AB781: Bill Text

AB781,,25 (9) “Medical aid in dying” means the practice of evaluating a request, determining qualification, and providing a prescription to a qualified individual under this chapter.

AB781,,26 (10) “Medically confirmed” means that a consulting provider, after performing a medical evaluation, has confirmed an attending provider’s medical opinion that an individual is eligible to receive medication under this chapter.

AB781,,27 (11) “Mentally capable” means that in the opinion of an attending provider or consulting provider, or a licensed mental health care provider if a determination is requested under s. 156.17, an individual requesting medication under this chapter has the ability to make and communicate an informed decision.

AB781,,28 (12) “Prognosis of 6 months or less” means an individual’s terminal disease will, within reasonable medical judgment, result in the death of that individual within 6 months.

AB781,,29 (13) “Provider” means a person licensed, certified, or otherwise authorized or permitted by this state to diagnose and treat medical conditions and prescribe and dispense medication, including controlled substances, but does not include a health care facility. Provider includes any of the following:

AB781,,30 (a) A physician licensed under ch. 448.

AB781,,31 (b) An advanced practice registered nurse, as defined in s. 154.01 (1g).

AB781,,32 (c) A physician assistant licensed under subch. IX of ch. 448.

AB781,,33 (14) “Qualified individual” means a mentally capable adult who has satisfied the requirements of this chapter in order to obtain a prescription for medication to bring about a peaceful death. No person will be considered a “qualified individual” under this chapter solely because of advanced age or disability.

AB781,,34 (15) “Self-administer” means a qualified individual performs an affirmative, conscious, and voluntary act to ingest medication prescribed under this chapter to bring about the individual’s peaceful death. Self-administration does not include administration by intravenous or other parenteral injection or infusion.

AB781,,35 (16) “Terminal disease” means an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, produce death within 6 months.

AB781,,36 156.05 Informed consent. (1) Nothing in this chapter may be construed to limit the information a provider must provide to an individual in order to comply with the medical standard of care and with informed consent requirements under state law.

AB781,,37 (2) If a provider is unable or unwilling to fulfill a request for medication under this chapter, the provider shall proceed as required under s. 156.21 (2).

AB781,,38 (3) Failure by a provider to provide information about medical aid in dying to an individual who requests it, or failure to refer the individual to another provider who can provide the information upon request, shall constitute a failure to obtain informed consent for subsequent medical treatments.

AB781,,39 156.07 Standard of care. (1) Care that complies with the requirements of this chapter meets the medical standard of care.

AB781,,40 (2) Nothing in this chapter exempts a provider or other medical personnel from meeting the medical standard of care for the treatment of individuals with a terminal disease.

AB781,,41 156.09 Qualification. (1) A mentally capable adult with a terminal disease and a prognosis of 6 months or less may request a prescription for medication under this chapter. A qualified individual shall have made an oral request and a written request, and reiterated the oral request to the individual’s attending provider no less than 15 days after making the initial oral request.

AB781,,42 (2) The attending provider and consulting provider of a qualified individual shall have met each of their respective requirements as set forth in ss. 156.13 and 156.15.

AB781,,43 (3) Notwithstanding sub. (1), if an individual’s attending provider has medically determined that the individual will, within reasonable medical judgment, die within 15 days after making an initial oral request under sub. (1), the 15-day waiting period set forth in sub. (1) is waived and the individual may reiterate the oral request to the attending provider as required under sub. (1) at any time after making the initial oral request.

AB781,,44 (4) At the time an individual makes the second oral request under sub. (1), the individual’s attending provider shall offer the individual an opportunity to rescind the request.

AB781,,45 (5) Oral and written requests under sub. (1) for medical aid in dying may be made only by the requesting individual and may not be made by the individual’s surrogate decision-maker, health care proxy, attorney-in-fact for health care, or through an advance health care directive.

AB781,,46 (6) If an individual decides to transfer care to another provider, the former provider shall transfer all relevant medical records, including written documentation of the date of the individual’s request or requests concerning medical aid in dying.

AB781,,47 156.11 Form of written request. (1) A valid written request for medication under this chapter shall be signed and dated by the requesting individual and witnessed by at least one person who, in the presence of the requesting individual, attests that, to the best of the witness’s knowledge and belief, the individual is capable, acting voluntarily, and is not being coerced nor unduly influenced to sign the request.

AB781,,48 (2) The witness required under this section must be a person who is not any of the following:

AB781,,49 (a) A relative of the requesting individual by blood, marriage, or adoption.

AB781,,50 (b) A person who, at the time the request is signed, would be entitled to any portion of the estate of the requesting individual upon death under any will or by operation of law.

AB781,,51 (c) An owner, operator, or employee of a health care facility where the requesting individual is receiving medical treatment or is a resident.

AB781,,52 (3) The requesting individual’s attending provider at the time the request is signed may not be a witness.

AB781,,53 (4) The requesting individual’s interpreter may not be a witness.

AB781,,54 (5) The written request for medication shall be in substantially the following form:

AB781,,55 REQUEST FOR MEDICATION

AB781,,56 TO END MY LIFE IN A

AB781,,57 PEACEFUL MANNER

AB781,,58 I, .... (insert name), am an adult of sound mind. I have been diagnosed with .... (insert description of terminal disease), and given a prognosis of 6 months or less to live.

AB781,,59 I have been fully informed of the feasible alternative, concurrent, or additional treatment opportunities for my terminal disease, including comfort care, palliative care, hospice care, or pain control, and the potential risks and benefits of each. I have been offered or received resources or referrals to pursue these alternative, concurrent, or additional treatment opportunities for my terminal disease.

AB781,,60 I have been fully informed of the nature of the medication to be prescribed and the risks and benefits, including that the likely outcome of self-administering the medication is death. I understand that I can rescind this request at any time and that I am under no obligation to fill the prescription once written nor to self-administer the medication if I obtain it.

AB781,,61 I request that my attending provider furnish a prescription for medication that will end my life in a peaceful manner if I choose to self-administer it, and I authorize my attending provider to contact a pharmacist to dispense the prescription at a time of my choosing.

AB781,,62 I make this request voluntarily, free from coercion or undue influence.

AB781,,63 Signed: ....

AB781,,64 Dated: ....

AB781,,65 Witness Signature: ....

AB781,,66 Dated: ....

AB781,,67 156.13 Attending provider responsibilities. (1) The attending provider for an individual shall do all of the following with regard to requests for medication under this chapter:

AB781,,68 (a) Determine whether the individual has a terminal disease with a prognosis of 6 months or less and is mentally capable.

AB781,,69 (b) Confirm that the individual’s request for medication under this chapter does not arise from coercion or undue influence by asking the individual about coercion and influence outside the presence of other persons, except for an interpreter if necessary.

AB781,,70 (c) Inform the individual of all of the following:

AB781,,71 1. The individual’s diagnosis.

AB781,,72 2. The individual’s prognosis.

AB781,,73 3. The potential risks, benefits, and probable result of self-administering the prescribed medication to bring about a peaceful death.

AB781,,74 4. The potential benefits and risks of feasible alternatives, including concurrent or additional treatment options for the individual’s terminal disease, palliative care, comfort care, hospice care, and pain control.

AB781,,75 5. The individual’s right to rescind the request for medication under this chapter at any time and in any manner.

AB781,,76 (d) Inform the individual that there is no obligation to fill the prescription nor an obligation to self-administer the medication if it is obtained.

AB781,,77 (e) Provide the individual with a referral for comfort care, palliative care, hospice care, pain control, or any other end-of-life treatment option as requested or as clinically indicated.

AB781,,78 (f) Refer the individual to a consulting provider for medical confirmation that the individual requesting medication under this chapter both has a terminal disease with a prognosis of 6 months or less and is mentally capable.

AB781,,79 (g) Include the consulting provider’s written determination, as provided under s. 156.15, in the individual’s medical record.

AB781,,80 (h) Refer the individual to a licensed mental health care provider if the attending provider observes signs that the individual may not be capable of making an informed decision.

AB781,,81 (i) Include the licensed mental health care provider’s written determination, as provided under s. 156.17, in the individual’s medical record if such determination was requested.

AB781,,82 (j) Inform the individual of the benefits of notifying next of kin of the individual’s decision to request medication under this chapter.

AB781,,83 (k) Fulfill all medical record documentation requirements.

AB781,,84 (L) Ensure that all procedures required in order to fulfill a request for medication under this chapter are followed before providing a prescription to a qualified individual for medication under this chapter, including all of the following:

AB781,,85 1. Confirm that the individual has made an informed decision to obtain a prescription for medication under this chapter.

AB781,,86 2. Offer the individual an opportunity to rescind the request for medication under this chapter.

AB781,,87 3. Educate the individual on the recommended procedure for self-administering the medication to be prescribed; the safekeeping and proper disposal of unused medication in accordance with state and federal law; the importance of having another person present when the individual self-administers the medication to be prescribed; and not taking the medication in a public place.

AB781,,88 (m) Deliver the prescription personally, by mail, or through an authorized electronic transmission to a licensed pharmacist who will dispense the medication, including any ancillary medications, to the attending provider, to the qualified individual, or to an individual expressly designated by the qualified individual in person or with a signature required on delivery, by mail service or by messenger service, or, if authorized by the federal drug enforcement agency, dispense the prescribed medication, including any ancillary medications, to the qualified individual or an individual expressly designated by the qualified individual in person.

AB781,,89 (n) Document in the qualified individual’s medical record the individual’s diagnosis and prognosis, determination of mental capability, the date of the oral request or requests, a copy of the written request, a notation that the requirements under this chapter have been completed, and identification of the medication and ancillary medications prescribed to the qualified individual under this chapter.

AB781,,90 (2) Notwithstanding any other provision of law, the attending provider may sign the individual’s death certificate.

AB781,,91 156.15 Consulting provider responsibilities. A consulting provider for an individual shall do all of the following with regard to requests for medication under this chapter:

AB781,,92 (1) Evaluate the individual and the individual’s relevant medical records.

AB781,,93 (2) Confirm, in writing, to the individual’s attending provider that all of the following are true:

AB781,,94 (a) The individual has a terminal disease with prognosis of 6 months or less.

AB781,,95 (b) The individual is mentally capable. If the consulting provider is unable to confirm that the individual is mentally capable, the consulting provider shall provide documentation that the consulting provider has referred the individual for further evaluation in accordance with s. 156.17.

AB781,,96 (c) The individual is acting voluntarily, free from coercion or undue influence.

AB781,,97 156.17 Referral for confirmation that the requesting individual is mentally capable. (1) If either an attending provider or a consulting provider is unable to confirm that an individual making a request for medication under this chapter is capable of making an informed decision, the attending provider or the consulting provider shall refer the individual to a licensed mental health care provider for determination regarding mental capability.

AB781,,98 (2) The licensed mental health care provider who evaluates the individual under this section shall submit to the requesting attending provider or consulting provider a written determination of whether the individual is mentally capable.

AB781,,99 (3) If the licensed mental health care provider determines that the individual is not mentally capable, the individual may not be deemed a qualified individual and the attending provider may not prescribe medication to the individual under this chapter.

AB781,,100 156.19 Safe disposal of unused medications. A person who has custody or control of medication prescribed under this chapter after a qualified individual’s death shall dispose of the medication by lawful means in accordance with state and federal guidelines.

AB781,,101 156.21 No duty to provide medical aid in dying. (1) A provider shall provide sufficient information to an individual with a terminal disease regarding available options, the alternatives, and the foreseeable risks and benefits of each option so that the individual is able to make informed decisions regarding his or her end-of-life health care, but a provider may choose whether or not to practice medical aid in dying under this chapter.

AB781,,102 (2) If a provider is unable or unwilling to fulfill an individual’s request for medication under this chapter, the provider shall do all of the following:

AB781,,103 (a) Document the date of the individual’s request in the individual’s medical record.

AB781,,104 (b) Upon the individual’s request, transfer the individual’s medical records to the new provider, consistent with federal and state law.

AB781,,105 (3) A provider may not engage in false, misleading, or deceptive practices relating to the provider’s willingness to qualify an individual or provide a prescription to a qualified individual under this chapter. Intentionally misleading an individual constitutes coercion or undue influence.

AB781,,106 156.23 Health care facility permissible prohibitions and duties. (1) A health care facility may prohibit providers from qualifying, prescribing, or dispensing medication under this chapter while performing duties for the facility. A prohibiting facility must provide express advance notice in writing at the time of hiring, contracting with, or privileging providers and staff, and on a yearly basis thereafter. A health care facility that fails to provide advance notice in writing waives the right to enforce any prohibition.

AB781,,107 (2) If an individual who is a patient at a prohibiting health care facility, as described under sub. (1), and who has made a request concerning medical aid in dying wishes to transfer care to another health care facility, the prohibiting facility shall coordinate a timely transfer, including transfer of the individual’s medical records that include notation of the date the individual first made a request concerning medical aid in dying.

AB781,,108 (3) No health care facility may prohibit a provider from doing any of the following in fulfilling the requirements of informed consent and meeting the medical of standard of care:

AB781,,109 (a) Providing information to an individual regarding the individual’s health status, including diagnosis, prognosis, recommended treatment, treatment alternatives, and any potential risks to the individual’s health.

AB781,,110 (b) Providing information about available services, including health care services available under this chapter, information about relevant community resources, and information about how to access those resources to obtain the care of the individual’s choice.

AB781,,111 (c) Prescribing medication under this chapter for a qualified individual outside the scope of the provider’s employment or contract with the prohibiting facility and off the premises of the prohibiting facility.

AB781,,112 (d) Being present when a qualified individual self-administers medication prescribed under this chapter or at the time of death, if requested by the qualified individual or his or her representative and if outside the scope of the provider’s employment or contractual duties with the prohibiting facility.

AB781,,113 (4) A health care facility may not engage in false, misleading, or deceptive practices relating to its policy regarding end-of-life care services, including whether it has a policy that prohibits affiliated providers from determining an individual’s qualification for medical aid in dying or writing a prescription for a qualified individual under this chapter. A health care facility may not intentionally deny an individual access to medication under this chapter by failing to transfer an individual and the individual’s medical records to another provider in a timely manner. Intentionally misleading an individual or deploying misinformation to obstruct access to services under this chapter constitutes coercion or undue influence.