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REFERENCE TITLE: terminally ill patients; suffering; control |
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State of Arizona House of Representatives Forty-eighth Legislature First Regular Session 2007
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HB 2357 |
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Introduced by Representatives Lopez, Bradley, Saradnik, Sinema: Cajero Bedford, DeSimone, Garcia M, Miranda
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AN ACT
Amending
title 36, chapter 32, Arizona Revised Statutes,
by adding article 8; relating to TERMINALLY ill patients.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it enacted by the Legislature of the State of Arizona:
Section 1. Title 36, chapter 32,
Arizona Revised Statutes,
is amended by adding article 8, to read:
ARTICLE 8. TERMINALLY ILL PATIENTS
36-3301. Definitions
In this article, unless the context otherwise requires:
1. "Advance
directive for control of suffering" means
a directive pursuant to this chapter that has language
that meets the requirements of section 36-3302, subsection A, paragraph
1.
2. "Attending
physician" means the physician who has primary responsibility
for the care of the patient and treatment of the patient's disease.
3. "Consulting
physician" means the physician who is qualified
by specialty or experience to make a professional diagnosis and
prognosis
regarding the patient's disease.
4. "Health
care provider" means a health professional
licensed pursuant to title 32 or a health care facility.
5. "Incapable"
means that in the opinion of a court
or the patient's attending or consulting physician,
the patient lacks the ability to make and communicate
health care decisions to a health care provider,
including communication through persons familiar
with the patient's manner of communicating.
6. "Informed
decision" means a decision by a qualified patient
to request and assume control of the patient's suffering
by obtaining a prescription to prevent unbearable suffering
after that patient's attending physician has fully informed the patient
of the following:
(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 physician directed pain management.
7. "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.
8. "Physician" means a physician licensed pursuant to title 32, chapter 13 or 17.
9. "Qualified patient" means an adult who is not incapable.
10. "Terminal
disease" means an incurable and irreversible disease
that has been medically confirmed and that will result,
within reasonable medical judgment, in a person's death within six
months.
36-3302. Request for medication; requirements
A. A
competent adult who is a resident of this state
may make a written request for medication for patient control of
suffering
pursuant to subsection C if that person:
1. At
least three months before, has executed an advance directive
for control of suffering that contains language
that is the same or substantially similar to the following:
If I am
diagnosed with a terminal illness,
I want to be able to control my own medication to lessen suffering
and preserve my dignity and be in control of my own pain and suffering.
2. Has
been determined by that person's attending physician
and consulting physician to be suffering from a terminal disease.
3. Has voluntarily expressed a wish to control the suffering from that disease.
B. The
medication shall be as agreed on by the patient and the prescribing
physician.
The physician may allow the prescription to be refilled
as is necessary for the patient to control the suffering pursuant to
this article.
C. The written request must be in substantially the following form:
Request for medication to take control of
my own management of my own suffering
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 and prognosis,
the nature of medication to be prescribed and the potential associated
risks,
the expected result and the feasible alternatives,
including comfort care, hospice care and physician directed pain
control.
I
request that my attending physician prescribe medication
that will allow me full control over management of my suffering.
Initial one:
_____ I have informed family members 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 understand that a secondary effect
of taking the prescribed medication is that it may hasten death.
I make
this request voluntarily and without reservation,
and I accept full 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 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.
D. 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. At the time the request is signed, entitled to any portion of the patient's estate.
3. An
owner, operator or employee of a health care facility
where the patient is receiving medical treatment or is a resident.
E. The patient's attending physician at the time the request is signed shall not be a witness.
36-3303. Responsibilities of attending physician
On
receiving a request from a patient
to prescribe medication to control suffering pursuant to this article,
the attending physician must do all of the following before issuing the
prescription:
1. Confirm that the patient has executed an advance directive for control of suffering.
2. Diagnose
whether a patient has a terminal disease,
is competent and has made the request voluntarily.
3. Inform the patient of:
(a) The patient's medical diagnosis.
(b) The patient's prognosis.
(c) The feasible
alternatives, including comfort care, hospice care
and traditional physician directed pain control.
4. Refer the patient to a consulting physician pursuant to section 36‑3304.
5. Before
writing the prescription for medication,
verify that the patient is making an informed decision.
6. Fulfill the medical record documentation requirements of section 36-3307.
7. Pursuant
to section 36-3307, ensure that all appropriate steps are carried out
in accordance with this article before writing the prescription for
medication.
36-3304. Consulting physician confirmation
Before a
patient can be prescribed medication pursuant to section 36‑3303,
a consulting physician must examine the patient
and the patient's relevant medical records,
confirm in writing the attending physician's diagnosis
that the patient is suffering from a terminal disease
and verify that the patient is competent,
is acting voluntarily and has made an informed decision.
36-3305. Informed decision
A person
shall not receive a prescription pursuant to this article
unless that person has made an informed decision as prescribed by this
article.
36-3306. Family notification
A. The
patient's attending physician
shall ask the patient to inform the patient's next of kin
of the patient's request for medication pursuant to this article.
B. A
patient who declines or is unable to notify next of kin
shall not have the patient's request denied for that reason.
36-3307. Medical record documentation requirements
A physician must document the following in the patient's medical records:
1. A copy of the advance directive for control of suffering executed by the patient.
2. All
written requests by the patient for medication
to control the patient's own suffering.
3. The
attending physician's diagnosis and prognosis,
and the determination 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
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.
36-3308. 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 the making or rescinding
of a request by a person for medication to control that person's
suffering.
B. A
qualified patient's act of taking medication
to control that person's own suffering
shall not have an effect on a life, health or accident insurance or
annuity policy.
36-3309. Construction of article
A. This
article does not authorize a physician or any other person
to end another person's life by lethal injection, mercy killing or
active euthanasia.
This article authorizes a physician to prescribe or order the
medication
and permits trained medical professionals to offer assistance,
but the actual act of controlling the intake of medication
must be in the immediate control of the patient.
B. If
the patient's decision to control suffering
has the secondary effect of hastening death,
this shall not for any purpose be constituted as
suicide, assisted suicide, mercy killing or homicide
or be cause for any professional disciplinary action
or civil or criminal penalty under the law.
C. This
article expands the right of a physician under certain circumstances
to prescribe or order medication to control suffering.
D. This
article does not interfere with or limit
any existing right of a physician to prescribe medication.