The petition which was circulated by assisted suicide activists in Maine contained the following in very large print:
Maine Death with Dignity Act
Should a terminally ill adult who is of sound mind be allowed to ask for and receive a doctor’s help to die?
Registered voters were asked to sign the petition based on this question. The following text of the proposed law began on a separate page and was in extremely small type:
STATE OF MAINE
To the Legislature of the State of Maine:
In accordance with Section 18 of Article IV, Part Third of the Constitution of the State of Maine, the undersigned electors of the State of Maine, qualified to vote for Governor, residing in said State, whose names have been certified, hereby respectfully propose to the Legislature for its consideration the following entitled legislation:
“The Maine Death with Dignity Act.” The full text of this Act is printed on this petition.
SHOULD A TERMINALLY ILL ADULT WHO IS OF SOUND MIND BE ALLOWED TO ASK FOR AND RECEIVE A DOCTOR’S HELP TO DIE?
Be it enacted by the People of the State of Maine as follows:
Sec. 1. 18-A MRSA art. V, Part 9 is enacted read:
PART 9
MAINE DEATH WITH DIGNITY ACT
§5-901. Short title
This Part may be known and cited as the “Maine Death with Dignity Act.”
§5-902. Definitions
As used in this Act, unless the context otherwise indicates, the following terms have the following meanings.
(a) “Adult” means a person who is 18 years of age or older.
(b) “Attending physician” means a physician who has primary responsibility for the care of a patient and treatment of that patient’s terminal disease.
(c) “Capable” means not incapable.
(d) “Consulting physician” means a physician who is qualified by specialty or experience to make a professional diagnosis and prognosis regarding the patient’s disease. The consulting physician may not be a partner or similar business associate of the attending physician and may not have an office in the same building as the attending physician.
(e) “Counseling” means a consultation between a counselor and a patient to carry out the purposes set forth in section 5-907.
(f) “Counselor” means a psychiatrist licensed under Title 32, chapter 48 or a psychologist licensed under Title 32, chapter 56.
(g) “Health care provider” means a person licensed, certified or otherwise authorized or permitted by the laws of this State, to administer health care in the ordinary course of business or the practice of a profession and includes a health care facility.
(h) “Incapable” means that, in the opinion of the patient’s attending physician or consulting physician, a patient lacks the ability to make and communicate health care decisions to health care providers.
(i) “Informed decision” means a decision that is made by a qualified patient to request and obtain a prescription to end that patient’s life in a humane and dignified manner and that is based on the patient’s appreciation of the relevant facts after being fully informed by the attending of:
(1) The patient’s medical diagnosis;
(2) The patient’s prognosis;
(3) The potential risks associated with taking the medication that is prescribed;
(4) The probable results of taking the prescribed medication; and
(5) The feasible alternatives, including, but not limited to, comfort care, hospice care and pain control.
(j) “Medically confirmed” means that the medical opinion of the attending physician is confirmed by a consulting physician who has examined the patient and the patient’s relevant medical records.
(k) “Next of kin” includes a family member or an adult who has exhibited special concern for the patient and who is familiar with the patient’s personal values.
(l) “Palliative Care Specialist” means a person who is recognized to have expertise in palliative care. A palliative care specialist may be, but is not limited to, a hospice worker, nurse, nurse practitioner, or physician.
(m) “Patient” means a person who is under the care of a physician.
(n) “Personally communicated request” means a request that the patient makes directly in a face-to-face meeting with the attending physician. A “personally communicated request” may be made orally, by sign language or by some other method of communication, including a method using an interpreter, that clearly and unambiguously communicates the patient’s intentions.
(o) “Physician” means a doctor of medicine or osteopathy licensed to practice medicine by the Board of Licensure in Medicine or the Board of Osteopathic Licensure.
(p) “Qualified patient” means a capable adult who is a resident of this State and who has satisfied the requirements of this Act in order to obtain a prescription for medication to end that person’s life in a humane and dignified manner.
(q) “Terminal disease” means an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, produce death within 6 months.
§5-903, Written request for medication
(a) A patient who is an adult, is capable, is a resident of this State and is determined by the attending physician and the consulting physician to be suffering from a terminal disease and who has voluntarily expressed the wish to die, may make a written request for medication for the purpose of ending that patient’s life in a humane and dignified manner in accordance with this Act.
(b) A valid request for medication under this Act must be in the form described in section 5-921, signed and dated by the patient and witnessed by at least 2 individuals who, in the presence of the patient, attest that to the best of their knowledge and belief the patient is capable, is acting voluntarily and is not coerced to sign the request.
(1) A witness may not be a person who is:
(i) A relative of the patient by blood, marriage or adoption;
(ii) At the time the request is signed, entitled to any portion of the estate of the qualified patient upon that patient’s death, under a will or by operation of law; or
(iii) An owner, operator or employee of a health care facility where the qualified patient is receiving medical treatment or is a resident.
(2) The patient’s attending physician at the time the request is signed may not be a witness.
(3) If the patient is a resident in a long-term care facility at the time the written request is made, one of the witnesses must be an individual designated by the facility and must have the qualifications specified by the Department of Human Services by a routine technical rule, as defined in Title 5, chapter 375, subchapter II-A.
(4) If the patient is physically unable to make a written request, the attending physician shall enter that fact in the patient’s medical record. The patient may then comply with the requirement of a written request by making a separate personally communicated request:
(i) To the attending physician;
(ii) Before 2 witnesses qualified to witness a written request; and
(iii) That is recorded verbatim and transcribed into written form and entered in the patient’s medical record.
§5-904, Attending physician’s responsibilities
The attending physician shall: (a) Make the initial determination of whether a patient has a terminal disease, is capable and has voluntarily requested medication under section 5-903;
(b) Inform the patient of:
(1) The patient’s medical diagnosis;
(2) The patient’s prognosis;
(3) The potential risks associated with taking the medication prescribed;
(4) The probable result of taking the medication prescribed; and
(5) The feasible alternatives, including, but not limited to, comfort care, hospice care and pain control;
(c) Refer the patient to a consulting physician for medical confirmation of the diagnosis and for a determination that the patient is capable and acting voluntarily;
(d) Refer the patient to a palliative care specialist pursuant to section 5-906;
(e) Refer the patient for counseling pursuant to section 5-907;
(f) Request that the patient notify the next of kin. If requested by the patient, the physician shall provide assistance in arranging notification of or contact with the patient’s next of kin;
(g) Inform the patient of the opportunity to revoke the request for a prescription for medication under this Act at any time and in any manner and offer the patient an opportunity to revoke the request at the end of the 15-day waiting period pursuant to section 5-912;
(h) Verify, immediately before writing the prescription for medication under this Act, that the patient is making an informed decision;
(i) Fulfill the medical record documentation requirements of section 5-913; and
(j) Ensure that all appropriate steps are carried out in accordance with this Act before writing a prescription for medication to enable a qualified patient to end that patient’s life in a humane and dignified manner.
§5-905, Consulting physician confirmation
A patient is qualified under this Act if a consulting physician examines the patient and the patient’s relevant medical records and confirms, in writing, the attending physician’s diagnosis that the patient is suffering from a terminal disease and verifies that the patient is capable, is acting voluntarily and has made an informed decision. The consulting physician shall inquire whether the patient wishes to notify the next of kin if the patient has not already done so. If requested by the patient, the consulting physician shall provide assistance in arranging notification of or contact with the patient’s next of kin.
§5-906, Palliative Care Specialist’s responsibilities
The palliative care specialist shall determine whether high-quality palliative care has been made available to the patient. The palliative care specialist shall further make all appropriate recommendations and referrals necessary to overcome any deficiencies in the current level of palliative care provided to the patient. Nothing in this section may be construed to limit or restrict in any way a capable patient’s right to refuse palliative care or any other type of medical care.
§5-907, Counseling referral
The attending physician and the consulting physician shall refer the patient for counseling. The counselor shall determine whether the patient is suffering from a psychiatric or psychological disorder or depression that causes impaired judgment. Counseling must also include discussion about choosing to die.
Medication to end a patient’s life in a humane and dignified manner may not be prescribed until the counselor determines that the patient is not suffering from a psychiatric or psychological disorder or depression that causes impaired judgment.
The counselor shall inquire whether the patient wishes to notify the next of kin if the patient has not already done so. If requested by the patient, the counselor shall provide assistance in arranging notification of or contact with the patient’s next of kin.
§5-908, Informed decision
A person may not receive a prescription for medication to end that person’s life in a humane and dignified manner unless that person has made an informed decision as defined in section 5-902, subsection (i). Before prescribing medication under this Act, the attending physician shall verify that the patient is making an informed decision.
§5-909, Family notification
The attending physician, consulting physician, and counselor shall ask the patient to notify the next of kin of the patient’s request for medication pursuant to this Act. If requested by the patient, the attending physician, consulting physician or counselor shall provide assistance in arranging notification of or contact with the patient’s next of kin. A patient who declines or is unable to notify the next of kin may not be denied the request for medication for that reason.
§5-910, Requests
To receive a prescription for medication to end the patient’s life in a humane and dignified manner, a qualified patient must personally communicate a request and repeat the personally communicated request to the attending physician no sooner that 15 days after the initial request. Before the 2nd personally communicated request is made, the patient must make the request in writing as described in section 5-903. When the qualified patient makes the 2nd personally communicated request, the attending physician shall offer the patient an opportunity to revoke the request.
§5-911, Right to revoke request
A patient may revoke a request for medication under this Act at any time and in any manner without regard to the patient’s mental state. A prescription for medication under this Act may not be written without the attending physician offering the qualified patient an opportunity to revoke the request.
§5-912, Waiting period
No fewer than 15 days may elapse between the patient’s initial personally communicated request and the writing of a prescription under this Act. No fewer than 48 hours may elapse between the patient’s written request and the writing of a prescription under this Act.
§5-913, Medical record filing requirements
The following information must be filed or noted on a chart in the patient’s medical record:
(a) All personally communicated requests by a patient for medication to end the patient’s life in a humane and dignified manner;
(b) All written requests by a patient for medication to end the patient’s life in a humane and dignified manner;
(c) The attending physician’s diagnosis and prognosis and that physician’s determination that the patient is capable, is acting voluntarily and is making an informed decision;
(d) The consulting physician’s diagnosis and prognosis and that physician’s determination that the patient is capable, is acting voluntarily and is making an informed decision;
(e) A report of the determination made during counseling;
(f) The attending physician’s offer to the patient to revoke the request at the time of the patient’s 2nd personally communicated request pursuant to section 5-910; and
(g) A note by the attending physician stating that requirements under this Act have been met and indicating the steps taken to carry out the request and the medication prescribed.
§5-914, Residency requirement
Only persons who have been residents of this State for at least 6 months immediately preceding the request may make and be granted requests under this Act.
§5-915, Reporting requirements
(a) The Department of Human Services, Bureau of Health shall annually review records maintained pursuant to this Act.
(b) The Department of Human Services, Bureau of Health shall adopt rules to facilitate the collection of information in compliance with this Act. The information is not a public record and is not available to the public.
(c) The Department of Human Services, Bureau of Health shall make available to the public an annual statistical report of information collected under subsection (b).
§5-916, Effect on construction of wills, contracts and laws
(a) A provision in a contract, will or other agreement, whether written or oral, to the extent the provision affects the decision of a person to make or revoke a request for medication to end the person’s life in a humane and dignified manner, is not valid.
(b) An obligation owing under any existing contract is not conditional to or affected by the making or revoking of a request for medication under this Act to end the person’s life in a humane and dignified manner.
§5-917, Insurance or annuity policies
Benefits payable under a life, health or accident insurance or annuity policy are not affected by making or revoking a request under this Act for medication to end the patient’s life in a humane and dignified manner. A qualified patient’s act of ingesting medication to end that patient’s life in a humane and dignified manner may not have an effect upon benefits payable under a life, health or accident insurance or annuity policy.
§5-918 Construction
(a) This Act may not be construed to authorize a physician or any other person to end a patient’s life by lethal injection, mercy killing or active euthanasia. Actions taken in accordance with this Act do not, for any purpose, constitute suicide, assisted suicide, mercy killing or homicide.
(b) This Act may not be construed to authorize any person to assist in the administration of medication prescribed under the provisions of this Act.
§5-919, Immunities
Except as provided in Sec. 5-920, the following immunities apply:
(a)The Act may not be construed to repeal the State prohibition against assisted suicide except that a person or entity may not be subjected to civil or criminal liability or professional disciplinary action for participating in good-faith compliance with this Act. The requirement of good faith is an additional requirement and not a substitute for the reasonable standard of care otherwise imposed upon health care providers in the exercise of their professions.
(b) A professional organization or association or health care provider may not subject a person to censure, discipline, suspension, loss of license, loss of privileges, loss of membership or any other penalty for participating or refusing to participate in good faith in any act under this Act.
(c) A request by a patient for medication or provision of medication by an attending physician in accordance with the provisions of this Act does not provide the sole basis for the appointment of a guardian or conservator. The provision of medication to a qualified patient does not constitute neglect on the part of an attending physician.
(d) A health care provider is not under a duty, whether by contract, by law or by any other legal requirement, to provide medication to end the patient’s life in a humane and dignified manner. If a health care provider is unable or unwilling to carry out a patient’s request under this Act and the patient transfers that patient’s care to a new health care provider, the prior health care provider shall transfer, upon request, a copy of the patient’s relevant medical records to the new health care provider.
(e) A pharmacist is not under a duty, whether by contract, by law or by any other legal requirement, to fill a prescription written in accordance with this Act that the pharmacist knows or has reason to know is intended to be ingested by a qualified patient to end that patient’s life in a humane and dignified manner. If a pharmacist is unable or unwilling to fill a prescription under this Act, the pharmacist shall make that inability or refusal known to the patient, who may then seek another pharmacist to fill the prescription.
§5-920, Liabilities
(a) A person who, without authorization of the patient, willfully alters or forges a request for medication or conceals or destroys a revocation of that request with the intent or effect of causing the patient’s death commits a Class A crime.
(b) A person who coerces or exerts undue influence on a patient to request medication for the purpose of ending the patient’s life or to destroy a revocation of such a request commits a Class A crime.
(c) This Act does not limit liability for civil damages resulting from negligent conduct or intentional misconduct by any person or entity.
(d) The penalties in this Act do not preclude criminal penalties applicable under other law for conduct that is inconsistent with the provisions of this Act.
§5-921, Form of request
A request for medication as authorized by this Act must be substantially in the following form.
REQUEST FOR MEDICATION
TO END MY LIFE IN A HUMANE AND DIGNIFIED MANNER
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 the medication to be prescribed and its potential associated risks, the expected result of taking the medication and the feasible alternatives to ending my life in a humane and dignified manner, including comfort care, hospice care and pain control.
I request that my attending physician prescribe medication that will end my life in a humane and dignified manner.
INITIAL ONE:
____I have informed my family or next of kin of my decision and I have taken their opinions into consideration.
____I have decided not to inform my family or next of kin of my decision.
____I have no family or next of kin to inform of my decision.
I understand that I have the right to revoke this request at any time. I understand the full importance of this request, and I expect to die when I take the medication to be prescribed.
I make this request voluntarily and without reservation.
Signed:___________________________ Dated:________________________
DECLARATION OF WITNESSES
We declare that the person signing this request:
(A) Is personally known to us or has provided proof of identity;
(B) Signed this request in our presence;
(C) Appears to be of sound mind and not to be under duress or fraudulent or undue influence; and
(D) Is not a patient for whom either of us is the attending physician.
________________________Witness 1 __________________Date
________________________Witness 2 __________________Date
Note: Neither witness may be a relative by blood, marriage or adoption of the person signing this request, may be entitled to any portion of the person’s estate upon death or may own, operate or be employed at a health care facility where the person is a patient or a resident. If the patient is an inpatient at a health care facility, one of the witnesses must be an individual designated by the facility.
SUMMARY
This initiated bill creates the Maine Death with Dignity Act. It allows a mentally competent adult who is suffering from a terminal illness to request and obtain medication from a physician to end that patient’s own life in a humane and dignified manner, with safeguards to ensure that the patient’s request is voluntary and based on an informed decision.
