AN ACT ESTABLISHING AN END OF LIFE OPTION ACT TO ALLOW QUALIFIED INDIVIDUALS DIAGNOSED WITH A TERMINAL DISEASE TO END LIFE IN A HUMANE AND DIGNIFIED MANNER.
Enacts new Article 23B, End of Life Option Act (Act), in GS Chapter 90, providing as follows.
Sets out terms and definitions used in the Act.
Gives an individual suffering from a terminal disease a right to be informed of all available end-of-life options and to receive answers on questions about the foreseeable risks and benefits of medication without the physician withholding any requested information, regardless of the purpose of the inquiry or the nature of the information. Specifies that a physician who engages in such discussions is not construed as assisting in or contributing to an individual's independent decision to self-administer a lethal dose of medication, and prohibits the discussions from being used to establish civil or criminal liability or professional disciplinary action. The act defines terminal disease as an incurable and irreversible disease that has been medically confirmed by the attending physician and will, within reasonable medical judgment, result in death within six months.
Allows a qualified individual to request a prescription for a terminal comfort care drug (defined as a controlled substance determined and prescribed by a physician licensed in this state for a qualified individual with the purpose of hastening the qualified individual's death due to a terminal disease). Requires that a request for a prescription for a terminal comfort care drug be made solely and directly by the qualified individual and not on behalf of the patient. The act defines a qualified individual as an adult who is a state resident, who has the capacity to make medical decisions, has the physical and mental ability to self-administer a terminal comfort care drug, has been diagnosed by the attending physician as suffering from a terminal disease, has undergone a hospice evaluation, has expressed verbally and in writing the desire to receive a prescription for a terminal comfort care drug, is acting voluntarily and without coercion or duress, has documented a request for a terminal comfort care drug pursuant to new GS 90-326.3 and GS 90-326.3A, and has satisfied the requirements of this Act in order to obtain a prescription for a terminal comfort care drug to hasten death.
Requires a qualified individual seeking to obtain a prescription for a terminal comfort care drug to submit a verbal request, followed by a written request no later than 7 days after the verbal request, that meets the specified requirements directly to his or her attending physician and not to a designee of the physician. Requires the attending physician to directly, and not through a designee, receive all required requests, and keep records of the requests in the qualified individual's medical file that document the date and time of the request as well as a summary of the request. Specifies items that must be included in order for a written request to be considered valid, including that the request be in the form specified in GS 90‑326.3A.
Requires that an Attending Witness Completion Form, as specified in the act, be given by the attending physician to the qualified individual at the time the attending physician writes the prescription for a terminal comfort care drug. An attending witness is an individual nominated by the qualified individual to be present if and when the qualified individual self‑administers the terminal comfort care drug and who undertakes to: (1) complete the Attending Witness Completion Form confirming self-administration of the drug and that the qualified individual died as a result of such self-administration and (2) return the Attending Witness Completion Form to the attending physician within 48 hours after the death of the qualified individual. The attending witness may, but need not be (1) related to the qualified individual by blood, adoption, or marriage or (2) a health care provider. Allows, at the discretion of the qualified individual, the attending witness to be the attending physician.
Allows a qualified individual to discontinue, withdraw, or rescind his or her request for a terminal comfort care drug or decide not to ingest a terminal comfort care drug once obtained, at any time.
Prohibits any person other than the attending physician from writing a prescription for a terminal comfort care drug. Sets out 11 things the attending physician must do before prescribing a terminal comfort care drug, including: determining that the requesting individual has the capacity to make medical decisions, has a terminal disease, has undergone a hospice evaluation, has voluntarily made the request for the drug on the specified form, and is a qualified individual, and verify, immediately prior to writing the prescription for a terminal comfort care drug, that the qualified individual is making an informed decision and is in no way acting under undue coercion or undue influence. Once the 11 specified tasks have been completed, requires the attending physician to deliver the terminal comfort care drug in any of the specified ways.
Sets out requirements of a mental health specialist, upon referral from the attending physician.
Specifies eight items that must be documented in the qualified individual's medical record.
Requires the attending physician to submit a copy of the prescription to the Department of Health and Human Services (DHHS) within 48 hours after writing a prescription for a terminal comfort care drug. Requires the pharmacist to submit a copy of the Pharmacist Compliance Form to DHHS within 48 hours after dispensing a terminal comfort care drug. Requires the attending physician to submit to DHHS a copy of the qualifying individual's request and the Attending Physician Checklist and Compliance Form within 30 days after writing a prescription for a terminal comfort care drug. Requires the attending physician, within 30 calendar days after receipt of actual notice of the qualified individual's death from self-administering the terminal comfort care drug, or from any other cause, to submit to DHHS a Supplemental Physician Checklist and Compliance Form, including a copy of the Attending Witness Completion Form if applicable.
Allows the attending physician to sign the qualified individual's death certificate and requires the cause of death to be recorded as the underlying terminal disease.
Prohibits the sale, procurement, or issuance of any life, health, or annuity policy; health care service plan contract; or health benefit plan or the rate charged for any policy, plan contract, or benefit plan from being conditioned upon or affected by the making or rescinding of a person's request for a terminal comfort care drug. Specifies that a qualified individual's act of self‑administering a terminal comfort care drug does not have any effect upon a life, health, or annuity policy other than that of a natural death from the underlying disease. Prohibits an insurance carrier from providing any information in communications to a qualified individual about the availability of terminal comfort care drugs absent a request by the qualified individual or the qualified individual's attending physician at the behest of the qualified individual.
Protects a person from civil or criminal liability or professional disciplinary action for participating in good faith compliance with the activities authorized under this Act or for being present when a qualified individual self‑administers a terminal comfort care drug. Prohibits from considering a qualified individual who self‑administers a terminal comfort care drug as a person exposed to grave physical harm under any Good Samaritan law, and specifies that no person is subject to civil or criminal liability solely for being present when a qualified individual self-administers a terminal comfort care drug or for failure to act to prevent the qualified individual from self-administering a terminal comfort care drug. Allows a person who is present when a qualified individual with a terminal disease self‑administers a terminal comfort care drug, without civil or criminal liability, to assist the qualified individual at his or her request by preparing the drug as long as the person does not directly assist the qualified individual in self‑administering the drug. Protects a health care provider, pharmacist, licensing board, or professional organization or association from censure, discipline, suspension, adverse action on a license, loss of privileges, loss of membership, or other penalty for participating in good faith compliance with the activities authorized under this Act or for refusing to participate in activities authorized under this Act. Also protects a health care provider or pharmacist from civil, criminal, administrative, disciplinary, employment, credentialing, professional discipline, contractual liability, or medical staff action, sanction, penalty, or other liability for participating in the activities authorized under this Act, including determining the diagnosis or prognosis of an individual, determining the capacity of an individual for the purpose of determining if he or she is a qualified individual under this Act, providing information about this Act to an individual, and providing a referral to a physician licensed in this state who participates in the activities authorized under this Act.
Provides that a request by a qualified individual to an attending physician to provide a terminal comfort care drug in good faith compliance with the provisions of this Act does not provide the basis for the appointment of a guardian or conservator. Specifies that no actions taken in compliance with the provisions of this Act constitute or provide the basis for any claim of neglect or elder abuse.
Specifies that participation in activities authorized by the Act is strictly voluntary and sets out permissible activities that run contrary to the Act.
Prohibits sanctioning a health care provider for: (1) making an initial determination pursuant to the standard of care that an individual has a terminal disease and informing him or her of the medical prognosis; (2) providing information about the End of Life Options Act to an individual upon inquiry; or (3) providing an individual, upon request, with a referral to another physician.
Specifies that the following are punishable as felonies: (1) altering, forging, concealing, or destroying a request for a terminal comfort care drug without the qualified individual's authorization; (2) concealing or destroying a withdrawal or rescission of a request for a terminal comfort care drug without the qualified individual's authorization; (3) concealing or destroying a qualified individual's prescribed terminal comfort care drug without the qualified individual's authorization, or preventing a qualified individual from self-administering the prescribed terminal comfort care drug; (4) coercing or exerting undue influence on a qualified individual to request or to self-administer a terminal comfort care drug for the purpose of ending the qualified individual's life; and (5) coercing or exerting undue influence on a qualified individual to prevent the qualified individual from requesting or self-administering a terminal comfort care drug.
Requires DHHS to collect and review the information required to be submitted to DHHS, which is considered confidential and not a public record. Requires DHHS to annually, by April 15, make available to the public on the DHHS website a report based on the collected information. Specifies information that the report must contain, including the number of known qualified individuals who died each year for whom a terminal comfort care drug was prescribed and the underlying terminal disease for each of these individuals, the number of physicians licensed in this state who wrote prescriptions for terminal comfort care drugs, and the names and dosages of prescribed terminal comfort care drugs.
Requires DHHS to develop, update, and publish the forms required under the Act.
Specifies the manner of disposing of terminal comfort care drugs after a qualified individual's death.
Includes a severability clause.
The above provisions are effective December 1, 2021.
Requires DHHS, by December 31, 2021, to develop and publish on its website downloadable versions of the required forms. Requires DHHS to publish the first required report on its website by March 15, 2022. Effective when the act becomes law.
© 2021 School of Government The University of North Carolina at Chapel Hill
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