This bill did not become law in California.
But it is kept here because it contains some features
worthy of consideration when new right-to-die legislation is created anywhere.
In 2015, California did create an End of Life Option Act,
which has fewer safeguards than the earlier bill below.


The CALIFORNIA COMPASSIONATE CHOICES BILL

{downloaded from the California state website February 2007}

SAFEGUARDS HIGHLIGHTED AND LINKED BY JAMES PARK

 {The words highlighted in the text below are the words of the California bill,
but the hyperlinks are not part of this proposed law for California.
And the explanations to which the hyperlinks lead are not part of the bill.
The rest of the text has merely been reformatted
to make it easier to read on computer screens.
But no other changes have been made,
which can be confirmed by going to the website of the California legislature:
www.legislature.ca.gov. This is Assembly Bill AB 374.}




BILL NUMBER: AB 374 INTRODUCED
BILL TEXT


INTRODUCED BY Assembly Members Berg, Levine, and Nunez
(Principal coauthor: Assembly Member Feuer)
(Coauthors: Assembly Members Bass, Beall, Brownley, De Leon,
DeSaulnier, Dymally, Eng, Evans, Huffman, Jones, Karnette, Laird,
Leno, Ma, Saldana, and Wolk)
(Coauthors: Senators Calderon, Kuehl, Lowenthal, Oropeza, Romero,
Steinberg, and Wiggins)

FEBRUARY 15, 2007

An act to add Chapter 3.95 (commencing with Section 7195)
to Part 1 of Division 7 of the Health and Safety Code, relating to death.


LEGISLATIVE COUNSEL'S DIGEST


AB 374, as introduced, Berg. California Compassionate Choices Act.

Existing law provides for the licensure and regulation of health facilities
by the State Department of Health Services.
Effective July 1, 2007,
responsibility for the administration of the abovementioned provisions
will be transferred to the State Department of Public Health.
Existing law authorizes an adult to give an individual health care instruction
and to appoint an attorney to make health care decisions
for that individual in the event of his or her incapacity
pursuant to a power of attorney for health care.
This bill would enact the California Compassionate Choices Act,
which would authorize an adult who meets certain qualifications,
and who has been determined by his or her attending physician to be
suffering from a terminal disease, as defined,
to make a request for medication prescribed pursuant to this bill
to provide comfort with an assurance of peaceful dying
if suffering becomes unbearable.
The bill would establish procedures for making these requests.
This bill would further provide that no provision in a contract,
will, or other agreement, or in a health care service plan contract,
policy of disability insurance, or health benefit plan contract,
shall be valid to the extent it would affect whether a person may
make or rescind a request for the above-described medication.
The bill would prohibit the sale, procurement, or issuance
of any life, health, or accident insurance or annuity policy,
or the rate charged for any policy,
from being conditioned upon or affected by the request.
The bill would require that nothing in its provisions
be construed to authorize ending a patient's life by lethal injection,
mercy killing, or active euthanasia,
and would provide that action taken in accordance with the act
shall not constitute suicide or homicide.
This bill would provide immunity from civil or criminal liability
or professional disciplinary action
for participating in good faith compliance with the act.
The bill would provide that no health care provider
is under any duty to participate in providing
to a qualified patient medication to end that patient's life
and would authorize a general acute care hospital
to prohibit a licensed physician from carrying out a patient's request
under this act on the premises of the hospital
if the hospital has notified the licensed physician
of its policy regarding this act.
This bill would require the State Department of Public Health
to adopt regulations regarding the collection of information
to determine the use of and compliance with the act,
and would require the department
to annually review a sample of certain records
and make a statistical report of the information collected.
Vote: majority.
Appropriation: no.
Fiscal committee: yes.
State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

SECTION 1. Chapter 3.95 (commencing with Section 7195) is added to
Part 1 of Division 7 of the Health and Safety Code, to read:
CHAPTER 3.95. CALIFORNIA COMPASSIONATE CHOICES ACT



Article 1. General Provisions


7195. (a)

The Legislature believes that dying patients
should have choices throughout the continuum of palliative care
and that much must be done to improve access
to hospice care and pain management.
Hospice and effective palliative care
successfully assist many thousands of terminally ill patients
to die with dignity and without pain,
and the Legislature hopes that all patients considering
the procedures available under this chapter
will properly consider other options,
including hospice care and effective pain management.
The Legislature finds that medical studies have shown
that between 5 and 10 percent of dying patients
experience severe pain and suffering
that cannot be palliated by the best hospice or comfort care.
The Legislature finds that in response to
the Death with Dignity Act in the State of Oregon,
that the referrals to hospice increased significantly.
In addition, doctors significantly increased the use
of morphine and other strong pain medications,
thus improving the end-of-life care for more dying patients.

(b) (1) It is the intent of the Legislature
that the personal and autonomous choice of dying patients
regarding the time and manner of their death provided under this chapter
be viewed as but one of several end-of-life options for dying patients.

(2) It is the intent of the Legislature
that this chapter be strictly construed and not expanded in any manner.
The restrictions and safeguards in the provisions of this chapter
are based on the intent of the Legislature
to balance the personal and autonomous choice of dying patients
regarding the time and manner of their death
and the Legislature's goal of providing safeguards
to ensure that there are not instances of
a coerced, unwanted, or early death by a vulnerable dying patient.

(3) The Legislature finds and declares
that historically persons with disabilities
have been subject to discrimination in the provision of medical care
and have been treated by some as though
their lives were less valuable or worthy of maintenance
than those without disabilities.
The Legislature finds that this discriminatory conduct
is both illegal and reprehensible.

(4) It is the intent of the Legislature
that a disability or age alone is not a reason
for a patient to be a qualified patient
as defined in subdivision (l) of Section 7195.1.
Any disabled individual or elderly person,
and any physician who is the attending physician to these individuals,
must strictly comply with all of the provisions of this chapter.
Strict and rigorous attention
must be evidenced in distinguishing chronic conditions,
that are not eligible conditions under this chapter,
and terminal illnesses, which are eligible, as described in this chapter.

(5) It is the intent of the Legislature
for the physician discussions and written patient documents
in this chapter to be translated
in a manner that is consistent with Section 7295.2 of the Government Code,
Section 10133.8 of the Insurance Code, and Section 1367.04
if the otherwise qualified patient is non-English proficient
and meets the criteria of those sections.

7l95.1.

For purposes of this chapter the following definitions shall apply:

(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 the patient
and for treatment of the patient's terminal disease.

(c) "Capable" means that in the opinion
of the patient's attending physician or consulting physician,
a patient has the ability to make and communicate
health care decisions to health care providers,
including communication through persons
familiar with the patient's manner of communicating,
if those persons are available.

(d) "Consulting physician" means a physician,
other than the attending physician,
who is qualified by specialty or experience
to make a professional diagnosis and prognosis
regarding the patient's disease.

(e) "Counseling" means a consultation between
a state licensed psychiatrist or psychologist and a patient
for the purpose of determining whether the patient is 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
in the ordinary course of business or practice of a profession,
and includes a licensed health care facility.

(g) (1) "Health care facility" means
any health facility described in Section 1250.

(2) "Hospice" means a comprehensive, interdisciplinary program
of medical and socially supportive care
delivered to patients with a terminal disease
in order to palliate their symptoms and pain
since the patient's condition is no longer amenable to curative therapies
and for whom the primary therapeutic goal
is comfort and dignity at the end of life.

(h) "Informed decision" means a decision,
made by a qualified patient,
to request and obtain a prescription to end his or her life
in a humane and dignified manner,
that is not based on coercion by the patient's next-of-kin
or any other third parties,
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:

(1) His or her medical diagnosis.

(2) His or her prognosis.

(3) The potential risk associated with taking the medication to be prescribed.

(4) The probable result of taking the medication to be prescribed.

(5) The feasible alternatives,
as provided in paragraph (5) of subdivision (b) of Section 7196,
including, but not limited to,
comfort care, hospice care, and pain control.

(i) "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.

(j) "Medication" means medication prescribed
pursuant to this chapter
to provide comfort with an assurance of peaceful dying
if suffering becomes unbearable.

(k) "Patient" means a person who is under the care of a physician.

(l) "Physician" means a doctor of medicine or osteopathy
licensed to practice medicine by the Medical Board of California.

(m) "Qualified patient" means
a capable adult who is a resident of California
and has satisfied the requirements of this chapter
in order to obtain a prescription for medication .

(n) "Resident" means a person who has lived
in a principal place of residence in the State of California
for six months or more.

(o) "Terminal disease" means
an incurable and irreversible disease
that has been medically confirmed and will,
within reasonable medical judgment,
produce death within six months.

7195.3.

An adult who is capable, is a resident of California,
has been determined by the attending physician
and a consulting physician
to be suffering from a terminal disease,
and who has voluntarily expressed
his or her wish to obtain life-ending medication
to his or her attending physician
shall, in addition to the other requirements of this chapter,
make both an oral and a written request for medication
in accordance with this chapter
in order to be eligible for qualification under this chapter.

7195.5.

(a) A valid written request for medication under this chapter
shall be in substantially the form prescribed by Section 7199,
signed and dated by the patient
and witnessed by at least two 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 is not being coerced to sign the request.

(b) Both of the witnesses shall be a person who is not any of the following:

(1) A relative of the patient by blood, marriage, or adoption.

(2) A person who at the time the request is signed
would be entitled to any portion of the estate of the qualified patient
upon death under any will or by operation of law.

(3) An owner, operator, or employee of a health care facility
where the qualified patient is receiving medical treatment or is a resident.

(c) The patient's attending physician at the time the request is signed
shall not be a witness.

Article 2. Safeguards


7196.

Upon being voluntarily informed by a qualified patient
that the patient wishes to receive medication in accordance with this chapter,
the attending physician shall do all of the following:

(a) Make the initial determination of whether a patient
has a terminal disease, is capable, and has made the request voluntarily.

(b) Inform the patient of all of the following:

(1) His or her medical diagnosis.

(2) His or her prognosis.

(3) The potential risks associated with taking the medication to be prescribed.

(4) The probable result of taking the medication to be prescribed.

(5) The feasible alternatives, including, but not limited to,
comfort care, hospice care, and pain control.
This disclosure must be provided in writing to the patient,
and shall include, but not be limited to,
contact information about locally based providers of comfort and hospice care.

(c) 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.

(d) Refer the patient for counseling,
if appropriate pursuant to Section 7196.2.

(e) Request that the patient notify next of kin.

(f) Inform the patient that he or she has an opportunity
to rescind the request at any time and in any manner,
and offer the patient an opportunity to rescind
at the end of the 15-day waiting period described in Section 7196.5.

(g) Verify, immediately prior to writing the prescription
for medication under this chapter,
that the patient is making an informed decision.

(h) Fulfill the medical record documentation requirements of Section 7196.8.

(i) Ensure that all appropriate steps
are carried out in accordance with this chapter
prior to writing a prescription for medication.

7196.1.

Before a patient is qualified under this chapter,
a consulting physician shall examine the patient
and his or her relevant medical records
and shall, in writing, confirm, the attending physician's diagnosis
and that the patient is suffering from a terminal disease
and verify that the patient is capable,
is acting voluntarily, and has made an informed decision.

7196.2.

If, in the opinion of the attending physician or the consulting physician,
a patient may be suffering from a psychiatric or psychological disorder
that impairs judgment or from depression
or medication that impairs judgment,
or the patient is not a hospice patient,
the attending physician or consulting physician
shall require the patient to undergo counseling
as specified in subdivision (e) of Section 7195.1.
In this case, no medication shall be prescribed
unless the patient first undergoes the requisite consultation or counseling
and until the person performing the counseling
determines that the patient is not suffering
from a psychiatric or psychological disorder that impairs judgment,
or from impaired judgment caused by depression or medication.

7196.3.

No person shall receive a prescription for medication
unless he or she has made an informed decision
as defined in subdivision (h) of Section 7195.
Immediately prior to writing a prescription for medication
in accordance with this chapter,
the attending physician shall verify
that the patient is making an informed decision.

7196.4.

The attending physician shall ask the patient
to notify the patient's next of kin
of his or her request for medication pursuant to this chapter.
A patient who declines or is unable to notify next of kin
shall not have his or her request denied for that reason.

7196.5.

In order to receive a prescription for medication,
a qualified patient shall have made an oral request and a written request,
and reiterate the oral request to his or her attending physician
no 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.

7196.6.

A patient may rescind his or her request at any time and in any manner
without regard to his or her mental state.
No prescription for medication under this chapter may be written
without the attending physician offering the qualified patient
an opportunity to rescind the request.

7196.7.

No less than 15 days shall elapse
between the patient's initial oral request
and the writing of a prescription under this chapter.
No less than 48 hours shall elapse
between the patient's written request
and the writing of a prescription under this chapter.

7196.8.

The following shall be documented or filed in the patient's medical record:

(a) All oral requests by a patient for medication.

(b) All written requests by a patient for medication.

(c) The attending physician's diagnosis and prognosis,
and his or her determination that the patient is capable,
acting voluntarily, and has made an informed decision.

(d) The consulting physician's diagnosis and prognosis,
and his or her verification that the patient is capable,
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 pursuant to Section 7196.5.

(g) The attending physician's discussion with the patient
of feasible alternatives, including, but not limited to,
hospice care, comfort care, and pain control.

(h) A note by the attending physician
indicating that all the requirements of this chapter have been met
and indicating the steps taken to carry out the request,
including a notation of the medication prescribed.

7196.9.

Only requests made by California residents under this chapter shall be granted.

7197.1.

(a) The department shall adopt regulations
regarding requirements for the collection of information
to determine the use of and compliance with this chapter.
The information collected shall not be a public record
and shall not be made available for inspection by the public.

(b) The department shall generate and make available to the public
an annual statistical report of information collected,
disaggregated by age, gender, race, ethnicity,
and language spoken at home, pursuant to subdivision (a).

(c) The department shall annually review a sample of records
maintained pursuant to this chapter.

7197.3.

(a) No provision in a contract, will, or other agreement,
whether written or oral,
to the extent the provision would affect
whether a person may make or rescind a request for medication,
shall be valid.

(b) No obligation owing under any contract in existence
on or before January 1, 2008,
shall be conditioned or affected by
the making or rescinding of a request by a person for medication.

(c) No health care service plan contract,
as defined in subdivision (r) of Section 1345,
shall be conditioned upon or affected by
the making or rescinding of a request by a person for medication.
Any such contract provision shall be invalid.

(d) No provision of a policy of disability insurance
or a health benefit plan contract
that provides coverage for hospital, medical, or surgical expenses
pursuant to Part 2 (commencing with Section 10110)
of Division 2 of the Insurance Code
shall be conditioned upon or affected by
the making or rescinding of a request by a person
to end his or her life in a humane and dignified manner.
Any such policy provision shall be invalid.

7197.5.

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 upon or affected by
the making or rescinding of a request by a person for medication.
A qualified patient's act of ingesting medication
to end his or her life in a humane and dignified manner
in accordance with this chapter
shall not have an effect upon
a life, health, or accident insurance or annuity policy.

7197.7.

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.
The patient must self-administer the medication provided under this chapter.
Actions taken in accordance with this chapter shall not, for any purpose,
constitute suicide, assisted suicide, mercy killing, or homicide, under the law.
Every state agency, department, or office
that prepares or issues a document or report
that describes or refers to the medical practice described in this chapter
shall use the phrase "aid in dying"
to describe or reference the medical practice in the document or report.

7197.8.

Nothing in this chapter shall affect the authority
of a coroner or medical examiner to investigate a death.

Article 3. Immunities and Liabilities


7198.

Except as provided in Section 7198.5:
(a) Notwithstanding any other provision of law,
no person shall be subject to civil or criminal liability
or professional disciplinary action
for participating in good faith compliance with this chapter.
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) No professional organization or association, or heath care provider,
may subject a person to censure, discipline, suspension,
loss of license, loss of privileges, loss of membership, or other penalty
for participating or refusing to participate
in good faith compliance with this chapter.

(c) No request by a patient for
or provision by an attending physician of
medication in good faith compliance with this chapter
shall constitute neglect for any purpose of law
or provide the sole basis for the appointment of a guardian or conservator.

(d) No health care provider shall be 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.
If a health care provider is unable or unwilling
to carry out a patient's request under this chapter,
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.

(e) Notwithstanding any other provision of law,
a general acute care hospital,
as defined in subdivision (a) of Section 1250,
may prohibit a licensed physician
from carrying out a patient's request under this chapter
on the premises of the hospital
if the hospital has notified the licensed physician
of its policy regarding this chapter.

7198.5.

(a) Nothing in this chapter limits civil or criminal liability
resulting from other negligent conduct
or intentional misconduct by any person.

(b) The penalties in this chapter
do not preclude criminal penalties applicable under other law
for conduct that is inconsistent with this chapter.

Article 4. Severability


7198.9.

Any section of this chapter that is held invalid
as to any person or circumstance
shall not affect the application of any other section of this chapter
that can be given full effect without the invalid section or portion thereof.

Article 5. Form of the Request


7199.

A request for a medication as authorized by this chapter
shall 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
which will, within reasonable medical judgment,
likely lead to my death within six months,
and which has been medically confirmed by a consulting physician.
I have been fully informed of my diagnosis,
prognosis, the nature of the medication to be prescribed,
and the 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 allow me to hasten the end of my life
in a humane and dignified manner.

INITIAL ONE:
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 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:
(a) Is personally known to us or has provided proof of identity;
(b) Signed this request in our presence;
(c) Appears to be of sound mind
and not under duress, fraud, or undue influence;
(d) Is not a patient for whom either of us is the attending physician.
------------------------ Witness 1/Date
------------------------ Witness 2/Date


NOTE: Neither witness shall be a relative
(by blood, marriage, or adoption)
of the person signing this request.
Neither witness shall be entitled to any portion
of the person's estate upon death.
Neither witness shall own, operate, or be employed
at a health care facility where the person is a patient or resident.

Go to an organized list of the safeguards
included in this bill (and others like it).

Go to an open letter to drafters of gentle poison legislation.
This letter suggests some minor revisions to the text above.


Go to Safeguards for the Right-to-Die

Go to Portal for the Right-to-Die

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James Leonard Park—Free Library