00 CS FOR SPONSOR SUBSTITUTE FOR HOUSE BILL NO. 54(HSS)
01 "An Act providing an end-of-life option for terminally ill individuals; and providing for
02 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 a
06 defense that the defendant was performing an action allowed under AS 13.56.
07 * Sec. 2. AS 11.41.120 is amended by adding a new subsection to read:
08 (c) In a prosecution under this section, it is a defense that the defendant was
09 performing an action allowed under AS 13.56.
10 * Sec. 3. AS 13 is amended by adding a new chapter to read:
11 Chapter 56. Voluntary Ending of Life.
12 Sec. 13.56.010. Individuals allowed to end life. (a) As provided in this
13 chapter, a qualified individual may use medicine obtained from the qualified
14 individual's attending physician to end the qualified individual's life.
01 (b) To be a qualified individual under (a) of this section, an individual must
02 (1) be a resident of this state;
03 (2) be 18 years of age or older;
04 (3) have been determined to be capable;
05 (4) have been determined to be suffering from a terminal disease; and
06 (5) have voluntarily expressed the wish to die.
07 (c) An individual does not qualify under (b) of this section solely because of
08 the individual's age or disability.
09 Sec. 13.56.020. Attending physician and pharmacist authority. If a
10 qualified individual's attending physician complies with this chapter, the attending
11 physician may
12 (1) dispense medication directly to the qualified individual, including
13 ancillary medications intended to facilitate the desired effect or minimize the qualified
14 individual's discomfort; or
15 (2) write a prescription for the medication for the qualified individual
16 and in person, by mail, or by electronic transmission deliver the prescription for the
17 medication to a pharmacist, who may dispense the medication to the qualified
18 individual, the attending physician, or an expressly identified agent of the qualified
20 Sec. 13.56.030. Requests for medication. (a) To receive medication under this
21 chapter, a qualified individual shall make an oral request and a written request to the
22 qualified individual's attending physician. The qualified individual shall repeat the oral
23 request to the qualified individual's attending physician not sooner than 15 days after
24 making the initial oral request.
25 (b) Notwithstanding (a) of this section, if a qualified individual is not
26 physically able to speak, a qualified individual may make an oral request by whatever
27 means the qualified individual can use to make the request, including electronic
28 means, as long as the request is made in person.
29 (c) Notwithstanding (a) of this section, if a qualified individual is not
30 physically able to sign a written request, the qualified individual may direct another
31 individual to sign for the qualified individual.
01 Sec. 13.56.040. Right to rescind request. When a qualified individual makes
02 the second oral request under AS 13.56.030, the attending physician shall offer the
03 qualified individual an opportunity to rescind the initial oral request and the written
04 request. A qualified individual may rescind a request at any time and in any manner
05 without regard to the qualified individual's mental state. An attending physician may
06 not dispense or prescribe medication under this chapter unless the attending physician
07 offers the qualified individual an opportunity to rescind the request.
08 Sec. 13.56.050. Written request requirements. (a) A written request for
09 medication under this chapter must be in substantially the form described in
10 AS 13.56.060, signed and dated by the qualified individual, and witnessed by at least
11 two other individuals. The attending physician may not witness the request. The
12 witnesses shall, in the presence of the qualified individual, attest that, to the best of
13 their knowledge and belief, the qualified individual is capable, acting voluntarily, and
14 not under undue influence to sign the request.
15 (b) Only one witness may be
16 (1) a relative of the qualified individual by blood, marriage, or
18 (2) an individual who, at the time the qualified individual signs the
19 request, would be entitled to a portion of the estate of the qualified individual at death
20 under a will or by operation of law; or
21 (3) an owner, operator, or employee of a health care facility where the
22 qualified individual is receiving medical treatment or is a resident.
23 (c) If the qualified individual is an inpatient in a long-term care facility when
24 the qualified individual signs the request, one of the witnesses shall be an individual
25 designated by the facility who has the qualifications established by the department by
26 regulation. In this subsection, "long-term care facility" includes an assisted living
27 home as defined in AS 47.32.900 and a nursing facility as defined in AS 47.32.900.
28 Sec. 13.56.060. Form for written request. A request for a medication under
29 this chapter must be in substantially the following form:
30 REQUEST FOR MEDICATION TO END MY LIFE
31 I, _________________, am an adult of sound mind.
01 I am suffering from _______________, which my attending physician
02 has determined is a terminal disease and which has been medically confirmed
03 by a consulting physician.
04 I have been fully informed of my diagnosis, prognosis, the nature of the
05 medication to be prescribed and potential associated risks, the expected result,
06 and the feasible alternatives, including comfort care, hospice care, and pain
08 I request that my attending physician prescribe medication that will end
09 my life in a humane and dignified manner.
10 INITIAL ONE OF THE FOLLOWING:
11 _____ I have informed my family of my decision and taken their
12 opinions into consideration.
13 _____ I have decided not to inform my family of my decision.
14 _____ I have no family to inform of my decision.
15 I understand that I have the right to rescind this request at any time.
16 I understand the full import of this request, and I expect to die when I
17 take the medication to be prescribed. I further understand that, although most
18 deaths occur within three hours, my death may take longer, and my attending
19 physician has counseled me about this possibility.
20 I make this request voluntarily and without reservation, and I accept
21 full moral responsibility for my actions.
22 Signed: _____________________
23 Dated: ______________________
24 DECLARATION OF WITNESSES
25 We declare that the person signing this request
26 (1) is personally known to us or has provided proof of
28 (2) in our presence signed or directed another person to
29 sign this request;
30 (3) is not an individual for whom either of us is the
31 attending physician; and
01 (4) to the best of our knowledge and belief,
02 (A) has the ability to make and communicate
03 health care decisions to health care providers; and
04 (B) is acting voluntarily and not under undue
06 _______________________ Witness 1 Date: _____
07 _______________________ Witness 2 Date: _____
08 NOTE: One witness may not be a relative (by blood, marriage, or adoption) of
09 the individual signing this request, may not be entitled to a portion of the individual's
10 estate on death, and may not own, operate, or be employed at a health care facility
11 where the person is an individual or resident. If the individual is an inpatient at a
12 health care facility, one of the witnesses shall be an individual designated by the
14 Sec. 13.56.070. Attending physician duties and authority. (a) The attending
15 physician shall
16 (1) make the initial determination of whether an individual has a
17 terminal disease, is capable, and has made the request for medication voluntarily;
18 (2) request that the individual demonstrate that the individual is a
19 resident of this state;
20 (3) inform the individual of the
21 (A) individual's medical diagnosis;
22 (B) individual's prognosis;
23 (C) potential risks associated with taking the medication;
24 (D) probable result of taking the medication; and
25 (E) feasible alternatives, including comfort care, hospice care,
26 and pain control;
27 (4) refer the individual to a consulting physician for medical
28 confirmation of the diagnosis and for a determination that the individual is capable and
29 acting voluntarily;
30 (5) refer the individual for counseling if appropriate under
31 AS 13.56.090;
01 (6) recommend that the individual notify the individual's next of kin;
02 (7) counsel the individual about the importance of having another
03 person present when the individual takes the medication prescribed under this chapter
04 and of not taking the medication in a public place;
05 (8) inform the individual that the individual has an opportunity to
06 rescind the request at any time and in any manner and offer the individual an
07 opportunity to rescind the request at the end of the 15-day waiting period under
08 AS 13.56.030;
09 (9) immediately before dispensing or prescribing medication under this
10 chapter, verify that the individual is making an informed decision;
11 (10) fulfill the requirements of AS 13.56.130 for medical record
13 (11) ensure that all appropriate steps are carried out under this chapter
14 before dispensing or prescribing medication to enable a qualified individual to end the
15 qualified individual's life under this chapter; and
16 (12) if the attending physician has a current federal Drug Enforcement
17 Administration registration number and complies with applicable regulations, dispense
18 medication directly, including ancillary medications intended to facilitate the desired
19 effect or minimize the qualified individual's discomfort, or, with the qualified
20 individual's consent,
21 (A) contact a pharmacist and inform the pharmacist of a
22 prescription for the medication; and
23 (B) deliver the written prescription in person, by mail, or by
24 electronic transmission to the pharmacist who will dispense the medication to
25 the qualified individual, the attending physician, or an agent of the qualified
26 individual who is expressly identified as an agent by the qualified individual.
27 (b) Notwithstanding any other provision of law to the contrary, the attending
28 physician may sign the qualified individual's death certificate.
29 Sec. 13.56.080. Confirmation by consulting physician. Before an individual
30 becomes a qualified individual under this chapter, a consulting physician shall
31 examine the individual and the individual's relevant medical records, confirm in
01 writing the attending physician's diagnosis that the individual is suffering from a
02 terminal disease, and verify that the individual is capable, is acting voluntarily, and
03 has made an informed decision.
04 Sec. 13.56.090. Counseling referral. If the attending physician or the
05 consulting physician determines that an individual may be suffering from a psychiatric
06 or psychological disorder or depression causing impaired judgment, either physician
07 shall refer the individual for counseling, and the attending physician may not dispense
08 or prescribe medication until the person performing the counseling determines that the
09 individual is not suffering from depression or a psychiatric or psychological disorder
10 causing impaired judgment.
11 Sec. 13.56.100. Informed decision. An attending physician may not dispense
12 or prescribe medication unless the qualified individual has made an informed decision.
13 Immediately before dispensing or prescribing medication under this chapter, the
14 attending physician shall verify that the qualified individual is making an informed
16 Sec. 13.56.110. Family notification. The attending physician may not deny a
17 qualified individual's request for medication if the qualified individual declines or is
18 unable to notify the qualified individual's next of kin.
19 Sec. 13.56.120. Waiting periods. An attending physician may not dispense
20 medication or write a prescription for medication for a qualified individual unless at
21 least 15 days have elapsed between the qualified individual's initial oral request and
22 the writing of the prescription and more than 48 hours have elapsed between the
23 qualified individual's written request and the writing of the prescription.
24 Sec. 13.56.130. Medical record documentation requirements. Before a
25 qualified individual receives medication under this chapter, the medical record of the
26 qualified individual must contain
27 (1) a record of all oral requests by a qualified individual for medication
28 under this chapter;
29 (2) all written requests by a qualified individual for medication under
30 this chapter;
31 (3) the attending physician's diagnosis, prognosis, and determination
01 that the individual is capable, is acting voluntarily, and has made an informed
03 (4) the consulting physician's diagnosis, prognosis, and verification
04 that the individual is capable, is acting voluntarily, and has made an informed
06 (5) if counseling is performed, a report of the determinations made
07 during counseling and the outcome;
08 (6) a record of the attending physician's offer to the qualified
09 individual to rescind the qualified individual's request at the time of the qualified
10 individual's second oral request under AS 13.56.030;
11 (7) a note by the attending physician indicating that all requirements
12 under this chapter have been met and indicating the steps taken to carry out the
13 request, including a statement describing the medication prescribed.
14 Sec. 13.56.140. Effect on construction of wills and contracts. A provision in
15 a will or a contract, whether written or oral, is not valid to the extent that the provision
16 requires, prohibits, imposes a condition on, or otherwise addresses whether an
17 individual may make or rescind a request for medication under this chapter.
18 Sec. 13.56.150. Immunity; effect of action on status of individuals. (a) A
19 person is not subject to civil or criminal liability or professional disciplinary action,
20 including disciplinary action by a licensing authority, for participating or otherwise
21 acting in good faith compliance with this chapter, including being present when a
22 qualified individual takes the prescribed medication to end the qualified individual's
23 life under this chapter.
24 (b) A professional organization or association or health care provider may not
25 subject a person to censure, discipline, suspension, loss of license, loss of privileges,
26 loss of membership, or other penalty for participating in or refusing to participate in
27 good faith compliance with this chapter.
28 (c) A request by an individual for, or provision by an attending physician of,
29 medication in good faith compliance with this chapter does not provide the sole basis
30 for the appointment of a guardian or conservator of the individual.
31 Sec. 13.56.160. No duty to participate. A health care provider is not under a
01 duty, whether by contract, statute, or other legal requirement, to dispense medication,
02 prescribe medication, or otherwise participate in the provision of medication to a
03 qualified individual under this chapter. If a health care provider is unable or unwilling
04 to carry out a qualified individual's request under AS 13.56.030 and the qualified
05 individual transfers the qualified individual's care to another health care provider, the
06 transferring health care provider shall provide to the other health care provider, at the
07 qualified individual's request, a copy of the qualified individual's relevant medical
09 Sec. 13.56.170. Prohibitions. Notwithstanding another provision of law to the
10 contrary, a health care provider may not prohibit another health care provider,
11 including an employee, contractor, or lessee of the prohibiting health care provider,
12 from participating in this chapter. However, a health care provider may prohibit
13 another health care provider, including an employee, contractor, or lessee of the
14 prohibiting health care provider, from allowing a patient of the prohibited health care
15 provider to administer medication on the premises of the prohibiting health care
16 provider if the medication was obtained under this chapter.
17 Sec. 13.56.180. Prohibition notice. To prohibit another health care provider
18 from allowing a patient to administer medication on the premises of the prohibiting
19 health care provider, the prohibiting health care provider shall notify the prohibited
20 health care provider in writing about the prohibition.
21 Sec. 13.56.190. Sanctions. (a) Notwithstanding AS 13.56.150 and 13.56.160,
22 if a health care provider violates a prohibition allowed under AS 13.56.170 after
23 receiving a written notice under AS 13.56.180, the prohibiting health care provider
24 may impose the following sanctions on the prohibited health care provider:
25 (1) loss of privileges, loss of membership, or other sanction provided
26 under the bylaws, policies, or procedures of the prohibiting health care provider if the
27 prohibited health care provider is a member of the prohibiting health care provider's
28 medical staff;
29 (2) termination of a lease or another contract between the prohibiting
30 health care provider and the prohibited health care provider, or an imposition of
31 nonmonetary remedies provided by the lease or other contract; in this paragraph,
01 "remedies" does not include the loss or restriction of medical staff privileges or
02 exclusion from a medical care provider panel.
03 (b) A prohibiting health care provider who imposes sanctions under (a) of this
04 section shall follow all procedures that are provided under an applicable contract, the
05 applicable terms of employment, or law for imposing the sanctions.
06 (c) Suspension or termination of staff membership or privileges under (a) of
07 this section is not reportable under AS 08.64.336.
08 Sec. 13.56.200. Criminal penalties. (a) A person commits the crime of abuse
09 of life-ending process if the person, with the intent to cause the individual's death or
10 knowing that the death of the individual is substantially certain to result,
11 (1) without the authorization of the individual, falsely makes,
12 completes, or alters a request for medication or conceals or destroys a rescission of the
13 individual's request; or
14 (2) exerts undue influence on an individual to request medication for
15 the purpose of ending the individual's life or to destroy a rescission of the individual's
16 request; in this paragraph, "undue influence" means the control of an individual by a
17 person who stands in a position of trust or confidence to exploit wrongfully the trust,
18 dependency, or fear of the individual to gain control over the decision making of the
20 (b) Abuse of life-ending process is a class A felony and may be punished as
21 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. 13.56.210. Civil penalties. This chapter does not limit liability for civil
25 damages resulting from a person's negligent conduct or intentional misconduct.
26 Sec. 13.56.220. Claims for costs incurred. A governmental entity that incurs
27 expenses that result from a qualified individual's ending the qualified individual's life
28 under this chapter in a public place may file a claim against the estate of the individual
29 to recover the costs and attorney fees related to enforcing the claim.
30 Sec. 13.56.230. 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 40.25.110, 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
12 (e) In this section, "department" means the Department of Health and Social
14 Sec. 13.56.240. Attending physician qualifications. (a) To qualify as an
15 attending physician under this chapter, a physician must
16 (1) have primary responsibility for the patient's health care;
17 (2) have primary responsibility for the treatment of the patient's
18 terminal illness; and
19 (3) routinely provide medical care to patients with advanced and
20 terminal illnesses in the normal course of the physician's practice.
21 (b) Notwithstanding (a)(3) of this section, an attending physician's practice
22 may not be primarily or solely made up of individuals requesting medication under
23 this chapter.
24 Sec. 13.56.250. Construction of chapter. (a) This chapter may not be
25 construed to authorize or require a health care provider to provide health care contrary
26 to generally accepted health care standards applicable to the health care provider.
27 (b) This chapter may not be construed to authorize a physician or another
28 person to end an individual's life by lethal injection, mercy killing, or active
29 euthanasia. An action allowed by this chapter is an affirmative defense to a criminal
30 charge of homicide, murder, manslaughter, criminally negligent homicide, suicide,
31 assisted suicide, mercy killing, or euthanasia under the law of this state.
01 Sec. 13.56.260. Insurance or annuity policies; contracts. Notwithstanding
02 AS 21.45.250 or another provision of law to the contrary, a person may not condition
03 the sale, procurement, issuance, rate, delivery, issuance for delivery, or other aspect of
04 a life insurance policy, health insurance policy, accident insurance policy, or annuity
05 policy, or another contract on the making or rescission of a request by a qualified
06 individual for medication under this chapter.
07 Sec. 13.56.270. Coordination with other law. A request for medication under
08 this chapter is not an advance health care directive under AS 13.52, and AS 13.52 does
09 not apply to an activity allowed by this chapter.
10 Sec. 13.56.290. Definitions. In this chapter, unless the context indicates
12 (1) "attending physician" means a physician who qualifies under
13 AS 13.56.240 as an attending physician;
14 (2) "capable" means that an individual has the ability to make and
15 communicate health care decisions to health care providers; in this paragraph,
16 "communicate" includes communication through a person familiar with the
17 individual's manner of communicating if the person is available;
18 (3) "consulting physician" means a physician who is qualified by
19 specialty or experience to make a professional diagnosis and prognosis about the
20 individual's disease;
21 (4) "counseling" means consultation as necessary between a
22 psychiatrist or psychologist and an individual to determine whether the individual is
23 capable and not suffering from a psychiatric or psychological disorder or depression
24 causing impaired judgment;
25 (5) "health care provider" means a person or health care facility
26 licensed, certified, or otherwise authorized or permitted by the law of this state to
27 administer health care or dispense medication in the ordinary course of business or
28 practice of a profession; in this paragraph, "health care facility" means a private,
29 municipal, or state hospital; independent diagnostic testing facility; primary care
30 outpatient facility; skilled nursing facility; kidney disease treatment center, including
31 freestanding hemodialysis units; intermediate care facility; ambulatory surgical
01 facility; Alaska Pioneers' Home or Alaska Veterans' Home administered by the
02 department under AS 47.55; state correctional facility as defined in AS 33.30.901;
03 private, municipal, or state facility employing one or more public health nurses; and
04 long-term care facility;
05 (6) "informed decision" means a decision that is based on an
06 appreciation of the relevant facts and that is made after the attending physician fully
07 informs an individual of the
08 (A) individual's medical diagnosis;
09 (B) individual's prognosis;
10 (C) potential risks associated with taking the medication to be
12 (D) probable result of taking the medication to be prescribed;
14 (E) feasible alternatives, including comfort care, hospice care,
15 and pain control;
16 (7) "medication" means medication to end a qualified individual's life
17 under this chapter;
18 (8) "physician" means a doctor of medicine or osteopathy who is
19 licensed under AS 08.64 to practice medicine or osteopathy;
20 (9) "prescription" means a prescription for medication to end a
21 qualified individual's life under this chapter;
22 (10) "prohibited health care provider" means a health care provider
23 that is prohibited by another health care provider under AS 13.56.170;
24 (11) "prohibiting health care provider" means a health care provider
25 that prohibits another health care provider under AS 13.56.170;
26 (12) "qualified individual" means an individual who is qualified under
27 AS 13.56.010(b);
28 (13) "request" means a request under AS 13.56.030;
29 (14) "terminal disease" means an incurable and irreversible disease
30 that has been medically confirmed and that will, within reasonable medical judgment,
31 produce death within six months; in this paragraph, "medically confirmed" means that
01 a consulting physician who has examined the individual's relevant medical records has
02 confirmed the medical opinion of the attending physician.
03 * Sec. 4. The uncodified law of the State of Alaska is amended by adding a new section to
05 APPLICABILITY. AS 13.56, enacted by sec. 3 of this Act, applies to a contract, will,
06 or life, health, or accident insurance or annuity policy if the contract, will, or policy is
07 delivered or issued for delivery on or after the effective date of sec. 3 of this Act.
08 * Sec. 5. The uncodified law of the State of Alaska is amended by adding a new section to
10 TRANSITION: REGULATIONS. The Department of Health and Social Services may
11 adopt regulations authorized by AS 13.56, enacted by sec. 3 of this Act. The regulations take
12 effect under AS 44.62 (Administrative Procedure Act), but not before January 1, 2019.
13 * Sec. 6. Section 5 of this Act takes effect immediately under AS 01.10.070(c).
14 * Sec. 7. Except as provided in sec. 6 of this Act, this Act takes effect January 1, 2019.