Establishes the "Marilyn Teitelbaum Death with Dignity Act"

SECOND REGULAR SESSION
HOUSE BILL NO. 2188
103RD GENERAL ASSEMBL Y
INTRODUCED BY REPRESENT A TIVE MACKEY .
3994H.01I JOSEPH ENGLER, Chief Clerk
AN ACT
T o amend chapters 191 and 565, RSMo, by adding thereto twenty-seven new sections relating
to patient-directed care at the end of life.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Chapters 191 and 565, RSMo, are amended by adding thereto twenty-
2 seven new sections, to be known as sections 191.2400, 191.2405, 191.2410, 191.2415,
3 191.2420, 191.2425, 191.2430, 191.2435, 191.2440, 191.2445, 191.2450, 191.2455,
4 191.2460, 191.2465, 191.2470, 191.2475, 191.2480, 191.2485, 191.2490, 191.2495,
5 191.2496, 191.2500, 191.2505, 191.2510, 191.2515, 191.2520, and 565.017, to read as
6 follows:
191.2400. Sections 191.2400 to 191.2520 shall be known and may be cited as the
2 "Marilyn T eitelbaum Death with Dignity Act".
191.2405. As used in sections 191.2400 to 191.2520, unless the context otherwise
2 indicates, the following terms mean:
3 (1) "Adult", a person who is eighteen years of age or older;
4 (2) "Attending physician", the physician who has primary r esponsibility for the
5 car e of a patient and the tr eatment of that patient's terminal disease;
6 (3) "Competent", in the opinion of a court or in the opinion of the patient's
7 attending physician or consulting physician, psychiatrist, or psychologist, a patient has
8 the ability to make and communicate an informed decision to health car e pro viders,
9 including communication thr ough persons familiar with the patient's manner of
10 communicating if those persons ar e available;
EXPLANA TION — Matter enclosed in bold-faced brackets [thus] in the above bill is not enacted and is
intended to be omitted from the law . Matter in bold-face type in the above bill is proposed language.
11 (4) "Consulting physician", a physician who is qualified by specialty or
12 experience to make a pro fessional diagnosis and pro gnosis regard ing a patient's disease;
13 (5) "Counseling", one or more consultations between a state-licensed
1 4 psychiatrist, state-licensed psychologist, state-licensed clinical social worker , or state-
15 licensed clinical pr ofessional counselor and a patient for the purpose of determining that
16 the patient is competent and not suffering fro m a psychiatric or psychological disorder
17 or depr ession that so impairs judgment as to prev ent the patient's informed decision;
18 (6) "Health car e pr ovider", the same meaning given to the term in section
19 376.1350 and includes any person licensed, certified, or otherwise permitted by law to
20 dispense medication in the ordinary course of business or practice of a pr ofession;
21 (7) "Informed decision", a decision by a qualified patient to r equest and obtain a
22 pr escription for medication that the qualified patient may self-administer to end the
23 qualified patient's life in a humane and dignified manner that is based on an
24 appr eciation of the relevan t facts and that is made after being fully informed by the
25 attending physician of:
26 (a) The qualified patient's medical diagnosis;
27 (b) The qualified patient's pr ognosis;
28 (c) The potential risks associated with taking the medication to be pr escribed;
29 (d) The pr obable r esult of taking the medication to be pr escribed; and
30 (e) The feasible alternatives to taking the medication to be pr escribed, including
31 palliative care and comfort car e, hospice care, pain contr ol, and disease-direct ed
32 tr eatment options;
33 (8) "Medically confirmed", the medical opinion of an attending physician has
34 been confirmed by a consulting physician who has examined the patient and the
35 patient's relev ant medical reco rds;
36 (9) "Patient", an adult who is under the car e of a physician;
37 (10) "Physician", a doctor of medicine or osteopathy licensed to practice
38 medicine in this state;
39 (1 1) "Qualified patient", a competent adult who is a res ident of this state and
40 who has satisfied the r equir ements of sections 191.2400 to 191.2520 in order to obtain a
41 pr escription for medication that the qualified patient may self-administer to end the
42 qualified patient's life in a humane and dignified manner;
43 (12) "Self-administer", for a qualified patient, to voluntarily and consciously
44 perform the physical act of ingesting or otherwise administering to himself or herself the
45 medication to end the qualified patient's own life;
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46 (13) "T erminal disease", an incurable and irr eversible disease that has been
47 medically confirmed and will, within reas onable medical judgment, prod uce death
48 within six months.
191.2410. A patient has a right to information r egarding all trea tment options
2 r easonably available for the care of the patient, including, but not limited to,
3 information in res ponse to specific questions about the for eseeable risks and benefits of
4 medication, without a physician withholding req uested information r egardless of the
5 purpose of the questions or the nature of the information.
191.2415. An adult who is competent, is a r esident of this state, has been
2 determined by an attending physician and a consulting physician to be suffering fr om a
3 terminal disease, and has voluntarily expr essed the wish to die may make a written
4 r equest for medication that the adult may self-administer in accordance with sections
5 191.2400 to 191.2520. An adult does not qualify under sections 191.2400 to 191.2520
6 solely because of age or disability .
191.2420. 1. A valid requ est for medication under sections 191.2400 to 191.2520
2 shall be substantially in the form described in section 191.2515, signed and dated by the
3 patient, and witnessed by at least two individuals who, in the presence of the patient,
4 attest that to the best of their knowledge and belief the patient is competent, is acting
5 voluntarily , and is not being coerced to sign the r equest.
6 2. (1) The language of a written requ est for medication under sections 191.2400
7 to 191.2520 shall be the language in which any conversations or consultations or
8 interpr eted conversations or consultations between a patient and the patient's attending
9 physician or consulting physician are held.
10 (2) Notwithstanding subdivision (1) of this subsection, the language of a written
11 r equest for medication under sections 191.2400 to 191.2520 may be English when the
12 conversations or consultations or interpr eted conversations or consultations between a
13 patient and the patient's attending physician or consulting physician wer e conducted in
14 a language other than English if the form described in section 191.2515 contains the
15 attachment described in section 191.2520.
16 3. At least one of the two or mor e witnesses requi red under this section and any
17 interpr eter r equir ed under this section shall be a person who is not:
18 (1) A re lative of the patient by blood, marriage, or adoption;
19 (2) A person who at the time the r equest is signed would be entitled to any
20 portion of the estate of the qualified patient upon death, under any will, trust, transfer
21 on death election, beneficiary designation, or otherwise by operation of any law; or
22 (3) An owner , operator , or employee of a health car e facility wher e the qualified
23 patient is re ceiving medical tr eatment or is a r esident.
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24 4. The patient's attending physician at the time the written requ est is signed
25 shall not be a witness.
26 5. If the patient is a patient in a long-term care facility at the time the patient
27 makes the written r equest, one of the witnesses shall be an individual designated by the
28 facility who has the qualifications specified by the department of health and senior
29 services by rule.
191.2425. The attending physician shall:
2 (1) Make the initial determination of whether a patient has a terminal disease, is
3 competent, and has made the written r equest under section 191.2415 voluntarily;
4 (2) Request that the patient demonstrate state re sidency as r equir ed by section
5 191.2470;
6 (3) T o ensur e that the patient is making an informed decision, inform the patient
7 of:
8 (a) The patient's medical diagnosis;
9 (b) The patient's progn osis;
10 (c) The potential risks associated with taking the medication to be pr escribed;
11 (d) The pr obable r esult of taking the medication to be pr escribed; and
12 (e) The feasible alternatives to taking the medication to be pr escribed, including
13 palliative care and comfort car e, hospice care, pain contr ol, and disease-direct ed
14 tr eatment options;
15 (4) Refer the patient to a consulting physician for medical confirmation of the
16 diagnosis and for a determination that the patient is competent and acting voluntarily;
17 (5) Confirm that the patient's req uest does not arise fr om coer cion or undue
18 influence by another individual by discussing with the patient, outside the presence of
19 any other individual, except for an interpr eter , whether the patient is feeling coerced or
20 unduly influenced;
21 (6) Refer the patient for counseling, if appr opriate, as described in section
22 191.2435;
23 (7) Recommend that the patient notify the patient's next of kin;
24 (8) Counsel the patient about the importance of having another person present
25 when the patient takes the medication pr escribed under sections 191.2400 to 191.2520
26 and counsel the patient about not taking the medication pr escribed under sections
27 191.2400 to 191.2520 in a public place;
28 (9) Inform the patient that the patient has an opportunity to res cind the req uest
29 at any time and in any manner and offer the patient an opportunity to r escind the
30 r equest at the end of the fifteen-day waiting period in accordance with section 191.2450;
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31 (10) V erify , immediately before writing the pr escription for medication under
32 sections 191.2400 to 191.2520, that the patient is making an informed decision;
33 (1 1) Fulfill the medical reco rd documentation r equir ements of section 191.2465;
34 (12) Ensure that all appr opriate steps are carried out in accordance with sections
35 191.2400 to 191.2520 befor e writing a pr escription for medication to enable a qualified
36 patient to end the qualified patient's life in a humane and dignified manner; and
37 (13) Dispense medications dir ectly , including ancillary medications intended to
38 minimize the patient's discomfort, if the attending physician is authorized under state
39 law or rule to dispense medications and has a curr ent Drug Enfor cement
4 0 Administration certificate or , with the patient's written consent:
41 (a) Contact a pharmacist and inform the pharmacist of the prescrip tion; and
42 (b) Deliver the written pr escription personally , by mail, or electr onically to the
43 pharmacist, who may dispense the medications in person to the patient, the attending
44 physician, or an expr essly identified agent of the patient.
191.2430. Befor e a patient is determined to be a qualified patient under sections
2 191.2400 to 191.2520, a consulting physician shall examine the patient and the patient's
3 r elevant medical recor ds and confirm, in writing, the attending physician's diagnosis
4 that the patient is suffering fr om a terminal disease and verify that the patient is
5 competent, is acting voluntarily , and has made an informed decision.
191.2435. If, in the opinion of the attending physician or the consulting
2 physician, a patient may be suffering fr om a psychiatric or psychological disorder or
3 depr ession causing impair ed judgment, the physician shall r efer the patient for
4 counseling. Medication for the patient to self-administer to end the patient's own life in
5 a humane and dignified manner shall not be prescrib ed until the person performing the
6 counseling determines that the patient is not suffering fr om a psychiatric or
7 psychological disorder or depr ession that so impairs judgment as to pr event the
8 patient's informed decision.
191.2440. A qualified patient shall not receiv e a prescrip tion for medication
2 under sections 191.2400 to 191.2520 unless the qualified patient has made an informed
3 decision. Immediately before writing a pr escription for medication under sections
4 191.2400 to 191.2520, the attending physician shall verify that the qualified patient is
5 making an informed decision.
191.2445. A patient who declines or is unable to notify the patient's next of kin
2 shall not have the patient's request for medication denied for that rea son.
191.2450. T o recei ve a pr escription for medication that the qualified patient may
2 self-administer under sections 191.2400 to 191.2520, a qualified patient shall make an
3 oral req uest and a written req uest and reit erate the oral requ est to the qualified
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4 patient's attending physician at least fifteen days after making the initial oral requ est.
5 At the time the qualified patient makes the qualified patient's second oral r equest, the
6 attending physician shall offer the qualified patient an opportunity to res cind the
7 r equest.
191.2455. A patient may res cind the patient's req uest at any time and in any
2 manner without regard to the patient's mental state. A pr escription for medication shall
3 not be written under sections 191.2400 to 191.2520 without the attending physician
4 offering the qualified patient an opportunity to res cind the req uest.
191.2460. At least fifteen days are re quir ed to elapse between the patient's initial
2 oral req uest and the date the patient signs the written requ est under section 191.2450.
3 At least forty-eight hours are requ ired to elapse between the date the patient signs the
4 written requ est and the writing of a pr escription under sections 191.2400 to 191.2520.
191.2465. The following shall be documented or filed in a patient's medical
2 r ecord:
3 (1) All oral r equests by the patient for medication to end that patient's life in a
4 humane and dignified manner;
5 (2) All written r equests by the patient for medication to end that patient's life in
6 a humane and dignified manner;
7 (3) The attending physician's diagnosis and progn osis and the attending
8 physician's determination that the patient is competent, is acting voluntarily , and has
9 made an informed decision;
10 (4) The consulting physician's diagnosis and prog nosis and the consulting
11 physician's verification that the patient is competent, is acting voluntarily , and has made
12 an informed decision;
13 (5) A report of the outcome and determinations made during counseling, if
14 counseling is provi ded as described in section 191.2435;
15 (6) The attending physician's offer to the patient to re scind the patient's requ est
16 at the time of the patient's second oral request under section 191.2450; and
17 (7) A note by the attending physician indicating that all req uirements under
18 sections 191.2400 to 191.2520 have been met, including the requi rem ents of section
19 191.2425, and indicating the steps taken to carry out the patient's re quest, including a
20 notation of the medication prescrib ed.
191.2470. For purposes of sections 191.2400 to 191.2520, only r equests made by
2 r esidents of this state shall be granted. The res idence of a person is that place where the
3 person has established a fixed and principal home to which the person, whenever
4 temporarily absent, intends to r eturn. The following factors may be offered in
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5 determining a person's r esidence under sections 191.2400 to 191.2520 and need not all
6 be pr esent in order to determine a person's res idence:
7 (1) Possession of a valid driver's license issued by the department of revenu e;
8 (2) Registration to vote in this state;
9 (3) Evidence that the person owns or leases prop erty in this state;
10 (4) The location of any dwelling curren tly occupied by the person;
11 (5) The place wher e any motor vehicle owned by the person is regi stered;
12 (6) The r esidence addr ess, not a post office box, shown on a curren t income tax
13 r eturn;
14 (7) The res idence addr ess, not a post office box, at which the person's mail is
15 r eceived;
16 (8) The r esidence addr ess, not a post office box, shown on any curr ent res ident
17 hunting or fishing licenses held by the person;
18 (9) The res idence addr ess, not a post office box, shown on any driver's license
19 held by the person;
20 (10) The receipt of any public benefit conditioned upon res idency , defined
21 substantially as pr ovided in this section; or
22 (1 1) Any other objective facts tending to indicate a person's place of res idence.
191.2475. A person who has custody of or contr ol over any unused medications
2 pr escribed in accordance with sections 191.2400 to 191.2520 after the death of the
3 qualified patient shall personally deliver the unused medications to the neare st facility
4 qualified to dispose of control led substances or , if such delivery is impracticable,
5 personally dispose of the unused medications by any lawful means, in accordance with
6 any guidelines adopted by the department of health and senior services.
191.2480. 1. The department of health and senior services shall annually rev iew
2 all records maintained under sections 191.2400 to 191.2520.
3 2. (1) The department of health and senior services shall r equir e any health car e
4 pr ovider upon writing a pr escription or dispensing medication under sections 191.2400
5 to 191.2520 to file a copy of the pr escription or dispensing reco rd, and other
6 documentation r equir ed under section 191.2465 associated with writing the pr escription
7 or dispensing the medication, with the department.
8 (2) Documentation r equir ed to be filed under this subsection shall be mailed or
9 otherwise transmitted as allowed by rules of the department no later than thirty
10 calendar days after the writing of the pr escription or the dispensing of medication under
11 sections 191.2400 to 191.2520, except that all documents r equir ed to be filed with the
12 department by the pre scribing physician after the death of the qualified patient shall be
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13 submitted no later than thirty calendar days after the date of the death of the qualified
14 patient.
15 (3) In the event that a person requi red under sections 191.2400 to 191.2520 to
16 r eport information to the department pro vides an inadequate or incomplete repo rt, the
17 department shall contact the person to r equest an adequate or complete r eport.
18 3. The department of health and senior services shall pr omulgate rules to
19 facilitate the collection of information regard ing compliance with sections 191.2400 to
20 191.2520. Except as otherwise pro vided by law , the information collected is confidential,
21 is not a public record, and shall not be made available for inspection by the public.
22 4. The department of health and senior services shall generate and make
23 available to the public an annual statistical rep ort of information collected under this
24 section and submit a copy of the repor t to the standing committees of the house of
25 r epresent atives and the senate having jurisdiction over health matters annually by
26 Mar ch first.
27 5. In addition to the rules requ ired to be promulg ated under this section, the
28 department of health and senior services shall promul gate all necessary rules for the
29 administration of sections 191.2400 to 191.2520. Any rule or portion of a rule, as that
30 term is defined in section 536.010, that is creat ed under the authority delegated in this
31 section shall become effective only if it complies with and is subject to all of the
32 pr ovisions of chapter 536 and, if applicable, section 536.028. This section and chapter
33 536 are nonseverable and if any of the powers vested with the general assembly
34 pursuant to chapter 536 to revi ew , to delay the effective date, or to disappr ove and annul
35 a rule are subsequently held unconstitutional, then the grant of rulemaking authority
36 and any rule prop osed or adopted after August 28, 2026, shall be invalid and void.
191.2485. Any pr ovision in a contract, will, or other agreement, whether written
2 or oral, to the extent the pr ovision would affect whether a person may make or res cind a
3 r equest for medication to end the person's life in a humane and dignified manner , is not
4 valid. Any obligation owing under any curren tly existing contract shall not be
5 conditioned upon or affected by the making or res cinding of a req uest by a person for
6 medication to end the person's life in a humane and dignified manner .
191.2490. The sale, pr ocurement, or issuance of any life, health, or accident
2 insurance or annuity policy or the rate charged for any life, health, or accident
3 insurance or annuity policy shall not be conditioned upon or affected by the making or
4 r escinding of a req uest by a qualified patient for medication that the patient may self-
5 administer to end the patient's life in accordance with sections 191.2400 to 191.2520. A
6 qualified patient whose life is insur ed under a life insurance policy issued by insurers
7 organized under chapter 376 and the beneficiaries of the policy shall not be denied
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8 benefits on the basis of self-administration of medication by the qualified patient in
9 accordance with sections 191.2400 to 191.2520. The rating, sale, pr ocur ement, or
10 issuance of any medical pro fessional liability insurance policy deliver ed or issued for
11 delivery in this state shall be in accordance with the insurance laws of this state.
191.2495. Sections 191.2400 to 191.2520 do not authorize a physician or any
2 other person to end a patient's life by lethal injection, mer cy killing, or active
3 euthanasia. Actions taken in accordance with sections 191.2400 to 191.2520 do not, for
4 any purpose, constitute suicide, assisted suicide, mer cy killing, or homicide under the
5 law . State r eports shall not refe r to acts committed under sections 191.2400 to 191.2520
6 as "suicide" or "assisted suicide". Consistent with the pro visions of sections 191.2400 to
7 191.2520, state repo rts shall r efer to acts committed under sections 191.2400 to 191.2520
8 as obtaining and self-administering life-ending medication. Nothing contained in
9 sections 191.2400 to 191.2520 shall be interpr eted to lower the applicable standard of
10 car e for the attending physician, the consulting physician, a psychiatrist, a psychologist,
11 or other health care pro vider prov iding services under sections 191.2400 to 191.2520.
191.2496. 1. As used in this section, the term "cover ed individual" means a
2 health car e provider , physician, psychiatrist, psychologist, clinical social worker ,
3 pr ofessional counselor , pharmacist, pharmacist's assistant, patient, witness, or family
4 member or friend of a patient.
5 2. Any covered individual who is present during, has knowledge of, performs, or
6 engages in any of the activities described in sections 191.2400 to 191.2520 shall not, on
7 account of such activities, be subject to any civil or criminal liability , pr ofessional
8 discipline, or other penalty of any natur e so long as such covered individual is acting in
9 good faith and is not guilty of willful misconduct or gr oss negligence.
191.2500. Nothing in sections 191.2400 to 191.2520 req uires a health care
2 pr ovider to pr ovide medication to a qualified patient to end the qualified patient's life.
3 If a health car e pr ovider is unable or unwilling to carry out the qualified patient's
4 r equest under sections 191.2400 to 191.2520, the health car e pro vider shall transfer any
5 r elevant medical reco rds for the patient to a new health care provi der upon r equest by
6 the patient.
191.2505. 1. As used in this section, unless the context otherwise indicates, the
2 following terms mean:
3 (1) "Notice", a separate statement in writing advising of the pr ohibiting health
4 car e pro vider's policy with res pect to participating in activities under sections 191.2400
5 to 191.2520;
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6 (2) "Participating, or entering into an agreement to participate, in activities
7 under sections 191.2400 to 191.2520", doing or entering into an agr eement to do any one
8 or mor e of the following:
9 (a) Performing the duties of an attending physician as specified in sections
10 191.2400 to 191.2520;
11 (b) Performing the duties of a consulting physician as specified in sections
12 191.2400 to 191.2520;
13 (c) Performing the duties of a state-licensed psychiatrist, state-licensed
14 psychologist, state-licensed clinical social worker , or state-licensed clinical pr ofessional
15 counselor , in the circu mstance that a ref erral to one is made under section 191.2435;
16 (d) Delivering the pr escription for , dispensing, or delivering the dispensed
17 medication in accordance with sections 191.2400 to 191.2520; or
18 (e) Being pre sent when the qualified patient takes the medication pr escribed in
19 accordance with sections 191.2400 to 191.2520.
20
21 "Participating, or entering into an agr eement to participate, in activities under sections
22 191.2400 to 191.2520" does not include doing, or entering into an agree ment to do, any
23 of the following: diagnosing whether a patient has a terminal disease; informing the
24 patient of the medical pr ognosis or determining whether a patient has the capacity to
25 make decisions; pr oviding information to a patient about sections 191.2400 to 191.2520;
26 or provi ding a patient, upon the patient's requ est, with a ref erral to another health car e
27 pr ovider for the purposes of participating in the activities authorized by sections
28 191.2400 to 191.2520.
29 2. The provi sions of this section govern the basis for pr ohibiting persons or
30 entities from participating in activities under sections 191.2400 to 191.2520, notification,
31 penalties, and permissible actions.
32 3. Subject to compliance with subsection 4 of this section and notwithstanding
33 any other law , a health car e pr ovider may pr ohibit its employees, independent
34 contractors, or other persons or entities, including other health care pr oviders, fr om
35 participating in activities under sections 191.2400 to 191.2520 while on pr emises owned
36 or under the management or direct control of that pr ohibiting health care pr ovider or
37 while acting within the course and scope of any employment by , or contract with, the
38 pr ohibiting health care prov ider .
39 4. A health care pro vider that elects to pr ohibit its employees, independent
40 contractors, or other persons or entities, including other health care pr oviders, fr om
41 participating in activities under sections 191.2400 to 191.2520, as described in subsection
42 3 of this section, shall first give notice of the policy pro hibiting participation under
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43 sections 191.2400 to 191.2520 to those employees, independent contractors, or other
44 persons or entities, including other health car e pr oviders. A health care prov ider that
45 fails to pr ovide notice to those employees, independent contractors, or other persons or
46 entities, including other health care pr oviders, in compliance with this subsection shall
47 not enforce such a policy against those employees, independent contractors, or other
48 persons or entities, including other health care prov iders.
49 5. Subject to compliance with subsection 4 of this section, the proh ibiting health
50 car e prov ider may take action, including, but not limited to, the following, as applicable,
51 against an employee, independent contractor , or other person or entity , including
52 another health car e pro vider , that violates the health care pr ovider's policy pr ohibiting
53 participation in activities under sections 191.2400 to 191.2520:
54 (1) Loss of privileges, loss of membership, or other action authorized by the
55 bylaws or rules and reg ulations of the medical staff;
56 (2) Suspension, loss of employment, or other action authorized by the policies
57 and practices of the proh ibiting health care prov ider;
58 (3) T ermination of any lease or other contract between the pr ohibiting health
59 car e pro vider and the employee, independent contractor , or other person or entity ,
60 including another health care prov ider , that violates the policy; or
61 (4) Imposition of any other nonmonetary r emedy pr ovided for in any lease or
62 contract between the pro hibiting health care pr ovider and the employee, independent
63 contractor , or other person or entity , including another health car e prov ider , in violation
64 of the policy .
65 6. Nothing in this section shall be construed to pr event, or to allow a pr ohibiting
66 health care pr ovider to proh ibit, an employee, independent contractor , or other person
67 or entity , including another health care pro vider , fro m any of the following:
68 (1) Participating, or entering into an agreement to participate, in activities under
69 sections 191.2400 to 191.2520 while on pr emises that are not owned or under the
70 management or direct contr ol of the proh ibiting health care prov ider or while acting
71 outside the course and scope of the participant's duties as an employee of, or an
72 independent contractor for , the pr ohibiting health car e pr ovider; or
73 (2) Participating, or entering into an agreement to participate, in activities under
74 sections 191.2400 to 191.2520 as an attending physician or consulting physician while on
75 pr emises that are not owned or under the management or dir ect control of the
76 pr ohibiting health care prov ider .
77 7. In taking actions under subsection 5 of this section, a health car e provi der
78 shall comply with all pr ocedur es requ ired by law , its own policies or pro cedure s, and
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79 any contract with the employee, independent contractor , or other person or entity ,
80 including another health care prov ider , in violation of the policy , as applicable.
81 8. Any action taken by a proh ibiting health care provi der under this section is
82 not re portable to the appr opriate licensing board including, but not limited to, the state
83 board of regist ration for the healing arts and the state board of pharmacy . The fact that
84 a health car e provi der participates in activities under sections 191.2400 to 191.2520 shall
85 not be the sole basis for a complaint or report by another health car e pr ovider to the
86 appr opriate licensing board including, but not limited to, the state board of regist ration
87 for the healing arts and the state board of pharmacy .
191.2510. Any governmental entity that incurs costs res ulting fr om a person
2 ending the person's life under sections 191.2400 to 191.2520 in a public place has a claim
3 against the estate of the person to recover the costs and reas onable attorney's fees
4 r elated to enforcing the claim.
191.2515. A requ est for medication as authorized by sections 191.2400 to
2 191.2520 shall be in substantially the following form:
3 REQUEST FOR MEDICA TION T O END MY LIFE IN A
4 HUMANE AND DIGNIFIED MANNER
5 I, ______ , am an adult of sound mind. I am suffering fr om _____
6 _ , which my attending physician has determined is a terminal
7 disease and which has been medically confirmed by a consulting
8 physician.
9 I have been fully informed of my diagnosis and pr ognosis, the
10 nature of medication to be pr escribed and potential associated
11 risks, the expected r esult, and feasible alternatives, including
12 palliative car e and comfort car e, hospice car e, pain control , and
13 disease-direct ed trea tment options.
14 I req uest that my attending physician prescrib e medication that I
15 may self-administer to end my life in a humane and dignified
16 manner and contact any pharmacist to fill the prescrip tion.
17 INITIAL ONE:
18 ______ I have informed my family of my decision and taken their
19 opinions into consideration.
20 ______ I have decided not to inform my family of my decision.
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21 ______ I have no family to inform of my decision.
22 I understand that I have the right to resc ind this requ est at any
23 time.
24 I understand the full import of this requ est, and I expect to die
25 when I take the medication to be pre scribed. I further
26 understand that, although most deaths occur within thr ee hours,
27 my death may take longer , and my physician has counseled me
28 about this possibility .
29 I make this requ est voluntarily and without res ervation, and I
30 accept full moral res ponsibility for my actions.
31 Signed: __________________
32 Dated: __________________
33 DECLARA TION OF WITNESSES
34 By initialing and signing below on or after the date the person
35 named above signs, we declar e that the person making and
36 signing the above requ est:
37 Initials of W itness 1:
38 ______ 1. Is personally known to us or has pr ovided pr oof of
39 identity;
40 ______ 2. Signed this reque st in our pr esence on the date of the
41 person's signature;
42 ______ 3. Appears to be of sound mind and not under duress ,
43 fraud, or undue influence; and
44 ______ 4. Is not a patient for whom either of us is the attending
45 physician.
46 Printed Name of W itness 1: __________________
47 Signatur e of Witness 1/Date: __________________
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48 Initials of W itness 2:
49 ______ 1. Is personally known to us or has pr ovided pr oof of
50 identity;
51 ______ 2. Signed this reque st in our pr esence on the date of the
52 person's signature;
53 ______ 3. Appears to be of sound mind and not under duress ,
54 fraud, or undue influence; and
55 ______ 4. Is not a patient for whom either of us is the attending
56 physician.
57 Printed Name of W itness 2: __________________
58 Signatur e of Witness 2/Date: __________________
59 NOTE: One witness must be a person who is not a r elative by
60 blood, marriage, or adoption of the person signing this r equest, is
61 not entitled to any portion of the person's estate upon death, and
62 does not own or operate or is not employed at a health care
63 facility wher e the person is a patient or res ident. The person's
64 attending physician at the time the request is signed may not be a
65 witness. If the person is an inpatient at a long-term car e facility ,
66 one of the witnesses must be an individual designated by the
67 facility .
191.2520. The form of an attachment for purposes of pro viding interpr etive
2 services as described in subsection 2 of section 191.2420 shall be in substantially the
3 following form:
4 I, ______ , am fluent in English and (language of patient).
5 On (date) at appr oximately (time) I r ead the "REQUEST FOR
6 MEDICA TION T O END MY LIFE IN A HUMANE AND
7 DIGNIFIED MANNER" to (name of patient) in (language of
8 patient).
9 Mr ./Ms. (name of patient) affirmed to me that he/she understands
10 the content of this form, that he/she desires to sign this form
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11 under his/her own power and volition and that he/she r equested
12 to sign the form after consultations with an attending physician
13 and a consulting physician.
14 Under penalty of perjury , I declar e that I am fluent in English
15 and (language of patient) and that the contents of this form, to the
16 best of my knowledge, ar e true and correc t.
17 Executed at (name of city , county , and state) on (date).
18 Interpr eter's signature: __________________
19 Interpr eter's printed name: __________________
20 Interpr eter's addr ess: __________________
565.017. It shall be an affirmative defense to pro secutions under sections
2 565.020, 565.021, and 565.023 that the person's conduct was expr essly authorized by
3 sections 191.2400 to 191.2520.
✔
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