HF 2152

as introduced - 91st Legislature (2019 - 2020) Posted on 02/11/2020 03:04pm

A bill for an act
relating to health; establishing an end-of-life option for terminally ill adults;
imposing criminal penalties; 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 Options Act."
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 unless the context requires otherwise.
new text end

new text begin (b) "Adult" means an individual 18 years of age or older.
new text end

new text begin (c) "Attending health care provider" means a health care provider who has primary
responsibility for the patient's health care and treatment of the terminal illness, and who
provides medical care to patients with advanced and terminal illnesses in the normal course
of their medical practice. The attending health care provider's treatment may not be limited
to or primarily comprised of medical aid-in-dying.
new text end

new text begin (d) "Consulting health care provider" means a health care provider who is qualified by
specialty or experience to make a professional diagnosis and prognosis regarding an
individual's terminal illness(es).
new text end

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

new text begin (f) "Health care provider" or "provider" means a person who is licensed, certified,
registered or otherwise authorized or permitted by law to administer health care or prescribe
and dispense medication under the provider's scope of practice including:
new text end

new text begin (1) a doctor of medicine or a doctor of osteopathic medicine licensed under chapter 147
or prior to May 1, 1963, sections 148.11 to 148.16;
new text end

new text begin (2) an advanced practice registered nurse licensed under chapter 148 and certified by a
national nurse certification organization acceptable to the Board of Nursing to practice as
a clinical nurse specialist or nurse practitioner; and
new text end

new text begin (3) a pharmacist licensed under chapter 151.
new text end

new text begin (g) "Informed decision" means a decision by a terminally ill adult to request and obtain
a prescription for medication that the terminally ill adult may self-administer for a peaceful
death that is based on an understanding and acknowledgment of the relevant medical facts
and that is made after being fully informed by the attending health care provider of:
new text end

new text begin (1) the terminally ill adult's medical diagnosis and prognosis of six months or less;
new text end

new text begin (2) any feasible alternative, concurrent or additional treatment opportunities, including
but not limited to comfort care, palliative care, hospice care and pain control. Nothing in
this section will be construed to limit the information or counseling a health care provider
must provide to a patient in order to meet the medical standard of care and to obtain informed
consent for subsequent medical treatment;
new text end

new text begin (3) the potential risks associated with taking the medication to be prescribed for medical
aid-in-dying;
new text end

new text begin (4) the probable result of taking the medication to be prescribed for medical aid-in-dying;
and
new text end

new text begin (5) the choices available to the terminally ill adult that demonstrate the terminally ill
adult's self determination, including the possibility that the terminally ill adult may choose
not to fill the prescription for the medication, or may fill the prescription for the medication
but may decide not to self-administer the medication.
new text end

new text begin (h) "Licensed mental health care professional" means a psychiatrist, psychologist, or
clinical social worker licensed under the respective boards of practice.
new text end

new text begin (i) "Medical aid-in-dying" means the practice of evaluating an informed decision to
request medical aid-in-dying medication by eligible individuals and writing a prescription
for qualified individuals according to established standards of medical care.
new text end

new text begin (j) "Medically confirmed" means the consulting health care provider agrees with the
medical opinion of the attending health care provider after the consulting health care provider
evaluates the terminally ill adult and the terminally ill adult's relevant medical records.
new text end

new text begin (k) "Mental capacity" or "mentally capable" means in the opinion of the terminally ill
adult's attending health care provider and consulting health care provider, or licensed mental
health care professional if an opinion is requested under subdivision 11, the terminally ill
adult has the ability to make and communicate an informed decision to health care providers.
new text end

new text begin (l) "Prognosis of six months or less" means a prognosis resulting from a terminal illness
that will, within reasonable medical judgment, result in death within six months.
new text end

new text begin (m) "Qualified individual" means a terminally ill adult with a prognosis of six months
or less, who has the mental capacity to make an informed decision and has made an informed
decision to request medical aid-in-dying, and has satisfied the requirements of this section
in order to obtain a prescription for medical aid-in-dying medication to bring about a peaceful
death.
new text end

new text begin (n) "Self-administer" means an individual performing an affirmative, conscious, voluntary
act to take medication for medical aid-in-dying to bring about the terminally ill adult's own
peaceful death.
new text end

new text begin (o) "Terminal illness" means an incurable and irreversible illness that will, within
reasonable medical judgment, result in death.
new text end

new text begin Subd. 3. new text end

new text begin Information to patients. new text end

new text begin (a) Nothing in this section shall be construed to lessen
the requirements in section 144.651.
new text end

new text begin (b) A health care provider must provide sufficient information to terminally ill adults
regarding all available treatment options and alternatives, and the foreseeable risks and
benefits of each, so that the terminally ill adult may make an independent, informed, and
voluntary decision regarding end-of-life health care.
new text end

new text begin (c) Failure to inform a terminally ill adult who requests additional information about
available end-of-life treatments including medical aid-in-dying, or failing to refer the
terminally ill adult to another health care provider who can provide the information, shall
be considered a failure to obtain informed consent for subsequent medical treatment.
new text end

new text begin Subd. 4. new text end

new text begin Standard of care. new text end

new text begin (a) Health care providers who provide end-of-life services
covered under this section shall meet or exceed the standard of care of the provider's scope
of practice.
new text end

new text begin (b) If a health care provider is unable or unwilling to provide care related to medical
aid-in-dying for a qualified individual's request for medical aid-in-dying, nothing in this
section exempts a health care provider from meeting the medical standard of care under the
provider's scope of practice, including but not limited to accurately responding to questions,
obtaining informed consent, and timely transferring care of the qualified individual and any
related records to a new health care provider if the health care provider is unwilling to
provide the requested services.
new text end

new text begin Subd. 5. new text end

new text begin Right to request medical aid-in-dying medication by qualified
individuals. new text end

new text begin (a) A qualified individual may make a request to receive a prescription for
medical aid-in-dying medication if:
new text end

new text begin (1) the qualified individual's attending health care provider has determined the qualified
individual has a terminal illness with a prognosis of six months or less;
new text end

new text begin (2) the qualified individual's attending health care provider has determined the individual
has the mental capacity to make an informed decision; and
new text end

new text begin (3) the qualified individual has voluntarily expressed the wish to receive a prescription
for medical aid-in-dying medication.
new text end

new text begin (b) An individual adult shall not be considered a "qualified individual" under this section
solely because of age or disability.
new text end

new text begin (c) Request for medical aid-in-dying prescription must be made by the terminally ill
adult and may not be made by any other individual including the terminally ill adult's
qualified power of attorney, durable medical power of attorney, or by advanced health care
directive.
new text end

new text begin Subd. 6. new text end

new text begin Request process. new text end

new text begin (a) A terminally ill adult wishing to receive a prescription
for medical aid-in-dying medication under this section must make one oral request and one
written request to the attending health care provider.
new text end

new text begin (b) For terminally ill adults who may have difficulty with oral communication, note
taking, written materials, technology-assisted communication, or, if viable, lip reading and
communication through persons familiar with the terminally ill adult's manner of
communicating are acceptable.
new text end

new text begin (c) A written request for medical aid-in-dying medication must be in substantially the
following format, signed and dated, or attested to by the terminally ill adult seeking the
medical aid-in-dying medication.
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. I have been diagnosed with
....................................., which my attending health care provider has determined is a terminal
illness. I have been fully informed of my diagnosis and prognosis of six months or less to
live, the nature of the medical aid-in-dying medication to be prescribed, the potential
associated risks, the expected result, and the feasible alternatives or additional treatment
opportunities available to me, including comfort care, palliative care, hospice care, and pain
control.
new text end

new text begin I request that my attending health care provider prescribe medical aid-in-dying medication
that will end my life in a peaceful manner if I choose to take the medication, and I authorize
my attending health care provider to contact a pharmacist to fill my prescription. I understand
that I have the right to rescind this request at any time. I understand the seriousness of this
request and I expect to die if I take the medical aid-in-dying medication prescribed.
new text end

new text begin I make this request voluntarily, without reservation, free from coercion or pressure, and
I accept full responsibility for my actions.
new text end

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

new text begin Subd. 7. new text end

new text begin Informed decision required. new text end

new text begin (a) An individual adult with a terminal illness is
not a qualified individual and may not receive a prescription for medical aid-in-dying
medication unless the individual adult has made an informed decision as defined in
subdivision 2.
new text end

new text begin (b) Immediately before writing a prescription for medical aid-in-dying medication, the
attending health care provider must verify that the individual adult with a terminal illness
is making an informed decision.
new text end

new text begin Subd. 8. new text end

new text begin Right to rescind request; opportunity to rescind. new text end

new text begin (a) At any time, a terminally
ill adult may rescind a request for medical aid-in-dying medication without regard to the
terminally ill adult's mental state being a factor.
new text end

new text begin (b) An attending health care provider must not write a prescription for medical
aid-in-dying medication under this section unless the provider has offered the qualified
individual an opportunity to rescind the request.
new text end

new text begin Subd. 9. new text end

new text begin Attending health care provider responsibilities. new text end

new text begin The attending health care
provider shall:
new text end

new text begin (1) provide care that conforms with accepted medical standards and guidelines under
the provider's scope of practice;
new text end

new text begin (2) make the initial determination of whether an individual adult requesting medical
aid-in-dying:
new text end

new text begin (i) has a terminal illness with a prognosis of six months or less;
new text end

new text begin (ii) is mentally capable; and
new text end

new text begin (iii) has made the request for medical aid-in-dying medication voluntarily;
new text end

new text begin (3) provide full disclosure to confirm that the terminally ill adult is making an informed
decision by discussing with the terminally ill adult:
new text end

new text begin (i) the terminally ill adult's medical diagnosis and prognosis of six months or less;
new text end

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

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

new text begin (iv) the choices available to the terminally ill adult, including the possibility that the
terminally ill adult may choose not to fill the prescription for the medication, or may fill
the prescription for the medication but may decide not to self-administer it; and
new text end

new text begin (v) any feasible alternatives, concurrent or additional treatment opportunities, including
but not limited to comfort care, palliative care, hospice care, and pain control;
new text end

new text begin (4) provide the terminally ill adult with a referral for any alternative, concurrent, or
additional treatment option as needed;
new text end

new text begin (5) confirm that the terminally ill adult's request does not arise from coercion or undue
influence by another person by discussing with the terminally ill adult, outside the presence
of other persons, except for an interpreter if necessary, whether the terminally ill adult is
feeling coerced or unduly influenced by another person;
new text end

new text begin (6) refer the terminally ill adult to a consulting health care provider for:
new text end

new text begin (i) medical confirmation of the terminally ill adult's diagnosis and prognosis;
new text end

new text begin (ii) determination of whether the terminally ill adult is mentally capable and is making
an informed decision; and
new text end

new text begin (iii) determination of whether the terminally ill adult is acting voluntarily;
new text end

new text begin (7) add the consulting health care provider's written determination to the terminally ill
adult's medical record;
new text end

new text begin (8) refer the terminally ill adult to a licensed mental health professional if the attending
health care provider believes the terminally ill adult may not be mentally capable of making
an informed decision, and add the mental health professional's written determination to the
terminally ill adult's medical record;
new text end

new text begin (9) counsel the terminally ill adult on the potential benefits of:
new text end

new text begin (i) notifying family of the terminally ill adult's decision to request and obtain medical
aid-in-dying medication as one end-of-life care option; and
new text end

new text begin (ii) having another person present when the terminally ill adult self-administers the
medical aid-in-dying medication to be prescribed;
new text end

new text begin (10) counsel the terminally ill adult on the importance of:
new text end

new text begin (i) safe-keeping and proper disposal of unused medical aid-in-dying medication according
to federal Food and Drug Administration guidelines, and state law, if applicable; and
new text end

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

new text begin (11) inform the terminally ill adult that the request for medical aid-in-dying medication
may be rescinded at any time and in any manner;
new text end

new text begin (12) ensure that all appropriate steps are carried out under this section before writing a
prescription for medical aid-in-dying medication and either:
new text end

new text begin (i) dispense the medical aid-in-dying medication to the qualified individual, including
ancillary medications intended to minimize the terminally ill adult's discomfort, if the
attending health care provider has a current drug enforcement administration certificate and
complies with any applicable administrative rule; or
new text end

new text begin (ii) deliver the written prescription personally, by mail, or through an authorized electronic
transmission to a licensed pharmacist who will dispense the medical aid-in-dying medication
in person to the qualified individual, the attending health care provider, or to an individual
expressly designated by the qualified individual or, with a signature required on delivery,
by mail service or by messenger service; and
new text end

new text begin (13) document in the terminally ill adult's medical record the diagnosis and prognosis,
mental capability, date of the oral request and valid written request, and a notation that all
the requirements under this section have been completed including the medical aid-in-dying
medication and any ancillary medications prescribed.
new text end

new text begin Subd. 10. new text end

new text begin Consulting health care provider responsibilities. new text end

new text begin Before a terminally ill
adult may receive a prescription for medical aid-in-dying medication, a consulting health
care provider must:
new text end

new text begin (1) evaluate the terminally ill adult and all relevant medical records; and
new text end

new text begin (2) confirm in writing to the attending health care provider:
new text end

new text begin (i) that the terminally ill adult has a terminal illness and prognosis of six months or less;
new text end

new text begin (ii) that the terminally ill adult is mentally capable, or provide documentation that the
consulting health care provider has referred the terminally ill adult for further evaluation
according to subdivision 11;
new text end

new text begin (iii) that the terminally ill adult is making an informed decision; and
new text end

new text begin (iv) that the terminally ill adult is acting voluntarily.
new text end

new text begin Subd. 11. new text end

new text begin Terminally ill adult mentally capable; referral to mental health
professional. new text end

new text begin (a) If either the attending health care provider or the consulting health care
provider believes the terminally ill adult may not be mentally capable of making an informed
decision, the attending health care provider or consulting health care provider shall refer
the terminally ill adult to a licensed mental health professional for determination of whether
the terminally ill adult is mentally capable of making an informed decision.
new text end

new text begin (b) A licensed mental health professional who evaluates a terminally ill adult under this
subdivision shall communicate in writing to the attending or consulting health care provider
who requests the evaluation the mental health professional's conclusion about whether the
terminally ill adult is mentally capable of making an informed decision.
new text end

new text begin (c) If the licensed mental health professional determines that the terminally ill adult is
not currently mentally capable of making informed decisions, the terminally ill adult shall
not be deemed a qualified individual under this section and the attending health care provider
shall not prescribe medical aid-in-dying medication to the terminally ill adult.
new text end

new text begin Subd. 12. new text end

new text begin Use of interpreters. new text end

new text begin (a) An interpreter whose services are provided to a
terminally ill adult requesting information or services under this section shall meet the
standards of the National Council on Interpreting in Health Care or other standards deemed
acceptable by the commissioner of health.
new text end

new text begin (b) An interpreter used according to this section must not be related to the qualified
terminally ill adult by blood, marriage, registered domestic partnership, or adoption or be
entitled to a portion of the terminally ill adult's estate upon death.
new text end

new text begin Subd. 13. new text end

new text begin Death certificate. new text end

new text begin (a) Unless otherwise prohibited by law, the attending health
care provider or the hospice medical director shall sign the death certificate of a terminally
ill adult who obtained and self-administered medical aid-in-dying medication.
new text end

new text begin (b) When a death has occurred by use of medical aid-in-dying medication, the manner
of death shall be listed as the underlying terminal illness and not as a suicide or homicide.
new text end

new text begin (c) When a death has occurred by use of medical aid-in-dying medication, this alone
does not constitute grounds for a post-mortem inquiry.
new text end

new text begin Subd. 14. new text end

new text begin Safe disposal of unused medical aid-in-dying medications. new text end

new text begin A person who
has custody or control of medical aid-in-dying medication dispensed under this section that
remains unused after the terminally ill adult's death shall dispose of the unused medical
aid-in-dying medication by lawful means according to state and federal guidelines including:
new text end

new text begin (1) returning the unused medical aid-in-dying medication to a federally approved
medication take-back program or mail-back program; or
new text end

new text begin (2) returning the unused medical aid-in-dying medication to the local or state police
departments who shall dispose of the medication by lawful means.
new text end

new text begin Subd. 15. new text end

new text begin Reporting requirements; rulemaking. new text end

new text begin (a) The commissioner of health shall:
new text end

new text begin (1) adopt rules to facilitate the collection of information regarding compliance with this
section; and
new text end

new text begin (2) review a sample of records maintained according to this section annually and generate
and make available to the public a statistical report of the information collected.
new text end

new text begin (b) Except as otherwise required by law, information collected under this section is not
for public data under chapter 13.
new text end

new text begin Subd. 16. new text end

new text begin Effect on construction of wills, contracts, and statutes. new text end

new text begin (a) Any provision
in a contract, will or other agreement, whether written or oral, that would affect whether a
terminally ill adult may make or rescind a request for medical aid-in-dying medication, is
not valid.
new text end

new text begin (b) Any obligation owing under a currently existing contract may not be conditioned on
or affected by a terminally ill adult's act of making or rescinding a request for medical
aid-in-dying medication.
new text end

new text begin Subd. 17. new text end

new text begin Insurance or annuity policies. new text end

new text begin (a) The sale, procurement, or issuance of a
life, health or accident insurance or annuity policy, or the rate charged for a policy may not
be conditioned on or affected by a terminally ill adult's act of making or rescinding a request
for medical aid-in-dying medication.
new text end

new text begin (b) A qualified terminally ill adult's act of self-administering medical aid-in-dying
medication shall not invalidate any part of a life, health, or accident insurance or annuity
policy.
new text end

new text begin (c) It is unlawful for an insurer to deny or alter health care benefits otherwise available
to a terminally ill adult based on the availability of medical aid-in-dying medication or
otherwise attempt to coerce a terminally ill adult to make a request for medical aid-in-dying
medication.
new text end

new text begin Subd. 18. new text end

new text begin Immunities for actions in good faith; prohibition against reprisals. new text end

new text begin (a) A
health care provider or health care facility is not subject to civil or criminal liability or
professional disciplinary action, including censure, suspension, loss of license, loss of
privileges, loss of membership, or any other penalty for providing medical care in good
faith compliance with this section, which includes being present when a qualified terminally
ill adult self-administers the prescribed medical aid-in-dying medication.
new text end

new text begin (b) A health care provider, health care facility or professional organization or association
must not subject a health care provider to censure, discipline, suspension, loss of license,
loss of privileges, loss of membership, or any other penalty for, in good faith, writing or
refusing to write a prescription for medication under this section or for providing scientific
and accurate information about medical aid-in-dying to a terminally ill adult.
new text end

new text begin (c) A health care provider is not subject to civil or criminal liability when, in compliance
with this section, the provider writes or dispenses a prescription for medical aid-in-dying
medication.
new text end

new text begin (d) A person is not subject to civil or criminal liability, when in compliance with this
section, the person is present when a qualified individual self-administers the prescribed
medical aid-in-dying medication.
new text end

new text begin (e) A request by a terminally ill adult for medical aid-in-dying medication or an attending
health care provider providing medical aid-in-dying medication under this section does not
solely constitute neglect or elder abuse for any purpose of law or provide the sole basis for
the appointment of a guardian or conservator.
new text end

new text begin (f) This section does not limit civil or criminal liability for negligence, recklessness, or
intentional misconduct.
new text end

new text begin Subd. 19. new text end

new text begin No duty to provide medical aid-in-dying. new text end

new text begin (a) A health care provider may
choose whether to provide medical aid-in-dying to a terminally ill adult according to this
section.
new text end

new text begin (b) If a health care provider is unable or unwilling to carry out a terminally ill adult's
request for medical aid-in-dying, the provider must make reasonable efforts to accommodate
the terminally ill adult's request including transferring care of the terminally ill adult to a
new health care provider.
new text end

new text begin Subd. 20. new text end

new text begin Health care facility permissible prohibitions. new text end

new text begin (a) A health care facility may
not prohibit a health care provider employed or under contract to the facility from providing
medical aid-in-dying for a qualified individual unless the qualified individual intends to
self-administer the medical aid-in-dying medication on the facility's premises.
new text end

new text begin (b) The health care facility must notify qualified individuals and health care providers
in writing if the facility intends to prohibit health care providers from prescribing medical
aid-in-dying medication for qualified individuals who intend to self-administer on the
facility's premises, and refer the qualified adult to a new health care facility without a
prohibition.
new text end

new text begin (c) If the qualified individual wishes to transfer care to a new health care facility, the
health care providers shall coordinate a timely transfer, including transfer of the qualified
individual's medical records.
new text end

new text begin (d) A health care facility that fails to provide advance notice in writing to qualified
individuals and health care providers must not enforce any policy against a health care
provider.
new text end

new text begin (e) A health care facility or health care provider must not prohibit a health care provider
from providing service consistent with the applicable standard of medical care under the
provider's scope of practice including:
new text end

new text begin (1) informing and providing information to qualified individuals about medical
aid-in-dying;
new text end

new text begin (2) being present when a qualified individual self-administers medical aid-in-dying
medication if requested by the qualified individual or the qualified individual's representative;
and
new text end

new text begin (3) providing a referral to another health care provider.
new text end

new text begin Subd. 21. new text end

new text begin Liabilities and penalties. new text end

new text begin (a) Purposely or knowingly altering or forging a
request for medical aid-in-dying medication to end an individual's life without the individual's
authorization or concealing or destroying a recission by a qualified individual of a request
for medical aid-in-dying medication is punishable as a felony if the act is done with the
intent or effect of causing the individual adult's death.
new text end

new text begin (b) Purposely or knowingly coercing or exerting undue influence on a terminally ill adult
to request medical aid-in-dying medication for the purpose of ending the terminally ill adult's
life or to destroy a recission of a request for medical aid-in-dying medication is punishable
as a felony. This includes individual adults who:
new text end

new text begin (1) are elderly;
new text end

new text begin (2) have a disability;
new text end

new text begin (3) have a psychiatric illness;
new text end

new text begin (4) have a chronic illness;
new text end

new text begin (5) are of gender, racial, or ethnic minorities;
new text end

new text begin (6) have a lower economic or educational level; or
new text end

new text begin (7) are uninsured.
new text end

new text begin (c) Nothing in this section limits further liability for civil damages resulting from
negligent conduct or intentional misconduct by any person.
new text end

new text begin (d) The penalties specified in this section do not preclude criminal penalties applicable
under other law for conduct inconsistent with this section.
new text end

new text begin Subd. 22. new text end

new text begin Construction. new text end

new text begin (a) Nothing in this section authorizes a health care provider or
any other person to end an individual's life by lethal injection, mercy killing, or euthanasia.
new text end

new text begin (b) Actions taken under this section do not, for any purpose, constitute suicide, assisted
suicide, euthanasia, mercy killing, homicide, or elder abuse under the law.
new text end

new text begin Subd. 23. new text end

new text begin Severability. new text end

new text begin If a part of this section is determined invalid, all valid parts that
are severable from the invalid part remain in effect. If a part of this section is determined
invalid in one of more of its applications, the remaining parts remain in effect in all valid
applications and are severable from the invalid applications.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end