HB 54: "An Act relating to the voluntary termination of life by terminally ill individuals; and providing for an effective date."
00 HOUSE BILL NO. 54 01 "An Act relating to the voluntary termination of life by terminally ill individuals; and 02 providing for an effective date." 03 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 04 * Section 1. AS 11.41.115 is amended by adding a new subsection to read: 05 (g) In a prosecution under AS 11.41.100(a)(1) or 11.41.110(a)(1) or (2), it is an 06 affirmative defense that the defendant was performing an action allowed under 07 AS 13.55. 08 * Sec. 2. AS 11.41.120 is amended by adding a new subsection to read: 09 (c) In a prosecution under this section, it is an affirmative defense that the 10 defendant was performing an action allowed under AS 13.55. 11 * Sec. 3. AS 13 is amended by adding a new chapter to read: 12 Chapter 55. Voluntary Termination of Life. 13 Sec. 13.55.010. Individuals allowed to terminate life. (a) A qualified 14 individual may terminate the qualified individual's life under this chapter. To be
01 qualified, an individual shall 02 (1) be a resident of this state; 03 (2) be an adult; 04 (3) have been determined by a court, the individual's attending 05 physician, the individual's consulting physician, the individual's psychiatrist, or the 06 individual's psychologist to be capable; 07 (4) have been determined by the individual's attending physician and 08 consulting physician to be suffering from a terminal disease; and 09 (5) have voluntarily expressed the wish to die. 10 (b) An individual does not qualify under (a) of this section solely because of 11 the individual's age or disability. 12 Sec. 13.55.020. Attending physician and pharmacist authority. If a 13 qualified individual's attending physician complies with this chapter, the attending 14 physician may 15 (1) dispense medication directly to the qualified individual, including 16 ancillary medications intended to facilitate the desired effect or minimize the qualified 17 individual's discomfort; or 18 (2) write a prescription for the medication for the qualified individual 19 and personally or by mail deliver the prescription for the medication to a pharmacist, 20 who may dispense the medication to the qualified individual, the attending physician, 21 or an expressly identified agent of the qualified individual. 22 Sec. 13.55.030. Requests for medication. (a) To receive medication under this 23 chapter, a qualified individual shall make an oral request and a written request to the 24 qualified individual's attending physician. The qualified individual shall repeat the oral 25 request to the qualified individual's attending physician more than 15 days after 26 making the initial oral request. 27 (b) Notwithstanding (a) of this section, if a qualified individual is not 28 physically able to speak, a qualified individual may make an oral request by whatever 29 means the qualified individual can use to make the request, including electronic 30 means, as long as the request is made in person. 31 (c) Notwithstanding (a) of this section, if a qualified individual is not
01 physically able to sign a written request, the qualified individual may direct another 02 individual to sign for the qualified individual. 03 Sec. 13.55.040. Right to rescind request. When a qualified individual makes 04 the second oral request under AS 13.55.030, the attending physician shall offer the 05 qualified individual an opportunity to rescind the initial oral request and the written 06 request. A qualified individual may rescind a request at any time and in any manner 07 without regard to the qualified individual's mental state. An attending physician may 08 not dispense or prescribe medication under this chapter unless the attending physician 09 offers the qualified individual an opportunity to rescind the request. 10 Sec. 13.55.050. Written request requirements. (a) A written request for 11 medication under this chapter must be in substantially the form described in 12 AS 13.55.060, signed and dated by the qualified individual, and witnessed by at least 13 two other individuals. The attending physician may not witness the request. The 14 witnesses shall, in the presence of the qualified individual, attest that, to the best of 15 their knowledge and belief, the qualified individual is capable, acting voluntarily, and 16 not under undue influence to sign the request. 17 (b) Only one witness may be 18 (1) a relative of the qualified individual by blood, marriage, or 19 adoption; 20 (2) an individual who, at the time the qualified individual signs the 21 request, would be entitled to a portion of the estate of the qualified individual at death 22 under a will or by operation of law; or 23 (3) an owner, operator, or employee of a health care facility where the 24 qualified individual is receiving medical treatment or is a resident. 25 (c) If the qualified individual is an inpatient in a long-term care facility when 26 the qualified individual signs the request, one of the witnesses shall be an individual 27 designated by the facility who has the qualifications established by the department by 28 regulation. In this subsection, "long-term care facility" includes an assisted living 29 home as defined in AS 47.32.900 and a nursing facility as defined in AS 47.32.900. 30 Sec. 13.55.060. Form for written request. A request for a medication under 31 this chapter must be in substantially the following form:
01 REQUEST FOR MEDICATION TO END MY LIFE 02 I, _________________, am an adult of sound mind. 03 I am suffering from _______________, which my attending physician 04 has determined is a terminal disease and which has been medically confirmed 05 by a consulting physician. 06 I have been fully informed of my diagnosis, prognosis, the nature of the 07 medication to be prescribed and potential associated risks, the expected result, 08 and the feasible alternatives, including comfort care, hospice care, and pain 09 control. 10 I request that my attending physician prescribe medication that will end 11 my life in a humane and dignified manner. 12 INITIAL ONE OF THE FOLLOWING: 13 _____ I have informed my family of my decision and taken their 14 opinions into consideration. 15 _____ I have decided not to inform my family of my decision. 16 _____ I have no family to inform of my decision. 17 I understand that I have the right to rescind this request at any time. 18 I understand the full import of this request, and I expect to die when I 19 take the medication to be prescribed. I further understand that, although most 20 deaths occur within three hours, my death may take longer, and my attending 21 physician has counseled me about this possibility. 22 I make this request voluntarily and without reservation, and I accept 23 full moral responsibility for my actions. 24 Signed: _____________________ 25 Dated: ______________________ 26 DECLARATION OF WITNESSES 27 We declare that the person signing this request 28 (1) is personally known to us or has provided proof of 29 identity; 30 (2) in our presence signed or directed another person to 31 sign this request;
01 (3) is not an individual for whom either of us is the 02 attending physician; and 03 (4) to the best of our knowledge and belief, 04 (A) has the ability to make and communicate 05 health care decisions to health care providers; and 06 (B) is acting voluntarily and not under undue 07 influence. 08 _______________________ Witness 1 Date: _____ 09 _______________________ Witness 2 Date: _____ 10 NOTE: One witness may not be a relative (by blood, marriage, or 11 adoption) of the individual signing this request, may not be entitled to a portion 12 of the individual's estate on death, and may not own, operate, or be employed 13 at a health care facility where the person is an individual or resident. If the 14 individual is an inpatient at a health care facility, one of the witnesses shall be 15 an individual designated by the facility. 16 Sec. 13.55.070. Attending physician duties and authority. (a) The attending 17 physician shall 18 (1) make the initial determination of whether an individual has a 19 terminal disease, is capable, and has made the request for medication voluntarily; 20 (2) request that the individual demonstrate that the individual is a 21 resident of this state; 22 (3) inform the individual of the 23 (A) individual's medical diagnosis; 24 (B) individual's prognosis; 25 (C) potential risks associated with taking the medication; 26 (D) probable result of taking the medication; and 27 (E) feasible alternatives, including comfort care, hospice care, 28 and pain control; 29 (4) refer the individual to a consulting physician for medical 30 confirmation of the diagnosis and for a determination that the individual is capable and 31 acting voluntarily;
01 (5) refer the individual for counseling if appropriate under 02 AS 13.55.090; 03 (6) recommend that the qualified individual notify the qualified 04 individual's next of kin; 05 (7) counsel the qualified individual about the importance of having 06 another person present when the qualified individual takes the medication prescribed 07 under this chapter and of not taking the medication in a public place; 08 (8) inform the qualified individual that the qualified individual has an 09 opportunity to rescind the request at any time and in any manner and offer the 10 qualified individual an opportunity to rescind the request at the end of the 15-day 11 waiting period under AS 13.55.030; 12 (9) immediately before dispensing or prescribing medication under this 13 chapter, verify that the qualified individual is making an informed decision; 14 (10) fulfill the requirements of AS 13.55.130 for medical record 15 documentation; 16 (11) ensure that all appropriate steps are carried out under this chapter 17 before dispensing or prescribing medication to enable a qualified individual to end the 18 qualified individual's life under this chapter; and 19 (12) if the attending physician has a current federal Drug Enforcement 20 Administration registration number and complies with applicable regulations, dispense 21 medication directly, including ancillary medications intended to facilitate the desired 22 effect or minimize the qualified individual's discomfort, or, with the qualified 23 individual's written consent, 24 (A) contact a pharmacist and inform the pharmacist of a 25 prescription for the medication; and 26 (B) deliver the written prescription personally or by mail to the 27 pharmacist who will dispense the medication to the qualified individual, the 28 attending physician, or an agent of the qualified individual who is expressly 29 identified as an agent by the qualified individual. 30 (b) Notwithstanding any other provision of law to the contrary, the attending 31 physician may sign the qualified individual's death certificate.
01 Sec. 13.55.080. Confirmation by consulting physician. Before an individual 02 becomes a qualified individual under this chapter, a consulting physician shall 03 examine the individual and the individual's relevant medical records, confirm in 04 writing the attending physician's diagnosis that the individual is suffering from a 05 terminal disease, and verify that the individual is capable, is acting voluntarily, and 06 has made an informed decision. 07 Sec. 13.55.090. Counseling referral. If the attending physician or the 08 consulting physician determines that an individual may be suffering from a psychiatric 09 or psychological disorder or depression causing impaired judgment, either physician 10 shall refer the individual for counseling, and the attending physician may not dispense 11 or prescribe medication until the person performing the counseling determines that the 12 individual is not suffering from depression or a psychiatric or psychological disorder 13 causing impaired judgment. 14 Sec. 13.55.100. Informed decision. An attending physician may not dispense 15 or prescribe medication unless the qualified individual has made an informed decision. 16 Immediately before dispensing or prescribing medication under this chapter, the 17 attending physician shall verify that the qualified individual is making an informed 18 decision. 19 Sec. 13.55.110. Family notification. The attending physician may not deny a 20 qualified individual's request for medication if the qualified individual declines or is 21 unable to notify the qualified individual's next of kin. 22 Sec. 13.55.120. Waiting periods. An attending physician may not dispense 23 medication or write a prescription for medication for a qualified individual unless 24 more than 15 days have elapsed between the qualified individual's initial oral request 25 and the writing of the prescription and more than 48 hours have elapsed between the 26 qualified individual's written request and the writing of the prescription. 27 Sec. 13.55.130. Medical record documentation requirements. Before a 28 qualified individual receives medication under this chapter, the medical record of the 29 qualified individual must contain 30 (1) all oral requests by a qualified individual for medication under this 31 chapter;
01 (2) all written requests by a qualified individual for medication under 02 this chapter; 03 (3) the attending physician's diagnosis, prognosis, and determination 04 that the individual is capable, is acting voluntarily, and has made an informed 05 decision; 06 (4) the consulting physician's diagnosis, prognosis, and verification that 07 the individual is capable, is acting voluntarily, and has made an informed decision; 08 (5) if counseling is performed, a report of the determinations made 09 during counseling and the outcome; 10 (6) the attending physician's offer to the qualified individual to rescind 11 the qualified individual's request at the time of the qualified individual's second oral 12 request under AS 13.55.030; 13 (7) a note by the attending physician indicating that all requirements 14 under this chapter have been met and indicating the steps taken to carry out the 15 request, including a statement describing the medication prescribed. 16 Sec. 13.55.140. Effect on construction of wills and contracts. A provision in 17 a will or a contract, whether written or oral, is not valid to the extent that the provision 18 requires, prohibits, imposes a condition on, or otherwise addresses whether an 19 individual may make or rescind a request for medication under this chapter. 20 Sec. 13.55.150. Immunity. (a) A person is not subject to civil or criminal 21 liability or professional disciplinary action, including disciplinary action by a licensing 22 authority, for participating in good faith compliance with this chapter, including being 23 present when a qualified individual takes the prescribed medication to end the 24 qualified individual's life under this chapter. 25 (b) A professional organization or association or health care provider may not 26 subject a person to censure, discipline, suspension, loss of license, loss of privileges, 27 loss of membership, or other penalty for participating in or refusing to participate in 28 good faith compliance with this chapter. 29 (c) A request by an individual for, or provision by an attending physician of, 30 medication in good faith compliance with this chapter does not provide the sole basis 31 for the appointment of a guardian or conservator of the individual.
01 Sec. 13.55.160. No duty to participate. A health care provider is not under a 02 duty, whether by contract, statute, or other legal requirement, to dispense medication, 03 prescribe medication, or otherwise participate in the provision of medication to a 04 qualified individual under this chapter. If a health care provider is unable or unwilling 05 to carry out a qualified individual's request under AS 13.55.030 and the qualified 06 individual transfers the qualified individual's care to another health care provider, the 07 transferring health care provider shall provide to the other health care provider, at the 08 qualified individual's request, a copy of the qualified individual's relevant medical 09 records. 10 Sec. 13.55.170. Prohibition against participation; sanctions. (a) 11 Notwithstanding another provision of law to the contrary, a health care provider may 12 prohibit another health care provider from participating in this chapter on the premises 13 of the prohibiting health care provider if the prohibiting health care provider notifies 14 the other health care provider of the prohibiting health care provider's policy regarding 15 not participating in this chapter. This subsection does not prevent a health care 16 provider from providing health care services to an individual if the health care services 17 do not constitute participating in this chapter. 18 (b) Notwithstanding AS 13.55.150 and 13.55.160, a health care provider may 19 sanction another health care provider as follows if the sanctioning health care provider 20 notifies the sanctioned health care provider before participating under this chapter that 21 the sanctioning health care provider prohibits participating in this chapter: 22 (1) loss of privileges, loss of membership, or other sanction provided 23 under the bylaws, policies, or procedures of the sanctioning health care provider if the 24 sanctioned health care provider is a member of the sanctioning health care provider's 25 medical staff and is participating in this chapter while on the health care facility 26 premises of the sanctioning health care provider; in this paragraph, "health care 27 facility premises" does not include the private medical office of the sanctioned health 28 care provider even if located on the health care facility premises of the sanctioning 29 health care provider; 30 (2) termination of lease or other contract or imposition of nonmonetary 31 remedies provided by the lease or other contract if the sanctioned health care provider
01 is participating in this chapter while on the premises of the sanctioning health care 02 provider or on property that is owned by or under the direct control of the sanctioning 03 health care provider; in this paragraph, "remedies" does not include the loss or 04 restriction of medical staff privileges or exclusion from a provider panel; or 05 (3) termination of a contract or imposing other nonmonetary remedies 06 provided by a contract if the sanctioned health care provider is participating in this 07 chapter while acting in the course and scope of the sanctioned health care provider's 08 capacity as an employee, except as a member of the sanctioning health care provider's 09 medical staff, or independent contractor of the sanctioning health care provider; this 10 paragraph does not prevent 11 (A) a health care provider from participating in this chapter 12 while acting outside the course and scope of the health care provider's capacity 13 as an employee or independent contractor; or 14 (B) an individual from contracting with the individual's 15 attending physician or consulting physician to act outside the course and scope 16 of the physician's capacity as an employee or independent contractor of the 17 sanctioning health care provider. 18 (c) A health care provider who imposes sanctions under (b) of this section shall 19 follow all procedures that are provided under an applicable contract, the applicable 20 terms of employment, or law for imposing the sanctions. 21 (d) Suspension or termination of staff membership or privileges under (b) of 22 this section is not reportable under AS 08.64.336. 23 (e) In this section, 24 (1) "notifies" means delivers a written statement to the health care 25 provider specifically informing the health care provider before the health care 26 provider's participation in this chapter of the sanctioning health care provider's policy 27 about participation in activities covered by this chapter; 28 (2) "participating in this chapter" means performing the duties of an 29 attending physician under AS 13.55.070, the function of a consulting physician under 30 AS 13.55.080, or the counseling function under AS 13.55.090; in this paragraph, 31 "performing the duties" does not include
01 (A) making an initial determination that an individual has a 02 terminal disease and informing the individual of the medical prognosis; 03 (B) providing information about this chapter to an individual at 04 the request of the individual; 05 (C) providing an individual with a referral to another physician 06 at the request of the individual; or 07 (D) contracting with the individual's attending physician or 08 consulting physician to act outside the course and scope of the health care 09 provider's capacity as an employee or independent contractor of a sanctioning 10 health care provider. 11 Sec. 13.55.180. Criminal penalties. (a) A person commits the crime of abuse 12 of life termination process if the person, with the intent to cause the individual's death 13 or knowing that the death of the individual is substantially certain to result, 14 (1) without the authorization of the individual, falsely makes, completes, or 15 alters a request for medication or conceals or destroys a rescission of the individual's 16 request; or 17 (2) exerts undue influence on an individual to request medication for the 18 purpose of ending the individual's life or to destroy a rescission of the individual's 19 request. 20 (b) Abuse of life termination process is a class A felony and may be punished 21 as provided in AS 12.55. 22 (c) This chapter does not prevent the imposition of criminal penalties that 23 apply under another law for conduct that is inconsistent with this chapter. 24 Sec. 13.55.190. Civil penalties. This chapter does not limit liability for civil 25 damages resulting from a person's negligent conduct or intentional misconduct. 26 Sec. 13.55.200. Claims for costs incurred. A governmental entity that incurs 27 expenses that result from the termination by a qualified individual of the qualified 28 individual's life under this chapter in a public place may file a claim against the estate 29 of the individual to recover the costs and attorney fees related to enforcing the claim. 30 Sec. 13.55.210. Duties of department. (a) The department shall annually 31 review a sample of records maintained under this chapter.
01 (b) After dispensing medication under this chapter, a health care provider shall 02 file with the department a copy of the record of dispensing the medication. 03 (c) The department shall adopt regulations under AS 44.62 (Administrative 04 Procedure Act) to facilitate the collection of information about compliance with this 05 chapter. The information collected is not a public record under AS 40.25.100, and the 06 department may not make the information available for inspection by the public. 07 (d) The department shall generate and make available to the public an annual 08 statistical report of the information collected under (c) of this section. The statistical 09 report may not disclose information that is confidential under (c) of this section, but 10 shall present the information in a manner that prevents the identification of particular 11 persons. 12 Sec. 13.55.220. Construction of chapter. (a) This chapter may not be 13 construed to authorize or require a health care provider to provide health care contrary 14 to generally accepted health care standards applicable to the health care provider. 15 (b) This chapter may not be construed to authorize a physician or another 16 person to end an individual's life by lethal injection, mercy killing, or active 17 euthanasia. An action allowed by this chapter is an affirmative defense to a criminal 18 charge of homicide, murder, manslaughter, criminally negligent homicide, suicide, 19 assisted suicide, mercy killing, or euthanasia under the law of this state. 20 Sec. 13.55.230. Insurance or annuity policies; contracts. Notwithstanding 21 AS 21.45.250 or another provision to the contrary, a person may not condition the 22 sale, procurement, issuance, rate, delivery, issuance for delivery, or other aspect of a 23 life, health, or accident insurance or annuity policy or another contract on the making 24 or rescission of a request by a qualified individual for medication under this chapter. 25 Sec. 13.55.240. Coordination with other law. A written or oral request for 26 medication under this chapter is not an advance health care directive under AS 13.52, 27 and AS 13.52 does not apply to an activity allowed by this chapter. 28 Sec. 13.55.900. Definitions. In this chapter, unless the context indicates 29 otherwise, 30 (1) "adult" means an individual who is 18 years of age or older; 31 (2) "attending physician" means the physician who has primary
01 responsibility for the care of the individual and treatment of the individual's terminal 02 disease; 03 (3) "capable" means that an individual has the ability to make and 04 communicate health care decisions to health care providers; in this paragraph, 05 "communicate" includes communication through a person familiar with the 06 individual's manner of communicating if the person is available; 07 (4) "consulting physician" means a physician who is qualified by 08 specialty or experience to make a professional diagnosis and prognosis about the 09 individual's disease; 10 (5) "counseling" means consultation as necessary between a 11 psychiatrist or psychologist and an individual to determine if the individual is capable 12 and not suffering from a psychiatric or psychological disorder or depression causing 13 impaired judgment; 14 (6) "department" means the Department of Health and Social Services; 15 (7) "health care facility" means a private, municipal, or state hospital; 16 independent diagnostic testing facility; primary care outpatient facility; skilled nursing 17 facility; kidney disease treatment center, including freestanding hemodialysis units; 18 intermediate care facility; ambulatory surgical facility; Alaska Pioneers' Home or 19 Alaska Veterans' Home administered by the department under AS 47.55; correctional 20 facility owned or administered by the state; private, municipal, or state facility 21 employing one or more public health nurses; and long-term care facility; 22 (8) "health care provider" means a person licensed, certified, or 23 otherwise authorized or permitted by the law of this state to administer health care or 24 dispense medication in the ordinary course of business or practice of a profession; in 25 this paragraph, "person" includes a health care facility; 26 (9) "informed decision" means a decision that is based on an 27 appreciation of the relevant facts and that is made after the attending physician fully 28 informs a qualified individual of the 29 (A) qualified individual's medical diagnosis; 30 (B) qualified individual's prognosis; 31 (C) potential risks associated with taking the medication to be
01 prescribed; 02 (D) probable result of taking the medication to be prescribed; 03 and 04 (E) feasible alternatives, including comfort care, hospice care, 05 and pain control; 06 (10) "medically confirmed" means that a consulting physician who has 07 examined the individual's relevant medical records has confirmed the medical opinion 08 of the attending physician; 09 (11) "medication" means medication to end a qualified individual's life 10 under this chapter; 11 (12) "physician" means a doctor of medicine or osteopathy who is 12 licensed under AS 08.64 to practice medicine or osteopathy; 13 (13) "prescription" means a prescription for medication to end a 14 qualified individual's life under this chapter; 15 (14) "qualified individual" means an individual who is qualified under 16 AS 13.55.010 to end the individual's life under this chapter; 17 (15) "request" means a request under AS 13.55.030; 18 (16) "terminal disease" means an incurable and irreversible disease 19 that has been medically confirmed and that will, within reasonable medical judgment, 20 produce death within six months; 21 (17) "undue influence" means the control of an individual by a person 22 who stands in a position of trust or confidence to exploit wrongfully the trust, 23 dependency, or fear of the individual to gain control over the decision making of the 24 individual. 25 * Sec. 4. The uncodified law of the State of Alaska is amended by adding a new section to 26 read: 27 APPLICABILITY. AS 13.55, enacted by sec. 3 of this Act, applies to a contract, will, 28 or life, health, or accident insurance or annuity policy if the contract, will, or policy is 29 delivered or issued for delivery on or after the effective date of sec. 3 of this Act. 30 * Sec. 5. The uncodified law of the State of Alaska is amended by adding a new section to 31 read:
01 TRANSITION: REGULATIONS. The Department of Health and Social Services may 02 adopt regulations authorized by AS 13.55, enacted by sec. 3 of this Act. The regulations take 03 effect under AS 44.62 (Administrative Procedure Act), but not before January 1, 2018. 04 * Sec. 6. Section 5 of this Act takes effect immediately under AS 01.10.070(c). 05 * Sec. 7. Except as provided in sec. 6 of this Act, this Act takes effect January 1, 2018.