At the Hemlock Society’s 13th Biennial Conference held in San Diego in January 2003, assisted suicide advocates unveiled a plan for a model bill called the “Patients’ Comfort and Control Act” (PCCA). The model bill would permit assisted suicide but is written in a manner that, according to Hemlock officials, “will be very difficult for the federal government to block.” The act and its wording grew out of extensive research done by Hemlock’s public relations firms. In January 2004, the PCCA (HB 2564), was introduced in Arizona by Representative Linda Lopez who had previously introduced unsuccessful bills modeled on Oregon’s assisted suicide law. The bill was titled, “An Act Relating to Terminally Ill Patients.” The bill failed.
In January 2005, Lopez again introduced the bill (HB 2311) with the reference title, “Terminally ill patients; Suffering; Control.”
Report on background of PCCA. Note: In midsummer 2003, Hemlock changed its name to “End-of-Life Choices” and, at the end of 2004, it merged with its spin-off group, “Compassion in Dying.” It is now known as “Compassion and Choices.”
PATIENT COMFORT AND CONTROL ACT
STATE OF ARIZONA
HOUSE OF REPRESENTATIVES
FORTY-SIXTH LEGISLATURE
SECOND REGULAR SESSION
2004
HB 2564
INTRODUCED BY
REPRESENTATIVES LOPEZ L, BRADLEY, BURTON CAHILL, DOWNING, LANDRUM TAYLOR, LOREDO, MEZA, SENATOR CHEUVRONT: REPRESENTATIVES AGUIRRE A, ALVAREZ, CAJERO BEDFORD, CHASE, CLARK, GALLARDO, JACKSON JR, LOPES, MIRANDA B, PREZELSKI, SENATOR GIFFORDS
AN ACT
AMENDING TITLE 36, CHAPTER 32, ARIZONA REVISED STATUTES, BY ADDING ARTICLE 7; RELATING TO TERMINALLY ILL PATIENTS.
Be it enacted by the Legislature of the State of Arizona:
Section 1. Title 36, chapter 32, Arizona Revised Statutes, is amended by adding article 7, to read:
ARTICLE 7. TERMINALLY ILL PATIENTS
36-3301. DEFINITIONS
IN THIS ARTICLE, UNLESS THE CONTEXT OTHERWISE REQUIRES:
- “ADVANCE DIRECTIVE FOR CONTROL OF SUFFERING” MEANS A DIRECTIVE PURSUANT TO THIS CHAPTER THAT HAS LANGUAGE THAT MEETS THE REQUIREMENTS OF SECTION 36-3302, SUBSECTION A, PARAGRAPH 1.
- “ATTENDING PHYSICIAN” MEANS THE PHYSICIAN WHO HAS PRIMARY RESPONSIBILITY FOR THE CARE OF THE PATIENT AND TREATMENT OF THE PATIENT’S DISEASE.
- “CONSULTING PHYSICIAN” MEANS THE PHYSICIAN WHO IS QUALIFIED BY SPECIALTY OR EXPERIENCE TO MAKE A PROFESSIONAL DIAGNOSIS AND PROGNOSIS REGARDING THE PATIENT’S DISEASE.
- “HEALTH CARE PROVIDER” MEANS A HEALTH PROFESSIONAL LICENSED PURSUANT TO TITLE 32 OR A HEALTH CARE FACILITY.
- “INCAPABLE” MEANS THAT IN THE OPINION OF A COURT OR THE PATIENT’S ATTENDING OR CONSULTING PHYSICIAN, THE PATIENT LACKS THE ABILITY TO MAKE AND COMMUNICATE HEALTH CARE DECISIONS TO A HEALTH CARE PROVIDER, INCLUDING COMMUNICATION THROUGH PERSONS FAMILIAR WITH THE PATIENT’S MANNER OF COMMUNICATING.
- “INFORMED DECISION” MEANS A DECISION BY A QUALIFIED PATIENT TO REQUEST AND ASSUME CONTROL OF THE PATIENT’S SUFFERING BY OBTAINING A PRESCRIPTION TO PREVENT UNBEARABLE SUFFERING AFTER THAT PATIENT’S ATTENDING PHYSICIAN HAS FULLY INFORMED THE PATIENT OF THE FOLLOWING:
- (A) THE PATIENT’S MEDICAL DIAGNOSIS.
- (B) THE PATIENT’S PROGNOSIS.
- (C) THE POTENTIAL RISKS ASSOCIATED WITH TAKING THE MEDICATION TO BE PRESCRIBED.
- (D) THE PROBABLE RESULT OF TAKING THE MEDICATION TO BE PRESCRIBED.
- (E) THE FEASIBLE ALTERNATIVES, INCLUDING COMFORT CARE, HOSPICE CARE AND PHYSICIAN DIRECTED PAIN MANAGEMENT.
- “MEDICALLY CONFIRMED” MEANS THE MEDICAL OPINION OF THE ATTENDING PHYSICIAN HAS BEEN COMFIRMED BY A CONSULTING PHYSICIAN WHO HAS EXAMINED THE PATIENT AND THE PATIENT’S RELEVANT MEDICAL RECORDS.
- “PHYSICIAN” MEANS A PHYSICIAN LICENSED PURSUANT TO TITLE 32, CHAPTER 13 OR 17.
- “QUALIFIED PATIENT” MEANS AN ADULT WHO IS NOT INCAPABLE.
- “TERMINAL DISEASE” MEANS AN INCURABLE AND IRREVERSIBLE DISEASE THAT HAS BEEN MEDICALLY CONFIRMED AND THAT WILL RESULT, WITHIN REASONABLE MEDICAL JUDGMENT, IN A PERSON’S DEATH WITHIN SIX MONTHS.
36-3302. REQUEST FOR MEDICATION; REQUIREMENTS
A. A COMPETENT ADULT WHO IS A RESIDENT OF THIS STATE MAY MAKE A WRITTEN REQUEST FOR MEDICATION FOR PATIENT CONTROL OF SUFFERING PURSUANT TO SUBSECTION C IF THAT PERSON:
1. AT LEAST THREE MONTHS BEFORE THAT PERSON REQUESTS MEDICATION PURSUANT TO THIS SECTION, HAS EXECUTED AN ADVANCE DIRECTIVE FOR CONTROL OF SUFFERING THAT CONTAINS LANGUAGE THAT IS THE SAME OR SUBSTANTIALLY SIMILAR TO THE FOLLOWING:
IF I AM DIAGNOSED WITH A TERMINAL ILLNESS, I WANT TO BE ABLE TO CONTROL MY OWN MEDICATION TO LESSEN SUFFERING AND PRESERVE MY DIGNITY AND BE IN CONTROL OF MY OWN PAIN AND SUFFERING.
2. HAS BEEN DETERMINED BY THAT PERSON’S ATTENDING PHYSICIAN AND CONSULTING PHYSICIAN TO BE SUFFERING FROM A TERMINAL DISEASE.
3. HAS VOLUNTARILY EXPRESSED A WISH TO CONTROL THE SUFFERING FROM THAT DISEASE.
B. THE MEDICATION SHALL BE AS AGREED ON BY THE PATIENT AND THE PRESCRIBING PHYSICIAN. THE PHYSICIAN MAY ALLOW THE PRESCRIPTION TO BE REFILLED AS IS NECESSARY FOR THE PATIENT TO CONTROL THE SUFFERING PURSUANT TO THIS ARTICLE.
C. THE WRITTEN REQUEST MUST BE IN SUBSTANTIALLY THE FOLLOWING FORM:
REQUEST FOR MEDICATION TO TAKE CONTROL OF MY OWN MANAGEMENT OF MY OWN SUFFERING
I, _________________________, AM AN ADULT OF SOUND MIND.
I AM SUFFERING FROM ________________, WHICH MY ATTENDING PHYSICIAN HAS DETERMINED IS A TERMINAL DISEASE AND WHICH HAS BEEN MEDICALLY CONFIRMED BY A CONSULTING PHYSICIAN.
I HAVE BEEN FULLY INFORMED OF MY DIAGNOSIS AND PROGNOSIS, THE NATURE OF MEDICATION TO BE PRESCRIBED AND THE POTENTIAL ASSOCIATED RISKS, THE EXPECTED RESULT AND THE FEASIBLE ALTERNATIVES, INCLUDING COMFORT CARE, HOSPICE CARE AND PHYSICIAN DIRECTED PAIN CONTROL.
I REQUEST THAT MY ATTENDING PHYSICIAN PRESCRIBE MEDICATION THAT WILL ALLOW ME FULL CONTROL OVER MANAGEMENT OF MY SUFFERING.
INITIAL ONE:
______ I HAVE INFORMED FAMILY MEMBERS OF MY DECISION AND HAVE TAKEN THEIR OPINIONS INTO CONSIDERATION.
______ I HAVE DECIDED NOT TO INFORM MY FAMILY OF MY DECISION.
______ I HAVE NO FAMILY TO INFORM OF MY DECISION.
I UNDERSTAND THAT I HAVE THE RIGHT TO RESCIND THIS REQUEST AT ANY TIME.
I UNDERSTAND THE FULL IMPORT OF THIS REQUEST AND I UNDERSTAND THAT A SECONDARY EFFECT OF TAKING THE PRESCRIBED MEDICATION IS THAT IT MAY HASTEN DEATH.
I MAKE THIS REQUEST VOLUNTARILY AND WITHOUT RESERVATION, AND I ACCEPT FULL RESPONSIBILITY FOR MY ACTIONS.
SIGNED:_________________
DATED:_________________
DECLARATION OF WITNESSES
WE DECLARE THAT THE PERSON SIGNING THIS REQUEST:
1. IS PERSONALLY KNOWN TO US OR HAS PROVIDED PROOF OF IDENTITY.
2. SIGNED THIS REQUEST IN OUR PRESENCE.
3. APPEARS TO BE OF SOUND MIND AND NOT UNDER DURESS, FRAUD OR UNDUE INFLUENCE.
4. IS NOT A PATIENT FOR WHOM EITHER OF US IS ATTENDING PHYSICIAN.
___________________WITNESS 1/
DATE
___________________WITNESS 2/
DATE
NOTE: ONE WITNESS SHALL NOT BE A RELATIVE (BY BLOOD, MARRIAGE OR ADOPTION) OF THE PERSON SIGNING THIS REQUEST, SHALL NOT BE ENTITLED TO ANY PORTION OF THE PERSON’S ESTATE ON DEATH AND SHALL NOT OWN, OPERATE OR BE EMPLOYED AT A HEALTH CARE FACILITY WHERE THE PERSON IS A PATIENT OR RESIDENT.
D. AT LEAST ONE OF THE WITNESSES MUST BE A PERSON WHO IS NOT:
1. A RELATIVE OF THE PATIENT BY BLOOD, MARRIAGE OR ADOPTION.
2. AT THE TIME THE REQUEST IS SIGNED, ENTITLED TO ANY PORTION OFTHE PATIENT’S ESTATE.
3. AN OWNER, OPERATOR OR EMPLOYEE OF A HEALTH CARE FACILITY WHERE THE PATIENT IS RECEIVING MEDICAL TREATMENT OR IS A RESIDENT.
E. THE PATIENT’S ATTENDING PHYSICIAN AT THE TIME THE REQUEST IS SIGNED SHALL NOT BE A WITNESS.
36-3303. RESPONSIBILITIES OF ATTENDING PHYSICIAN
ON RECEIVING A REQUEST FROM A PATIENT TO PRESCRIBE MEDICATION TO CONTROL SUFFERING PURSUANT TO THIS ARTICLE, THE ATTENDING PHYSICIAN MUST DO ALL OF THE FOLLOWING BEFORE ISSUING THE PRESCRIPTION:
1. CONFIRM THAT THE PATIENT HAS EXECUTED AN ADVANCE DIRECTIVE FOR CONTROL OF SUFFERING.
2. DIAGNOSE WHETHER A PATIENT HAS A TERMINAL DISEASE, IS COMPETENT AND HAS MADE THE REQUEST VOLUNTARILY.
3. INFORM THE PATIENT OF:
(A) THE PATIENT’S MEDICAL DIAGNOSIS.
(B) THE PATIENT’S PROGNOSIS.
(C) THE FEASIBLE ALTERNATIVES, INCLUDING COMFORT CARE, HOSPICE CARE AND TRADITIONAL PHYSICIAN DIRECTED PAIN CONTROL.
4. REFER THE PATIENT TO A CONSULTING PHYSICIAN PURSUANT TO SECTION 36-3304.
5. VERIFY BEFORE WRITING THE PRESCRIPTION FOR MEDICATION THAT THE PATIENT IS MAKING AN INFORMED DECISION.
6. FULFILL THE MEDICAL RECORD DOCUMENTATION REQUIREMENTS OF SECTION 36-3307.
7. DOCUMENT, PURSUANT TO SECTION 36-3307, PARAGRAPH 5, THAT ALL APPROPRIATE STEPS ARE CARRIED OUT IN ACCORDANCE WITH THIS ARTICLE BEFORE WRITING THE PRESCRIPTION FOR MEDICATION.
36-3304. CONSULTING PHYSICIAN CONFIRMATION
BEFORE A PATIENT CAN BE PRESCRIBED MEDICATION PURSUANT TO SECTION 36-3303, A CONSULTING PHYSICIAN MUST EXAMINE THE PATIENT AND THE PATIENT’S RELEVANT MEDICAL RECORDS, CONFIRM IN WRITING THE ATTENDING PHYSICIAN’S DIAGNOSIS THAT THE PATIENT IS SUFFERING FROM A TERMINAL DISEASE AND VERIFY THAT THE PATIENT IS COMPETENT, IS ACTING VOLUNTARILY AND HAS MADE AN INFORMED DECISION.
36-3305. INFORMED DECISION
A PERSON SHALL NOT RECEIVE A PRESCRIPTION PURSUANT TO THIS ARTICLE UNLESS THAT PERSON HAS MADE AN INFORMED DECISION AS PRESCRIBED BY THIS ARTICLE.
36-3306. FAMILY NOTIFICATION
A. THE PATIENT’S ATTENDING PHYSICIAN SHALL ASK THE PATIENT TO CONTACT THE PATIENT’S NEXT OF KIN AND INFORM THEM OF THE PATIENT’S REQUEST FOR MEDICATION PURSUANT TO THIS ARTICLE.
B. A PATIENT WHO DECLINES OR IS UNABLE TO NOTIFY NEXT OF KIN SHALL NOT HAVE THE PATIENT’ REQUEST DENIED FOR THAT REASON.
36-3307. MEDICAL RECORD DOCUMENTATION REQUIREMENTS
A PHYSICIAN MUST DOCUMENT THE FOLLOWING IN THE PATIENT’S MEDICAL RECORDS:
1. A COPY OF THE ADVANCE DIRECTIVE FOR CONTROL OF SUFFERING EXECUTED BY THE PATIENT.
2. ALL ORAL REQUESTS BY THE PATIENT FOR MEDICATION TO CONTROL THE PATIENT’S OWN SUFFERING.
3. THE ATTENDING PHYSICIAN’S DIAGNOSIS AND PROGNOSIS, AND THE DETERMINATION THAT THE PATIENT IS COMPETENT, IS ACTING VOLUNTARILY AND HAS MADE AN INFORMED DECISION.
4. THE CONSULTING PHYSICIAN’S DIAGNOSIS AND PROGNOSIS, AND VERIFICATION THAT THE PATIENT IS COMPETENT, IS ACTING VOLUNTARILY AND HAS MADE AN INFORMED DECISION.
5. A NOTE BY THE ATTENDING PHYSICIAN INDICATING THAT ALL REQUIREMENTS UNDER THIS ARTICLE HAVE BEEN MET AND INDICATING THE STEPS TAKEN TO CARRY OUT THE REQUEST, INCLUDING A NOTATION OF THE MEDICATION PRESCRIBED.
36-3308. INSURANCE OR ANNUITY POLICIES
A. THE SALE, PROCUREMENT OR ISSUANCE OF ANY LIFE, HEALTH OR ACCIDENT INSURANCE OR ANNUITY POLICY OR THE RATE CHARGED FOR ANY POLICY SHALL NOT BE CONDITIONED ON OR AFFECTED BY THE MAKING OR RESCINDING OF A REQUEST BY A PERSON FOR MEDICATION TO CONTROL THAT PERSON’S SUFFERING.
B. A QUALIFIED PATIENT’S ACT OF TAKING MEDICATION TO CONTROL THAT PERSON’S OWN SUFFERING SHALL NOT HAVE AN EFFECT ON A LIFE, HEALTH OR ACCIDENT INSURANCE OR ANNUITY POLICY.
36-3309. CONSTRUCTION OF ARTICLE
A. THIS ARTICLE DOES NOT AUTHORIZE A PHYSICIAN OR ANY OTHER PERSON TO END ANOTHER PERSON’S LIFE BY LETHAL INJECTION, MERCY KILLING OR ACTIVE EUTHANASIA. THIS ARTICLE AUTHORIZES A PHYSICIAN TO PRESCRIBE OR ORDER THE MEDICATION AND PERMITS TRAINED MEDICAL PROFESSIONALS TO OFFER ASSISTANCE, BUT THE ACTUAL ACT OF CONTROLLING THE INTAKE OF MEDICATION MUST BE IN THE IMMEDIATE CONTROL OF THE PATIENT.
B. IF THE PATIENT’S DECISION TO CONTROL SUFFERING HAS THE SECONDARY EFFECT OF HASTENING DEATH, THIS SHALL NOT FOR ANY PURPOSE BE CONSTITUTED AS SUICIDE, ASSISTED SUICIDE, MERCY KILLING OR HOMICIDE OR BE CAUSED FOR ANY PROFESSIONAL DISCIPLINARY ACTION OR CIVIL OR CRIMINAL PENALTY UNDER THE LAW.
C. THIS ARTICLE EXPANDS THE RIGHT OF A PHYSICIAN UNDER CERTAIN CIRCUMSTANCES TO PRESCRIBE OR ORDER MEDICATION TO CONTROL SUFFERING.
D. THIS ARTICLE DOES NOT INTERFERE WITH OR LIMIT ANY EXISTING RIGHT OF A PHYSICIAN TO PRESCRIBE MEDICATION.
