BILL NUMBER: SB 128 AMENDED
BILL TEXT
AMENDED IN SENATE JUNE 1, 2015
AMENDED IN SENATE APRIL 14, 2015
AMENDED IN SENATE MARCH 17, 2015
INTRODUCED BY Senators Wolk and Monning
(Principal coauthors: Senators Jackson and Leno)
(Principal coauthors: Assembly Members Alejo and Eggman)
(Coauthors: Senators Block, Hall, Hancock, Hernandez, Hill,
McGuire, and Wieckowski)
(Coauthors: Assembly Members Chu, Cooper, Frazier, Cristina
Garcia, Low, Quirk, Rendon, and Mark Stone)
JANUARY 20, 2015
An act to add Part 1.85 (commencing with Section 443) to Division
1 of the Health and Safety Code, relating to end of life.
LEGISLATIVE COUNSEL'S DIGEST
SB 128, as amended, Wolk. End of life.
Existing law authorizes an adult to give an individual health care
instruction and to appoint an attorney to make health care decisions
for that individual in the event of his or her incapacity pursuant
to a power of attorney for health care.
This bill would enact the End of Life Option Act authorizing an
adult who meets certain qualifications, and who has been determined
by his or her attending physician to be suffering from a terminal
disease, as defined, to make a request for medication
a drug prescribed pursuant to these provisions
for the purpose of ending his or her life. The bill would establish
the procedures for making these requests. The bill would also
establish the forms to request aid-in-dying medication
an aid-in-dying drug and, under specified
circumstances, an interpreter declaration to be signed subject to
penalty of perjury, thereby imposing a crime and state-mandated local
program. This bill would require specified information to be
documented in the individual's medical record, including, among other
things, all oral and written requests for an aid-in-dying drug.
This bill would prohibit a provision in a contract, will, or other
agreement from being conditioned upon or affected by a person making
or rescinding a request for the above-described medication.
drug. The bill would prohibit the sale,
procurement, or issuance of any life, health, or accident insurance
or annuity policy, health care service plan, contract, or health
benefit plan, or the rate charged for any policy or plan contract,
from being conditioned upon or affected by the request. The bill
would prohibit an insurance carrier from providing any information in
communications made to an individual about the availability of
aid-in-dying medication an aid-in-dying drug
absent a request by the individual, his or her attending
physician at the behest of the individual, or the individual's
designee. The bill would also prohibit any communication from
containing both the denial of treatment and information as to the
availability of aid-in-dying medication drug
coverage.
This bill would provide immunity from civil or criminal
civil, criminal, administrative, employment, or
contractual liability or professional disciplinary action for
participating in good faith compliance with the act, and would
specify that the immunities and prohibitions on sanctions of a health
care provider are solely reserved for conduct provided for by the
bill. The bill would provide that participation in activities
authorized pursuant to this bill shall be voluntary. The bill would
authorize a health care provider to prohibit its employees,
independent contractors, or other persons or entities, including
other health care providers, from participating in activities under
this act while on the premises owned or under the management or
direct control of that prohibiting health care provider, or while
acting within the course and scope of any employment by, or contract
with, the prohibiting health care provider.
This bill would make it a felony to knowingly alter or forge a
request for medication drugs to end an
individual's life without his or her authorization or to conceal or
destroy a withdrawal or rescission of a request for
medication a drug , if it is done with
the intent or effect of causing the individual's death. The bill
would make it a felony to knowingly coerce or exert undue influence
on an individual to request medication a drug
for the purpose of ending his or her life or to destroy a
withdrawal or rescission of a request. By creating a new
crime, the bill would impose a state-mandated local program. The bill
would provide that nothing in its provisions is to be
construed to authorize ending a patient's life by lethal injection,
mercy killing, or active euthanasia, and would provide that action
taken in accordance with the act shall not constitute, among
others, other things, suicide or homicide.
This bill would require the State Public Health Officer to adopt
regulations establishing additional reporting requirements for
physicians and pharmacists to determine the use of, and compliance
with, the act, and would require the state
State Public Health Officer to annually review a sample of
certain records and the State Department of Public Health to make a
statistical report of the information collected.
This bill would require specified information to be documented in
the individual's medical record, including, among other things, all
oral and written requests for aid-in-dying medication.
Existing constitutional provisions require that a statute that
limits the right of access to the meetings of public bodies or the
writings of public officials and agencies be adopted with findings
demonstrating the interest protected by the limitation and the need
for protecting that interest.
This bill would make legislative findings to that effect.
The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
This bill would provide that no reimbursement is required by this
act for a specified reason.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Part 1.85 (commencing with Section 443) is added to
Division 1 of the Health and Safety Code, to read:
PART 1.85. End of Life Option Act
443. This part shall be known and may be cited as the End of Life
Option Act.
443.1. As used in this part, the following definitions shall
apply:
(a) "Adult" means an individual 18 years of age or older.
(b) "Aid-in-dying medication" drug
" means medication a drug
determined and prescribed by a physician for a qualified individual,
which the qualified individual may choose to self-administer to bring
about his or her death due to a terminal disease.
(c) "Attending physician" means the physician who has primary
responsibility for the health care of an individual and treatment of
the individual's terminal disease.
(d) "Competent" "Capacity to make medical
decisions" means that, in the opinion of a court or
in the opinion of an individual's attending physician,
consulting physician, psychiatrist, or psychologist, the
individual has pursuant to Section 4609 of the Probate
Code, the individual has the ability to understand the nature and
consequences of a health care decision, the ability to understand its
significant benefits, risks, and alternatives, and the ability
to make and communicate an informed decision to health care
providers, including communication through a person familiar with the
individual's manner of communicating, if that person is available.
(e) "Consulting physician" means a physician who is
independent from the attending physician and who is qualified
by specialty or experience to make a professional diagnosis and
prognosis regarding an individual's terminal disease.
(f) "Counseling" means one or more consultations, as necessary,
between an individual and a psychiatrist or psychologist licensed in
this state for the purpose of determining that the individual is
competent and is not suffering from a psychiatric or psychological
disorder or depression causing impaired judgment.
(g)
(f) "Department" means the State Department of Public
Health.
(g) "End of Life Option Act Checklist" means a checklist
identifying each and every requirement that must be fulfilled by a
health care provider to be in good faith compliance with the End of
Life Option Act should the health care provider choose to
participate.
(h) "Health care provider" or "provider" means a person
licensed, certified, or otherwise authorized or permitted by law to
administer health care or dispense medication in the ordinary course
of business or practice of a profession, including, but not limited
to, physicians, doctors of osteopathy, and pharmacists. "Health care
provider" or "provider" includes a health care facility as identified
in Section 1250. "provider of health care" means any
person licensed or certified pursuant to Division 2 (commencing with
Section 500) of the Business and Professions Code; any person
licensed pursuant to the Osteopathic Initiative Act or the
Chiropractic Initiative Act; any person certified pursuant to
Division 2.5 (commencing with Section 1797) of this code; and any
clinic, health dispensary, or health facility licensed pursuant to
Division 2 (commencing with Section 1200) of this code.
(i) "Informed decision" means a decision by an individual with a
terminal disease to request and obtain a prescription for
medication a drug that the individual may
self-administer to end the individual's life, that is based on an
understanding and acknowledgment of the relevant facts, and that is
made after being fully informed by the attending physician of all of
the following:
(1) The individual's medical diagnosis and prognosis.
(2) The potential risks associated with taking the
medication drug to be prescribed.
(3) The probable result of taking the medication
drug to be prescribed.
(4) The possibility that the individual may choose not to obtain
the medication drug or may obtain the
medication drug but may decide not to
take ingest it.
(5) The feasible alternatives or additional treatment
opportunities, including, but not limited to, comfort care, hospice
care, palliative care, and pain control.
(j) "Medically confirmed" means the medical opinion
diagnosis and prognosis of the attending
physician has been confirmed by a consulting physician who has
examined the individual and the individual's relevant medical
records.
(k) "Mental health specialist assessment" means one or more
consultations between an individual and a mental health specialist
for the purpose of determining that the individual has the capacity
to make medical decisions and is not suffering from impaired judgment
due to a mental disorder.
(l) "Mental health specialist" means a psychiatrist or a licensed
psychologist.
(k)
(m) "Physician" means a doctor of medicine or
osteopathy currently licensed to practice medicine in this state.
(l)
(n) "Public place" means any street, alley, park,
public building, any place of business or assembly open to or
frequented by the public, and any other place that is open to the
public view, or to which the public has access.
(m)
(o) "Qualified individual" means a competent
adult who an adult who has the capacity to make
medical decisions and is a resident of California and has
satisfied the requirements of this part in order to obtain a
prescription for medication a drug to
end his or her life.
(n)
(p) "Self-administer" means a qualified individual's
affirmative, conscious, and physical act of using
ingesting the medication
aid-in-dying drug to bring about his or her own death.
(o)
(q) "Terminal disease" means an incurable and
irreversible disease that has been medically confirmed and will,
within reasonable medical judgment, result in death within six
months.
443.2. (a) A competent, qualified individual
who is an adult with the capacity to make medical decisions and
with a terminal disease may make a request to receive a
prescription for aid-in-dying medication an
aid-in-dying drug if all of the following conditions are
satisfied:
(1) The qualified individual's attending
physician has determined diagnosed the
individual to be suffering from with a
terminal disease.
(2) The qualified individual has voluntarily
expressed the wish to receive a prescription for an
aid-in-dying medication. drug.
(3) The qualified individual is a resident of
California and is able to establish residency through any of the
following means:
(A) Possession of a California driver license or other
identification issued by the State of California.
(B) Registration to vote in California.
(C) Evidence that the person owns or leases property in
California.
(D) Filing of a California tax return for the most recent tax
year.
(4) The qualified individual documents his or
her request pursuant to the requirements set forth in Section 443.3.
(5) The individual has the physical and mental ability to
self-administer the aid-in-dying drug.
(b) A person may not qualify shall not be
considered a "qualified individual" under the provisions of
this part solely because of age or disability.
(c) A request for a prescription for aid-in-dying
medication an aid-in-dying drug under this part
shall be made solely and directly by the individual diagnosed
with the terminal disease and shall not be made on behalf of
the patient patient, including, but not
limited to, through a power of attorney, an advance health care
directive, or a conservator. a conservator,
health care agent, surrogate, or any other legally recognized health
care decisionmaker.
443.3. (a) A qualified An
individual wishing to receive seeking to
obtain a prescription for aid-in-dying medication
an aid-in-dying drug pursuant to this part shall
submit two oral requests, a minimum of 15 days apart, and a written
request to his or her attending physician. The attending physician
must shall directly, and not through a
designee, receive all three requests required pursuant to this
section.
(b) A valid written request for aid-in-dying medication
an aid-in-dying drug under subdivision (a) shall
meet all of the following conditions:
(1) The request shall be in substantially the form described in
Section 443.9.
(2) The request shall be signed and dated, in the presence of two
witnesses in accordance with paragraph (3), by the qualified
individual individual seeking the
medication. aid-in-dying drug.
(3) The request shall be witnessed by at least two other adult
persons who, in the presence of the qualified
individual, shall attest that to the best of their knowledge and
belief that the qualified individual is
all of the following:
(A) Competent. A person who has the
capacity to make medical decisions.
(B) Acting voluntarily.
(C) Not being coerced to make or sign the request.
(c) Only one of the two witnesses at the time the written request
is signed may:
(1) Be related to the qualified individual by blood, marriage,
registered domestic partnership, or adoption or be
entitled to a portion of the person's
individual's estate upon death.
(2) Own, operate, or be employed at a health care facility where
the qualified individual is receiving medical
treatment or resides.
(d) The attending physician physician,
consulting physician, or mental health specialist of the
qualified individual shall not be one of the
witnesses required pursuant to paragraph (3) of subdivision (b).
443.4. (a) A qualified An
individual may at any time withdraw or rescind his or her
request for aid-in-dying medication an
aid-in-dying drug, or decide not to ingest an aid-in dying drug,
without regard to the qualified individual's
mental state.
(b) A prescription for aid-in-dying medication
an aid-in-dying drug provided under this part may not be
written without the attending physician directly, and not
through a designee, offering the qualified
individual an opportunity to withdraw or rescind the
request.
443.5. (a) Before prescribing aid-in-dying medication,
an aid-in-dying drug, the attending physician
shall do all of the following:
(1) Make the initial determination of all of the following:
(A) (i) Whether the requesting adult
is competent. has the capacity to make
medical decisions.
(ii) If there are indications of a mental disorder, the physician
shall refer the individual for a mental health specialist assessment.
(iii) If a mental health specialist assessment referral is made,
no aid-in-dying drugs shall be prescribed until the mental health
specialist determines that the individual has the capacity to make
medical decisions and is not suffering from impaired judgment due to
a mental disorder.
(B) Whether the requesting adult has a terminal disease.
(C) Whether the requesting adult has voluntarily made the request
for aid-in-dying medication an aid-in-dying
drug pursuant to Sections 443.2 and 443.3.
(D) Whether the requesting adult is a qualified individual
pursuant to subdivision (m) of Section 443.1.
(2) Ensure the qualified Confirm that the
individual is making an informed decision by discussing with
him or her all of the following:
(A) His or her medical diagnosis and prognosis.
(B) The potential risks associated with taking
ingesting the requested aid-in-dying
medication to be prescribed. drug.
(C) The probable result of taking
ingesting the aid-in-dying medication to be
prescribed. drug.
(D) The possibility that he or she may choose to obtain the
aid-in-dying medication drug but not
take it.
(E) The feasible alternatives or additional treatment
opportunities, options, including, but not
limited to, comfort care, hospice care, palliative care, and pain
control.
(3) Refer the qualified individual to a
consulting physician for medical confirmation of the diagnosis and
prognosis, and for a determination that the qualified
individual is competent individual has the capacity to
make medical decisions and has complied with the provisions of
this part.
(4) Refer the qualified individual for counseling if appropriate.
No aid-in-dying medication shall be prescribed until the person
performing the counseling determines that the patient is not
suffering from a psychiatric or psychological disorder or depression
causing impaired judgment.
(5) Ensure
(4) Confirm that the qualified
individual's request does not arise from coercion or undue influence
by another person by discussing with the qualified individual,
outside of the presence of any other persons, whether or not the
qualified individual is feeling coerced or unduly influenced by
another person.
(6)
(5) Counsel the qualified individual about the
importance of all of the following:
(A) Having another person present when he or she takes
ingests the aid-in-dying medication
drug prescribed pursuant to this part.
(B) Not taking ingesting the
aid-in-dying medication drug in a
public place.
(C) Notifying the next of kin of his or her request for
aid-in-dying medication. an aid-in-dying drug. A
qualified individual who declines or is unable to notify next of kin
shall not have his or her request denied for that reason.
(D) Participating in a hospice program.
(E) Maintaining the aid-in-dying drug in a safe and secure
location until the time that the qualified individual will ingest it.
(7)
(6) Inform the qualified individual
that he or she may withdraw or rescind the request for
aid-in-dying medication an aid-in-dying drug
at any time and in any manner.
(8)
(7) Offer the qualified individual
an opportunity to withdraw or rescind the request for
aid-in-dying medication an aid-in-dying drug
before prescribing the aid-in-dying medication.
drug.
(9)
(8) Verify, immediately prior to writing the
prescription for aid-in-dying medication,
drug, that the qualified individual is making an informed
decision.
(10) Ensure
(9) Confirm that all
requirements are met and all appropriate steps are carried out
in accordance with this part before writing a prescription for
aid-in-dying medication. an aid-in-dying
drug.
(11)
(10) Fulfill the record documentation required under
Sections 443.16 and 443.19. 443.7 and 443.17.
(11) Complete the End of Life Option Act Checklist and include it
in the individual's medical record.
(b) If the conditions set forth in subdivision (a) are satisfied,
the attending physician may deliver the aid-in-dying
medication drug in any of the following ways:
(1) Dispense aid-in-dying medications
Dispensing the aid-in-dying drug directly, including ancillary
medication intended to minimize the qualified individual's
discomfort, if the attending physician meets all of the following
criteria:
(A) Is authorized to dispense medicine under California law.
(B) Has a current United States Drug Enforcement Administration
(USDEA) certificate.
(C) Complies with any applicable administrative rule or
regulation.
(2) With the qualified individual's written consent, the
attending physician may contact contacting a
pharmacist, inform informing the
pharmacist of the prescriptions, and deliver
delivering the written prescriptions personally, by mail, or
electronically to the pharmacist, who may dispense the
medications drug to the qualified individual,
the attending physician, or a person expressly designated by the
qualified individual and with the designation delivered to the
pharmacist in writing or verbally.
(c) Delivery of the dispensed medication
drug to the qualified individual, the attending physician, or a
person expressly designated by the qualified individual may be made
by: by personal delivery, or, with
a signature required on deliver y, by United Parcel
Service, United States Postal Service, Federal Express, or by
messenger service with a signature required at delivery.
service.
443.6. Prior to a qualified individual obtaining
aid-in-dying medication an aid-in-dying drug
from the attending physician, the consulting physician shall perform
all of the following:
(a) Examine the qualified individual and his or
her relevant medical records.
(b) Confirm in writing the attending physician's diagnosis and
prognosis.
(c) Verify, in the opinion of the consulting physician,
that the qualified individual is competent, Determine
that the individual has capacity to make medical
decisions, is acting voluntarily, and has made an informed
decision.
(d) If there are indications of a mental disorder, the consulting
physician shall refer the individual for a mental health specialist
assessment.
(d)
(e) Fulfill the record documentation required under
Sections 443.16 and 443.19. this part.
443.7. (a) Unless otherwise prohibited by law, the attending
physician may sign the qualified individual's death certificate.
(b) The cause of death listed on the death certificate of an
individual who uses aid-in-dying medication shall be the underlying
terminal disease.
443.7. All of the following shall be documented in the individual'
s medical record:
(a) All oral requests for aid-in-dying drugs.
(b) All written requests for aid-in-dying drugs.
(c) The attending physician's diagnosis and prognosis, and the
determination that a qualified individual has the capacity to make
medical decisions, is acting voluntarily, and has made an informed
decision, or that the attending physician has determined that the
individual is not a qualified individual.
(d) The consulting physician's diagnosis and prognosis, and
verification that the qualified individual has the capacity to make
medical decisions, is acting voluntarily, and has made an informed
decision, or that the consulting physician has determined that the
individual is not a qualified individual.
(e) A report of the outcome and determinations made during a
mental health specialist's assessment, if performed.
(f) The attending physician's offer to the qualified individual to
withdraw or rescind his or her request at the time of the individual'
s second oral request.
(g) A note by the attending physician indicating that all
requirements under Sections 443.5 and 443.6 have been met and
indicating the steps taken to carry out the request, including a
notation of the aid-in-dying drug prescribed.
443.8. A qualified individual may not receive a prescription for
aid-in-dying medication an aid-in-dying drug
pursuant to this part, part
unless he or she has made an informed decision. Immediately before
writing a prescription for aid-in-dying medication
an aid-in-dying drug under this part, the attending
physician shall verify that the individual is making an informed
decision.
443.9. (a) A request for aid-in-dying medication
an aid-in-dying drug as authorized by this part
shall be in substantially the following form:
REQUEST FOR MEDICATION TO END MY LIFE IN A
REQUEST FOR AN AID-IN-DYING DRUG TO END MY LIFE
IN A HUMANE AND DIGNIFIED MANNER I,
.................................................
....., am an adult of sound mind and a
resident of the State of California.
I am suffering from ................, which my
attending physician has determined is in its
terminal phase and which has been medically
confirmed.
I have been fully informed of my diagnosis and
prognosis, the nature of the aid-in-dying
drug
medication to be prescribed and potential
associated
risks,
associated risks, the expected result, and the
feasible
feasible alternatives or additional
treatment options,
opportunities, including comfort care, hospice
care,
palliative
care, palliative care, and pain control.
I request that my attending physician prescribe
medication that will end my life in a humane and
an aid-in-dying drug that will end my life in a
humane and dignified manner if I choose to take
it, and I
it, and I authorize my attending physician to
contact any
contact any pharmacist about my request.
INITIAL ONE:
............ I have informed one or more members
of 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
I understand that I have the right to withdraw
or rescind this request at any time.
I understand the full import of this request and
I expect to die if I take the aid-in-dying
drug
medication to be prescribed. My attending
physician
has
physician has counseled me about the possibility
that my death
that my death may not be immediately upon
the consumption of
consumption of the medication.
the drug.
I make this request voluntarily, without
reservation, and without being coerced.
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) is an individual whom we believe to be of
sound mind and not under duress, fraud, or undue
influence; and
(d) is not an individual for whom either of us
is the attending physician . ,
consulting
physician, or mental health specialist.
............................Witness 1/Date
............................Witness 2/Date
NOTE: Only one of the two witnesses may be a
relative (by blood, marriage, or adoption) of
relative (by blood, marriage, registered
domestic partnership, or adoption) of the person
the person signing this request or be entitled
to a
portion
to a portion of the person's estate upon death.
Only one of
Only one of the two witnesses may own,
operate , or be
or b e e mployed at a health
care facility where the
the person is a patient or resident.
(b) (1) The written language of the request shall be written in
the same translated language as any conversations, consultations, or
interpreted conversations or consultations between a patient and his
or her attending or consulting physicians.
(2) Notwithstanding paragraph (1), the written request may be
prepared in English even where when the
conversations or consultations or interpreted conversations or
consultations where were conducted in a
language other than English if the English language form includes an
attached interpreter's declaration that is signed under penalty of
perjury. The interpreter's declaration shall state words to the
effect that:
I (INSERT NAME OF INTERPRETER), am fluent in
English and (INSERT TARGET LANGUAGE).
On (insert date) at approximately (insert time),
I read the ""Request for Medication to End My
I read the ""Request for an Aid-In-Dying Drug to
End My Life'' to (insert name of
L i fe'' to (insert name of i
ndividual/patient) in (insert
target language).
(insert target language).
Mr./Ms. (insert name of patient/qualified
individual) affirmed to me that he/she
understood the content of this form and affirmed
his/her desire to sign this form under his/her
own power and volition and that the request to
sign the form followed consultations with an
attending and consulting physician.
I declare that I am fluent in English and
(insert target language) and further declare
under penalty of perjury that the foregoing is
true and correct.
Executed at (insert city, county, and state) on
this (insert day of month) of (insert month),
(insert year).
X______Interpreter signature
X______Interpreter printed name
X______Interpreter address
(3) An interpreter whose services are provided
by pursuant to paragraph (2) shall not be
related to the qualified individual by blood, marriage,
registered domestic partnership, or adoption or be entitled to
a portion of the person's estate upon death. An interpreter
whose services are provided by pursuant
to paragraph (2) shall meet the standards promulgated by the
California Healthcare Interpreters
Interpreting Association or the National Council on
Interpreting in Health Care or other standards deemed acceptable
by the department for health care providers in California.
443.10. (a) A provision in a contract, will, or other
agreement, agreement executed on or after January 1,
2016, whether written or oral, to the extent the provision
would affect whether a person may make make,
withdraw, or rescind a request for aid-in-dying
medication, an aid-in-dying drug is not valid.
(b) An obligation owing under any contract in effect
executed on or after January 1, 2016, may not be
conditioned or affected by a qualified individual making
making, withdrawing, or rescinding a request for
aid-in-dying medication. an aid-in-dying
drug.
443.11. (a)
The sale, procurement, or issuance of a life, health, or
accident insurance or annuity policy, health care service plan
contract, or health benefit plan, or the rate charged for a policy or
plan contract may not be conditioned upon or affected by a person
making or rescinding a request for aid-in-dying medication.
an aid-in-dying drug.
(b) Notwithstanding any other law, a qualified individual's act of
self-administering aid-in-dying medication
an aid-in-dying drug may not have an effect upon a life,
health, or accident insurance or annuity policy other than that of a
natural death from the underlying disease.
(c) An insurance carrier shall not provide any information in
communications made to an individual about the availability of
aid-in-dying medication an aid-in-dying drug
absent a request by the individual, his or her attending
physician at the behest of the individual, or the individual's
designee. Any communication shall not include both the denial of
treatment and information as to the availability of aid-in-dying
medication drug coverage. For the
purposes of this subdivision, "insurance carrier" means a health care
service plan pursuant to as defined in
Section 1345 of this code or a health insurer
pursuant to carrier of health insurance as defined in
Section 106 of the Insurance Code.
443.12. (a) Notwithstanding any other law, a person shall not be
subject to civil or criminal civil, criminal,
administrative, employment, or contractual liability or
professional disciplinary action for participating in good faith
compliance with this part, including an individual who is present
when a qualified individual self-administers the prescribed
aid-in-dying medication. drug.
(b) A health care provider or professional organization or
association shall not subject an individual to censure, discipline,
suspension, loss of license, loss of privileges, loss of membership,
or other penalty for participating in good faith compliance with this
part or for refusing to participate in accordance with subdivision
(d). (e).
(c) Notwithstanding any other law, a health care provider shall
not be subject to civil, criminal, administrative, disciplinary,
employment, credentialing, professional discipline, contractual
liability, or medical staff action, sanction, or penalty or other
liability for participating in this part, including, but not limited
to, determining the diagnosis or prognosis of an individual,
determining the capacity of an individual for purposes of qualifying
for the act, providing information to an individual regarding this
part, and providing a referral to a physician who participates in
this part.
(c)
(d) (1) A request by a qualified individual to an
attending physician to provide aid-in-dying medication
an aid-in-dying drug in good faith
compliance with the provisions of this part shall not provide the
sole basis for the appointment of a guardian or conservator.
(2) A request by an individual to a pharmacist to
dispense aid-in-dying medication in good faith No
actions taken in compliance with the provisions of this part
shall not constitute or provide the basis for
any claim of neglect or elder abuse for any purpose of law.
(d)
(e) (1) Participation in activities authorized pursuant
to this part shall be voluntary. A person or entity that elects, for
reasons of conscience, morality, or ethics, not to engage in
activities authorized pursuant to this part is not required to take
any action in support of a patient's decision under this part, except
as required by Sections 442 through to
442.7, inclusive.
(2) If a health care provider is unable or unwilling to carry out
a qualified individual's request under this part and the qualified
individual transfers care to a new health care provider, the
prior health care provider shall transfer, upon request, a copy of
the qualified individual's relevant medical records to the new health
care provider. the individual may request a copy of
his or her medical records pursuant to law.
(e) (1) Subject to paragraph (2), notwithstanding any other law, a
health care provider may prohibit its employees, independent
contractors, or other persons or entities, including other health
care providers, from participating in activities under this part
while on premises owned or under the management or direct control of
that prohibiting health care provider or while acting within the
course and scope of any employment by, or contract with, the
prohibiting health care provider.
(2) A health care provider that elects to prohibit its employees,
independent contractors, or other persons or entities, including
health care providers, from participating in activities under this
part, as described in paragraph (1), shall first give notice of the
policy prohibiting participation in this part to the individual or
entity. A health care provider that fails to provide notice to an
individual or entity in compliance with this paragraph shall not be
entitled to enforce such a policy against that individual or entity.
(3) Subject to compliance with paragraph (2), the prohibiting
health care provider may take action, including, but not limited to,
the following, as applicable, against any individual or entity that
violates this policy:
(A) Loss of privileges, loss of membership, or other action
authorized by the bylaws or rules and regulations of the medical
staff.
(B) Suspension, loss of employment, or other action authorized by
the policies and practices of the prohibiting health care provider.
(C) Termination of any lease or other contract between the
prohibiting health care provider and the individual or entity that
violates the policy.
(D) Imposition of any other nonmonetary remedy provided for in any
lease or contract between the prohibiting health care provider and
the individual or entity in violation of the policy.
(4) Nothing in this subdivision shall be construed to prevent, or
to allow a prohibiting health care provider to prohibit any other
health care provider, employee, independent contractor, or other
person or entity from any of the following:
(A) Participating, or entering into an agreement to participate,
in activities under this part, while on premises that are not owned
or under the management or direct control of the prohibiting provider
or while acting outside the course and scope of the participant's
duties as an employee of, or an independent contractor for, the
prohibiting health care provider.
(B) Participating, or entering into an agreement to participate,
in activities under this part as an attending physician or consulting
physician while on premises that are not owned or under the
management or direct control of the prohibiting provider.
(5) In taking actions pursuant to paragraph (3), a health care
provider shall comply with all procedures required by law, its own
policies or procedures, and any contract with the individual or
entity in violation of the policy, as applicable.
(6) For purposes of this subdivision:
(A) "Notice" means a separate statement in writing advising of the
prohibiting health care provider policy with respect to
participating in activities under this part.
(B) "Participating, or entering into an agreement to participate,
in activities under this part" means doing or entering into an
agreement to do any one or more of the following:
(i) Performing the duties of an attending physician specified in
Section 443.5.
(ii) Performing the duties of a consulting physician specified in
Section 443.6.
(iii) Delivering the prescription for, dispensing, or delivering
the dispensed aid-in-dying medication pursuant to paragraph (2) of
subdivision (b) of, and subdivision (c) of, Section 443.5.
(iv) Being present when the qualified individual takes the
aid-in-dying medication prescribed pursuant to this part.
(C) "Participating, or entering into an agreement to participate,
in activities under this part" does not include doing, or entering
into an agreement to do, any of the following:
(i) Making an initial determination that a patient has a terminal
illness and informing the patient of the medical prognosis.
(ii) Providing information to a patient about the End of Life
Option Act.
(iii) Providing a patient, upon the patient's request, with a
referral to another health care provider for the purposes of
participating in the activities authorized by the End of Life Option
Act.
(7) Any action taken by a prohibiting provider pursuant to this
subdivision shall not be reportable under Sections 800 through 809.9,
inclusive, of the Business and Professions Code. The fact that a
health care provider participates in activities under this part shall
not be the sole basis for a complaint or report by another health
care provider of unprofessional or dishonorable conduct under
Sections 800 through 809.9, inclusive, of the Business and
Professions Code.
(f) Nothing in this part shall prevent a health care provider from
providing an individual with health care services that do not
constitute participation in this part.
443.13. (a) Subject to subdivision (b), notwithstanding any other
law, a health care provider may prohibit its employees, independent
contractors, or other persons or entities, including other health
care providers, from participating in activities under this part
while on premises owned or under the management or direct control of
that prohibiting health care provider or while acting within the
course and scope of any employment by, or contract with, the
prohibiting health care provider.
(b) A health care provider that elects to prohibit its employees,
independent contractors, or other persons or entities, including
health care providers, from participating in activities under this
part, as described in subdivision (a), shall first give notice of the
policy prohibiting participation under this part to the individual
or entity. A health care provider that fails to provide notice to an
individual or entity in compliance with this subdivision shall not be
entitled to enforce such a policy against that individual or entity.
(c) Subject to compliance with subdivision (b), the prohibiting
health care provider may take action, including, but not limited to,
the following, as applicable, against any individual or entity that
violates this policy:
(1) Loss of privileges, loss of membership, or other action
authorized by the bylaws or rules and regulations of the medical
staff.
(2) Suspension, loss of employment, or other action authorized by
the policies and practices of the prohibiting health care provider.
(3) Termination of any lease or other contract between the
prohibiting health care provider and the individual or entity that
violates the policy.
(4) Imposition of any other nonmonetary remedy provided for in any
lease or contract between the prohibiting health care provider and
the individual or entity in violation of the policy.
(d) Nothing in this section shall be construed to prevent, or to
allow a prohibiting health care provider to prohibit any other health
care provider, employee, independent contractor, or other person or
entity from any of the following:
(1) Participating, or entering into an agreement to participate,
in activities under this part, while on premises that are not owned
or under the management or direct control of the prohibiting provider
or while acting outside the course and scope of the participant's
duties as an employee of, or an independent contractor for, the
prohibiting health care provider.
(2) Participating, or entering into an agreement to participate,
in activities under this part as an attending physician or consulting
physician while on premises that are not owned or under the
management or direct control of the prohibiting provider.
(e) In taking actions pursuant to subdivision (c), a health care
provider shall comply with all procedures required by law, its own
policies or procedures, and any contract with the individual or
entity in violation of the policy, as applicable.
(f) For purposes of this section:
(1) "Notice" means a separate statement in writing advising of the
prohibiting health care provider policy with respect to
participating in activities under this part.
(2) "Participating, or entering into an agreement to participate,
in activities under this part" means doing or entering into an
agreement to do any one or more of the following:
(A) Performing the duties of an attending physician as specified
in Section 443.5.
(B) Performing the duties of a consulting physician as specified
in Section 443.6.
(C) Performing the duties of a mental health specialist, in the
circumstance that a referral to one is made.
(D) Delivering the prescription for, dispensing, or delivering the
dispensed aid-in-dying drug pursuant to paragraph (2) of subdivision
(b) of, and subdivision (c) of, Section 443.5.
(E) Being present when the qualified individual takes the
aid-in-dying drug prescribed pursuant to this part.
(3) "Participating, or entering into an agreement to participate,
in activities under this part" does not include doing, or entering
into an agreement to do, any of the following:
(A) Diagnosing whether a patient has a terminal disease, informing
the patient of the medical prognosis, or determining whether a
patient has the capacity to make decisions.
(B) Providing information to a patient about this part.
(C) Providing a patient, upon the patient's request, with a
referral to another health care provider for the purposes of
participating in the activities authorized by this part.
(g) Any action taken by a prohibiting provider pursuant to this
section shall not be reportable under Sections 800 to 809.9,
inclusive, of the Business and Professions Code. The fact that a
health care provider participates in activities under this part shall
not be the sole basis for a complaint or report by another health
care provider of unprofessional or dishonorable conduct under
Sections 800 to 809.9, inclusive, of the Business and Professions
Code.
(h) Nothing in this part shall prevent a health care provider from
providing an individual with health care services that do not
constitute participation in this part.
443.13. 443.14. (a) A health care
provider may not be sanctioned for any of the following:
(1) Making an initial determination pursuant to the standard of
care that an individual has a terminal disease and informing him or
her of the medical prognosis.
(2) Providing information about the End of Life Option Act to a
patient upon the request of the individual.
(3) Providing an individual, upon request, with a referral to
another physician.
(b) A health care provider that prohibits activities under this
part in accordance with subdivision (e) of Section 443.12
Section 443.13 shall not sanction an individual
health care provider for contracting with a qualified individual to
engage in activities authorized by this part if the individual health
care provider is acting outside of the course and scope of his or
her capacity as an employee or independent contractor of the
prohibiting health care provider.
(c) Notwithstanding any contrary provision in this section, the
immunities and prohibitions on sanctions of a health care provider
are solely reserved for actions taken pursuant to this part
part, and those health care providers may be
sanctioned for conduct and actions not included and provided for in
this part if the conduct and actions do not comply with the standards
and practices set forth by the Medical Board of California.
443.14. 443.15. (a) Knowingly
altering or forging a request for aid-in-dying medication
an aid-in-dying drug to end an individual's life
without his or her authorization or concealing or destroying a
withdrawal or rescission of a request for aid-in-dying
medication an aid-in-dying drug is punishable
as a felony if the act is done with the intent or effect of causing
the individual's death.
(b) Knowingly coercing or exerting undue influence on an
individual to request aid-in-dying medication
an aid-in-dying drug for the purpose of ending his or her life
or to destroy a withdrawal or rescission of a request is
punishable as a felony.
(c) For purposes of this section, "knowingly" has the meaning
provided in Section 7 of the Penal Code.
(d) Nothing in this section shall be construed to limit civil
liability.
(e) The penalties in this section do not preclude criminal
penalties applicable under any law for conduct inconsistent with the
provisions of this part. section.
443.15. 443.16. Nothing in this
part may be construed to authorize a physician or any other person to
end an individual's life by lethal injection, mercy killing, or
active euthanasia. Actions taken in accordance with this part shall
not, for any purposes, constitute suicide, assisted suicide,
mercy killing, homicide, or elder abuse under the law.
443.16. 443.17. (a) The State
Public Health Officer shall annually review a sample of records
maintained pursuant to Section 443.19 443.7
and shall adopt regulations establishing additional reporting
requirements for physicians and pharmacists pursuant to this part.
(b) The reporting requirements shall be designed to collect
information to determine utilization and compliance with this part.
The information collected shall be confidential and shall be
collected in a manner that protects the privacy of the patient, the
patient's family, and any medical provider or pharmacist involved
with the patient under the provisions of this part.
(c) Based on the information collected, the department shall
provide an annual compliance and utilization statistical report
aggregated by age, gender, race, ethnicity, and primary language
spoken at home and other data the department may determine relevant.
The department shall make the report public within 30 days of
completion of each annual report.
(d) The State Public Health Officer shall make available to health
care providers the End of Life Option Act Checklist by posting it on
its Internet Web site.
443.17. 443.18. A person who has
custody or control of any unused aid-in-dying medication
drugs prescribed pursuant to this part after the
death of the patient shall personally deliver the unused
aid-in-dying medication drugs for
disposal by delivering it to the nearest qualified facility that
properly disposes of controlled substances, or if none is available,
shall dispose of it by lawful means. means in
accordance with guidelines promulgated by the California State Board
of Pharmacy or a federal Drug Enforcement Administration approved
take back program.
443.18. 443.19. Any governmental
entity that incurs costs resulting from a qualified individual
terminating his or her life pursuant to the provisions of this part
in a public place shall have a claim against the estate of the
qualified individual to recover those costs and reasonable attorney
fees related to enforcing the claim.
443.19. All of the following shall be documented in the
individual's medical record:
(a) All oral requests for aid-in-dying medication.
(b) All written requests for aid-in-dying medication.
(c) The attending physician's diagnosis and prognosis,
determination that a qualified individual is competent, acting
voluntarily, and has made an informed decision, or that the attending
physician has determined that the individual is not a qualified
individual.
(d) The consulting physician's diagnosis and prognosis, and
verification that the qualified individual is competent, acting
voluntarily, and has made an informed decision, or that the
consulting physician has determined that the individual is not a
qualified individual.
(e) A report of the outcome and determinations made during
counseling, if performed.
(f) The attending physician's offer to the qualified individual to
rescind his or her request at the time of the qualified individual's
second oral request.
(g) A note by the attending physician indicating that all
requirements under Sections 443.5 and 443.6 have been met and
indicating the steps taken to carry out the request, including a
notation of the aid-in-dying medication prescribed.
SEC. 2. The Legislature finds and declares that Section 1 of this
act, which adds Section 443.16 443.17
to the Health and Safety Code, imposes a limitation on the public's
right of access to the meetings of public bodies or the writings of
public officials and agencies within the meaning of Section 3 of
Article I of the California Constitution. Pursuant to that
constitutional provision, the Legislature makes the following
findings to demonstrate the interest protected by this limitation and
the need for protecting that interest:
(a) Any limitation to public access to personally identifiable
patient data collected pursuant to Section 443.16
443.17 of the Health and Safety Code as proposed to be
added by this act is necessary to protect the privacy rights of the
patient and his or her family.
(b) The interests in protecting the privacy rights of the patient
and his or her family in this situation strongly outweigh the public
interest in having access to personally identifiable data relating to
services.
(c) The statistical report to be made available to the public
pursuant to subdivision (c) of Section 443.16
443.17 of the Health and Safety Code is sufficient to satisfy
the public's right to access.
SEC. 3. The provisions of this part are severable. If any
provision of this part or its application is held invalid, that
invalidity shall not affect other provisions or applications that can
be given effect without the invalid provision or application.
SEC. 4. No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of the
Government Code, or changes the definition of a crime within the
meaning of Section 6 of Article XIII B of the California
Constitution.