Bill > AB351

Introduced Session

Legislative Counsel's Digest: Existing law authorizes a patient who has been diagnosed with a terminal 1 condition to refuse life-resuscitating or life-sustaining treatment in certain 2 circumstances. (NRS 449A.400-449A.581, 450B.400-450B.590) Sections 5-30of 3 this bill authorize a patient, under certain circumstances, to self-administer a 4 medication that is designed to end the life of the patient. Sections 6-12of this bill 5 define relevant terms. Section 13of this bill authorizes a patient to request that his 6 or her physician prescribe a medication that is designed to end his or her life if the 7 patient: (1) is at least 18 years of age; (2) has been diagnosed with a terminal 8 condition by at least two physicians; (3) is a resident of this State; (4) has made an 9 informed and voluntary decision to end his or her own life; (5) is competent; and 10 (6) is not requesting the medication because of coercion or undue influence. 11 Section 14of this bill prescribes certain requirements concerning the manner in 12 which a patient may request a medication that is designed to end the life of the 13 patient, including that the patient must make two verbal requests and one written 14 request for the medication, and that the written request for the medication must be 15 signed by a witness. Section 15of this bill prescribes the form for the written 16 request for the medication. Section 16of this bill imposes certain requirements 17 before a physician is allowed to prescribe a medication that is designed to end the 18 life of a patient, including that the physician: (1) inform the patient of his or her 19 right to revoke a request for the medication at any time; (2) determine and verify 20 that the patient meets the requirements for making such a request; (3) discuss 21 certain relevant factors with the patient, including the diagnosis and prognosis of 22 the patient and alternative options for care; (4) refer the patient to a consulting 23 physician who can confirm the diagnosis, prognosis and competence of the patient 24 and that the patient has not been coerced or unduly influenced; and (5) instruct the 25 patient against self-administering the medication in public. Section 17of this bill 26 requires a physician who determines that a patient who has requested a prescription 27 for a medication that is designed to end his or her life may not be competent to refer 28 the patient to a qualified mental health professional and to receive confirmation 29 about the patient s competence. 30 Section 18of this bill: (1) prescribes procedures for the issuance of a 31 prescription for a medication that is designed to end the life of the patient; and (2) 32 provides that only an attending physician or pharmacist may dispense such a 33 medication. Section 19of this bill prohibits an attending physician from 34 prescribing a medication that is designed to end the life of a patient based solely on 35 the age or disability of the patient. Section 20of this bill requires certain providers 36 of health care to include certain information concerning requests and prescriptions 37 for and the dispensing of a medication that is designed to end the life of a patient in 38 the medical record of the patient. If a patient who has requested a medication that is 39 designed to end the life of a patient transfers care to another physician or health 40 care facility, sections 20and 28of this bill require the physician or health care 41 facility that previously provided care to the patient to transfer the patient s medical 42 records to the new physician or health care facility. Section 23of this bill 43 prescribes certain information that must be reported to the Division of Public and 44 Behavioral Health of the Department of Health and Human Services relating to a 45 patient who has been prescribed or self-administered such a medication. Section 2446 of this bill requires the Division to compile an annual report concerning the 47 implementation of the provisions of this bill authorizing a patient to request a 48 prescription for a medication that is designed to end the life of the patient. Sections 49 23, 24, 37and 41of this bill provide that such information is otherwise 50 confidential when reported to the Division. 51 Section 21of this bill allows a patient, at any time, to revoke a request for a 52 medication that is designed to end his or her life. Sections 22and 32of this bill 53 provide that only the patient to whom a medication that is designed to end his or 54 her life is prescribed may administer the medication. Section 22establishes 55 requirements for the disposal of any unused portion of the medication. 56 Section 30of this bill makes certain persons exempt from professional 57 discipline and immune from civil and criminal penalties and provides that such 58 persons do not violate any applicable standard of care for taking actions authorized 59 by this bill to assist a patient in acquiring a medication that is designed to end the 60 life of the patient. Section 25of this bill provides that a death resulting from the 61 self-administration of a medication that is designed to end the life of a patient is not 62 suicide or homicide when done in accordance with the provisions of this bill, and 63 section 2of this bill requires a death certificate to list the terminal condition of the 64 patient as the cause of death of the patient. Sections 1and 3of this bill provide that 65 a coroner, coroner s deputy or local health officer is: (1) not required to certify the 66 cause of such a death; and (2) prohibited from investigating such a death under 67 certain circumstances. 68 Sections 26and 35of this bill prohibit a person from preventing or requiring a 69 person to make or revoke a request for a medication that is designed to end the life 70 of the person as a condition to receiving health care or as a condition in an 71 agreement, contract or will. 72 Existing law makes it a category A felony to administer poison or cause poison 73 to be administered with the intention of causing the death of a person. Such a crime 74 is punishable by imprisonment for life with eligibility for parole after 5 years, or by 75 a definite term of 15 years with eligibility for parole after 5 years. (NRS 200.390) 76 Section 27of this bill makes it a category A felony with the same punishment to 77 engage in certain fraudulent or coercive acts intended to cause a person to self-78 administer a medication that is designed to end the life of the person. 79 Section 28of this bill clarifies that a physician is not required to prescribe a 80 medication that is designed to end the life of a patient and remains responsible for 81 treating the patient s pain. However, if a patient who is diagnosed with a terminal 82 condition requests information concerning the prescription and self-administration 83 of a medication that is designed to end the life of the patient, section 28requires a 84 physician to provide that information or refer the patient to another provider of 85 health care who is willing to do so. Section 28also provides that a pharmacist is 86 not required to fill a prescription for or dispense such a medication. Section 29of 87 this bill allows the owner or operator of a health care facility to prohibit an 88 employee or independent contractor of a health care facility or any person who 89 provides services on the premises of the health care facility from providing any 90 services relating to prescribing a medication that is designed to end the life of a 91 patient while acting within the scope of his or her employment or contract with the 92 facility or while on the premises of the facility. Section 30of this bill prohibits a 93 health care facility, provider of health care or professional association from taking 94 certain actions against an employee, independent contractor or member who: (1) 95 provides accurate information concerning end-of-life care to a patient within or 96 outside the scope of employment, contract or membership, as applicable; or (2) 97 facilitates the prescription or self-administration of a medication that is designed to 98 end the life of the patient outside the scope of the employment, contract or 99 membership, as applicable. Sections 31-34of this bill make conforming changes to 100 clarify that a physician or pharmacist may dispense a medication that is designed to 101 end the life of a patient that is a controlled substance or dangerous drug and a 102 patient may self-administer such a medication in accordance with other provisions 103 governing medications designed to end the life of a patient. 104 Section 36of this bill provides that a proposed protected person shall not be 105 deemed to be in need of a general or special guardian solely because the proposed 106 protected person requested a medication that is designed to end his or her life or 107 revoked such a request. 108 Existing law creates certain civil and criminal penalties for willfully engaging 109 in a deceptive trade practice. (NRS 598.0973, 598.0999) Section 38of this bill 110 makes it a deceptive trade practice for a provider of health care or an owner, 111 officer, employee or independent contractor of a health care facility to knowingly 112 engage in any false, misleading or deceptive conduct concerning the willingness of 113 the provider or health care facility to take certain actions relating to the prescription 114 and self-administration of a medication that is designed to end the life of the 115 patient. 116 Sections 39and 40of this bill clarify that an advanced practice registered 117 nurse is not authorized to prescribe a medication that is designed to end the life of a 118 patient. 119 Sections 42and 43of this bill prohibit insurers from: (1) refusing to sell, 120 provide or issue a policy of life insurance or group life insurance or annuity 121 contract or charging a higher rate because a person makes or revokes a request for a 122 medication that is designed to end the life of the person or self-administers such a 123 medication; or (2) conditioning life insurance benefits, group life insurance benefits 124 or the payment of claims on whether the insured makes, fails to make or revokes a 125 request for a medication that is designed to end the life of the insured or self-126 administers such a medication. Section 44of this bill makes a conforming change 127 to reflect this prohibition on a policy of group life insurance. 128 WHEREAS, A mentally capable adult patient should have the 1 right to self-determination concerning his or her health care 2 decisions based on his or her values, beliefs or personal preferences; 3 and 4 WHEREAS, It is important that patients have the full range of 5 options for their care, especially at the end of their lives; and 6 WHEREAS, Patients with a terminal illness may undergo 7 unremitting pain, agonizing discomfort and a sudden, continuing 8 and irreversible reduction in their quality of life; and 9 WHEREAS, The availability of medical aid in dying provides an 10 additional palliative care option for persons with a terminal illness 11 who seek to retain their autonomy and some level of control over 12 the progression of their disease or ease unnecessary pain and 13 suffering; and 14 WHEREAS, The integration of medical aid in dying into standard 15 end-of-life care has demonstrably improved such care by 16 contributing to better conversations between providers of health care 17 and patients, earlier and more appropriate enrollment in hospice care 18 and better training concerning palliative care for providers; and 19 WHEREAS, Patient-directed care respects and responds to the 20 decisions, preferences, needs and values of individual patients, 21 ensures that the values of patients direct all clinical decisions 22 concerning their care and ensures that patients are fully informed of 23 and able to access the options for care that they desire; now, 24 therefore, 25 SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS: 2 Section 1. Chapter 440 of NRS is hereby amended by adding 4 thereto a new section to read as follows: 5 1. A coroner, coroner s deputy or local health officer: 6 (a) Is not required to certify the cause of death of a patient 7 who dies after self-administering a medication that is designed to 8 end the life of the patient in accordance with the provisions of 9 sections 5 to 30, inclusive, of this act; and 10 (b) Must not investigate the death of a patient who dies after 11 self-administering a medication that is designed to end the life of 12 the patient in accordance with the provisions of sections 5 to 30, 13 inclusive, of this act if the coroner or coroner s deputy confirms 14 the circumstances of the death with a physician responsible for 15 overseeing the care of the patient or the physician who prescribed 16 the medication. 17 2. A coroner, coroner s deputy or local health officer may 18 access any records or information submitted to the Division of 19 Public and Behavioral Health of the Department of Health and 20 Human Services pursuant to section 23 of this act to confirm that 21 a patient died from self-administering a medication that is 22 designed to end the life of the patient in accordance with the 23 provisions of sections 5 to 30, inclusive, of this act. 24 Sec. 2. NRS 440.380 is hereby amended to read as follows: 440.380 1. The Except as otherwise provided in subsection 26 3, the medical certificate of death must be signed by the physician 27 or advanced practice registered nurse, if any, last in attendance on 28 the deceased, or pursuant to regulations adopted by the Board, it 29 may be signed by the attending physician s associate physician, the 30 chief medical officer of the hospital or institution in which the death 31 occurred, or the pathologist who performed an autopsy upon the 32 deceased. The person who signs the medical certificate of death 33 shall specify: 34 (a) The social security number of the deceased. 35 (b) The hour and day on which the death occurred. 36 (c) The cause of death, so as to show the cause of disease or 37 sequence of causes resulting in death, giving first the primary cause 38 of death or the name of the disease causing death, and the 39 contributory or secondary cause, if any, and the duration of each. 40 2. In deaths in hospitals or institutions, or of nonresidents, the 41 physician or advanced practice registered nurse shall furnish the 42 information required under this section, and may state where, in his 43 or her opinion, the disease was contracted. 44 3. The medical certificate of death of a patient who dies after 1 self-administering a medication that is designed to end the life of 2 the patient in accordance with sections 5 to 30, inclusive, of this 3 act: 4 (a) May be signed by the physician who prescribed the 5 medication or the operator of a facility for hospice care, as defined 6 in NRS 449.0033, at which the patient dies; 7 (b) Must specify the terminal condition with which the patient 8 was diagnosed as the cause of death; and 9 (c) Must not mention that the patient self-administered a 10 medication that is designed to end the life of the patient. 11

AI Summary

Committee Categories

Edgar Flores (D)*, 

(No further action taken.) (on 06/01/2021)

Official Document