2019 -- S 0320

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LC001194

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2019

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A N   A C T

RELATING TO HEALTH AND SAFETY -- LILA MANFIELD SAPINSLEY

COMPASSIONATE CARE ACT

     Introduced By: Senators Goldin, Miller, Euer, and Coyne

     Date Introduced: February 13, 2019

     Referred To: Senate Judiciary

     It is enacted by the General Assembly as follows:

     SECTION 1. Title 23 of the General Laws entitled "HEALTH AND SAFETY" is hereby

amended by adding thereto the following chapter:

CHAPTER 4.13

LILA MANFIELD SAPINSLEY COMPASSIONATE CARE ACT

     23-4.13-1. Short title.

     This chapter shall be known and may be cited as the "Lila Manfield Sapinsley

Compassionate Care Act."

     23-4.13-2. Definitions.

     As used in this chapter, the following words and terms shall have the following

meanings:

     (1) "Bona fide physician-patient relationship" means a treating or consulting relationship

in the course of which a physician has completed a full assessment of the patient's medical history

and current medical condition.

     (2) "Capable" means that a patient has the ability to make and communicate health care

decisions to a physician, including communication through persons familiar with the patient's

manner of communicating if those persons are available.

     (3) "Health care facility" shall have the same meaning as in § 23-17-2.

     (4) "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 dispense

medication in the practice of the medical profession.

     (5) "Impaired judgment" means that a person does not sufficiently understand or

appreciate the relevant facts necessary to make an informed decision.

     (6) "Interested person" means:

     (i) The patient's physician;

     (ii) A person who knows that they are a relative of the patient by blood, civil marriage,

civil union, or adoption;

     (iii) A person who knows that they would be entitled, upon the patient's death, to any

portion of the estate or assets of the patient under any will or trust, by operation of law, or by

contract.

     (7) "Medical aid in dying" means a medical practice that allows mentally capable,

terminally ill adults to request a prescription for life-ending medication from their physician,

which the person may self-administer if and when they choose.

     (8) "Palliative care" shall have the same definition as in § 23-89-3.

     (9) "Patient" means a person who is eighteen (18) years of age or older, a resident of

Rhode Island, and under the care of a physician

     (10) "Physician" means an individual licensed to engage in the practice of medicine as

defined in § 5-37-1.

     (11) "Self-administer" means an individual performing an affirmative conscious,

voluntary act to take into their body medication for medical aid in dying to themselves to bring

about their own peaceful death.

     (12) "Terminal condition" means an incurable and irreversible disease which would,

within reasonable medical judgment, result in death within six (6) months or less.

     23-4.13-3. Requirements for prescription and documentation -- Immunity.

     (a) A physician shall not be subject to any civil or criminal liability or professional

disciplinary action if the physician prescribes to a patient with a terminal condition medication to

be self-administered for the purpose of bringing about a peaceful death and the physician affirms

by documenting in the patient's medical record that all of the following occurred:

     (1) The patient made an oral request directly to the physician to be prescribed medication

for the purpose of being self-administered to bring about a peaceful death.

     (2) No fewer than fifteen (15) days after the first oral request, the patient made a second

oral request to the physician to be prescribed medication to be self-administered for the purpose

of bringing about a peaceful death.

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     (3) At the time of the second oral request, the physician offered the patient an opportunity

to rescind the request.

     (4) The patient made a written request to be prescribed medication to be self-

administered for the purpose of bringing about a peaceful death that was signed by the patient in

the presence of two (2) subscribing witnesses at least one of whom is not an interested person as

defined in § 23-4.13-2, who were at least eighteen (18) years of age, and who subscribed and

attested that the patient appeared to understand the nature of the document and to be free from

duress or undue influence at the time the request was signed.

     (5) The physician determined that the patient:

     (i) Has a terminal condition, after evaluating the patient and their relevant medical

records;

     (ii) Was capable;

     (iii) Was making an informed decision;

     (iv) Had made a voluntary request for medication to bring about a peaceful death; and

     (v) Was a Rhode Island resident.

     (6) The physician informed the patient in person, both verbally and in writing, of all the

following:

     (i) The patient's medical diagnosis;

     (ii) The patient's prognosis, including an acknowledgement that the physician's prediction

of the patient's life expectancy was an estimate based on the physician's best medical judgment

and was not a guarantee of the actual time remaining in the patient's life, and that the patient

could live longer or shorter than the time predicted;

     (iii) The range of treatment options available to the patient and the patient's diagnosis;

     (iv) If the patient was not enrolled or participating in hospice care, all feasible end-of-life

services, including palliative care, comfort care, hospice care, and pain control;

     (v) The range of possible results, risks, and benefits of each option including potential

risks associated with taking the medication to be prescribed.

     (7) The physician referred the patient to a second physician for medical confirmation of

the diagnosis, prognosis, and a determination that the patient was capable, was acting voluntarily,

and had made an informed decision.

     (8) The physician either verified that the patient did not have impaired judgment or

referred the patient for an evaluation by a psychiatrist, psychologist, or clinical social worker,

licensed in Rhode Island, for confirmation that the patient was capable and did not have impaired

judgment.

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     (9) The physician informed the patient that the patient may rescind the request at any

time and in any manner and offered the patient an opportunity to rescind after the patient's second

oral request.

     (10) The physician ensured that all required steps were carried out in accordance with this

section and confirmed, immediately prior to writing the prescription for medication, that the

patient was making an informed decision.

     (11) The physician wrote the prescription no fewer than forty-eight (48) hours after the

last to occur of the following events:

     (i) The patient's written request;

     (ii) The patient's second oral request; or

     (iii) The physician's offering the patient an opportunity to rescind the request.

     (12) The physician either:

     (i) Dispensed the medication directly, provided that at the time the physician dispensed

the medication, they were licensed to dispense medication in Rhode Island, had a current Drug

Enforcement Administration certificate, and complied with any applicable administrative rules;

     (ii) With the patient's consent:

     (A) Contacted a pharmacist and informed the pharmacist of the prescription; and

     (B) Delivered the written prescription personally, or by mail service or messenger service

(with a signature required on delivery), or electronically to the pharmacist, who dispensed the

medication to the patient, the physician, or an expressly identified agent of the patient.

     (13) The physician recorded and filed the following in the patient's medical record:

     (i) The date, time and detailed description of all oral requests of the patient;

     (ii) All written requests by the patient;

     (iii) The physician's diagnosis, prognosis, and basis for the determination that the patient

was capable, was acting voluntarily, and had made an informed decision;

     (iv) The second physician's diagnosis, prognosis, and verification that the patient was

capable, was acting voluntarily, and had made an informed decision;

     (v) The physician's attestation that the patient was enrolled in hospice care at the time of

the patient's oral and written requests or that the physician informed the patient of all feasible

alternatives, concurrent or additional treatment opportunities, and end-of-life care services; has

determined that the patient did not have impaired judgment;

     (vii) A report of the outcome and determinations made by the psychiatrist, psychologist,

or clinical social worker during any evaluation which the patient may have received;

     (viii) The date, time, and detailed description of the physician's offer to the patient to

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rescind the request for medication at the time of the patient's second oral request; and

     (ix) A note by the physician indicating that all requirements under this section were

satisfied and describing all of the steps taken to carry out the request, including a notation of the

medication prescribed.

     (14) After writing the prescription, the physician promptly filed a report with the

department of health documenting completion of all of the requirements under this section.

     (b) This section shall not be construed to limit civil or criminal liability for gross

negligence, recklessness, or intentional misconduct.

     23-4.13-4. No duty to aid.

     A patient with a terminal condition who self-administers prescribed medication to bring

about a peaceful death shall not be considered to be a person exposed to grave physical harm

under § 11-56-1, and no person shall be subject to civil or criminal liability solely for being

present when a patient with a terminal condition self-administers medication prescribed pursuant

to this chapter, or for not acting to prevent the patient from self-administering medication

prescribed pursuant to this chapter, or for not rendering aid to a patient who has self-administered

medication pursuant to this chapter.

     23-4.13-5. Limitations on actions.

     (a) A physician, nurse, pharmacist, or other person shall not be under any duty, by law or

contract, to provide medical aid in dying to an individual in accordance with this chapter.

     (b) A health care facility or health care provider shall not subject a physician, nurse,

pharmacist, or other person to discipline, suspension, loss of license, loss of privileges, or other

penalty for actions taken in good faith reliance on the provisions of this chapter or refusals to act

under this chapter.

     (c) Except as otherwise provided in this chapter herein, nothing in this chapter shall be

construed to limit liability for civil damages resulting from negligent conduct or intentional

misconduct by any person.

     23-4.13-6. No duty to provide medical aid in dying.

     (a) A health care provider may choose whether to provide medical aid in dying to an

individual in accordance with this chapter.

     (b) If a health care provider is unable or unwilling to carry out an individual's request for

medical aid in dying they must make reasonable efforts to accommodate the individual's request

including, transferring care of the individual to a new health care provider, and the unwilling

health care provider shall coordinate the transfer of the individual's medical records to the new

health care provider.

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     23-4.13-7. Health care facility exception.

     A health care facility may prohibit a physician from writing a prescription for medication

pursuant to this chapter for a patient who intends to self-administer said medication on the

facility's premises, provided the facility has previously notified the physician and patient in

writing of its policy with regard to the said prescriptions. Notwithstanding the provisions of § 23-

4.13-5(b), any physician who violates a policy established by a health care facility under this

section may be subject to sanctions otherwise allowable under law or contract.

     23-4.13-8. Insurance policies; Prohibitions.

     (a) A person and their beneficiaries shall not be denied benefits under any life insurance

policy, as defined in § 27-4-0.1, for actions taken in accordance with this chapter.

     (b) 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 upon or affected by an individual's

act of making or rescinding a request for medical aid-in-dying medication.

     (c) A patient's act of self-administering medication prescribed pursuant to this chapter

shall not invalidate any part of a life, health, or accident insurance or annuity policy.

     (d) It is unlawful for an insurer to deny or alter health care benefits otherwise available to

an individual with a terminal condition based on the availability of aid in dying or otherwise

attempt to coerce a patient with a terminal condition to make a request for medication pursuant to

this chapter.

     (e) The sale, procurement, or issue of any medical malpractice insurance policy or the

rate charged for the policy shall not be conditioned upon or affected by whether the physician is

willing or unwilling to participate in the provisions of this chapter.

     23-4.13-9. No effect on palliative sedation.

     This chapter shall not limit or otherwise affect the provision, administration, or receipt of

palliative sedation consistent with accepted medical standards.

     23-4.13-10. Protection of patient choice at end-of-life.

     A physician with a bona fide physician-patient relationship with a patient with a terminal

condition shall not be considered to have engaged in unprofessional conduct under § 5-37-5.1 if:

     (1) The physician determines that the patient is capable and does not have impaired

judgment; and

     (2) The physician informs the patient of all feasible end-of-life services, including

palliative care, comfort care, hospice care, and pain control; and

     (3) The physician prescribes a dose of medication intended to bring about a peaceful

death to the patient.

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     23-4.13-11. Immunity for physicians.

     (a) A health care provider or health care facility shall be immune from any civil or

criminal liability or professional disciplinary action for actions performed in good faith

compliance with the provisions of this chapter.

     (b) A request by an individual for or provision by a physician of medical aid-in-dying

medication with this chapter 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.

     (c) A person is not subject to civil or criminal liability when, in compliance with this

chapter for being present when a qualified individual self-administers the prescribed medical aid-

in-dying medication.

     (d) This section does not limit civil or criminal liability for negligence, recklessness or

intentional misconduct.

     23-4.13-12. Safe disposal of unused medications.

     A person who has custody or control of medical aid-in-dying medication dispensed under

this chapter that remains unused after the terminally ill individual's death will dispose of the

unused medical aid-in-dying medication by lawful means in accordance with state and federal

guidelines including:

     (1) Returning the unused medical aid-in-dying medication to the prescribing physician

who shall dispose of the medication by lawful means; or

     (2) Returning the unused medical aid-in-dying medication to a federally approved

medication take-back program.

     23-4.13-13. Death certificate.

     (a) Unless otherwise prohibited by law, the physician or the hospice medical director

shall sign the death certificate of a qualified individual who obtained and self-administered

medical aid-in-dying medication.

     (b) When a death has occurred in accordance with this chapter, the manner of death shall

not be listed as suicide or homicide.

     (c) When a death has occurred in accordance with this chapter, the cause of death shall be

listed as the underlying terminal illness.

     (d) When a death has occurred in accordance with this chapter, this alone does not

constitute grounds for a post-mortem inquiry, as described in § 23-4-4.

     23-4.13-14. Statutory construction.

     Nothing in this chapter shall be construed to authorize a physician or any other person to

end a patient's life by lethal injection, mercy killing, or active euthanasia. Action taken in

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accordance with this chapter shall not be construed for any purpose to constitute suicide, assisted

suicide, mercy killing, or homicide under the law. This section shall not be construed to conflict

with section 1553 of the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, as

amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152.

     SECTION 2. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO HEALTH AND SAFETY -- LILA MANFIELD SAPINSLEY

COMPASSIONATE CARE ACT

***

     This act would establish detailed steps and safeguards to create the Lila Manfield

Sapinsley Compassionate Care Act, to provide a legal mechanism whereby a terminally ill patient

may choose to end their life using drugs prescribed by a physician.

     This act would take effect upon passage.

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