Be it enacted by the Legislature of the State of Arizona:
Section 1. Title 36, Arizona Revised Statutes,
is amended by adding chapter 38, to read:
CHAPTER 38
AID IN DYING
ARTICLE 1. GENERAL PROVISIONS
START_STATUTE36-3801. Definitions
In this chapter, unless
the context otherwise requires:
1. "Aid in dying" means the issuance of
a prescription for medication for self-administration that will terminate the
life of a qualified patient in a painless, humane and dignified manner.
2. "Consulting physician" means a
physician who is qualified by specialty or experience to make a professional
diagnosis and prognosis regarding a patient's disease.
3. "Counseling" means a consultation
between a psychiatrist or psychologist licensed by this state and a patient for
the purpose of determining whether the patient is suffering from a psychiatric
or psychological disorder or depression causing impaired judgment.
4. "Department" means the department of
health services.
5. "Informed decision" means a decision
by a qualified patient to request and obtain a prescription to end the
patient's life that is based on an appreciation of the relevant facts and after
being fully informed by the attending physician of:
(a) The medical diagnosis.
(b) The Prognosis.
(c) The potential risks associated with taking the medication to
be prescribed.
(d) The probable result of taking the medication to be
prescribed.
(e) The feasible alternatives, including comfort care, hospice
care and pain control.
6. "Medically confirmed" means that 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.
7. "Qualified patient" means a capable
adult who has resided in this state for at least ninety days and who has
satisfied the requirements of this article in order to obtain a prescription to
end the patient's life.
8. "Terminal
condition" means a condition that results from an accident or an incurable
and irreversible disease, that has been medically confirmed and that will
cause, with reasonable medical judgment, death within six months. END_STATUTE
START_STATUTE36-3802. Request for medication; requirements;
signatures
A. A qualified patient may make a written request
for medication to end the patient's life as prescribed by this article.
B. A request for medication under this article
must be in substantially the form described in section 36-3818, signed and
dated by the patient and 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 competent, is acting voluntarily and is not being coerced to sign
the request.
C. At least one of the witnesses must be a person
who is not:
1. A relative of the patient by blood, marriage
or adoption.
2. A person who at the time the request is signed
is entitled to any portion of the estate of the patient on the patient's death
under any will or by operation of law.
3. An owner, operator or employee of a health
care facility where the patient is receiving medical treatment or is a
resident.
D. The patient's attending physician at the time
the request is signed shall not be a witness.
E. Notwithstanding the requirements of subsection
B of this section, if the patient resides in a long-term care facility at the
time the written request is made, one of the witnesses must be a person who is
designated by the facility and who has the qualifications specified by the
department as prescribed by rule.
F. If the patient is competent but is unable to
write or to sign a statement, the patient may substitute a video recording,
witnessed by two qualified individuals, for the written request. END_STATUTE
START_STATUTE36-3803. Safeguards; attending physician;
responsibilities
The attending physician must:
1. Make the initial determination of whether a
patient has a terminal condition, is competent and has made the request
voluntarily.
2. Inform the patient of:
(a) The
patient's medical diagnosis.
(b) The
patient's prognosis.
(c) The
potential risks associated with taking the medication to be prescribed.
(d) The
probable result of taking the medication to be prescribed.
(e) The
feasible alternatives, including comfort care, hospice care and pain control.
3. Refer the patient to a consulting physician
for medical confirmation of the diagnosis and for a determination that the
patient is competent and is acting voluntarily.
4. Refer the patient for counseling if required
pursuant to section 36-3805.
5. Request that the patient notify the patient's
next of kin.
6. Inform the patient that the patient can
rescind the request at any time and in any manner and offer the patient an opportunity to rescind at the end of the fifteen day waiting period prescribed in section
36-3810.
7. Verify, immediately before writing the
prescription for medication, that the patient is making an informed decision.
8. Fulfill the medical record documentation
requirement of section 36‑3811.
9. Ensure that all appropriate steps are carried
out in accordance with this article before writing a prescription for medication
to enable the qualified patient to end the patient's life in a humane and
dignified manner. END_STATUTE
START_STATUTE36-3804. Consulting physician; confirmation of
diagnosis
A. Before a patient is qualified under this
article, a consulting physician must examine the patient and the patient's
relevant medical records, must confirm, in writing, the attending physician's
diagnosis that the patient is suffering from a terminal condition and must
verify that the patient is competent, is acting voluntarily and has made an
informed decision.
B. The consulting physician may not be a partner,
shareholder or employee in the same medical practice as the attending
physician. END_STATUTE
START_STATUTE36-3805. Counseling referral
A. 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 causing impaired judgment, the physician
must refer the patient for counseling.
B. A physician shall not prescribe medication to
end a patient's life until the person performing the counseling determines that
the patient is not suffering from a psychiatric or psychological disorder or
depression causing impaired judgment.
C. A counseling psychiatrist or psychologist
shall not be a partner, shareholder or employee in the same practice as the
attending physician. END_STATUTE
START_STATUTE36-3806. Informed decision
A patient shall not receive a prescription for medication to
end the patient's life unless the patient has made an informed decision as
prescribed in section 36-3803. END_STATUTE
START_STATUTE36-3807. Family notification
The attending physician must ask the patient to notify the
patient's next of kin of the patient's request for medication pursuant to this
article. If a patient declines or is unable to notify the patient's next of
kin, the physician shall not deny a request for medication for this reason. END_STATUTE
START_STATUTE36-3808. Written and oral requests
A. In order to receive a prescription for
medication under this article, a patient must make an oral and a written
request and must reiterate the oral request to the patient's attending
physician at least fifteen days after making the initial oral request.
B. At the time the qualified patient makes the
second oral request, the attending physician must offer the patient an opportunity to rescind the request. END_STATUTE
START_STATUTE36-3809. Right to rescind request
A patient may rescind a request at any time and in any
manner without regard to the patient's mental state. No prescription for
medication under this article may be written without the attending physician
offering the qualified patient an opportunity to rescind the request. If a
directive or request is rescinded, it must be as if the directive or request
were never made. END_STATUTE
START_STATUTE36-3810. Waiting periods
A. At least fifteen days must elapse between the
patient's initial oral request and the writing of a prescription under this
article. At least forty-eight hours must elapse between the patient's written
request and the writing of a prescription under this article.
B. If all other requirements of this article are
met, the waiting periods provided in this section may be shortened if the
primary physician certifies in writing that the patient is in extreme pain and
the imposition of a waiting period would serve only to extend the suffering of
the patient. END_STATUTE
START_STATUTE36-3811. Medical records; documentation;
requirements
The following information must be documented or filed in the
patient's medical record:
1. All oral requests by a patient for medication
to end the patient's life.
2. All written requests by a patient for
medication to end the patient's life.
3. The attending physician's diagnosis and
prognosis and verification that the patient is competent, is acting voluntarily
and has made an informed decision.
4. The consulting physician's diagnosis and
prognosis and verification that the patient is competent, is acting voluntarily
and has made an informed decision.
5. A report of the outcome and determinations
made during counseling, if performed.
6. The attending physician's offer to the patient
to rescind the patient's request at the time of the patient's second oral
request pursuant to section 36-3808.
7. A note by the attending physician indicating
that all requirements under this article have been met and indicating the steps
taken to carry out the request, including a notation of the medication
prescribed. END_STATUTE
START_STATUTE36-3812. Reporting requirements
A. The department shall annually review a sample
of records maintained pursuant to this article.
B. The department shall adopt rules to facilitate
the collection of information regarding compliance with this article. The
information collected is not a public record and is not available for
inspection by the public.
C. The department shall generate and make
available to the public an annual statistical report of information collected
under this article. END_STATUTE
START_STATUTE36-3813. Effect on construction of wills and
contracts
A. A provision in any contract, will or other
agreement, whether written or oral, that would affect whether a person may make
or rescind a request for medication to end the patient's life in a humane and
dignified manner is not valid.
B. An obligation owing under any currently
existing contract shall not be conditioned on or affected by a person making or
rescinding a request for medication to end the person's life in a humane and
dignified manner. END_STATUTE
START_STATUTE36-3814. Insurance or annuity policies
A. The sale, procurement or issuance of any life,
health or accident insurance or annuity policy or the rate charged for any
policy shall not be conditioned on or affected by a person making or rescinding
a request for medication to end the person's life in a humane and dignified
manner.
B. An insurer shall not require or request an
insured to disclose whether the insured has considered or executed a request
for aid in dying.
C. A qualified patient's act of ingesting
medication to end the patient's life in a humane and dignified manner does not
affect a life, health or accident insurance or annuity policy. END_STATUTE
START_STATUTE36-3815. Construction
This article does not authorize a physician or any other
person to end a patient's life by lethal injection, mercy killing or active
euthanasia. Notwithstanding any other law, actions taken in accordance with
this article do not constitute, for any purpose, suicide, assisted suicide,
mercy killing or homicide. END_STATUTE
START_STATUTE36-3816. Immunities
Except as provided in section 36-3817:
1. A person is not subject to civil or criminal
liability or professional disciplinary action for participating in good faith
compliance with this article. This includes being present when a qualified
patient takes the prescribed medication to end the patient's life in a humane
and dignified manner.
2. This article does not authorize any person to
assist in the administration of medication unless that person is designated by
a qualified patient to administer or dispense the medication because of the
qualified patient's physical disability.
3. A professional organization or association or
health care provider shall not subject a person to censure, discipline,
suspension, loss of privileges, loss of membership or any other penalty for
participating or refusing to participate in good faith compliance with this
article.
4. A request by a patient for or provision by an
attending physician of medication in good faith compliance with this article
does not constitute neglect for any purpose of law or provide the sole basis
for the appointment of a guardian or conservator.
5. A health care provider is not
under any duty, whether by contract, by statute or by any other legal
requirement, to participate in the provision to a qualified patient of
medication to end the patient's 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 article, the health care provider must promptly transfer the
responsibility to another provider who is willing to act in accordance with the
qualified patient's wishes. The health care provider must transfer, on
request, a copy of the patient's relevant medical records to the new health
care provider.
6. A health care facility that refuses to allow
aid in dying to be prescribed or administered on its premises shall not deny
staff privileges or employment to a person for the sole reason that the person
previously participated in aid in dying.
7. A licensed pharmacist who dispenses lethal
medicine based on a valid prescription by a physician aiding a patient to die
under this article is not subject to civil, criminal or administrative liability
for doing so. END_STATUTE
START_STATUTE36-3817. Violations; classification; liability
A. A person who without authorization of the
patient wilfully 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 manslaughter.
B. A person who coerces or exerts undue influence
on a patient to request medication for the purpose of ending the patient's life
or to destroy a rescission of such a request is guilty of manslaughter.
C. This article does not limit further liability
for civil damages resulting from other negligent conduct or intentional
misconduct by any person.
D. The penalties in this article do not preclude
criminal penalties applicable under any other law for conduct that is
inconsistent with this article. END_STATUTE
START_STATUTE36-3818. Sample form
A request for a
medication as authorized by this article 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, my 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
ONE:
_____ I have informed my family of my decision and have
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 make this request
voluntarily and without reservation, and I accept full moral responsibility for
my actions.
Signed:
________________________
Dated:
________________________
DECLARATION
OF WITNESSES
We declare that the person signing this request:
1. Is personally known to us or has provided
proof of identity.
2. Signed this request in our presence.
3. Appears to be of sound mind and not under
duress, fraud or undue influence.
4. Is not a patient for whom either of us is the
attending physician.
Witness 1 ________________________________
Date _____________________________________
Witness 2 ________________________________
Date _____________________________________
NOTE: One
witness shall not be a relative (by blood, marriage or adoption) of the person
signing this request, shall not be entitled to any portion of the person's
estate on death and shall not own, operate or be employed at a health care
facility where the person is a patient or resident. If the patient is an
inpatient at a health care facility, one of the witnesses must
be an individual designated by the facility. END_STATUTE