CSHB 371(HES): "An Act relating to the rights of terminally ill persons."
00CS FOR HOUSE BILL NO. 371(HES) 01 "An Act relating to the rights of terminally ill persons." 02 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 03 * Section 1. AS 13.26.344(l) is amended to read: 04 (l) In the statutory form power of attorney, the language conferring general 05 authority with respect to health care services shall be construed to mean that, as to the 06 health care of the principal, whether to be provided in the state or elsewhere, the 07 principal authorizes the agent to 08 (1) have access to and disclose to others medical and related 09 information and records; 10 (2) consent or refuse to consent to medical care or relief for the 11 principal from pain, but the agent may not authorize the termination of life-sustaining 12 procedures nor originate a request for medication for the purpose of ending the 13 principal's life; 14 (3) take all steps necessary to enforce a properly executed declaration
01 or a request for medication under AS 18.12; 02 (4) consent or refuse to consent to the principal's psychiatric care, but 03 the consent does not authorize a voluntary commitment or placement in a mental 04 health treatment facility, convulsive or electric-shock therapy, psychosurgery, 05 sterilization, or an abortion; 06 (5) arrange for care or lodging of the principal in a hospital, nursing 07 home, or hospice; 08 (6) grant releases to health care professionals or health care institutions; 09 (7) hire, discharge, or compensate an attorney, accountant, expert 10 witness, or assistant when the agent considers the action to be desirable for the proper 11 execution of the powers described in this subsection; and 12 (8) do any other act or acts that the principal can do through an agent 13 and that the agent considers desirable or necessary to provide for the principal's 14 physical or mental well-being. 15 * Sec. 2. AS 18.12 is amended by adding a new section to read: 16 Sec. 18.12.005. FINDINGS; PURPOSE. (a) The legislature finds that the 17 people of the state have a fundamental right to make their own end-of-life decisions. 18 The right should include the ability to make a conscious and informed choice to enlist 19 the assistance of the medical profession in prescribing medication that will make death 20 as humane and dignified as possible. 21 (b) To enable competent adults of this state to exercise this right, this chapter 22 provides a method of 23 (1) permitting expression of people's wishes; 24 (2) protecting consenting health care professionals; and 25 (3) safeguarding against abuse of these procedures. 26 * Sec. 3. AS 18.12 is amended by adding a new section to read: 27 Sec. 18.12.015. REQUEST FOR MEDICATION TO END ONE'S LIFE IN A 28 HUMANE AND DIGNIFIED MANNER. (a) A competent person who is at least 18 29 years old and is a resident of the state may execute a revocable request for medication 30 that can be self-administered for the purpose of ending the person's life in a humane 31 and dignified manner, but the request for medication may be given operative effect
01 only if the condition of the requester is determined to be terminal and other 02 requirements of this chapter have been met. The request for medication shall be 03 signed by the requester and witnessed by two adults who at the time of witnessing 04 (1) are not related to the requester by blood, marriage, or adoption; 05 (2) are not entitled to a portion of the estate of the requester under a 06 will or by operation of law; 07 (3) do not have a creditor's claim against the requester and do not 08 anticipate making a claim against the estate of the requester; and 09 (4) are not the requester's attending physician, an employee of the 10 attending physician, a health care provider, or an employee of a health care provider. 11 (b) It is the responsibility of the requester to give the written request for 12 medication to the requester's physician. A physician or other health care provider shall 13 make it a part of the requester's medical records. 14 (c) The requester's request for medication may, but need not, be in the 15 following form: 16 REQUEST FOR MEDICATION 17 TO END MY LIFE IN A 18 HUMANE AND DIGNIFIED MANNER 19 I, ____________________, over the age of 18 years and of 20 sound mind, do voluntarily make known my desire that I want to end 21 my life in a humane and dignified manner when I have a condition or 22 illness certified to be terminal by my attending physician and at least 23 one consulting physician. 24 Upon my oral or written request for medication after execution 25 of this document but no sooner than 10 days after execution of this 26 document, and after I have been fully informed of my diagnosis, 27 prognosis, the nature of medication to be prescribed and potential 28 associated risks, the expected result and irreversible consequences, and 29 the feasible alternatives, including comfort care, hospice care, and pain 30 control, I ask my attending physician to prescribe medication that I can 31 use to end my life in a humane and dignified manner.
01 Determining the time and place of my death shall be in my sole 02 discretion and I understand that I must administer the medication to 03 myself. 04 Initial one of the following: 05 (1) _____ I have informed my family of my decision 06 and taken their opinions into consideration. 07 (2) _____ I have decided not to inform my family of 08 my decision. 09 (3) _____ I have no family to inform of my decision. 10 I understand that I have the right to rescind this request for 11 medication at any time. 12 I understand the full import of this request for medication, and 13 I expect to die when I take the medication to be prescribed. 14 I make this request for medication voluntarily and without 15 reservation, and I accept full moral responsibility for my actions. 16 Dated: __________ Signed: ______________________________ 17 Requester 18 Place: ______________________________ 19 STATEMENT OF WITNESSES 20 I declare under penalty of perjury that the maker of this request 21 for medication 22 (1) is personally known to me or has provided proof of 23 identity; 24 (2) signed this request for medication in my presence; 25 (3) appears to be of sound mind and not under duress, 26 fraud, or undue influence; and 27 (4) is not a patient for whom either of us is attending 28 physician, health care provider, or an employee of a health 29 provider. 30 I further declare under penalty of perjury that I am not related 31 to the requester by blood, marriage, or adoption, and, to the best of my
01 knowledge, I am not entitled to any part of the estate of the requester 02 under a will now existing or by operation of law, and have no claim nor 03 do I anticipate making a claim against any portion of the estate of the 04 requester. 05 Dated: ___________________________________ 06 Witness's Signature: ________________________ 07 Print Name: _______________________________ 08 Residence Address: _________________________ 09 Dated: ___________________________________ 10 Witness's Signature: ________________________ 11 Print Name: _______________________________ 12 Residence Address: _________________________ 13 (d) A physician may presume, in the absence of actual notice to the contrary, 14 that a request for medication complies with this chapter and is valid. 15 (e) Upon a subsequent oral or written request for medication by the maker of 16 the request for medication, the attending physician shall make the initial determination 17 of whether the requester has a terminal disease, is competent, and has made the request 18 for medication voluntarily, and shall inform the requester of the 19 (1) attending physician's medical diagnosis; 20 (2) attending physician's prognosis; 21 (3) potential risks, probable results, and irreversible consequences of 22 taking the medication to be prescribed; and 23 (4) feasible alternatives, including, but not limited to, comfort care, 24 hospice care, and pain control. 25 (f) After complying with (e) of this section, the attending physician shall refer 26 the patient to a consulting physician for medical confirmation of the diagnosis and for 27 a determination that the patient is competent and acting voluntarily. 28 (g) The attending physician shall ask the patient to notify next of kin of the 29 request for medication. A patient who declines or is unable to notify next of kin may 30 not have the request for medication denied for that reason. 31 (h) In order to receive a prescription for medication to end life in a humane
01 and dignified manner, a qualified patient shall have made a written request for 02 medication under (c) of this section followed by an oral or written request for 03 medication to the attending physician no less than 10 days after making the written 04 request under (c) of this section. A prescription for medication under this chapter may 05 not be written unless the attending physician has verified that the patient is making an 06 informed decision and offered the qualified patient an opportunity to revoke the request 07 for medication. 08 (i) A prescription written for medication under this chapter must be in writing 09 and must include a notation on the prescription that it is issued at the request of the 10 patient under this chapter. 11 * Sec. 4. AS 18.12.020 is amended to read: 12 Sec. 18.12.020. REVOCATION [OF DECLARATION]. (a) A declaration or 13 request for medication may be revoked at any time and in any manner by which the 14 declarant or requester is able to communicate an intent to revoke, without regard to 15 mental or physical condition. A revocation is only effective as to the attending 16 physician or a [ANY] health care provider acting under the guidance of that physician 17 upon communication to the physician or health care provider by the declarant or the 18 requester, as applicable, or by another to whom the revocation was communicated 19 by the declarant or requester. 20 (b) The attending physician or health care provider shall make the revocation 21 a part of the declarant's or requester's medical record. 22 * Sec. 5. AS 18.12.030 is amended to read: 23 Sec. 18.12.030. RECORDING DETERMINATION OF TERMINAL 24 CONDITION AND CONTENTS OF DECLARATION OR REQUEST FOR 25 MEDICATION. When an attending physician who has been provided a copy of a 26 declaration or request for medication determines that the declarant or requester is 27 in a terminal condition, the physician shall record that determination and the contents 28 of the declaration or request for medication in the declarant's or requester's medical 29 record. When recording a request for medication into the requester's medical 30 record under this section, the physician shall also record 31 (1) all oral or written requests by a patient for medication to end
01 the patient's life in a humane and dignified manner; 02 (2) the attending physician's diagnosis and prognosis for the patient 03 and the attending physician's determination that the patient is mentally 04 competent, acting voluntarily, and has made an informed decision; 05 (3) the consulting physician's diagnosis and prognosis for the 06 patient and the consulting physician's verification that the patient is mentally 07 competent, acting voluntarily, and has made an informed decision; 08 (4) that the attending physician has made an offer to the patient to 09 let the patient revoke the most recent request for medication; 10 (5) a note by the attending physician indicating that all 11 requirements under this chapter have been met and describing the steps taken to 12 comply with this chapter; and 13 (6) the type of medication, if any, prescribed as a result of the 14 patient's request for medication. 15 * Sec. 6. AS 18.12.040(c) is amended to read: 16 (c) The declaration or request for medication of a qualified patient known 17 to the attending or consulting physician to be pregnant may not be given operative 18 [IS GIVEN NO] effect as long as it is probable that the fetus could develop to the 19 point of live birth with continued application of life-sustaining procedures. 20 * Sec. 7. AS 18.12.050 is amended to read: 21 Sec. 18.12.050. TRANSFER OF PATIENTS. (a) An attending physician who 22 is unwilling to comply with the requirements of AS 18.12.030, [OR WHO IS 23 UNWILLING TO COMPLY WITH] the declaration of a qualified patient under 24 AS 18.12.040, or a request for medication of a qualified patient under 25 AS 18.12.015 shall withdraw as attending physician but the withdrawal is effective 26 only when the services of another attending physician have been obtained. 27 (b) If the policies of a health care facility preclude compliance with the 28 declaration or request for medication of a qualified patient under this chapter or a 29 do not resuscitate order issued by an attending physician, or the facility is unwilling 30 to accept DNR identification as evidence of the existence of a declaration or do not 31 resuscitate order, that facility shall take all reasonable steps to notify the patient or, if
01 the patient is not able to make treatment decisions, the patient's guardian or other 02 person who has the power to make health care decisions for the patient, of the 03 facility's policy and shall take all reasonable steps to effect the transfer of the patient 04 to the patient's home or to a facility where the provisions of this chapter can be carried 05 out. 06 * Sec. 8. AS 18.12.050 is amended by adding a new subsection to read: 07 (c) A physician or health care facility that provides for the transfer of a patient 08 under this section shall transfer, upon request, a copy of the patient's relevant medical 09 records to the new health care provider. 10 * Sec. 9. AS 18.12 is amended by adding a new section to read: 11 Sec. 18.12.055. REPORTING REQUIREMENTS. (a) The Department of 12 Health and Social Services may review records maintained under this chapter and may 13 issue appropriate regulations to facilitate the collection of information regarding 14 compliance with this chapter. The information collected under this subsection is 15 confidential and not subject to inspection or copying under AS 09.25.110 - 09.25.125. 16 (b) The Department of Health and Social Services shall prepare and make 17 available to the public an annual statistical report of information collected under (a) 18 of this section. 19 * Sec. 10. AS 18.12.060(a) is amended to read: 20 (a) In the absence of actual notice of the revocation of a declaration, request 21 for medication, or do not resuscitate order, as applicable, the following, while acting 22 in accordance with the do not resuscitate protocol adopted under AS 18.12.035 or with 23 the other requirements of this chapter, are not subject to civil or criminal liability or 24 guilty of unprofessional conduct: 25 (1) a physician who causes the withholding or withdrawal of life- 26 sustaining procedures from a qualified patient or the withholding or withdrawal of 27 cardiopulmonary resuscitation from a patient for whom a do not resuscitate order has been 28 issued or who possesses DNR identification; 29 (2) a person who participates in the withholding or withdrawal of 30 cardiopulmonary resuscitation or other life-sustaining procedures under the direction 31 or with the authorization of a physician or upon discovery of DNR identification upon
01 a person; 02 (3) persons who cause or participate in providing cardiopulmonary 03 resuscitation or other life-sustaining procedures after an oral or written request 04 communicated to them by a person who possesses DNR identification; 05 (4) the health care facility in which the providing, withholding, or 06 withdrawal occurs; 07 (5) a physician or pharmacist who prescribes, prepares, or 08 dispenses medication for a qualified patient to implement a request for medication 09 in accordance with the procedures required by this chapter. 10 * Sec. 11. AS 18.12.060 is amended by adding new subsections to read: 11 (c) A professional organization, professional association, or health care 12 provider may not subject to disciplinary measures or other penalty a person based on 13 the person's good faith participation or refusal to participate in procedures authorized 14 under this chapter if the participation or refusal to participate is done in a manner that 15 complies with this chapter. 16 (d) A request for medication by a patient or the provision by an attending 17 physician of medication in good faith compliance with this chapter does not constitute 18 neglect or self-harm and may not be the basis for the appointment of a guardian or 19 conservator for the patient. 20 (e) A provision of a contract that requires a health care provider to comply 21 with a request for medication executed under AS 18.12.015 is void. 22 * Sec. 12. AS 18.12.070 is amended to read: 23 Sec. 18.12.070. PENALTIES. (a) An attending physician who (1) fails to 24 comply with a do not resuscitate order or the declaration or request for medication 25 of a qualified patient who has complied with the requirements of this chapter; and 26 (2) fails [OR] to make the necessary arrangements to effect a transfer under 27 AS 18.12.050, has no right to compensation for medical services provided to a patient 28 after withholding, [OR] withdrawal, or the requested medication should have been 29 effective or after transfer should have occurred and may be liable to the patient and 30 to the heirs of the patient for a civil penalty not to exceed $1,000 plus the actual costs 31 associated with the failure to comply with the order, [OR] declaration, or request for
01 medication, and this shall be the exclusive remedy at law for damages. 02 (b) A person who wilfully conceals, cancels, defaces, obliterates, or damages 03 the DNR identification, [OR] declaration, or request for medication of another person 04 without the other's consent or who falsifies, alters, or forges a revocation of the DNR 05 identification, [OR] declaration, or request for medication of another person may be 06 civilly liable to the other person and to the heirs of the other person. 07 * Sec. 13. AS 18.12.070 is amended by adding new subsections to read: 08 (c) A person who without authorization of the patient intentionally alters or 09 forges a request for medication or conceals a revocation of a request for medication 10 with the intent or effect of causing the patient's death is guilty of a class A felony. 11 (d) A person who intentionally coerces or exerts undue influence on a patient 12 to request medication that can be used for the purpose of ending the patient's life or 13 to destroy a revocation of a request for medication, is guilty of a class A felony. 14 (e) This chapter does not limit liability for civil damages resulting from other 15 negligent conduct or intentional misconduct by any person. 16 (f) The penalties in this chapter do not preclude criminal penalties applicable 17 under other law for conduct that is inconsistent with the provisions of this chapter. 18 * Sec. 14. AS 18.12.080(a) is amended to read: 19 (a) Death resulting from the withholding or withdrawal of cardiopulmonary 20 resuscitation or other life-sustaining procedures under a do not resuscitate order or 21 protocol, under a declaration, or upon discovery of DNR identification on a person and 22 in accordance with this chapter does not, for any purpose, including civil or criminal 23 liability, constitute a suicide or homicide. Death resulting from medication 24 prescribed under a request for medication in accordance with this chapter does 25 not, for any purpose, including civil or criminal liability, constitute a suicide or 26 homicide if the medication is self-administered by the person who made the 27 request for medication and the person who made the request for medication 28 controlled the time, place, and manner of death. 29 * Sec. 15. AS 18.12.080(b) is amended to read: 30 (b) The issuing of a do not resuscitate order, the possession of DNR 31 identification, [OR] the making of a declaration under AS 18.12.010, or a request for
01 medication under AS 18.12.015 does not affect in any manner the sale, procurement, 02 or issuance of a policy of life insurance, nor does it modify the terms of an existing 03 policy of life insurance. A policy of life insurance is not legally impaired or 04 invalidated in any manner by the withholding or withdrawal of life-sustaining 05 procedures from an insured qualified patient, [OR] the withholding or withdrawal of 06 cardiopulmonary resuscitation from an insured patient who possesses DNR 07 identification or for whom a do not resuscitate order has been issued, or the use by 08 an insured qualified patient of medication prescribed in compliance with a request 09 for medication governed by this chapter, notwithstanding any term of the policy to 10 the contrary. 11 * Sec. 16. AS 18.12.080(c) is amended to read: 12 (c) A physician, health care facility, or other health care provider, and a health 13 care service plan, insurer issuing disability insurance, self-insured employee welfare 14 benefit plan, or nonprofit hospital plan, may not require a person to execute a 15 declaration or request for medication, obtain a do not resuscitate order from a 16 physician, or possess DNR identification as a condition for being insured for, or 17 receiving, health care services. 18 * Sec. 17. AS 18.12.080(d) is amended to read: 19 (d) This chapter creates no presumption concerning the intention or intended 20 treatment of an individual who does not have DNR identification, has not executed a 21 declaration or request for medication, or for whom a do not resuscitate order has not 22 been issued with respect to the use, withholding, or withdrawal of cardiopulmonary 23 resuscitation or other life-sustaining procedures. 24 * Sec. 18. AS 18.12.090 is amended to read: 25 Sec. 18.12.090. RECOGNITION OF DECLARATIONS, REQUESTS FOR 26 MEDICATION, AND ORDERS EXECUTED OR ISSUED IN OTHER STATES. 27 A declaration, request for life-ending medication, do not resuscitate order, or DNR 28 identification executed, issued, or authorized in another state or a territory or 29 possession of the United States in compliance with the law of that jurisdiction is 30 effective for purposes of this chapter. 31 * Sec. 19. AS 18.12.100(5) is amended to read:
01 (5) "do not resuscitate order" means an order [A DIRECTIVE] from 02 a licensed physician that emergency cardiopulmonary resuscitation should not be 03 administered to a particular person; 04 * Sec. 20. AS 18.12.100(10) is amended to read: 05 (10) "qualified patient" means a patient who, in accordance with this 06 chapter, has executed a declaration or a request for medication, as applicable, [IN 07 ACCORDANCE WITH THIS CHAPTER] and who has been determined by the 08 attending physician to be in a terminal condition; 09 * Sec. 21. AS 18.12.100 is amended by adding new paragraphs to read: 10 (12) "declarant" means a person who has executed a declaration under 11 AS 18.12.010; 12 (13) "intentionally" has the meaning given in AS 11.81.900; 13 (14) "requester" means a person who has executed a request for 14 medication under AS 18.12.015; 15 (15) "request for medication" means a document executed in 16 accordance with the requirements of AS 18.12.015.