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Minnesota Legislature

Office of the Revisor of Statutes

HF 1885

as introduced - 90th Legislature (2017 - 2018) Posted on 03/02/2017 12:48pm

KEY: stricken = removed, old language.
underscored = added, new language.

Current Version - as introduced

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A bill for an act
relating to health; adopting compassionate care for terminally ill patients;proposing
coding for new law in Minnesota Statutes, chapter 145.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

new text begin [145.871] END-OF-LIFE OPTION.
new text end

new text begin Subdivision 1. new text end

new text begin Citation. new text end

new text begin This section may be cited as the "End-of-Life Option Act of
2017."
new text end

new text begin Subd. 2. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of this section, the following terms have the
meanings given.
new text end

new text begin (b) "Adult" means a person who is 18 years of age or older.
new text end

new text begin (c) "Attending physician" means a person who is authorized to practice medicine or
osteopathic medicine, has primary responsibility for the patient's health care and treatment
of the patient's terminal illness, and who routinely provides medical care to patients with
advanced and terminal illnesses in the normal course of the attending physician's medical
practice. The attending physician's practice shall not be primarily or solely comprised of
persons requesting medical aid in dying.
new text end

new text begin (d) "Capable" or "capacity" means, in the opinion of the patient's attending physician,
consulting physician, or licensed medical professional, if an opinion is requested by the
attending or consulting physician, that the patient has the capacity to make and communicate
an informed medical decision to health care providers, including communicating through
a translator, interpreter, mechanical device, or a person familiar with the patient's manner
of communicating.
new text end

new text begin (e) "Consulting physician" means a physician who is qualified by specialty or experience
to make a professional diagnosis and prognosis regarding the patient's terminal illness and
decision-making capacity.
new text end

new text begin (f) "Counseling" means one or more consultations as necessary between a psychiatrist
or a psychologist and a patient for the purpose of determining that the patient is capable
and not suffering from depression or any other psychiatric or psychological disorder that
causes impaired judgment.
new text end

new text begin (g) "Health care provider" means a person licensed, certified, or otherwise authorized
or permitted by law to administer health care or dispense medication in the ordinary course
of business or practice of a profession, including but not limited to a physician, psychiatrist,
psychologist, nurse, or pharmacist.
new text end

new text begin (h) "Health care facility" means a hospital, residential care home, nursing home, rest
home, or hospice.
new text end

new text begin (i) "Informed decision" means a decision by a qualified patient to request and obtain a
prescription for medication that the qualified patient may self-administer for a peaceful
death, that is based on an understanding and acknowledgment of the relevant facts and after
being fully informed by the attending physician of:
new text end

new text begin (1) the patient's medical diagnosis and prognosis;
new text end

new text begin (2) the potential risks associated with self-administering the medication to be prescribed;
new text end

new text begin (3) the probable result of taking the medication to be prescribed; and
new text end

new text begin (4) the feasible alternatives and health care treatment options, including but not limited
to hospice and palliative care.
new text end

new text begin (j) "Medical aid in dying" means the medical practice of a physician prescribing
medication to a mentally capable adult with a terminal illness so that the individual may
decide to self-administer the medication to bring about a peaceful death.
new text end

new text begin (k) "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.
new text end

new text begin (l) "Nurse" means a person licensed as a registered nurse or advanced practice registered
nurse under sections 148.171 to 148.285.
new text end

new text begin (m) "Palliative care" means health care centered on a patient and the patient's family
that:
new text end

new text begin (1) optimizes the patient's quality of life by anticipating, preventing, and treating the
patient's suffering throughout the continuum of the patient's illness;
new text end

new text begin (2) addresses the physical, emotional, social, and spiritual needs of the patient;
new text end

new text begin (3) facilitates patient autonomy, the patient's access to information, and patient choice;
and
new text end

new text begin (4) includes but is not limited to discussions between the patient and a health care provider
concerning the patient's goals for treatment options available to the patient, including hospice
care and comprehensive pain and symptom management.
new text end

new text begin (n) "Patient" means a person who is under the care of a physician.
new text end

new text begin (o) "Pharmacist" means a person licensed under chapter 151.
new text end

new text begin (p) "Physician" means a person licensed to practice medicine and surgery under chapter
147.
new text end

new text begin (q) "Psychiatrist" means a psychiatrist licensed under chapter 147.
new text end

new text begin (r) "Psychologist" means a psychologist licensed under section 148.907.
new text end

new text begin (s) "Qualified patient" means an individual who has satisfied the requirements of this
section.
new text end

new text begin (t) "Self-administer" means any affirmative, voluntary, and final physical act by a
qualified individual to take a medication to bring about a peaceful death.
new text end

new text begin (u) "Terminal illness" means the final stage of an incurable and irreversible medical
condition that an attending physician anticipates, within reasonable medical judgment, will
produce a patient's death within six months.
new text end

new text begin Subd. 3. new text end

new text begin Request for medical aid in dying. new text end

new text begin (a) A request for medical aid in dying is
made when a person who:
new text end

new text begin (1) is an adult;
new text end

new text begin (2) is capable;
new text end

new text begin (3) has been determined by the person's attending physician to have a terminal illness;
and
new text end

new text begin (4) has voluntarily expressed a wish to receive medical aid in dying; and
new text end

new text begin has made two oral and one written request according to subdivisions 4 and 5.
new text end

new text begin (b) A person is not a qualified patient under this section based solely on age, disability,
or any specific illness.
new text end

new text begin (c) No person, including but not limited to a proxy designated under a living will, an
attorney-in-fact, or health care agent appointed under a durable power of attorney for health
care or health care directive, a guardian, a conservator, or other person who would otherwise
have authority to make health care decisions on behalf of a patient, may make a request or
otherwise act on behalf of a patient for purposes of this section.
new text end

new text begin Subd. 4. new text end

new text begin Signed, written requests required. new text end

new text begin (a) A patient wishing to receive aid in
dying shall submit one written request to the patient's attending physician in substantially
the form in subdivision 5. A valid written request for medical aid in dying under this section
shall be signed and dated by the patient. The request shall be 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: (1) of sound mind; and (2) acting voluntarily and not being coerced to
sign the request.
new text end

new text begin (b) At least one of the witnesses described in paragraph (a) shall be a person who is not:
(1) a relative of the patient by blood, marriage, or adoption; (2) at the time the request is
signed, entitled to any portion of the estate of the patient upon the patient's death, under any
will or by operation of law; or (3) an owner, operator, or employee of a health care facility
where the patient is receiving medical treatment or is a resident.
new text end

new text begin (c) The patient's attending physician at the time the request is signed shall not be a
witness.
new text end

new text begin Subd. 5. new text end

new text begin Request form. new text end

new text begin A request for medical aid in dying as authorized by this section
shall be in substantially the following form:
new text end

new text begin REQUEST FOR MEDICATION TO END MY LIFE IN A PEACEFUL MANNER
new text end

new text begin I, ......., am an adult of sound mind.
new text end

new text begin I am suffering from ......., which my attending physician has determined is an incurable
and irreversible medical condition that will, within reasonable medical judgment, result in
death within six months. This diagnosis of a terminal illness has been confirmed by another
physician.
new text end

new text begin I have been fully informed of my diagnosis, prognosis, the nature of medication to be
prescribed to aid me in dying peacefully, the potential associated risks, the expected result,
feasible alternatives, and additional health care treatment options, including hospice and
palliative care.
new text end

new text begin I request that my attending physician prescribe medical aid in dying medication that will
end my life in a peaceful manner if I choose to take it. I authorize my attending physician
to contact a pharmacist to fill the prescription for the medication, upon my request.
new text end

new text begin INITIAL ONE:
new text end

new text begin ....... I have informed my family of my decision and taken their opinions into
consideration.
new text end

new text begin ....... I have decided not to inform my family of my decision.
new text end

new text begin ....... I have no family to inform of my decision.
new text end

new text begin I understand that I have the right to rescind this request at any time.
new text end

new text begin I understand the full import of this request and I expect to die if and when I take the
medication to be prescribed. I further understand that although most deaths occur within
three hours, my death may take longer and my attending physician has counseled me about
this possibility.
new text end

new text begin I make this request voluntarily and without reservation, and I accept full responsibility
for my decision to request aid in dying.
new text end

new text begin Signed: .......
new text end

new text begin Dated: .......
new text end

new text begin DECLARATION OF WITNESSES
new text end

new text begin By initialing and signing below on the date the person named above signs, I declare that
the person making and signing the above request:
new text end

new text begin Witness 1 ....... Witness 2 .......
new text end

new text begin Initials ........ Initials .......
new text end

new text begin ....... 1. Is personally known to me or has provided proof of identity;
new text end

new text begin ....... 2. Signed this request in my presence on the date of the person's signature;
new text end

new text begin ....... 3. Appears to be of sound mind and not under duress, fraud, or undue influence;
and
new text end

new text begin ....... 4. Is not a patient for whom I am the attending physician.
new text end

new text begin Printed Name of Witness 1 ..............
new text end

new text begin Signature of Witness 1 ................ Date ...............
new text end

new text begin Printed Name of Witness 2 ...............
new text end

new text begin Signature of Witness 2 ................. Date .......
new text end

new text begin Subd. 6. new text end

new text begin Opportunity to rescind request. new text end

new text begin (a) A qualified patient may rescind the patient's
request for medical aid in dying at any time and in any manner without regard to the patient's
mental state.
new text end

new text begin (b) An attending physician shall offer a qualified patient an opportunity to rescind the
patient's request for medical aid in dying at any time.
new text end

new text begin Subd. 7. new text end

new text begin Physician responsibilities. new text end

new text begin When an attending physician is presented with a
patient's first written request for medical aid in dying under this section, the attending
physician shall:
new text end

new text begin (1) make a determination that the patient:
new text end

new text begin (i) is an adult;
new text end

new text begin (ii) has a terminal illness;
new text end

new text begin (iii) is capable; and
new text end

new text begin (iv) has voluntarily requested medical aid in dying;
new text end

new text begin (2) ensure that the patient is making an informed decision by informing the patient of:
new text end

new text begin (i) the patient's medical diagnosis;
new text end

new text begin (ii) the patient's prognosis;
new text end

new text begin (iii) the potential risks associated with self-administering the medication to be prescribed
for medical aid in dying;
new text end

new text begin (iv) the probable result of self-administering the medication to be prescribed for medical
aid in dying;
new text end

new text begin (v) the feasible alternatives and health care treatment options including, but not limited
to hospice or palliative care under section 144A.75, subdivision 12; and
new text end

new text begin (vi) refer to a hospice provider as defined in section 144A.75, subdivision 5, for
evaluation; and
new text end

new text begin (3) refer the patient to a consulting physician for medical confirmation of the attending
physician's diagnosis of the patient's terminal illness, the patient's prognosis, and for a
determination that the patient is capable and acting voluntarily in requesting medical aid in
dying.
new text end

new text begin Subd. 8. new text end

new text begin Qualified patient. new text end

new text begin In order for a patient to be found to be a qualified patient
for the purposes of this section, a consulting physician shall:
new text end

new text begin (1) examine the patient and the patient's relevant medical records;
new text end

new text begin (2) confirm, in writing, the attending physician's diagnosis that the patient has a terminal
illness;
new text end

new text begin (3) verify that the patient is capable, is acting voluntarily, and has made an informed
decision to request medical aid in dying; and
new text end

new text begin (4) refer the patient for counseling, if required according to subdivision 9.
new text end

new text begin Subd. 9. new text end

new text begin Medical determination on competency. new text end

new text begin (a) If, in the medical opinion of the
attending physician or the consulting physician, a patient may be suffering from a psychiatric
or psychological condition that is causing impaired judgment, either the attending or
consulting physician shall refer the patient for counseling to determine whether the patient
is capable of making and communicating an informed medical decision.
new text end

new text begin (b) An attending physician shall not provide the patient medical aid in dying until the
person providing the counseling determines that the patient is not suffering a psychiatric or
psychological condition that is causing impaired judgment.
new text end

new text begin Subd. 10. new text end

new text begin Process. new text end

new text begin (a) After an attending physician and a consulting physician determine
that a patient is a qualified patient, and after the qualified patient submits a second request
for medical aid in dying according to subdivision 4, the attending physician shall:
new text end

new text begin (1) recommend to the qualified patient that the patient notify the patient's next of kin of
the patient's request for medical aid in dying and inform the qualified patient that failure to
do so shall not be a basis for the denial of the request;
new text end

new text begin (2) counsel the qualified patient concerning the importance of:
new text end

new text begin (i) having another person present when the qualified patient self-administers the
medication prescribed for medical aid in dying; and
new text end

new text begin (ii) not taking the medication in a public place;
new text end

new text begin (3) inform the qualified patient that the patient may rescind the patient's request for
medical aid in dying at any time and in any manner;
new text end

new text begin (4) verify, immediately before writing the prescription for medication for medical aid
in dying, that the qualified patient is making an informed decision; and
new text end

new text begin (5) fulfill the medical record documentation requirements in subdivision 11.
new text end

new text begin Subd. 11. new text end

new text begin Medical record. new text end

new text begin With respect to a request by a qualified patient for medical
aid in dying, the attending physician shall ensure that the following items are documented
or filed in the qualified patient's medical record:
new text end

new text begin (1) all oral requests by a qualified patient for medication for medical aid in dying;
new text end

new text begin (2) all written requests by a qualified patient for medication for medical aid in dying;
new text end

new text begin (3) the attending physician's diagnosis of the qualified patient's terminal illness and
prognosis, and a determination that the qualified patient is capable, is acting voluntarily,
and has made an informed decision to request medical aid in dying;
new text end

new text begin (4) the consulting physician's confirmation of the qualified patient's diagnosis and
prognosis, and confirmation that the qualified patient is capable, is acting voluntarily, and
has made an informed decision to request medical aid in dying;
new text end

new text begin (5) a report of the outcome and determinations made during counseling, if counseling
was recommended and provided as required by subdivision 9;
new text end

new text begin (6) documentation of the attending physician's offer to the qualified patient to rescind
the patient's request for medical aid in dying at the time the attending physician writes the
qualified patient a prescription for medication for medical aid in dying; and
new text end

new text begin (7) a statement by the attending physician indicating that all requirements under this
section have been met and indicating the steps taken to carry out the qualified patient's
request for medical aid in dying, including the medication prescribed.
new text end

new text begin Subd. 12. new text end

new text begin Use of records. new text end

new text begin Records or information collected or maintained under this
section shall not be subject to subpoena or discovery or introduced into evidence in any
judicial or administrative proceeding except to resolve matters concerning compliance with
this section, or as otherwise specifically provided by law.
new text end

new text begin Subd. 13. new text end

new text begin General provisions. new text end

new text begin A qualified patient's act of requesting medical aid in
dying or self-administering medication prescribed for medical aid in dying shall not:
new text end

new text begin (1) affect a life, health, or accident insurance or annuity policy, or benefits payable under
the policy;
new text end

new text begin (2) be grounds for eviction from a person's place of residence or a basis for discrimination
in the terms, conditions, or privileges of sale or rental of a dwelling or in the provision of
services or facilities because of the patient's request for medical aid in dying;
new text end

new text begin (3) provide the sole basis for the appointment of a conservator or guardian; or
new text end

new text begin (4) constitute suicide for any purpose.
new text end

new text begin Subd. 14. new text end

new text begin Participate in provision of medication. new text end

new text begin (a) As used in this section, "participate
in the provision of medication" means to perform the duties of an attending physician or
consulting physician, a psychiatrist, a psychologist, a nurse, or a pharmacist according to
subdivisions 2 to 10, and does not include:
new text end

new text begin (1) making an initial diagnosis of a patient's terminal illness;
new text end

new text begin (2) informing a patient of the patient's medical diagnosis or prognosis;
new text end

new text begin (3) informing a patient concerning the provisions of this section, upon the patient's
request; or
new text end

new text begin (4) referring a patient to another health care provider for medical aid in dying.
new text end

new text begin (b) Participation in any act described in this section by a patient, health care provider,
or any other person shall be voluntary. Each health care provider shall individually and
affirmatively determine whether to participate in the provision of medication to a qualified
patient for medical aid in dying. A health care facility shall not require a health care provider
to participate in the provision of medication to a qualified patient for medical aid in dying,
but may prohibit such participation according to paragraph (d).
new text end

new text begin (c) If a health care provider is unwilling to participate in the provision of medication to
a qualified patient for medical aid in dying, the health care provider shall transfer all relevant
medical records to a health care provider as requested by a qualified patient.
new text end

new text begin (d) A health care facility may adopt written policies prohibiting a health care provider
associated with the health care facility from participating in the provision of medication to
a patient for medical aid in dying, provided the facility provides written notice of the policy
and any sanctions for violation of the policy to the health care provider. Notwithstanding
the provisions of this paragraph or any policies adopted according to this paragraph, a
qualified health care provider may:
new text end

new text begin (1) diagnose a patient with a terminal illness;
new text end

new text begin (2) inform a patient of the patient's medical prognosis;
new text end

new text begin (3) provide a patient with information concerning the provisions of this section, upon a
patient's request;
new text end

new text begin (4) refer a patient to another health care facility or health care provider; or
new text end

new text begin (5) transfer a patient's medical records to a health care provider or health care facility
as requested by a patient.
new text end

new text begin Subd. 15. new text end

new text begin Criminal act. new text end

new text begin (a) Any person who without authorization of a patient willfully
alters or forges a request for medical aid in dying, as described in subdivisions 4 and 5, or
conceals or destroys a rescission of a request for medical aid in dying with the intent or
effect of causing the patient's death, is guilty of attempted murder or murder.
new text end

new text begin (b) Any person who coerces or exerts undue influence on a patient to complete a request
for medical aid in dying, as described in subdivisions 4 and 5, or coerces or exerts undue
influence on a patient to destroy a rescission of the request with the intent or effect of causing
the patient's death, is guilty of attempted murder or murder.
new text end

new text begin Subd. 16. new text end

new text begin Medical aid in dying. new text end

new text begin (a) Nothing in this section authorizes a physician or
any other person to end a patient's life by lethal injection, mercy killing, assisting a suicide,
or any other active euthanasia.
new text end

new text begin (b) Any action taken according to this section does not constitute causing or assisting
another person to commit suicide.
new text end

new text begin (c) No report of a public agency may refer to the practice of obtaining and
self-administering life-ending medication to end a qualified patient's life as suicide or assisted
suicide, and shall refer to the practice as medical aid in dying.
new text end

new text begin Subd. 17. new text end

new text begin Death certificate. new text end

new text begin Unless otherwise prohibited by law, the attending physician
may sign the qualified patient's death certificate. The qualified patient's underlying terminal
illness shall be listed as the cause of death.
new text end

new text begin Subd. 18. new text end

new text begin Civil damages. new text end

new text begin This section does not limit liability for civil damages resulting
from negligent conduct or intentional misconduct by any person.
new text end

new text begin Subd. 19. new text end

new text begin Criminal prosecution. new text end

new text begin Nothing in this section precludes criminal prosecution
under any provision of law for conduct that is inconsistent with this section.
new text end

new text begin Subd. 20. new text end

new text begin Reporting requirements. new text end

new text begin (a) Within ten calendar days of prescribing
medication to a qualified patient to self-administer in accordance with this section, the
attending physician must submit to the commissioner of health the documentation required
under subdivision 11, on a form developed by the commissioner.
new text end

new text begin (b) Within ten calendar days of dispensing medication to a qualified patient, the qualified
patient's attending physician, or an identified agent of the qualified patient in accordance
with this section, the pharmacist must submit to the commissioner of health a dispensing
form developed by the commissioner of health.
new text end

new text begin (c) Within ten calendar days of the qualified patient's death, or ingestion of the medication
for medical aid in dying, the qualified patient's attending physician must submit to the
commissioner of health a follow-up form as developed by the commissioner.
new text end

new text begin (d) The commissioner of health shall develop the forms and procedures necessary to
facilitate the collection of the information required under this subdivision. The commissioner
shall annually review a sample of the records that are required to be maintained under this
section.
new text end

new text begin (e) Except as otherwise required by law, the information and data collected under this
subdivision shall be classified as nonpublic data and shall not be made available to the
public. The commissioner shall generate an annual statistical report of information collected
under this subdivision. The report shall consist of summary data as defined under section
13.02 and shall be made available to the public.
new text end