BILL NUMBER: SB 128 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY JUNE 16, 2015
AMENDED IN SENATE JUNE 1, 2015
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, Glazer, Hall, Hancock,
Hernandez, Hill, McGuire, and Wieckowski)
(Coauthors: Assembly Members Chu, Cooper, Frazier, Cristina
Garcia, Low, McCarty, 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 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 an aid-in-dying drug
and, under specified circumstances, an interpreter declaration to be
signed subject to penalty of perjury, thereby imposing
creating a crime and imposing
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 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 an aid-in-dying drug absent a
request by the individual, individual or
his or her attending physician at the behest of the
individual, or the individual's designee. individual.
The bill would also prohibit any communication from containing
both the denial of treatment and information as to the availability
of aid-in-dying drug coverage.
This bill would provide immunity from 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 make participation in
activities authorized pursuant to its provisions voluntary, and would
make health care providers immune from liability for refusing to
participate engage in activities
authorized pursuant to its provisions. 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
the 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 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 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
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 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 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.
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 drug" means 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) "Capacity to make medical decisions" means that, in the
opinion of an individual's attending physician, consulting physician,
psychiatrist, or psychologist, 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) "Department" means the State Department of Public Health.
(g) "End of Life Option Act Checklist" means a checklist , as
described in Section 443.6, 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 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 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 drug to be
prescribed.
(3) The probable result of taking the drug to be prescribed.
(4) The possibility that the individual may choose not to obtain
the drug or may obtain the drug but may decide not to 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 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.
(m) "Physician" means a doctor of medicine or osteopathy currently
licensed to practice medicine in this state.
(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.
(o) "Qualified individual" means 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 a drug to end his or her life.
(p) "Self-administer" means a qualified individual's affirmative,
conscious, and physical act of administering and ingesting the
aid-in-dying drug to bring about his or her own death.
(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 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 an aid-in-dying drug if
all of the following conditions are satisfied:
(1) The individual's attending physician has diagnosed the
individual with a terminal disease.
(2) The individual has voluntarily expressed the wish to receive a
prescription for an aid-in-dying drug.
(3) The 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 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 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 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, including, but not limited to, through a power of
attorney, an advance health care directive, a conservator, health
care agent, surrogate, or any other legally recognized health care
decisionmaker.
443.3. (a) An individual seeking to obtain a prescription for 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 shall directly, and
not through a designee, receive all three requests required pursuant
to this section.
(b) A valid written request for 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 443.10. 443.11.
(2) The request shall be signed and dated, in the presence of two
witnesses in accordance with paragraph (3), by the individual seeking
the aid-in-dying drug.
(3) The request shall be witnessed by at least two other adult
persons who, in the presence of the individual, shall attest that to
the best of their knowledge and belief that the individual is all of
the following:
(A) 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 individual's estate upon death.
(2) Own, operate, or be employed at a health care facility where
the individual is receiving medical treatment or resides.
(d) The attending physician, consulting physician, or mental
health specialist of the individual shall not be one of the witnesses
required pursuant to paragraph (3) of subdivision (b).
443.4. (a) An individual may at any time withdraw or rescind his
or her request for an aid-in-dying drug, or decide not to ingest an
aid-in-dying drug, without regard to the individual's mental state.
(b) A prescription for 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 individual an opportunity to
withdraw or rescind the request.
443.5. (a) Before prescribing 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 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 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) (o) of
Section 443.1.
(2) 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 ingesting the requested
aid-in-dying drug.
(C) The probable result of ingesting the aid-in-dying drug.
(D) The possibility that he or she may choose to obtain the
aid-in-dying drug but not take it.
(E) The feasible alternatives or additional treatment options,
including, but not limited to, comfort care, hospice care, palliative
care, and pain control.
(3) Refer the individual to a consulting physician for medical
confirmation of the diagnosis and prognosis, and for a determination
that the individual has the capacity to make medical decisions and
has complied with the provisions of this part.
(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, except for an interpreter as required pursuant to
this part, whether or not the qualified individual is feeling coerced
or unduly influenced by another person.
(5) Counsel the qualified individual about the importance of all
of the following:
(A) Having another person present when he or she ingests the
aid-in-dying drug prescribed pursuant to this part.
(B) Not ingesting the aid-in-dying drug in a public place.
(C) Notifying the next of kin of his or her request for 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.
(6) Inform the individual that he or she may withdraw or rescind
the request for an aid-in-dying drug at any time and in any manner.
(7) Offer the individual an opportunity to withdraw or rescind the
request for an aid-in-dying drug before prescribing the aid-in-dying
drug.
(8) Verify, immediately prior to before
writing the prescription for an aid-in-dying drug,
that the qualified individual is making an informed decision.
(9) Confirm that all requirements are met and all appropriate
steps are carried out in accordance with this part before writing a
prescription for an aid-in-dying drug.
(10) Fulfill the record documentation required under Sections
443.7 and 443.18. 443.9 and 443.19.
(11) Complete the End of Life Option Act Checklist ,
as described in Section 443.6, 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 drug in any of
the following ways:
(1) 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, contacting a
pharmacist, informing the pharmacist of the prescriptions, and
delivering the written prescriptions personally, by mail, or
electronically to the pharmacist, who may dispense the 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 drug to the qualified individual,
the attending physician, or a person expressly designated by the
qualified individual may be made by personal delivery, or, with a
signature required on delivery, by United Parcel Service, United
States Postal Service, Federal Express, or by messenger service.
443.6. The End of Life Option Act Checklist shall be in
substantially the following form: GRAPHIC INSERT HERE: SEE
PRINTED VERSION OF THE BILL]
443.6. Prior to
443.7. Before a qualified individual
obtaining obtains an aid-in-dying drug
from the attending physician, the consulting physician shall perform
all of the following:
(a) Examine the individual and his or her relevant medical
records.
(b) Confirm in writing the attending physician's diagnosis and
prognosis.
(c) Determine that the individual has the 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.
(e) Fulfill the record documentation required under this part.
443.7. 443.8. Upon referral from
the attending or consulting physician pursuant to this part, the
mental health specialist shall:
(a) Examine the qualified individual and his or her relevant
medical records.
(b) Determine that the individual has the mental capacity to make
medical decisions, act voluntarily, and make an informed decision.
(c) Determine that the individual is not suffering from impaired
judgment due to a mental disorder.
(d) Fulfill the record documentation requirements of this part.
443.8. 443.9. 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
443.7 have been met and indicating the steps taken to carry out
the request, including a notation of the aid-in-dying drug
prescribed.
443.9. 443.10. A qualified
individual may not receive a prescription for an aid-in-dying drug
pursuant to this part unless he or she has made an informed decision.
Immediately before writing a prescription for an aid-in-dying drug
under this part, the attending physician shall verify that the
individual is making an informed decision.
443.10. 443.11. (a) A request for
an aid-in-dying drug as authorized by this part shall be in
substantially the following form:
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
to be prescribed and potential associated risks,
the expected result, and the feasible
alternatives or additional treatment options,
including comfort care, hospice care, palliative
care, and pain control.
I request that my attending physician prescribe
an aid-in-dying drug that will end my life in a
humane and dignified manner if I choose to take
it, and I authorize my attending physician to
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 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
to be prescribed. My attending physician has
counseled me about the possibility that my death
may not be immediately upon the consumption of
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, registered
domestic partnership, or adoption) of the person
signing this request or be entitled to a portion
of the person's estate upon death. Only one of
the two witnesses may own, operate, or be
employed at a health care facility where
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 when the conversations or consultations or
interpreted conversations or consultations 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 an Aid-In-Dying Drug to
End My Life'' to (insert name of
individual/patient) in (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 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 pursuant to paragraph (2)
shall meet the standards promulgated by the California Healthcare
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.
443.11. 443.12. (a) A provision in
a contract, will, or other agreement executed on or after January 1,
2016, whether written or oral, to the extent the provision would
affect whether a person may make, withdraw, or rescind a request for
an aid-in-dying drug is not valid.
(b) An obligation owing under any contract executed on or after
January 1, 2016, may not be conditioned or affected by a qualified
individual making, withdrawing, or rescinding a request for an
aid-in-dying drug.
443.12. 443.13. (a) (1)
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 an
aid-in-dying drug.
(2) Pursuant to Section 443.18, death resulting from the
self-administration of an aid-in-dying drug is not suicide, and
therefore health and insurance coverage shall not be exempted on that
basis.
(b) Notwithstanding any other law, a qualified individual's act of
self-administering an aid-in-dying drug may
shall 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 an
aid-in-dying drug absent a request by the individual or his or her
attending physician at the behest of the individual. Any
communication shall not include both the denial of treatment and
information as to the availability of aid-in-dying drug coverage. For
the purposes of this subdivision, "insurance carrier" means a health
care service plan as defined in Section 1345 of this code or a
carrier of health insurance as defined in Section 106 of the
Insurance Code.
443.13. 443.14. (a) Notwithstanding
any other law, a person shall not be subject to 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 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
(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.
(d) (1) A request by a qualified individual to an attending
physician to provide 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) No actions taken in compliance with the provisions of this
part shall constitute or provide the basis for any claim of neglect
or elder abuse for any purpose of law.
(e) (1) Participation in activities authorized pursuant to this
part shall be voluntary. Notwithstanding Sections 442 to 442.7,
inclusive, 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 an
individual's decision under this part.
(2) Notwithstanding any other law, a health care provider is not
subject to civil, criminal, administrative, disciplinary, employment,
credentialing, professional discipline, contractual liability, or
medical staff action, sanction, or penalty or other liability for
refusing to participate in activities authorized under the
End of Life Option Act, this part, including,
but not limited to, refusing to inform a patient regarding his or her
rights under the End of Life Option Act this
part, and not referring an individual to a physician who
participates in activities authorized under the End of Life
Option Act. this part.
(3) 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
individual may request a copy of his or her medical records pursuant
to law.
443.14. 443.15. (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. 443.7.
(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.
443.15. 443.16. (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 Section 443.14 443.15
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, 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.
443.16. 443.17. (a) Knowingly
altering or forging a request for 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 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 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 section.
443.17. 443.18. 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,
homicide, or elder abuse under the law.
443.18. 443.19. (a) The State
Public Health Officer shall annually review a sample of records
maintained pursuant to Section 443.8 443.9
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 , as
described in Section 443.6, by posting it on its Internet Web
site.
443.19. 443.20. A person who has
custody or control of any unused aid-in-dying drugs prescribed
pursuant to this part after the death of the patient shall personally
deliver the unused aid-in-dying 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 in accordance with guidelines promulgated by the
California State Board of Pharmacy or a federal Drug Enforcement
Administration approved take-back program.
443.20. 443.21. 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.
SEC. 2. The Legislature finds and declares that Section 1 of this
act, which adds Section 443.18 443.19
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 443.18
443.19 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 443.18
443.19 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.