March 30, 2017, Introduced by Reps. Cochran and Faris and referred to the Committee on Health Policy.
A bill to regulate physician assistance for patient-requested
life-ending medication; to require safeguards for determining that
the patient has a terminal disease, receives adequate counseling,
and makes a voluntary request for medication; to require
documentation and reporting; to specify certain legal consequences
regarding insurance; to provide for civil and criminal immunity and
freedom from professional sanctions for persons acting in
conformity with this act; to provide for penalties and sanctions
for violations of this act; and to repeal acts and parts of acts.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 1. This act shall be known and may be cited as the "death
with dignity act".
Sec. 2. As used in this act:
(a) "Adult" means an individual who is 18 years of age or
older.
(b) "Attending physician" means the physician who has primary
responsibility for the care of a patient and treatment of the
patient's terminal disease.
(c) "Capable" means that, in the opinion of a court or in the
opinion of a patient's attending physician or consulting physician,
psychiatrist, or psychologist, the patient has the ability to make
and communicate health care decisions to health care providers,
including communication through individuals familiar with the
patient's manner of communicating if those individuals are
available.
(d) "Consulting physician" means a physician who is qualified
by specialty or experience to make a professional diagnosis and
prognosis regarding a patient's terminal disease.
(e) "Counseling" means 1 or more consultations as necessary
between a psychiatrist or psychologist and a patient for the
purpose of determining that the patient is capable and not
suffering from a psychiatric or psychological disorder or
depression causing impaired judgment.
(f) "Health care provider" means a person licensed, certified,
or otherwise authorized or permitted by the law of this state to
administer health care or dispense medication in the ordinary
course of business or practice of a profession, and includes a
health care facility.
(g) "Informed decision" means a decision by a qualified
patient to request and obtain a prescription for medication to end
his or her life in a humane and dignified manner, that is based on
an appreciation of the relevant facts and is made after being fully
informed by the attending physician of all of the following:
(i) The qualified patient's medical diagnosis.
(ii) The qualified patient's prognosis.
(iii) The potential risks associated with taking the
medication to be prescribed.
(iv) The probable result of taking the medication to be
prescribed.
(v) The feasible alternatives, including, but not limited to,
comfort care, hospice care, and pain control.
(h) "Medically confirmed" means 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.
(i) "Patient" means an individual who is under the care of a
physician.
(j) "Physician" means an individual who is licensed or
otherwise authorized to engage in the practice of medicine or the
practice of osteopathic medicine and surgery under article 15 of
the public health code, 1978 PA 368, MCL 333.16101 to 333.18838.
(k) "Psychiatrist" means 1 or more of the following:
(i) A physician who has completed a residency program in
psychiatry approved by the Accreditation Council for Graduate
Medical Education or the American Osteopathic Association, or who
has completed 12 months of psychiatric rotation.
(ii) A physician who devotes a substantial portion of his or
her time to the practice of psychiatry.
(l) "Psychologist" means an individual who is licensed or
otherwise authorized to engage in the practice of psychology under
part 182 of the public health code, 1978 PA 368, MCL 333.18201 to
333.18237.
(m) "Qualified patient" means an adult who is capable, who is
a resident of this state, and who has satisfied the requirements of
this act to obtain a prescription for medication to end his or her
life in a humane and dignified manner.
(n) "Terminal disease" means an incurable and irreversible
disease or progressive pathological condition that has been
medically confirmed and will, within reasonable medical judgment,
produce death within 6 months.
Sec. 3. (1) An adult who is capable, is a resident of this
state, has been determined by the attending and consulting
physicians to be suffering from a terminal disease, and has
voluntarily expressed his or her wish to die may make a written
request for medication for the purpose of ending his or her life in
a humane and dignified manner in accordance with this act.
(2) An individual is not qualified to make a request for
medication under this act solely because of age or disability.
Sec. 4. (1) A written request for medication under this act
must be in substantially the form described in section 22, signed
and dated by the patient, and, subject to subsections (2) and (3),
witnessed by 2 or more individuals who, in the presence of the
patient, attest that to the best of their knowledge and belief the
patient is capable, acting voluntarily, and not being coerced to
sign the request.
(2) One of the witnesses must be an individual who, at the
time the request is signed, is not any of the following:
(a) A relative of the patient by blood, marriage, or adoption.
(b) An individual who would be entitled to a portion of the
estate of the qualified patient upon death under a will or by
operation of law.
(c) An owner, operator, or employee of a health care facility
where the qualified patient is receiving medical treatment or is a
resident.
(d) The patient's attending physician.
(3) If the patient is in a long-term care facility at the time
the written request is made, 1 of the witnesses must be an
individual designated by the facility who has the qualifications
specified by the department of health and human services by rule.
The department of health and human services shall promulgate rules
under the administrative procedures act of 1969, 1969 PA 306, MCL
24.201 to 24.328, to implement this subsection.
Sec. 5. (1) The attending physician shall do all of the
following:
(a) Make the initial determination of whether the patient has
a terminal disease, is capable, and has made the request for
medication voluntarily.
(b) Request that the patient demonstrate residency in this
state as described in section 14.
(c) To ensure that the patient is making an informed decision,
inform the patient of all of the following:
(i) The patient's medical diagnosis.
(ii) The patient's prognosis.
(iii) The potential risks associated with taking the
medication to be prescribed.
(iv) The probable result of taking the medication to be
prescribed.
(v) The feasible alternatives, including, but not limited to,
comfort care, hospice care, and pain control.
(d) Refer the patient to a consulting physician for medical
confirmation of the diagnosis and for a determination that the
patient is capable and acting voluntarily.
(e) Refer the patient for counseling, if appropriate, under
section 7.
(f) Recommend that the patient notify his or her next of kin.
(g) Inform the patient about the importance of having another
individual present when the patient takes the medication prescribed
under this act and of not taking the medication in a public place.
(h) Inform the patient that he or she may rescind the request
for medication at any time and in any manner, and again inform the
patient of the opportunity to rescind the request at the end of the
15-day waiting period described in section 10.
(i) Immediately before writing the prescription for medication
under this act, verify that the patient is making an informed
decision.
(j) Fulfill the medical record documentation requirements of
section 13.
(k) Ensure that all appropriate steps are carried out in
accordance with this act before writing a prescription for
medication to enable the qualified patient to end his or her life
in a humane and dignified manner.
(2) Notwithstanding any other provision of law, the attending
physician may sign the patient's death certificate.
Sec. 6. A patient is not qualified to make a request for
medication under this act until a consulting physician has done
both of the following:
(a) Examined the patient and the patient's relevant medical
records and confirmed, in writing, the attending physician's
diagnosis that the patient is suffering from a terminal disease.
(b) Verified that the patient is capable, is acting
voluntarily, and has made an informed decision.
Sec. 7. 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 that causes impaired
judgment, 1 of the physicians shall refer the patient for
counseling. After referral, a physician shall not prescribe
medication to end the patient's life in a humane and dignified
manner until the psychiatrist or psychologist who is performing the
counseling determines that the patient is not suffering from a
psychiatric or psychological disorder or depression causing
impaired judgment.
Sec. 8. A physician shall not prescribe medication to end a
patient's life in a humane and dignified manner unless the patient
has made an informed decision. Immediately before writing a
prescription for medication under this act, the attending physician
shall verify that the patient is making an informed decision.
Sec. 9. The attending physician shall recommend that the
patient notify next of kin of the patient's request for medication
under this act. The physician shall not deny a request for
medication because the patient declines or is unable to notify his
or her next of kin.
Sec. 10. To receive a prescription for medication to end his
or her life in a humane and dignified manner, a qualified patient
shall make both an oral request and a written request, and shall
reiterate the oral request to his or her attending physician not
less than 15 days after making the initial oral request. At the
time the qualified patient makes his or her second oral request,
the attending physician shall offer the patient an opportunity to
rescind the request.
Sec. 11. A patient may rescind his or her request at any time
and in any manner without regard to his or her mental state. The
attending physician shall not prescribe medication under this act
unless he or she has offered the qualified patient an opportunity
to rescind the request.
Sec. 12. A physician shall not write a prescription for
medication under this act until 15 days or more after the patient's
initial oral request and 48 hours or more after the patient's
written request.
Sec. 13. All of the following must be documented or filed in a
patient's medical record:
(a) Each oral request by the patient for medication to end his
or her life in a humane and dignified manner.
(b) Each written request by the patient for medication to end
his or her life in a humane and dignified manner.
(c) The attending physician's diagnosis; prognosis; and
determination that the patient is capable, is acting voluntarily,
and has made an informed decision.
(d) The consulting physician's diagnosis; prognosis; and
verification that the patient is capable, is acting voluntarily,
and has made an informed decision.
(e) A report of the outcome and determinations made during
counseling, if performed.
(f) The attending physician's offer to the patient to rescind
his or her request at the time of the patient's second oral request
as required under section 10.
(g) A note by the attending physician indicating that all of
the requirements of this act have been met and indicating the steps
taken to carry out the request, including a notation of the
medication prescribed.
Sec. 14. A physician shall comply with a request under this
act only if the request is made by a resident of this state.
Factors that the physician may consider to demonstrate residency in
this state include, but are not limited to, any of the following:
(a) A driver license issued by this state.
(b) Documentation of registration to vote in this state.
(c) Evidence that the patient owns or leases property in this
state.
(d) A Michigan income tax return filed for the most recent tax
year.
Sec. 15. (1) The department of health and human services shall
annually review a sample of records maintained under this act. It
shall require a health care provider that dispenses medication
under this act to file a copy of the dispensing record with the
department.
(2) The department of health and human services shall
promulgate rules under the administrative procedures act of 1969,
1969 PA 306, MCL 24.201 to 24.328, to facilitate collecting
information regarding compliance with this act. The information
collected is privileged; is exempt from disclosure under the
freedom of information act, 1976 PA 442, MCL 15.231 to 15.246; and
is not available for inspection by the public.
(3) The department of health and human services shall generate
and make available to the public an annual statistical report of
information collected under subsection (2) that does not disclose
identifying information.
Sec. 16. (1) A provision in a contract, will, or other
agreement, whether written or oral, is not valid to the extent it
would affect whether an individual may make or rescind a request
for medication to end his or her life in a humane and dignified
manner.
(2) An obligation owed under any existing contract must not be
conditioned on or affected by an individual's request or rescission
of a request for medication to end his or her life in a humane and
dignified manner.
Sec. 17. The sale, procurement, or issuance of a life, health,
or accident insurance or annuity policy or the rate charged for a
policy must not be conditioned upon or affected by the individual's
making or rescinding a request for medication to end his or her
life in a humane and dignified manner. A qualified patient's act of
ingesting medication to end his or her life in a humane and
dignified manner must not have any effect on a life, health, or
accident insurance or annuity policy.
Sec. 18. This act does not authorize a physician or any other
person to end a patient's life by lethal injection, mercy killing,
or active euthanasia. Actions taken in accordance with this act do
not, for any purpose, constitute suicide, assisted suicide, mercy
killing, or homicide under the law.
Sec. 19. (1) Except as otherwise provided in this section and
section 20, all of the following apply to actions taken in
accordance with this act:
(a) A person is not subject to civil or criminal liability or
professional disciplinary action for participating in good-faith
compliance with this act. This includes being present when a
qualified patient takes the prescribed medication to end his or her
life in a humane and dignified manner.
(b) A professional organization or association or a health
care provider shall not subject a person to censure, discipline,
suspension, loss of license, loss of privileges, loss of
membership, or other penalty for refusing to participate in this
act or for participating in good-faith compliance with this act.
(c) A request by a patient for, or an attending physician's
provision of, medication in good-faith compliance with this act is
not neglect for any purpose of law and does not, in itself,
constitute sufficient basis for the appointment of a guardian or
conservator.
(d) A health care provider is not under a duty, whether by
contract, statute, or other legal requirement, to participate in
providing a qualified patient with medication to end his or her
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 act
and the patient transfers his or her care to a new health care
provider, the prior health care provider shall transfer, upon
request, a copy of the patient's relevant medical records to the
new health care provider.
(2) Notwithstanding any other provision of law, a health care
provider may prohibit another health care provider from
participating in this act on the premises of the prohibiting
provider if the prohibiting provider has notified the health care
provider of the prohibiting provider's policy regarding
participating in this act. This section does not prevent a health
care provider from providing health care services to a patient that
do not constitute participation in this act. Notwithstanding
subsection (1), a health care provider that has given notice that
it prohibits participation in this act may subject another health
care provider that participates in this act after that notification
to any of the following sanctions:
(a) Loss of privileges, loss of membership, or other sanction
provided under the medical staff bylaws, policies, and procedures
of the sanctioning health care provider, if the sanctioned health
care provider is a member of the sanctioning health care provider's
medical staff and participates in this act while on the premises of
the health care facility of the sanctioning health care provider.
However, this subdivision does not apply to a health care provider
that participates in this act at the private medical office of a
physician or other provider.
(b) Termination of a lease, other property contract, or other
nonmonetary remedies provided by a lease contract, not including
loss or restriction of medical staff privileges or exclusion from a
provider panel, if the sanctioned health care provider participates
in this act while on the premises of the sanctioning health care
provider or on property that is owned by or under the direct
control of the sanctioning health care provider.
(c) Termination of contract or other nonmonetary remedies
provided by contract if the sanctioned health care provider
participates in this act while acting in the course and scope of
the sanctioned health care provider's capacity as an employee or
independent contractor of the sanctioning health care provider.
(3) Subsection (2) does not prevent or allow sanctions for
either of the following:
(a) Participation in this act while acting outside the course
and scope of the provider's capacity as an employee or independent
contractor.
(b) An attending physician's or consulting physician's
contract with the physician's patient to act outside the course and
scope of the physician's capacity as an employee or independent
contractor of the sanctioning health care provider.
(4) A health care provider that imposes sanctions under
subsection (2) shall follow all due process and other policies and
procedures that the sanctioning health care provider has adopted
that are related to the imposition of sanctions on another health
care provider.
(5) As used in this section:
(a) "Notify" means a separate statement in writing to the
health care provider specifically informing the health care
provider before the provider participates in this act of the
sanctioning health care provider's policy about participating in an
activity that is covered by this act.
(b) "Participate in this act" means to perform the duties of
an attending physician in section 5, the consulting physician
function in section 6, or the counseling function in section 7, but
does not include any of the following:
(i) Making an initial determination that a patient has a
terminal disease and informing the patient of the medical
prognosis.
(ii) Providing information about this act to a patient upon
the request of the patient.
(iii) Providing a patient, upon the request of the patient,
with a referral to another physician.
(iv) An attending physician's or consulting physician's
contracting with the physician's patient to act outside of the
course and scope of the physician's capacity as an employee or
independent contractor of a health care provider.
(6) Suspension or termination of staff membership or
privileges under subsection (2) is not reportable for purposes of
qualification for licensure under article 15 of the public health
code, 1978 PA 368, MCL 333.16101 to 333.18838. Action taken in
accordance with section 4, 5, 6, or 7 is not grounds for
investigation or discipline under section 16221 of the public
health code, 1978 PA 368, MCL 333.16221.
(7) This act does not allow a lower standard of care for
patients in the community where the patient is treated or in a
similar community.
Sec. 20. (1) A person who without authorization of the patient
willfully 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 a felony punishable by
imprisonment for not more than 20 years or a fine of not more than
$375,000.00, or both.
(2) A person who coerces or exerts undue influence on a
patient to either request medication for the purpose of ending the
patient's life or destroy the patient's rescission of a request for
medication for the purpose of ending the patient's life is guilty
of a felony punishable by imprisonment for not more than 20 years
or a fine of not more than $375,000.00, or both.
(3) This act does not limit liability for civil damages
resulting from negligent conduct or intentional misconduct by any
person.
(4) The penalties in this act do not preclude criminal
penalties applicable under other law for conduct that is
inconsistent with this act.
Sec. 21. Any governmental entity that incurs costs resulting
from an individual terminating his or her life under this act in a
public place may recover those costs and reasonable and necessary
attorney fees related to enforcing the claim from the estate of the
individual.
Sec. 22. A request for a medication as authorized by this act
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, the 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 ONLY 1 OF THE FOLLOWING)
______I have informed my family of my decision and taken their
opinions into consideration.
______I have decided not to inform my family of my decision.
______I have no family to inform of my decision.
I understand that I have the right to 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 further
understand that although most deaths occur within 3 hours, my death
may take longer and my physician has counseled me about this
possibility.
I make this request voluntarily and without reservation, and I
accept full moral responsibility for my actions.
Signed: _______________ Dated: _______________
DECLARATION OF WITNESSES
I declare all of the following:
(a) The individual is personally known to me or has provided
proof of identity.
(b) The individual signed this request in my presence.
(c) The individual appears to be of sound mind and not under
duress, fraud, or undue influence.
(d) The individual is not a patient for whom I am an attending
physician.
______________Witness 1 Dated ______
______________Witness 2 Dated ______
NOTE: One of the witnesses must not be a relative (by blood,
marriage, or adoption) of the individual signing this request, must
not be entitled to any portion of the individual's estate upon
death, and must not own, operate, or be employed at a health care
facility where the individual is a patient or resident. If the
individual signing this request is an inpatient at a health care
facility, one of the witnesses must be an individual designated by
the health care facility.
Enacting section 1. The following acts and parts of acts are
repealed:
(a) Section 329a of the Michigan penal code, 1931 PA 328, MCL
750.329a.
(b) 1992 PA 270, MCL 752.1021 to 752.1027.
Enacting section 2. This act takes effect 90 days after the
date it is enacted into law.