SB610: SB610 "Georgia Death and Dignity Act"; enact

26 LC 48 1790 Senate Bill 610 By: Senators Jackson of the 41st, Orrock of the 36th, Jones II of the 22nd, Harrell of the 40th, Kemp of the 38th and others A BILL TO BE ENTITLED AN ACT To amend Title 31 of the Official Code of Georgia Annotated, re lating to health, so as to1 create provisions for physician-assisted end-of-life options for terminally ill individuals; to2 provide for definitions; to provide a criminal penalty; to provide a short title; to provide for3 related matters; to repeal conflicting laws; and for other purposes.4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:5 SECTION 1.6 This Act shall be known and may be cited as the ''Georgia Death with Dignity Act.''7 SECTION 2.8 Title 31 of the Official Code of Georgia Annotated, relating to health, is amended by adding9 a new chapter to read as follows:10 "CHAPTER 5511 31-55-1.12 As used in this chapter, the term:13 S. B. 610 - 1 - 26 LC 48 1790 (1) 'Adult' means an individual who is 18 years of age or older.14 (2) 'Attending physician' means a physician who has primary responsibility for the care15 of a terminally ill individual and the treatment of the individual's terminal illness.16 (3) 'Consulting physician' means a physician who is qualified by specialty or experience17 to make a professional diagnosis and prognosis regarding a term inally ill individual's18 illness.19 (4) 'Healthcare provider' or 'provider' means a person or facility that is licensed, certified,20 registered, or otherwise authorized or permitted by law to admi nister healthcare or21 dispense medication in the ordinary course of business or practice of a profession under22 this title or Title 34.23 (5) 'Informed decision' means a decision that is:24 (A) Made by an individual to obtain a prescription for medical aid-in-dying medication25 that the qualified individual may decide to self-administer to end his or her life in a26 peaceful manner;27 (B) Based on an understanding and acknowledgment of the relevant facts; and28 (C) Made after the attending physician fully informs the individual of:29 (i) His or her medical diagnosis and prognosis of six months or less;30 (ii) The potential risks associated with taking the medical aid-in-dying medication to31 be prescribed;32 (iii) The probable result of taking the medical aid-in-dying m edication to be33 prescribed;34 (iv) The choices available to such individual that demonstrate h i s o r h e r35 self-determination and intent to end his or her life in a peaceful manner, including the36 ability to choose whether to:37 (I) Request medical aid in dying;38 (II) Obtain a prescription for medical aid-in-dying medication to end his or her life;39 S. B. 610 - 2 - 26 LC 48 1790 (III) Fill the prescription and possess medical aid-in-dying m edication to end his40 or her life; and41 (IV) Ultimately self-administer the medical aid-in-dying medication to bring about42 a peaceful death; and43 (v) All feasible alternatives or additional treatment opportunities, including comfort44 care, palliative care, hospice care, and pain control.45 (6) 'Licensed mental health professional' means a psychiatrist licensed under Chapter 3446 of Title 43 or a psychologist licensed under Chapter 39 of Title 43.47 (7) 'Medical aid in dying' means the medical practice of a physician prescribing medical48 aid-in-dying medication to a qualified individual that the indi vidual may choose to49 self-administer to bring about a peaceful death.50 (8) 'Medical aid-in-dying medication' means medication prescri bed by a physician51 pursuant to this chapter to provide medical aid in dying to a qualified individual.52 (9) 'Medically confirmed' means that a consulting physician wh o has examined the53 terminally ill individual and the individual's relevant medical records has confirmed the54 medical opinion of the attending physician.55 (10) 'Mental capacity' or 'mentally capable' means that in the opinion of an individual's56 attending physician, consulting physician, psychiatrist or psychologist, the individual has57 the ability to make and communicate an informed decision to healthcare providers.58 (11) 'Physician' means a doctor of medicine or osteopathy licensed to practice medicine59 by the Georgia Composite Medical Board.60 (12) 'Prognosis of six months or less' means a prognosis resulting from a terminal illness61 that the illness will, within reasonable medical judgment, resu lt in death within six62 months and which has been medically confirmed.63 (13) 'Qualified individual' means a terminally ill adult with a prognosis of six months or64 less, who has mental capacity, has made an informed decision, is a resident of this state,65 S. B. 610 - 3 - 26 LC 48 1790 and has satisfied the requirements of this chapter in order to obtain a prescription for66 medical aid-in-dying medication to end his or her life in a peaceful manner.67 (14) 'Resident' means an individual who is able to demonstrate residency in this state by68 providing any of the following documentation to his or her attending physician:69 (A) A driver's license or identification card issued pursuant to Chapter 5 of Title 40;70 (B) A voter registration card or other documentation showing t he individual is71 registered to vote in this state;72 (C) Evidence that the individual owns or leases property in this state; or73 (D) An income tax return filed with the State of Georgia for the most recent tax year.74 (15) 'Self-administer' means a qualified individual's affirmative, conscious, and physical75 act of administering the medical aid-in-dying medication to him self or herself to bring76 about his or her own death.77 (16) 'Terminal illness' means an incurable and irreversible il lness that will, within78 reasonable medical judgment, result in death.79 31-55-2.80 (a) An adult resident of this state may make a request, pursuant to Code Sections 31-55-381 and 31-55-11, to receive a prescription for medical aid-in-dying medication if:82 (1) The individual's attending physician has diagnosed the ind ividual with a terminal83 illness with a prognosis of six months or less;84 (2) The individual's attending physician has determined the in dividual has mental85 capacity; and86 (3) The individual has voluntarily expressed the wish to recei ve a prescription for87 medical aid-in-dying medication.88 (b) The right to request medical aid-in-dying medication shall not exist because of age or89 disability.90 S. B. 610 - 4 - 26 LC 48 1790 31-55-3.91 (a) In order to receive a prescription for medical aid-in-dying medication pursuant to this92 chapter, an individual who satisfies the requirements in Code Section 31-55-2 shall make93 two oral requests, separated by at least three days, and a valid written request to his or her94 attending physician.95 (b) To be valid, a written request for medical aid-in-dying medication shall be:96 (1) Substantially in the same form as set forth in Code Section 31-55-11;97 (2) Signed and dated by the individual seeking the medical aid-in-dying medication;98 (3) Witnessed by at least two persons who, in the presence of the individual, attest to the99 best of their knowledge and belief that the individual is:100 (A) Mentally capable;101 (B) Acting voluntarily; and102 (C) Not being coerced to sign the request; and103 (4) Of the two witnesses to the written request, at least one must not be:104 (A) Related to the individual by blood, marriage, civil union, or adoption;105 (B) A person who, at the time the request is signed, is entitl ed, under a will or by106 operation of law, to any portion of the individual's estate upon his or her death; or107 (C) An owner, operator, or employee of a healthcare facility w here the individual is108 receiving medical treatment or is a resident.109 (c) Neither the individual's attending physician nor a person authorized as the individual's110 qualified power of attorney or durable medical power of attorney shall serve as a witness111 to the written request.112 31-55-4.113 (a) At any time, an individual may rescind his or her request for medical aid-in-dying114 medication without regard to the individual's mental state.115 S. B. 610 - 5 - 26 LC 48 1790 (b) An attending physician shall not write a prescription for medical aid-in-dying116 medication under this chapter unless the attending physician offers the qualified individual117 an opportunity to rescind the request for the medical aid-in-dying medication.118 31-55-5.119 The attending physician shall:120 (1) Make the initial determination of whether an individual re questing medical121 aid-in-dying medication has a terminal illness, has a prognosis of six months or less, is122 mentally capable, is making an informed decision, and has made the request voluntarily;123 (2) Request that the individual demonstrate Georgia residency by providing124 documentation as described in Code Section 31-55-1;125 (3) Provide care that conforms to established medical standard s and accepted medical126 guidelines;127 (4) Refer the individual to a consulting physician for medical confirmation of the128 diagnosis and prognosis and for a determination of whether the individual is mentally129 capable, is making an informed decision, and acting voluntarily;130 (5) Provide full, individual-centered disclosures to ensure that the individual is making131 an informed decision by discussing with the individual:132 (A) His or her medical diagnosis and prognosis of six months or less;133 (B) The feasible alternatives or additional treatment opportunities, including comfort134 care, palliative care, hospice care, and pain control;135 (C) The potential risks associated with taking the medical aid-in-dying medication to136 be prescribed;137 (D) The probable result of taking the medical aid-in-dying medication to be prescribed;138 and139 (E) The possibility that the individual can obtain the medical aid-in-dying medication140 but chooses not to use it;141 S. B. 610 - 6 - 26 LC 48 1790 (6) Refer the individual to a licensed mental health professio nal pursuant to Code142 Section 31-55-7 if the attending physician believes that the in dividual may not be143 mentally capable of making an informed decision;144 (7) Confirm that the individual's request does not arise from coercion or undue influence145 by another person by discussing with the individual, outside th e presence of other146 persons, whether the individual is feeling coerced or unduly in fluenced by another147 person;148 (8) Counsel the individual about the importance of:149 (A) Having another person present when the individual self-adm inisters the medical150 aid-in-dying medication prescribed pursuant to this chapter;151 (B) Not taking the medical aid-in-dying medication in a public place;152 (C) Safekeeping and proper disposal of unused medical aid-in-d ying medication in153 accordance with Code Section 31-55-19; and154 (D) Notifying his or her next of kin of the request for medical aid-in-dying medication;155 (9) Inform the individual that he or she may rescind the request for medical aid-in-dying156 medication at any time and in any manner;157 (10) Verify, immediately prior to writing the prescription for medical aid-in-dying158 medication, that the individual is making an informed decision;159 (11) Ensure that all appropriate steps are carried out in acco rdance with this chapter160 before writing a prescription for medical aid-in-dying medication; and161 (12)(A) Dispense medical aid-in-dying medications directly to the qualified individual,162 including ancillary medications intended to minimize the individual's discomfort, if the163 attending physician has a current drug enforcement administrati on certificate and164 complies with any applicable administrative rule; or165 (B) Deliver the written prescription personally, by mail, or t hrough authorized166 electronic transmission in the manner permitted by law to a licensed pharmacist, who167 S. B. 610 - 7 - 26 LC 48 1790 shall dispense the medical aid-in-dying medication to the quali fied individual, the168 attending physician, or a person expressly designated by the qualified individual.169 31-55-6.170 Before an individual who is requesting medical aid-in-dying med ication may receive a171 prescription for such medication, a consulting physician shall:172 (1) Examine the individual and his or her relevant medical records; and173 (2) Confirm, in writing, to the attending physician that:174 (A) The individual has a terminal illness;175 (B) The individual has a prognosis of six months or less;176 (C) The individual is making an informed decision; and177 (D) The individual is mentally capable, or provide documentation that the consulting178 physician has referred the individual for further evaluation in accordance with Code179 Section 31-55-7.180 31-55-7.181 (a) An attending physician shall not prescribe medical aid-in-dying medication under this182 chapter for an individual with a terminal illness until the ind ividual is determined to be183 mentally capable of making an informed decision, and those determinations are confirmed184 in accordance with this Code section.185 (b) If the attending physician or the consulting physician believes that the individual may186 not be mentally capable of making an informed decision, the att ending physician or187 consulting physician shall refer the individual to a licensed mental health professional for188 a determination of whether the individual is mentally capable o f making an informed189 decision.190 (c) A licensed mental health professional who evaluates an ind ividual under this Code191 section shall communicate, in writing, to the attending or cons ulting physician who192 S. B. 610 - 8 - 26 LC 48 1790 requested the evaluation his or her conclusions about whether t he individual is mentally193 capable of making an informed decision. If the licensed mental h e a l t h p r o f e s s i o n a l194 determines that the individual is not mentally capable of making an informed decision, the195 individual shall not be deemed a qualified individual under this chapter and the attending196 physician shall not prescribe medical aid-in-dying medication to the individual.197 31-55-8.198 (a) Unless otherwise prohibited by law, the attending physicia n or the hospice medical199 director shall sign the death certificate of a qualified indivi dual who obtained and200 self-administered aid-in-dying medication.201 (b) When a death has occurred in accordance with this chapter, the cause of death shall be202 listed as the underlying terminal illness and the death shall n ot constitute grounds for203 post-mortem inquiry under Article 2 of Chapter 16 of Title 45.204 31-55-9.205 (a) An individual with a terminal illness is not a qualified individual and shall not receive206 a prescription for medical aid-in-dying medication unless he or she has made an informed207 decision.208 (b) Immediately before writing a prescription for medical aid-in-dying medication under209 this chapter, the attending physician shall verify that the individual with a terminal illness210 is making an informed decision.211 31-55-10.212 (a) The attending physician shall document, in the individual' s medical record, the213 following information:214 (1) Dates of all oral requests;215 (2) A valid written request;216 S. B. 610 - 9 - 26 LC 48 1790 (3) The attending physician's diagnosis and prognosis, determination of mental capacity,217 and that the individual is making a voluntary request and an informed decision;218 (4) The consulting physician's confirmation of diagnosis and prognosis, mental capacity,219 and that the individual is making an informed decision;220 (5) If applicable, written confirmation of mental capacity from a licensed mental health221 professional;222 (6) A notation of notification of the right to rescind a reque st made pursuant to this223 chapter; and224 (7) A notation by the attending physician that all requirements under this chapter have225 been satisfied, indicating steps taken to carry out the request, including a notation of the226 medical aid-in-dying medications prescribed and when.227 (b)(1) The Department of Public Health shall annually review a sample of records228 maintained pursuant to this chapter to ensure compliance. The department shall adopt229 rules to facilitate the collection of information defined in su bsection (a) of this Code230 section. Except as otherwise required by law, the information collected by the231 department is not a public record and is not available for public inspection. However, the232 department shall generate and make available to the public an annual statistical report of233 information collected under this subsection.234 (2) The department shall require any healthcare provider, upon dispensing a medical235 aid-in-dying medication pursuant to this chapter, to file a cop y of a dispensing record236 with the department. The dispensing record is not a public record and is not available for237 public inspection.238 239 31-55-11.240 A request for medical aid-in-dying medication authorized by thi s chapter shall be in241 substantially the following form:242 S. B. 610 - 10 - 26 LC 48 1790 'REQUEST FOR MEDICATION TO END MY LIFE IN A PEACEFUL MANNER243 I,_____________________________________________, am an adult of sound mind. 244 I am suffering from _____________________________, which my attending physician245 has determined is a terminal illness and which has been medical ly confirmed. I have246 been fully informed of my diagnosis and prognosis of six months or less, the nature of247 the medical aid-in-dying medication to be prescribed and potential associated risks, the248 expected result, and the feasible alternatives or additional tr eatment opportunities,249 including comfort care, palliative care, hospice care, and pain control.250 I request that my attending physician prescribe medical aid-in-dying medication that will251 end my life in a peaceful manner if I choose to take it, and I authorize my attending252 physician to contact any pharmacist about my request.253 ____I understand that I have the right to rescind this request at any time.254 ____I understand the seriousness of this request, and I expect to die if I take the255 aid-in-dying medication prescribed.256 ____I further understand that although most deaths occur within three hours, my death257 may take longer, and my attending physician has counseled me about this possibility. I258 make this request voluntarily, without reservation, and without being coerced, and I259 accept full responsibility for my actions.260 Signed: ________________________________________________________261 Dated: _________________________________________________________262 DECLARATION OF WITNESSES263 We declare that the individual signing this request:264 S. B. 610 - 11 - 26 LC 48 1790 ____Is personally known to us or has provided proof of identity;265 ____Signed this request in our presence;266 ____Appears to be of sound mind and not under duress, coercion, or undue influence; and267 ____I am not the attending physician for the individual.268 WITNESS ONE269 Name:____________________________________________ Date:_________________270 WITNESS TWO271 Name:__________________________________________ Date:__________________272 Note:273 (a) Of the two witnesses to the written request, at least one must not:274 (1) Be a relative (by blood, marriage, civil union, or adoption) of the individual signing275 this request;276 (2) Be entitled to any portion of the individual's estate upon death; or277 (3) Own, operate, or be employed at a healthcare facility where the individual is a patient278 or resident; and279 (b) Neither the individual's attending physician nor a person authorized as the individual's280 qualified power of attorney or durable medical power of attorney shall serve as a witness281 to the written request.'282 31-55-12.283 (a) Physicians and healthcare providers shall provide medical services under this chapter284 that meet or exceed the standard of care for end-of-life medical care.285 (b) If a healthcare provider is unable or unwilling to carry o ut an eligible individual's286 request and the individual transfers care to a new healthcare p rovider, the healthcare287 S. B. 610 - 12 - 26 LC 48 1790 provider shall coordinate transfer of the individual's medical records to a new healthcare288 provider.289 31-55-13.290 (a) A provision in a contract, will, or other agreement, whether written or oral, that would291 affect whether an individual may make or rescind a request for medical aid in dying292 pursuant to this chapter is invalid.293 (b) An obligation owing under any currently existing contract shall not be conditioned294 upon, or affected by, an individual's act of making or rescindi ng a request for medical295 aid-in-dying medication pursuant to this chapter.296 31-55-14.297 (a) The sale, procurement, or issuance of, or the rate charged for, any life, health, or298 accident insurance or annuity policy shall not be conditioned u pon, or affected by, an299 individual's act of making or rescinding a request for medical aid-in-dying medication in300 accordance with this chapter.301 (b) A qualified individual's act of self-administering medical aid-in-dying medication302 pursuant to this chapter shall not affect a life, health, or ac cident insurance or annuity303 policy.304 (c) An insurer shall not deny or otherwise alter healthcare benefits available under a policy305 of sickness and accident insurance for an individual with a terminal illness who is covered306 under the policy, based on whether or not the individual makes a request pursuant to this307 chapter.308 (d) An individual with a terminal illness who is a recipient under any medical assistance309 program of this state shall not be denied benefits under such p rogram or have his or her310 benefits under such program otherwise altered based on whether or not such individual311 makes a request pursuant to this chapter.312 S. B. 610 - 13 - 26 LC 48 1790 31-55-15.313 (a) A person shall not be subject to civil or criminal liability or professional disciplinary314 action for acting in good faith under this chapter, which inclu des being present when a315 qualified individual self-administers the prescribed medical aid-in-dying medication.316 (b) Except as provided for in Code Section 31-55-17, a healthcare provider or professional317 organization or association shall not subject an individual to any of the following for318 participating or refusing to participate in good-faith compliance under this chapter:319 (1) Censure;320 (2) Discipline;321 (3) Suspension;322 (4) Loss of license, privileges, or membership; or323 (5) Any other penalty.324 (c) A request by an individual for, or the provision by an attending physician of, medical325 aid-in-dying medication in good-faith compliance with this chapter shall not:326 (1) Constitute neglect or elder abuse for any purpose of law; or327 (2) Provide the basis for the appointment of a guardian or conservator.328 (d) This Code section shall not limit civil or criminal liability for negligence, recklessness,329 or intentional misconduct.330 31-55-16.331 (a) A healthcare provider may choose whether to participate in providing medical332 aid-in-dying medication to an individual in accordance with this chapter.333 (b) If a healthcare provider is unable or unwilling to carry out an individual's request for334 medical aid-in-dying medication made in accordance with this chapter, and the individual335 transfers his or her care to a new healthcare provider, the pri or healthcare provider shall336 transfer, upon request, a copy of the individual's relevant med ical records to the new337 healthcare provider.338 S. B. 610 - 14 - 26 LC 48 1790 31-55-17.339 (a) A healthcare facility may prohibit a physician employed or under contract from writing340 a prescription for medical aid-in-dying medication for a qualified individual who intends341 to use the medical aid-in-dying medication on the facility's pr emises. The healthcare342 facility shall notify the physician in writing of its policy wi th regard to prescriptions for343 medical aid-in-dying medication. A healthcare facility that fails to provide advance notice344 to the physician shall not be entitled to enforce such a policy against the physician.345 (b) A healthcare facility or healthcare provider shall not sub ject a physician, nurse,346 pharmacist, or other person to discipline, suspension, loss of license or privileges, or any347 other penalty or sanction for actions taken in good-faith relia nce on this chapter or for348 refusing to act under this chapter.349 (c) A healthcare facility shall notify patients in writing of its policy with regard to medical350 aid in dying. A healthcare facility that fails to provide advance notification to patients shall351 not be entitled to enforce such a policy.352 31-55-18.353 (a) A person commits a felony and, upon conviction thereof, sh all be punished by354 imprisonment for not less than one nor more than five years if the person, knowingly or355 intentionally, causes an individual's death by:356 (1) Forging or altering a request for medical aid-in-dying med ication to end an357 individual's life without the individual's authorization; or358 (2) Concealing or destroying a rescission of a request for med ical aid-in-dying359 medication.360 (b) A person commits a felony and, upon conviction thereof, sh all be punished by361 imprisonment for not less than one nor more than five years if the person knowingly or362 intentionally coerces or exerts undue influence on an individual with a terminal illness to:363 S. B. 610 - 15 - 26 LC 48 1790 (1) Request medical aid-in-dying medication for the purpose of ending the terminally ill364 individual's life; or365 (2) Destroy a rescission of a request for medical aid-in-dying medication.366 (c) Nothing in this chapter limits further liability for civil damages resulting from other367 negligent conduct or intentional misconduct by any person.368 (d) The penalties specified in this chapter do not preclude cr iminal penalties applicable369 under Title 16 for conduct that is inconsistent with this chapter.370 31-55-19.371 A person who has custody or control of medical aid-in-dying medication dispensed under372 this chapter that the terminally ill individual decides not to use or that remains unused after373 the terminally ill individual's death shall dispose of the unus ed medical aid-in-dying374 medication either by:375 (1) Returning the unused medical aid-in-dying medication to the attending physician who376 prescribed the medical aid-in-dying medication, who shall dispose of the unused medical377 aid-in-dying medication in the manner required by law; or378 (2) Lawful means in accordance with a state or federally approved medication take-back379 program authorized under the federal Secure and Responsible Drug Disposal Act of 2010,380 Pub. L. 111-273, and regulations adopted pursuant to the federal act.381 31-55-20.382 Nothing in this chapter authorizes a physician or any other person to end an individual's life383 by lethal injection, mercy killing, or euthanasia. Actions tak en in accordance with this384 chapter shall not, for any purpose, constitute suicide, assiste d suicide, mercy killing,385 homicide, or elder abuse under Title 16.386 S. B. 610 - 16 - 26 LC 48 1790 31-55-21.387 A government entity that incurs costs resulting from an individual terminating his or her388 life pursuant to this chapter in a public place has a claim against the estate of the individual389 to recover the costs and reasonable attorney fees related to enforcing the claim.390 31-55-22.391 Nothing in this chapter shall change the legal effect of:392 (1) A declaration made under Chapter 32 of this title directin g that life-sustaining393 procedures be withheld or withdrawn;394 (2) A cardiopulmonary resuscitation directive executed under Chapter 32 of this title; or395 (3) An advance medical directive executed under Chapter 32 of this title."396 SECTION 3.397 All laws and parts of laws in conflict with this Act are repealed.398 S. B. 610 - 17 -