Bill Text: MI HB4461 | 2017-2018 | 99th Legislature | Introduced


Bill Title: Health; death; physician-assisted suicide; allow under certain circumstances. Creates new act & repeals sec. 329a of 1931 PA 328 (MCL750.329a) & repeals 1992 PA 270 (MCL 752.102 - 752.1027).

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2017-04-19 - Bill Electronically Reproduced 03/30/2017 [HB4461 Detail]

Download: Michigan-2017-HB4461-Introduced.html

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HOUSE BILL No. 4461

 

 

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.

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