Compassion & Choices Arizona
Arizona

HB 2313 - aid in dying (2006)

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REFERENCE TITLE: aid in dying

State of Arizona
House of Representatives
Forty-seventh Legislature
Second Regular Session
2006

HB 2313

Introduced by

Representatives Lopez L: Cajero Bedford, Gallardo, Garcia M, Lujan, Meza, Tom, Senator Rios

AN ACT

amending title 36, Arizona Revised Statutes, by adding chapter 38; relating to aid in dying.

Be it enacted by the Legislature of the State of Arizona:

Section 1. Title 36, Arizona Revised Statutes, is amended by adding chapter 38, to read:

CHAPTER 38

AID IN DYING

ARTICLE 1. GENERAL PROVISIONS

36-3801. Definitions

In this chapter, unless the context otherwise requires:

1. "Aid in dying" means the issuance of a prescription for medication for self-administration that will terminate the life of a qualified patient in a painless, humane and dignified manner.

2. "Consulting physician" means a physician who is qualified by specialty or experience to make a professional diagnosis and prognosis regarding a patient's disease.

3. "Counseling" means a consultation between a psychiatrist or psychologist licensed by this state and a patient for the purpose of determining whether the patient is suffering from a psychiatric or psychological disorder or depression causing impaired judgment.

4. "Department" means the department of health services.

5. "Informed decision" means a decision by a qualified patient to request and obtain a prescription to end the patient's life that is based on an appreciation of the relevant facts and after being fully informed by the attending physician of:

(a) The medical diagnosis.

(b) The Prognosis.

(c) The potential risks associated with taking the medication to be prescribed.

(d) The probable result of taking the medication to be prescribed.

(e) The feasible alternatives, including comfort care, hospice care and pain control.

6. "Medically confirmed" means that the medical opinion of the attending physician has been confirmed by a consulting physician who has examined the patient and the patient's relevant medical records.

7. "Qualified patient" means a capable adult who has resided in this state for at least ninety days and who has satisfied the requirements of this article in order to obtain a prescription to end the patient's life.

8. "Terminal condition" means a condition that results from an accident or an incurable and irreversible disease, that has been medically confirmed and that will cause, with reasonable medical judgment, death within six months.

36-3802. Request for medication; requirements; signatures

A. A qualified patient may make a written request for medication to end the patient's life as prescribed by this article.

B. A request for medication under this article must be in substantially the form described in section 36-3818, signed and dated by the patient and witnessed by at least two persons who, in the presence of the patient, attest that to the best of their knowledge and belief the patient is competent, is acting voluntarily and is not being coerced to sign the request.

C. At least one of the witnesses must be a person who is not:

1. A relative of the patient by blood, marriage or adoption.

2. A person who at the time the request is signed is entitled to any portion of the estate of the patient on the patient's death under any will or by operation of law.

3. An owner, operator or employee of a health care facility where the patient is receiving medical treatment or is a resident.

D. The patient's attending physician at the time the request is signed shall not be a witness.

E. Notwithstanding the requirements of subsection B of this section, if the patient resides in a long-term care facility at the time the written request is made, one of the witnesses must be a person who is designated by the facility and who has the qualifications specified by the department as prescribed by rule.

F. If the patient is competent but is unable to write or to sign a statement, the patient may substitute a video recording, witnessed by two qualified individuals, for the written request.

36-3803. Safeguards; attending physician; responsibilities

The attending physician must:

1. Make the initial determination of whether a patient has a terminal condition, is competent and has made the request voluntarily.

2. Inform the patient of:

(a) The patient's medical diagnosis.

(b) The patient's prognosis.

(c) The potential risks associated with taking the medication to be prescribed.

(d) The probable result of taking the medication to be prescribed.

(e) The feasible alternatives, including comfort care, hospice care and pain control.

3. Refer the patient to a consulting physician for medical confirmation of the diagnosis and for a determination that the patient is competent and is acting voluntarily.

4. Refer the patient for counseling if required pursuant to section 36-3805.

5. Request that the patient notify the patient's next of kin.

6. Inform the patient that the patient can rescind the request at any time and in any manner and offer the patient an opportunity to rescind at the end of the fifteen day waiting period prescribed in section 36-3810.

7. Verify, immediately before writing the prescription for medication, that the patient is making an informed decision.

8. Fulfill the medical record documentation requirement of section 36-3811.

9. Ensure that all appropriate steps are carried out in accordance with this article before writing a prescription for medication to enable the qualified patient to end the patient's life in a humane and dignified manner.

36-3804. Consulting physician; confirmation of diagnosis

A. Before a patient is qualified under this article, a consulting physician must examine the patient and the patient's relevant medical records, must confirm, in writing, the attending physician's diagnosis that the patient is suffering from a terminal condition and must verify that the patient is competent, is acting voluntarily and has made an informed decision.

B. The consulting physician may not be a partner, shareholder or employee in the same medical practice as the attending physician.

36-3805. Counseling referral

A. If, in the opinion of the attending physician or the consulting physician, a patient may be suffering from a psychiatric or psychological disorder or depression causing impaired judgment, the physician must refer the patient for counseling.

B. A physician shall not prescribe medication to end a patient's life until the person performing the counseling determines that the patient is not suffering from a psychiatric or psychological disorder or depression causing impaired judgment.

C. A counseling psychiatrist or psychologist shall not be a partner, shareholder or employee in the same practice as the attending physician.

36-3806. Informed decision

A patient shall not receive a prescription for medication to end the patient's life unless the patient has made an informed decision as prescribed in section 36-3803.

36-3807. Family notification

The attending physician must ask the patient to notify the patient's next of kin of the patient's request for medication pursuant to this article. If a patient declines or is unable to notify the patient's next of kin, the physician shall not deny a request for medication for this reason.

36-3808. Written and oral requests

A. In order to receive a prescription for medication under this article, a patient must make an oral and a written request and must reiterate the oral request to the patient's attending physician at least fifteen days after making the initial oral request.

B. At the time the qualified patient makes the second oral request, the attending physician must offer the patient an opportunity to rescind the request.

36-3809. Right to rescind request

A patient may rescind a request at any time and in any manner without regard to the patient's mental state. No prescription for medication under this article may be written without the attending physician offering the qualified patient an opportunity to rescind the request. If a directive or request is rescinded, it must be as if the directive or request were never made.

36-3810. Waiting periods

A. At least fifteen days must elapse between the patient's initial oral request and the writing of a prescription under this article. At least forty-eight hours must elapse between the patient's written request and the writing of a prescription under this article.

B. If all other requirements of this article are met, the waiting periods provided in this section may be shortened if the primary physician certifies in writing that the patient is in extreme pain and the imposition of a waiting period would serve only to extend the suffering of the patient.

36-3811. Medical records; documentation; requirements

The following information must be documented or filed in the patient's medical record:

1. All oral requests by a patient for medication to end the patient's life.

2. All written requests by a patient for medication to end the patient's life.

3. The attending physician's diagnosis and prognosis and verification that the patient is competent, is acting voluntarily and has made an informed decision.

4. The consulting physician's diagnosis and prognosis and verification that the patient is competent, is acting voluntarily and has made an informed decision.

5. A report of the outcome and determinations made during counseling, if performed.

6. The attending physician's offer to the patient to rescind the patient's request at the time of the patient's second oral request pursuant to section 36-3808.

7. A note by the attending physician indicating that all requirements under this article have been met and indicating the steps taken to carry out the request, including a notation of the medication prescribed.

36-3812. Reporting requirements

A. The department shall annually review a sample of records maintained pursuant to this article.

B. The department shall adopt rules to facilitate the collection of information regarding compliance with this article. The information collected is not a public record and is not available for inspection by the public.

C. The department shall generate and make available to the public an annual statistical report of information collected under this article.

36-3813. Effect on construction of wills and contracts

A. A provision in any contract, will or other agreement, whether written or oral, that would affect whether a person may make or rescind a request for medication to end the patient's life in a humane and dignified manner is not valid.

B. An obligation owing under any currently existing contract shall not be conditioned on or affected by a person making or rescinding a request for medication to end the person's life in a humane and dignified manner.

36-3814. Insurance or annuity policies

A. The sale, procurement or issuance of any life, health or accident insurance or annuity policy or the rate charged for any policy shall not be conditioned on or affected by a person making or rescinding a request for medication to end the person's life in a humane and dignified manner.

B. An insurer shall not require or request an insured to disclose whether the insured has considered or executed a request for aid in dying.

C. A qualified patient's act of ingesting medication to end the patient's life in a humane and dignified manner does not affect a life, health or accident insurance or annuity policy.

36-3815. Construction

This article does not authorize a physician or any other person to end a patient's life by lethal injection, mercy killing or active euthanasia. Notwithstanding any other law, actions taken in accordance with this article do not constitute, for any purpose, suicide, assisted suicide, mercy killing or homicide.

36-3816. Immunities

Except as provided in section 36-3817:

1. A person is not subject to civil or criminal liability or professional disciplinary action for participating in good faith compliance with this article. This includes being present when a qualified patient takes the prescribed medication to end the patient's life in a humane and dignified manner.

2. This article does not authorize any person to assist in the administration of medication unless that person is designated by a qualified patient to administer or dispense the medication because of the qualified patient's physical disability.

3. A professional organization or association or health care provider shall not subject a person to censure, discipline, suspension, loss of privileges, loss of membership or any other penalty for participating or refusing to participate in good faith compliance with this article.

4. A request by a patient for or provision by an attending physician of medication in good faith compliance with this article does not constitute neglect for any purpose of law or provide the sole basis for the appointment of a guardian or conservator.

5. A health care provider is not under any duty, whether by contract, by statute or by any other legal requirement, to participate in the provision to a qualified patient of medication to end the patient's life in a humane and dignified manner. If a health care provider is unable or unwilling to carry out a patient's request under this article, the health care provider must promptly transfer the responsibility to another provider who is willing to act in accordance with the qualified patient's wishes. The health care provider must transfer, on request, a copy of the patient's relevant medical records to the new health care provider.

6. A health care facility that refuses to allow aid in dying to be prescribed or administered on its premises shall not deny staff privileges or employment to a person for the sole reason that the person previously participated in aid in dying.

7. A licensed pharmacist who dispenses lethal medicine based on a valid prescription by a physician aiding a patient to die under this article is not subject to civil, criminal or administrative liability for doing so.

36-3817. Violations; classification; liability

A. A person who without authorization of the patient wilfully alters or forges a request for medication or conceals or destroys a rescission of that request with the intent or effect of causing the patient's death is guilty of manslaughter.

B. A person who coerces or exerts undue influence on a patient to request medication for the purpose of ending the patient's life or to destroy a rescission of such a request is guilty of manslaughter.

C. This article does not limit further liability for civil damages resulting from other negligent conduct or intentional misconduct by any person.

D. The penalties in this article do not preclude criminal penalties applicable under any other law for conduct that is inconsistent with this article.

36-3818. Sample form

A request for a medication as authorized by this article must be in substantially the following form:

REQUEST FOR MEDICATION

TO END MY LIFE IN A HUMANE AND DIGNIFIED MANNER

I, ___________________, am an adult of sound mind.

I am suffering from ___________________, which my attending physician has determined is a terminal disease and which has been medically confirmed by a consulting physician.

I have been fully informed of my diagnosis, my prognosis, the nature of medication to be prescribed and potential associated risks, the expected result and the feasible alternatives, including comfort care, hospice care and pain control.

I request that my attending physician prescribe medication that will end my life in a humane and dignified manner.

INITIAL ONE:

_____ I have informed my family of my decision and have taken their opinions into consideration.

_____ I have decided not to inform my family of my decision.

_____ I have no family to inform of my decision.

I understand that I have the right to rescind this request at any time.

I understand the full import of this request, and I expect to die when I take the medication to be prescribed.

I make this request voluntarily and without reservation, and I accept full moral responsibility for my actions.

Signed: ________________________

Dated: ________________________

DECLARATION OF WITNESSES

We declare that the person signing this request:

1. Is personally known to us or has provided proof of identity.

2. Signed this request in our presence.

3. Appears to be of sound mind and not under duress, fraud or undue influence.

4. Is not a patient for whom either of us is the attending physician.

Witness 1 ________________________________

Date _____________________________________

Witness 2 ________________________________

Date _____________________________________

NOTE: One witness shall not be a relative (by blood, marriage or adoption) of the person signing this request, shall not be entitled to any portion of the person's estate on death and shall not own, operate or be employed at a health care facility where the person is a patient or resident. If the patient is an inpatient at a health care facility, one of the 0witnesses must be an individual designated by the facility.