordance with this chapter shall not constitute suicide,
15assisted suicide, mercy killing or homicide under the law.

16§ 54B18. Immunities.

17Except as provided in section 54B20 (relating to
18liabilities):

19(1) No person may be subject to civil or criminal
20liability or professional disciplinary action for
21participating in good faith compliance with this chapter.
22This includes being present when a qualified patient takes
23the prescribed medication to end his or her life in a humane
24and dignified manner.

25(2) No professional organization or association or
26health care provider may subject a person to censure,
27discipline, suspension, loss of license, loss of privileges,
28loss of membership or other penalty for participating in good
29faith or refusing to participate under this chapter.

30(3) No request by a patient for or provision by an

1attending physician of medication in good faith compliance
2with this chapter may constitute negligence for any purpose
3of law or provide the sole basis for the appointment of a
4guardian or conservator.

5§ 54B19. Health care provider participation; notification;
6permissible sanctions.

7(a) Participation not required.--No health care provider may
8be under any duty, whether by contract, by statute or by any
9other legal requirement, to participate in the provision to a
10qualified patient of medication to end his or her life in a
11humane and dignified manner. If a health care provider is unable
12or unwilling to carry out a patient's request under this chapter
13and the patient transfers his or her care to a new health care
14provider, the prior health care provider shall transfer, upon
15request, a copy of the patient's relevant medical records to the
16new health care provider.

17(b) Prohibiting participation.--Notwithstanding any other
18provision of law, a health care provider may prohibit another
19health care provider from participating under this chapter on
20the premises of the prohibiting provider if the prohibiting
21provider has notified the health care provider of the
22prohibiting provider's policy regarding participating under this
23chapter. Nothing in this subsection prevents a health care
24provider from providing health care services to a patient that
25does not constitute participation under this chapter.

26(c) Sanctions by health care provider.--Notwithstanding
27subsection (a) or section 54B18 (relating to immunities), a
28health care provider may subject another health care provider to
29the sanctions stated in this subsection if the sanctioning
30health care provider has notified the sanctioned provider prior

1to its participation under this chapter that it prohibits
2participation under this chapter. The available sanctions shall
3include:

4(1) loss of privileges, loss of membership or other
5sanction provided under the medical staff bylaws, policies
6and procedures of the sanctioning health care provider if the
7sanctioned provider is a member of the sanctioning provider's
8medical staff and participates under this chapter while on
9the premises of a health care facility of the sanctioning
10health care provider, but not including the private medical
11office of a physician or other provider;

12(2) termination of lease or other property contract or
13other nonmonetary remedies provided by lease contract, not
14including loss or restriction of medical staff privileges or
15exclusion from a provider panel, if the sanctioned provider
16participates under this chapter while on the premises of the
17sanctioning health care provider or on property that is owned
18by or under the direct control of the sanctioning health care
19provider; or

20(3) termination of contract or other nonmonetary
21remedies provided by contract if the sanctioned provider
22participates under this chapter while acting in the course
23and scope of the sanctioned provider's capacity as an
24employee or independent contractor of the sanctioning health
25care provider. Nothing in this paragraph may be construed to
26prevent:

27(i) a health care provider from participating under
28this chapter while acting outside the course and scope of
29the provider's capacity as an employee or independent
30contractor; or

1(ii) a patient from contracting with his or her
2attending physician and consulting physician to act
3outside the course and scope of the provider's capacity
4as an employee or independent contractor of the
5sanctioning health care provider.

6(d) Due process.--A health care provider that imposes
7sanctions under subsection (c) must follow all due process and
8other procedures the sanctioning health care provider may have
9that are related to the imposition of sanctions on another
10health care provider.

11(e) Unprofessional or dishonorable conduct reports.--Action
12taken under section 54B03 (relating to form of written request),
1354B04 (relating to attending physician responsibilities), 54B05
14(relating to consulting physician confirmation) or 54B06
15(relating to counseling referral) may not be the sole basis for
16a report of unprofessional or dishonorable conduct to the State
17Board of Medicine or the State Board of Osteopathic Medicine.

18(f) Standard of care.--No provision of this chapter may be
19construed to allow a lower standard of care for patients in the
20community where the patient is treated or a similar community.

21(g) Definition.--As used in this section, the term "notify" 
22means a separate written statement to the health care provider 
23which sanctions its participation in activities covered by this 
24chapter before the participation occurs.

25§ 54B20. Liabilities.

26(a) Mishandling instrument.--A person who without
27authorization of the patient willfully alters or forges a
28request for medication or conceals or destroys a rescission of
29that request with the intent or effect of causing the patient's
30death shall not be immune from criminal liability under section

154B18 (relating to immunities).

2(b) Undue influence.--A person who coerces or exerts undue
3influence on a patient to request medication for the purpose of
4ending the patient's life or to destroy a rescission of such a
5request shall not be immune from criminal liability under
6section 54B18.

7(c) Civil damages.--Nothing under this chapter limits
8liability for civil damages resulting from negligent or
9intentional misconduct by any person.

10§ 54B21. Claims by governmental entity for costs incurred.

11A governmental entity that incurs costs resulting from a
12person terminating his or her life under the provisions of this
13chapter in a public place shall have a claim against the estate
14of the person to recover those costs and reasonable attorney
15fees related to enforcing the claim.

16§ 54B22. Instrument.

17A request for a medication as authorized under this chapter
18shall be in substantially the following form:

19REQUEST FOR MEDICATION

20TO END MY LIFE IN A HUMANE

21AND DIGNIFIED MANNER

22I, , am an adult of sound mind.

23I am suffering from , which my attending physician has
24determined is a terminal disease and which has been medically
25confirmed by a consulting physician.

26I have been fully informed of my diagnosis and prognosis, the
27nature of medication to be prescribed and potential associated
28risks, the expected result and the feasible alternatives,
29including comfort care, hospice care and pain control.

30I request that my attending physician prescribe medication

1that will end my life in a humane and dignified manner.

2INITIAL ONE:

3( ) I have informed my family of my decision and have taken
4their opinions into consideration.

5( ) I have decided not to inform my family of my decision.

6( ) I have no family to inform of my decision.

7I understand that I have the right to rescind this request at
8any time.

9I understand the full import of this request and I expect to
10die when I take the medication to be prescribed. I further
11understand that although most deaths occur within three hours,
12my death may take longer and my physician has counseled me about
13this possibility.

14I make this request voluntarily and without reservation, and
15I accept full moral responsibility for my actions.

16Signed:

17Date:

18DECLARATION OF WITNESSES

19We declare that the person signing this request:

20(a) Is personally known to us or has provided proof of
21identity.

22(b) Signed this request in our presence.

23(c) Appears to be of sound mind and not under duress, fraud
24or undue influence.

25(d) Is not a patient for whom either of us is an attending
26physician.

27Date:

28Witness' signature:

29Number and Street:

30City, State and Zip Code:

1Witness' signature:

2Number and Street:

3City, State and Zip Code:

4NOTE: One witness shall not be a relative by blood, marriage
5or adoption of the person signing this request, shall not be
6entitled to any portion of the person's estate upon death and
7shall not own, operate or be employed at a health care facility
8where the person is a patient or resident. If the patient is an
9inpatient at a health care facility, one of the witnesses shall
10be an individual designated by the facility.

11§ 54B23. Penalties for mishandling instrument.

12(a) Intent to hasten death.--A person who without
13authorization of the principal willfully alters, forges,
14conceals or destroys an instrument, the reinstatement or
15revocation of an instrument or any other evidence or document
16reflecting the principal's desires and interests with the intent
17and effect of causing a withholding or withdrawal of life-
18sustaining procedures or of artificially administered nutrition
19and hydration which hastens the death of the principal commits a
20felony of the first degree.

21(b) Intent to affect health care decision.--Except as
22provided in subsection (a), a person without authorization of
23the principal who willfully alters, forges, conceals or destroys
24an instrument, the reinstatement or revocation of an instrument,
25or any other evidence or document reflecting the principal's
26desires and interests with the intent or effect of affecting a
27health care decision commits a misdemeanor of the first degree.

28Section 2. This act shall take effect in 60 days.