An Act amending Title 20 (Decedents, Estates and Fiduciaries) of the Pennsylvania Consolidated Statutes, providing for compassionate aid in dying; and imposing penalties.

PRINTER'S NO. 1233
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No. 1109
Session of
2025
INTRODUCED BY HILL-EVANS, KHAN, SHUSTERMAN, RABB, GIRAL,
SANCHEZ, MADDEN, MAYES, KRAJEWSKI, PROBST, CERRATO,
D. WILLIAMS AND GREEN, APRIL 3, 2025
REFERRED TO COMMITTEE ON JUDICIARY, APRIL 3, 2025
AN ACT
Amending Title 20 (Decedents, Estates and Fiduciaries) of the
Pennsylvania Consolidated Statutes, providing for
compassionate aid in dying; and imposing penalties.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Title 20 of the Pennsylvania Consolidated
Statutes is amended by adding a chapter to read:
CHAPTER 54B
COMPASSIONATE AID IN DYING
Sec.
54B01. Definitions.
54B02. Qualified patient requirements.
54B03. Request for medication.
54B04. Right and opportunity to rescind request.
54B05. Form of written request.
54B06. Waiting periods.
54B07. Attending provider responsibilities.
54B08. Confirmation of terminal illness.
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54B09. Counseling referral.
54B10. Family notification.
54B11. Medical record documentation requirements.
54B12. Reporting requirements.
54B13. Effect on construction of wills and contracts.
54B14. Insurance and annuity policies.
54B15. Health care provider participation, notification and
permissible sanctions.
54B16. Claims by governmental entity for costs incurred.
54B17. Construction.
54B18. Immunity.
54B19. Liability.
54B20. Prohibitions and penalties.
§ 54B01. Definitions.
The following words and phrases when used in this chapter
shall have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Attending provider." A provider who has primary
responsibility for the care of a patient with a terminal illness
and treatment of the patient's terminal illness.
"Capable." The ability of a patient to make and communicate
informed health care decisions without impaired judgment to
health care providers, including communication through
individuals familiar with the patient's manner of communicating,
as determined by a court or a patient's attending provider,
consulting provider, mental health care professional or clinical
social worker.
"Confirmation of terminal illness." A written confirmation
from a consulting provider of a patient's terminal illness.
"Consulting provider." A provider who is qualified by
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specialty or experience to make a professional diagnosis and
prognosis regarding a patient's terminal illness.
"Counseling." One or more consultations between a mental
health care provider and a patient for the purpose of
determining if the patient is capable.
"Department." The Department of Health of the Commonwealth.
"End-of-life medication." A medication determined and
prescribed by an attending provider to a qualified patient for
the purpose of ending the qualified patient's life, which the
qualified patient may administer.
"Health care facility." A health care facility as defined in
section 802.1 of the act of July 19, 1979 (P.L.130, No.48),
known as the Health Care Facilities Act.
"Health care provider." A person licensed, certified or
otherwise authorized or permitted by the laws of this
Commonwealth to administer health care services or dispense
medication in the ordinary course of business or practice of a
profession.
"Informed decision." A decision by a patient to request and
obtain a prescription for end-of-life medication that is based
on an appreciation of the relevant facts after being fully
informed by the attending provider of the information required
under section 54B07 (relating to attending provider
responsibilities).
"Long-term care facility." A long-term care nursing facility
as defined in section 802.1 of the Health Care Facilities Act.
"Medical confirmation." Confirmation by a consulting
provider who has examined a patient and the patient's relevant
medical records that the patient has a terminal illness, is
capable and is voluntarily making an informed decision.
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"Mental health care provider." A person who is licensed,
certified or otherwise authorized by the laws of this
Commonwealth to administer or provide mental health care in the
ordinary course of business or practice of a profession.
"Participate under this chapter." To perform the duties of
an attending provider under section 54B07, the consulting
provider function under section 54B08 (relating to confirmation
of terminal illness) or the consultation function under section
54B09 (relating to counseling referral). The term does not
include:
(1) making an initial determination that a patient has a
terminal illness and informing the patient of the medical
prognosis;
(2) providing information about end-of-life medication
and related information to a patient upon request;
(3) providing, upon the request of the patient, a
referral to another provider; or
(4) contracting by a patient with the patient's
attending provider and consulting provider to act outside of
the course and scope of the health care provider's capacity
as an employee or independent contractor of the sanctioning
health care provider.
"Patient." An individual who is:
(1) eighteen years of age or older; and
(2) under the care of an attending provider.
"Provider." The following:
(1) A doctor of medicine or osteopathy licensed to
practice by the State Board of Medicine or State Board of
Osteopathic Medicine.
(2) An advanced practice registered nurse practitioner
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licensed to practice by the State Board of Nursing.
"Qualified patient." A patient who meets the requirements of
section 54B02 (relating to qualified patient requirements).
"Terminal illness." An incurable and irreversible illness
that will, within reasonable medical judgment, produce death
within six months.
§ 54B02. Qualified patient requirements.
To qualify to receive end-of-life medication under this
chapter, a patient must:
(1) Have a terminal illness, as determined by an
attending provider and a consulting provider.
(2) Be capable of making an informed decision, as
determined under sections 54B07 (relating to attending
provider responsibilities) and 54B08(3) (relating to
confirmation of terminal illness).
(3) Be a resident of this Commonwealth.
§ 54B03. Request for medication.
(a) Request.--A qualified patient may make a request under
subsection (b) for end-of-life medication for the purpose of
ending the qualified patient's life in a compassionate, humane
and dignified manner under this chapter.
(b) Request requirements.--In order to receive a
prescription for end-of-life medication, a qualified patient
must:
(1) Make an oral request to the attending provider.
(2) Except as provided for under section 54B06 (relating
to waiting periods), reiterate the oral request by making a
second oral request to the attending provider no less than 15
days after making the initial oral request.
(3) Make a written request to the attending provider in
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the form required under section 54B05 (relating to form of
written request).
§ 54B04. Right and opportunity to rescind request.
(a) Rescission.--A qualified patient may rescind the request
to end the qualified patient's life at any time and in any
manner without regard to mental state.
(b) Opportunity required.--At the time a qualified patient
makes the qualified patient's second oral request under section
54B06 (relating to waiting periods), the attending provider must
offer the qualified patient an opportunity to rescind the
request.
(c) Prohibition.--A prescription for end-of-life medication
under this chapter may not be written without the attending
provider offering the qualified patient an opportunity to
rescind the request.
§ 54B05. Form of written request.
(a) Signature, date and attestation.--A valid request for
end-of-life medication under this chapter shall be in
substantially the form under subsection (e), signed and dated by
the qualified patient and witnessed by at least two individuals
who, in the presence of the qualified patient, attest to the
best of the witnesses' knowledge and belief that the qualified
patient is capable, acting voluntarily and not being coerced to
sign the request.
(b) Witness.--One of the witnesses shall be an individual
who is not:
(1) a relative of the qualified patient by blood,
marriage or adoption;
(2) someone with whom the qualified patient has had a
significant relationship;
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(3) an individual who, at the time the request is
signed, would be entitled to a portion of the estate of the
qualified patient upon death under a will or by operation of
law; or
(4) an owner, operator or employee of a health care
facility where the qualified patient is receiving medical
treatment or is a resident.
(c) Prohibition.--The qualified patient's attending
provider, consulting provider or an individual who has conducted
an evaluation of the qualified patient at the time the request
is signed shall not be a witness.
(d) Long-term care patient.--If the qualified patient is in
a long-term care facility at the time the written request is
made, one of the witnesses shall be an individual designated by
the long-term care facility and who has the qualifications
required by the department by rule.
(e) Form.--A request for end-of-life medication as
authorized under this chapter shall be in substantially the
following form:
REQUEST FOR MEDICATION
TO END MY LIFE IN A COMPASSIONATE,
HUMANE AND DIGNIFIED MANNER
I, , am an adult of sound mind.
I am suffering from , which my
attending provider has determined is a terminal illness and
which has been medically confirmed by a consulting provider.
I have been fully informed of my diagnosis and prognosis, the
nature of medication to be prescribed and potential associated
risks, the expected result and the feasible alternatives,
including comfort care, hospice care, palliative care and pain
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control.
I request that my attending provider prescribe medication
that will end my life in a compassionate, humane and dignified
manner.
INITIAL ONE:
( ) I have informed my family or significant other of my
decision and have taken their opinions into consideration.
( ) I have decided not to inform my family or
significant other of my decision.
( ) I have no family or significant other to inform of
my decision.
I understand that I have the right to rescind this request at
any time.
I understand that this request will supersede any provision
of an advance directive in conflict with the provisions of this
request.
I understand the full import of this request and I expect to
die when I take the medication to be prescribed. I further
understand that although most deaths occur within three hours,
my death may take longer and my provider has counseled me about
this possibility.
I am not being coerced by another individual to make this
decision.
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
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identity.
(b) Signed this request in our presence on the date of
the person's signature.
(c) Appears to be of sound mind and not under duress,
fraud or undue influence, such as being coerced by another
individual.
(d) Is not a patient for whom either of us is an
attending provider.
Date:
Witness' printed name:
Witness' signature:
Number and Street:
City, State and Zip Code:
Date:
Witness' printed name:
Witness' signature:
Number and Street:
City, State and Zip Code:
NOTE: One witness shall not be a relative by blood, marriage
or adoption of the person signing this request, shall not be
someone with whom the person has a significant relationship,
shall not be entitled to any portion of the person's estate upon
death and shall not own, operate or be employed at a health care
facility where the person is receiving medical treatment or a
resident. If the patient is an inpatient at a long-term care
facility, one of the witnesses shall be a person designated by
the facility.
§ 54B06. Waiting periods.
(a) General rule.--Except as provided under subsection (b):
(1) At least 15 days shall elapse between a qualified
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patient's initial oral request and the writing of a
prescription for end-of-life medication under this chapter.
(2) At least 48 hours shall elapse between the qualified
patient's written request and the writing of a prescription
for end-of-life medication under this chapter.
(b) Exceptions.--
(1) If a qualified patient's attending provider has
determined, and a medical confirmation is received under
section 54B08 (relating to confirmation of terminal illness),
that the qualified patient will, within reasonable medical
judgment, die within 15 days of making the initial oral
request, the qualified patient may reiterate the second oral
request to the attending provider at any time after making
the initial oral request.
(2) If the qualified patient's attending provider has
determined, and a medical confirmation is received under
section 54B08, that the qualified patient will, within
reasonable medical judgment, die before the expiration of at
least one of the waiting periods described under subsection
(a), the attending provider may write the prescription for
end-of-life medication under this chapter at any time
following the later of the qualified patient's written
request or second oral request.
§ 54B07. Attending provider responsibilities.
(a) Responsibilities.--If a patient requests end-of-life
medication, an attending provider shall:
(1) Determine if the patient has a terminal illness, is
capable and has made the request for end-of-life medication
voluntarily.
(2) Ensure that the patient is making an informed
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decision and inform the patient of:
(i) The patient's medical diagnosis.
(ii) The patient's prognosis.
(iii) The potential risks associated with taking the
end-of-life medication to be prescribed.
(iv) The probable result of taking the end-of-life
medication to be prescribed.
(v) The feasible alternatives, including comfort
care, hospice care, palliative care and pain control.
(3) Refer the patient to a consulting provider for
medical confirmation of the diagnosis and for a determination
that the patient is capable and acting voluntarily.
(4) Refer the patient for counseling, if appropriate,
under section 54B09 (relating to counseling referral).
(5) Recommend to the patient that the patient notify
next of kin or someone with whom the patient has a
significant relationship.
(6) Counsel the patient about the importance of:
(i) having another individual present when the
patient takes end-of-life medication prescribed under
this chapter; and
(ii) not taking the end-of-life medication in a
public place.
(7) Inform the patient that the patient has an
opportunity to rescind the request at any time and in any
manner under section 54B04 (relating to right and opportunity
to rescind request) and offer the patient an opportunity to
rescind at the end of the 15-day waiting period or at the
time the patient makes the patient's second oral request
under section 54B06 (relating to waiting periods).
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(8) Immediately prior to writing a prescription for end-
of-life medication under this chapter, verify that the
patient is making an informed decision.
(9) Fulfill the medical record documentation
requirements under section 54B11 (relating to medical record
documentation requirements).
(10) If the patient fulfills all the requirements under
this chapter, approve the qualified patient's request to
receive end-of-life medication.
(11) (i) Dispense end-of-life medications directly,
including ancillary medications intended to facilitate
the desired effect to minimize the qualified patient's
discomfort if the attending provider is authorized to
prescribe medications in this Commonwealth, has a current
Drug Enforcement Administration certificate and complies
with applicable administrative rules; or
(ii) with the qualified patient's written consent:
(A) contact a pharmacist and inform the
pharmacist of the prescription; and
(B) deliver the written prescription personally,
electronically, by facsimile or by mail to the
pharmacist, who shall dispense the end-of-life
medications to the qualified patient, the attending
provider or an expressly identified agent of the
qualified patient.
(b) Death certificate.--The attending provider may sign the
qualified patient's death certificate.
§ 54B08. Confirmation of terminal illness.
A patient must receive a confirmation of terminal illness
before the patient may be determined to be a qualified patient
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under this chapter. The consulting provider performing the
confirmation of terminal illness shall physically examine a
patient requesting end-of-life medication under section 54B03
(relating to request for medication) and the patient's relevant
medical records to confirm the attending provider's diagnosis
that the patient is suffering from a terminal illness. The
consulting provider must also verify the patient is:
(1) Capable.
(2) Acting voluntarily.
(3) Making an informed decision.
§ 54B09. Counseling referral.
If the opinion of the attending provider or the consulting
provider is that the patient may not be capable, at the time a
written request is made under section 54B03 (relating to request
for medication), either the attending provider or consulting
provider shall refer the patient to a mental health care
provider for counseling. End-of-life medication may not be
prescribed until the mental health care provider performing the
counseling determines that the patient is capable and able to
make a voluntary informed decision without impaired judgment.
§ 54B10. Family notification.
The attending provider shall recommend that the qualified
patient notify the next of kin or an individual with whom the
qualified patient has a significant relationship of the
qualified patient's request for end-of-life medication under
this chapter. An attending provider may not deny a request for
end-of-life medication solely because a qualified patient
declines or is unable to notify the next of kin or an individual
with whom the qualified patient has a significant relationship.
§ 54B11. Medical record documentation requirements.
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The following shall be documented or filed in the qualified
patient's medical record:
(1) All oral requests by a qualified patient for end-of-
life medication.
(2) All written requests by a qualified patient for end-
of-life medication.
(3) The attending provider's diagnosis of terminal
illness and determination that the qualified patient is
capable, acting voluntarily and making an informed decision.
(4) All medical confirmations of terminal illness.
(5) Documentation that the qualified patient is capable
and acting voluntarily and has made an informed decision.
(6) A report of the outcome and determinations made
during counseling.
(7) A certification of the imminence of the qualified
patient's death.
(8) Documentation of the attending provider's offer to
the qualified patient to rescind the qualified patient's
request at the time of the qualified patient's second oral
request under section 54B03 (relating to request for
medication).
(9) Documentation by the attending provider that the
requirements under this chapter have been met and the steps
taken to carry out the request, including a notation of the
end-of-life medication prescribed.
§ 54B12. Reporting requirements.
(a) Review and rulemaking.--The department shall:
(1) Annually review a sample of records maintained under
this chapter.
(2) Require a health care provider to file a copy of the
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prescription or the dispensing record with the department
upon writing the prescription or dispensing end-of-life
medication under this chapter.
(3) Issue guidelines and promulgate regulations to
facilitate the collection of information regarding compliance
with this chapter.
(b) Records.--Information collected under subsection (a)
shall not be a public record and may not be made available for
inspection by the public.
(c) Report.--The department shall generate and make
available to the public, to the extent that doing so would not
be reasonably expected to violate the privacy of any person, an
annual statistical report of information collected under
subsection (a).
§ 54B13. Effect on construction of wills and contracts.
(a) Effect on existing agreements.--A provision in a
contract, will or other agreement, whether written or oral,
shall not be valid to the extent that the provision would
condition or restrict an individual's decision to make or
rescind a request for end-of-life medication.
(b) Obligations under an existing contract.--An obligation
under an existing contract shall not be affected by an
individual's making or rescinding of a request for end-of-life
medication.
§ 54B14. Insurance and annuity policies.
The sale, procurement or issuance of a life, health or
accident insurance or annuity policy or the rate charged for a
policy shall not be conditioned upon or affected by the making
or rescinding of a request by a qualified patient for end-of-
life medication. A qualified patient's act of ingesting end-of-
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life medication may not have an effect upon a life, health or
accident insurance or an annuity policy.
§ 54B15. Health care provider participation, notification and
permissible sanctions.
(a) Participation not required.--A health care provider may
not be under any duty, whether by contract, statute or other
legal requirement, to prescribe or administer end-of-life
medication to a qualified patient. If a health care provider is
unable or unwilling to carry out a qualified patient's request
under this chapter and the qualified patient transfers care to
another health care provider, the prior health care provider
shall transfer, upon request, a copy of the qualified patient's
relevant medical records to the new health care provider.
(b) Prohibiting participation.--A health care facility may
prohibit a health care provider from participating in actions
under this chapter if the prohibiting health care facility has
notified the health care provider of the prohibiting health care
facility's policy regarding participation under this chapter.
Nothing in this subsection shall prevent a health care provider
from providing health care services to a patient that does not
constitute participation under this chapter.
(c) Notification requirement.--A health care facility shall
notify a health care provider of a policy prohibiting
participation under this chapter. A health care facility that
fails to provide notice prohibiting participation under this
chapter may not enforce sanctions against a health care provider
under subsection (d).
(d) Sanctions.--Notwithstanding subsection (a) or section
54B18 (relating to immunity), a health care facility may subject
a health care provider to the sanctions under this subsection if
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the health care provider violated the health care facility's
policy prohibiting participation under this chapter and
notification was provided as required under subsection (c). The
available sanctions shall include:
(1) Loss of privileges, loss of membership or other
sanctions provided under the medical staff bylaws, policies
and procedures if the health care provider is a member of the
health care facility's medical staff and participates under
this chapter while on the premises, which shall not include
the private medical office of a provider or other health care
provider.
(2) Termination of lease or other property contract or
other nonmonetary remedies provided by lease contract, not
including loss or restriction of medical staff privileges or
exclusion from the health care facility panel, if the health
care provider participates under this chapter while on the
premises of or on property that is owned by or under the
direct control of the health care facility.
(3) Termination of contract or other nonmonetary
remedies provided by contract if the health care provider
participates under this chapter while acting in the course
and scope of the health care provider's capacity as an
employee or independent contractor of the health care
facility. Nothing in this paragraph may be construed to
prevent:
(i) a health care provider from participating under
this chapter while acting outside the course and scope of
the health care provider's capacity as an employee or
independent contractor; or
(ii) a patient from contracting with the patient's
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attending provider and consulting provider to act outside
the course and scope of the health care provider's
capacity as an employee or independent contractor of the
health care facility.
(e) Due process.--A health care facility that imposes
sanctions under subsection (d) shall follow all due process and
other procedures that the health care facility may have that are
related to the imposition of sanctions on a health care
provider.
(f) Unprofessional or dishonorable conduct reports.--
Authorized action taken under section 54B05 (relating to form of
written request), 54B07 (relating to attending provider
responsibilities), 54B08 (relating to confirmation of terminal
illness) or 54B09 (relating to counseling referral) may not be
the sole basis for a report of unprofessional or dishonorable
conduct to the State Board of Medicine or the State Board of
Osteopathic Medicine.
(g) Standard of care.--Nothing under this chapter may be
construed to allow a lower standard of care for a patient in the
community where the patient is treated, or a similar community.
(h) Definition.--As used in this section, the term "notify"
means a separate written statement to a health care provider
that sanctions the health care provider's participation in
activities covered by this chapter before the participation
occurs.
§ 54B16. Claims by governmental entity for costs incurred.
A governmental entity that incurs costs resulting from a
qualified patient ending the qualified patient's life under this
chapter in a public place shall have a claim against the estate
of the individual to recover costs and reasonable attorney fees
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related to enforcing the claim.
§ 54B17. Construction.
Nothing under this chapter may be construed to authorize a
provider or any other individual to end a patient's life by
lethal injection, mercy killing or active euthanasia. Actions
taken in accordance with this chapter shall not constitute
suicide, assisted suicide, mercy killing or homicide under the
laws of this Commonwealth.
§ 54B18. Immunity.
Except as provided in section 54B19 (relating to liability):
(1) An individual may not 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 end-of-life medication.
(2) A professional organization or association, health
care facility or health care provider may not subject an
individual to censure, discipline, suspension, loss of
license, loss of privileges, loss of membership or other
penalty for participating in good faith or refusing to
participate under this chapter.
(3) A request by a patient for or provision by an
attending provider of end-of-life medication in good faith
compliance with this chapter shall not constitute negligence
for any purpose under law or provide the sole basis for the
appointment of a guardian or conservator.
§ 54B19. Liability.
(a) Mishandling instrument.--An individual who, without
authorization of the patient, willfully alters or forges a
request for end-of-life medication or conceals or destroys a
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rescission of that request with the intent or effect of causing
the patient's death shall not be immune from criminal liability
under section 54B18 (relating to immunity).
(b) Undue influence.--An individual, including an attending
provider, who coerces or exerts undue influence on a patient to
request end-of-life medication for the purpose of ending the
patient's life or to destroy a rescission of a request shall not
be immune from criminal liability under section 54B18.
(c) Civil damages.--Nothing under this chapter shall be
construed to limit liability for civil damages resulting from
negligent or intentional misconduct or coercion by an
individual, including an attending provider.
§ 54B20. Prohibitions and penalties.
(a) Intent to hasten death.--An individual who, without
authorization of a patient, willfully alters, forges, conceals
or destroys an instrument, the reinstatement or revocation of an
instrument or any other evidence or document reflecting the
patient's desires and interests with the intent and effect of
causing a withholding or withdrawal of life-sustaining
procedures or of artificially administered nutrition and
hydration that hastens the death of the patient commits a felony
of the first degree.
(b) Intent to affect health care decision.--Except as
provided in subsection (a), an individual who, without
authorization of the patient, willfully alters, forges, conceals
or destroys an instrument, the reinstatement or revocation of an
instrument or any other evidence or document reflecting the
patient's desires and interests with the intent or effect of
affecting a health care decision commits a misdemeanor of the
first degree.
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Section 2. This act shall take effect in 120 days.
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