Death with dignity.

2017
STATE OF WYOMING
17LSO-0320
Introduced
1.2

HOUSE BILL

NO.

HB0122

Death with dignity.

Sponsored by:
Representative(s) Zwonitzer and Pelkey

A BILL

for

AN ACT relating to public health and safety; allowing an attending health care provider to prescribe medication that will end a terminally ill patient's life; providing qualifications; providing requirements to health care providers; providing a procedure to request medication; providing reporting requirements; authorizing rulemaking; providing immunity for persons in compliance with the act as specified; providing penalties; specifying applicability; providing definitions; and providing for an effective date.

Be It Enacted by the Legislature of the State of Wyoming:

Section
1
.

W.S. 35
‑
22
‑
601 through 35
‑
22
‑
6
11

are
created to read:

CHAPTER 22
END OF LIVE DECISIONS

ARTICLE
6
AID IN DYING

35
‑
22
‑
601
.

Definitions.

(a)

As used in this
act
:

(i)

"
Attending health care provider
"
means
a person
who has primary responsibility for the care of a patient and treatment of the patient's terminal condition and is
licensed under Wyoming law and practicing within the scope of that license as a physician
;

(
ii)

"
Competent
"
means an individual
'
s ability to understand the significant benefits, risks and
alternatives to proposed health care and to make and communicate a health care decision
;

(i
ii
)

"
Consulting health care provider
"
means
a person
who is not responsible for care of the patient or treating the patient's illness prior to the consultation and is
licensed under Wyoming law and practicing within the scope of that license as a physician;

(iv)

"
Counseling
"
means one (1) or more consultations as necessary between a mental health care provider and a patient for the purpose of determining that the patient
'
s judgment is not impaired by a psychiat
ric or psychological condition;

(v)

"
Department
"
means th
e Wyoming
department of h
ealth;

(vi)

"
Health care institution
"
means an institution authorized by
Wyoming
law to provide health care in the ordinary course
of business;

(vii)

"Medication" means a medically appropriate prescription to end a patient's life;

(vii
i
)

"
Mental h
ealth care provider
"
means
any person licensed under Wyoming
law
practicing within the scope of that license as a
psychiatrist or
p
s
y
chologist
;

(
ix
)

"
Patient
"
means a person who is under the care of an attending health care provider;

(x)

"
Resident
"
means a person physically present in Wyom
ing for sixty (60) or more days;

(x
i
)

"
Terminal condition
"
means a condition that will, within
a
reasonable
degree of
medical
certainty
, produce death within six (6) months;

(xi
i
)

"
Voluntarily
"
means free of un
due physical or mental coercion;

(xii
i
)

"
This act
"
means W.S. 35
‑
22
‑
601 through 35
‑
22
‑
6
11
.

35
‑
22
‑
602
.

Right to be informed
.

A patient has the right to be informed
by
the patient's
attending health care provider
of all available options
for the management or treatment of
the patient's
terminal condition
,
includ
ing
the option to request medication pursuant to this
act
.

35
‑
22
‑
603
.

Qualification
;
requirements
.

(a)

Any patient who qualifies under this act may receive a prescription for medication to end
the patient's
life.

(b
)

A patient is qualified to receive a prescription for medication from
the patient's
attending health care provider if
all of the following requirements are met
:

(i)

The patient is an adult Wyoming resident;

(ii)

The patient
has
a terminal condition;

(iii)

The patient is competent and acting voluntarily;

(iv)

The patient has
been

provided
all required
inform
ation

about their terminal condition
, the medication and any feasible alternatives
pursuant to W.S.
35
‑
22
‑
604(
a)(ii);

(v)

The patient has been informed
of the option to
rescind the request for medication at any time and
in
any manner pursuant to W.S.
35
‑
22
‑
604
(
a)
(v)
;

(v
i
)

If
the patient is recommended for counseling pursuant to W.S. 35
‑
22
‑
606, a
mental health care provider has determined the patient
'
s judgment is not impaired by a psychiatric or psychological condition;

(vi
i
)

A consulting health care provider has c
onfirmed
paragraphs
(i) through (
v) of this
subsection
;

(
viii
)

The request for medication complied with the proced
ure set forth in W.S. 35
‑
22
‑
605; and

(ix)

The attending health care provider has verified all requirements of this subsection have been completed.

(c)

No patient shall qualify for medication under this act on the sole basis of age, disability, or
any
condition
which is not a terminal condition
.

35
‑
22
‑
604
.

Attending health care provider responsibilities.

(a)

If a patient makes a request for medication pursuant to W.S. 35
‑
22
‑
605, t
he attending health care provider shall:

(i)

Make a determination of whether a patient is an adult Wyoming resident, has a terminal condition, is competent and acting voluntarily;

(ii)

Inform the patient of:

(A)

The
patient's
medical diagnosis and prognosis;

(B)

The risks an
d probable result of taking
medication
prescribed under this a
ct
; and

(C)

Any feasible alternatives, including treatment, comfort care, hospice care and palliative care.

(iii)

Refer the patient to
a consulting health care provider
for an
independent assess
ment of
whether
the patient has a terminal condition, has made an informed decision, is competent and
is
acting voluntarily
regarding the request of medication
;

(iv)

Refer
the patient for counseling if appropriate pursuant to W.S. 35
‑
22
‑
606;

(v)

Inform the patient
of the option to
rescind the request for medication at any time and in any manner;

(vi)

Comply
with the medical record documentation requirements pursuant to W.S. 35
‑
22
‑
607; and

(vii)

Ensure that all
requirements of this act
are
met
prior to writing a prescription for medication.

35
‑
22
‑
605
.

Request procedure.

(a)

To receive medication under this act a patient shall make to the attending health care provider:

(i)

An initial request
for medication
;

(ii)

A second request
for medication
in writing which shall be substantially in the form described in W.S. 35
‑
22
‑
611, signed and dated by the patient and witnessed by two
(2)
persons who, in the presence of the patient, attest that to the best of their knowledge the patient is competent and acting voluntarily
and at least one (1) of which complies with the requirements of subsection (b) of this section
;

(ii
i
)

A
third
request
for medication
in writing

which shall be
made not less than fifteen (15) days after
the date of
the initial request
.

(b)

At least o
ne
(1)
of the witnesses
signing the form
required by
paragraph
(a
)
(
ii)
of this section shall not be:

(i)

A relative of the patient by blood, marriage or adoption;

(ii)

A person who
would be entitled to any portion of the
patient's
estate upon the death of the patient under any will or by any other operation of law
at the time the
written
request is signed; or

(iii)

An owner, operator or employee of
any
health care institution where the patient is receiving medical treatment.

(c)

If the patient is physically unable to make a written request, he or she may direct a competent adult in
the patient's
presence
and the presence of the attending health care provider
who is not a witne
ss to
fill out
the written request
on
the patient's
behalf
.

(d)

The patient
'
s attending health care provider shall not be a witness
and shall not provide the patient
with
any assistance
in
completing the written request
.

35
‑
22
‑
606
.

Counseling referral.

If in the opinion of the attending health care provider or consulting health care provider a patient
'
s judgment may be impaired by a psychiatric or psychological condition, the
attending health care provider shall refer the
patient
to a mental health care provider
for counseling. No medication shall be prescribed until the
mental health care provider
determine
s
the patient
'
s judgment is not impaired by a psychiatric or psychological condition.

35
‑
22
‑
607
.

Medical record documentation requirements.

(a)

The following shall be documented
in writing

and
filed in the patient
'
s medical record:

(i)

Any requests made by a patient
for medication
pursuant to this act;

(ii)

The attending health care provider
'
s diagnosis, prognosis,
and
determination that the patient is competent, acting voluntarily and has made an informed decision;

(iii)

The consulting health care provider
'
s
diagnosis, prognosis, and determination that the patient is competent, acting voluntarily and has made an informed decision
;

(iv)

Verification

that the patient has been informed
of all information required by
W.S.

35
‑
22
‑
604(
a)(ii) and (v);

(v)

If the patient was referred for counseling pursuant to W.S. 35
‑
22
‑
606, a
report
from the mental health care provider who performed the counseling stating
the outcome and
any
determinations made during counseling
by the mental health care provider on whether the patient's judgment is impaired
;

(v
i
)

Verification
by the attending health care provider that all requirements of this act have been met and indicating the steps taken to carry out the patient
'
s request; and

(vii)

Whether the patient has rescinded a request for medication.

35
‑
22
‑
608
.

Reporting requirements
; rulemaking
.

(
a
)

The department shall require any health care provider upon prescribing medication under this act to file a copy of the record required by W.S. 35
‑
22
‑
607 with the department.
Except as otherwise provided by law, information collected by the department shall not be a
public record and shall not be made available for inspection by the public.

(b
)

The department
shall

promulgate
rules
and regulations
to
:

(i)

Annually review a sample of the records maintained pursuant to this act

to ensure
compliance with this act
; and

(ii)

Collect information to assist with the preparation of an annual statistical report pursuant to subsection (c) of this section.

(
c
)

The department may generate and make available to the public an annual statistical report of information collected pursuant to this section.
The report shall not include any information
which would tend to disclose the identity of any individual who has been prescribed medication pursuant to this act
or the identity of any attending health care provider who prescribed medication pursuant to this act
.

35
‑
22
‑
609
.

Immunities; health care provider participation; liabilities.

(a)

No person shall be subject to civil or criminal liability or professional disciplinary action for participating in
any

activity authorized

in compliance with
this act.

(b)

No professional organization or association or health care institution may subject a person to any penalty for participating or refusing
to participate
in any activity authorized
under this act.

(c)

Actions taken or information received in accordance with this act do
es
not impose a duty to report under W.S. 35
‑
20
‑
103 or any other similar requirement.

(d)

No health care provider shall be under any duty to participate in providing a patient with medication in accordance with this act. An attending health care provider
who is unable or unwilling to carry out a patient
'
s request
shall
:

(i)

Promptly i
nform the patient;

(ii)

Provide continuing care to the patient until a transfer of care can be effected; and

(iii)

Immediately make all reasonable efforts to assist in the transfer of care of the patient to another
attending
health care provider who is willing and able to carry out
the
patient
'
s request.

(e)

Notwithstanding
subsections
(a) and (b) of this section, any person who violates a policy established by a health care institution may be subject to sanctions otherwise allowable under law or contract.

(f)

A
ny
person who willfully alters or forges a request for medication or
willfully
conceals or destroys a rescission of
a
request
for medication
with the intent of causing the patient
'
s death shall be guilty of a felony
punishable by imprisonment for a term not less than twenty (20) years.

(g)

A
ny
person who
willfully
coerces or exerts undue influence on a patient to request medication for the purpose of ending the patient
'
s life
with the intent of causing the patient's death
shall be guilty of a felony punishable by imprisonment for a term not less than twenty (20) years.

(h)

A
ny
person who willfully alters, forges, conceals or destroys an instrument or any other evidence reflecting a patient
'
s desires and interests with the intent or effect of affecting any decision under this act
, but does not act with the intent of causing the patient's death,
shall be guilty of a misdemeanor punishable by imprisonment for a term not more than one (1) year, a fine of not more than two thousand dollars ($2,000.00) or both.

(
j
)

Nothing in this act shall be construed to limit further criminal or civil liability or professional
misconduct resulting from other intentional or negligent conduct by any person.

35
‑
22
‑
610
.

Construction of act.

(a)

Nothing in this act shall be construed to authorize any
person to

contribut
e
to ending a patient's life or
provid
e
any
assist
ance to
a patient in ending his own life beyond prescribing the medication authorized pursuant to this
act
.

(b)

Death
caused by medication prescribed
in accordance with this act shall not constitute suicide for any purpose
under Wyoming law
.

35
‑
22
‑
611
.

Form.

A written request for medication pursuant to W.S. 35
‑
22
‑
605(
a)(ii) shall be in substantially the following form:

REQUEST FOR MEDICATION

I,
the undersigned
, am of a sound mind and a resident of the state of Wyoming.

I am suffering from
...., (condition)
, which my attending health care provider has determined is in its terminal phase and which has been confirmed by a consulting health care provider.

I have been fully informed of my diagnosis, prognosis, the risks and probable result of t
aking the prescribed medication
and feasible alternatives, including treatments, comfort care, hospice care and palliative care.

I request that my attending health care provider prescribe medication that will end my life should I choose to take it.

I understand that I have a right to rescind this request at any time.

I understand the full import of this request and I expect to die when I take the medication prescribed.

I make this request voluntarily and without reservation.

Signature of Candidate

Dated
: ....

DECLARATION OF WITNESSES

We declare that the person signing this request:

Is personally known to us or has provided proof of identify;

Signed this request in our presence;

Appears to be of sound mind and not under duress, fraud or undue influence; and

Is not a patient for whom either of us is
an
attending health care provider.

Signature of Witness 1

Dated ....

Signature of Witness 2

Dated ....

Section 2
.

This act is effective July 1, 2017
.

(END)

1
HB0122