Section 1. Definitions
As used in this chapter, the following words shall, unless the context clearly indicates a different meaning, have the following meanings :
(1) "Adult" means an individual who is 18 years of age or older.
(2) (2) "Attending physician" means the physician who has primary responsibility for the care of the patient and treatment of the patient's termi nal disease.
(3) (3) "Capable" means that in the opinion of a court or in the opinion of the patient's attending physician or consulting physician, psychiatrist or psychologist, a patient has the ability to make and communicate health care decisions to health care providers, including communication through persons familiar with the patient's manner of communicating if those persons are available.
(4) (4) "Consulting physician" means a physician who is qualified by specialty or experience to make a professional di agnosis and prognosis regarding the patient's disease.
(5) (5) "Counseling" means one or more consultations as necessary between a state licensed psychiatrist or psychologist and a patient for the purpose of determining that the patient is capable and not suf fering from a psychiatric or psychological disorder or depression causing impaired judgment.
(6) (6) "Health care provider" means a person licensed, certified or otherwise authorized or permitted by the law of this state to administer health care or dispense medication in the ordinary course of business or practice of a profession, and includes a health care facility.
(7) (7) "Informed decision" means a decision by a qualified patient, to request and obtain a prescription to end his or her life in a humane and di gnified manner, that is based on an appreciation of the relevant facts and after being fully informed by the attending physician of:
(8) (a) His or her medical diagnosis;
(b) His or her prognosis;
(c) The potential risks associated with taking the medica tion to be prescribed;
(d) The probable result of taking the medication to be prescribed; and
(e) The feasible alternatives, including, but not limited to, comfort care, hospice care and pain control.
(8) "Medically confirmed" means the medical opinio n of the attending physician has been confirmed by a consulting physician who has examined the patient and the patient's relevant medical records.
(9) "Patient" means a person who is under the care of a physician.
(10) "Physician" means a doctor of medic ine or osteopathy licensed to practice medicine by the Board of Medical Examiners for the Commonwealth of Massachusetts.
(11) "Qualified patient" means a capable adult who is a resident of Massachusetts.
(12) "Terminal disease" means an incurable and irr eversible disease that has been medically confirmed and will, within reasonable medical judgment, produce death within six months.
Section 2 . Who may initiate a written request for medication.
(1) An adult who is capable, is a resident of Massachusetts, and has been determined by the attending physician and consulting physician to be suffering from a terminal disease, and who has voluntarily expressed his or her wish to die, may make a written request for medication for the purpose of ending his or her li fe in a humane and dignified manner.
(2) No person shall qualify under the provisions of this act solely because of age or disability.
Section 3. Form of the written request.
(1) A valid request for medication under this act shall be in substantially th e form described in Section 6, signed and dated by the patient and witnessed by at least two individuals who, in the presence of the patient, attest that to the best of their knowledge and belief the patient is capable, acting voluntarily, and is not being coerced to sign the request.
(2) (2) One of the witnesses shall be a person who is not:
(3) (a) A relative of the patient by blood, marriage or adoption;
(4) (b) A person who at the time the request is signed would be entitled to any portion of the estate of the qualified patient upon death under any will or by operation of law; or
(5) (c) An owner, operator or employee of a health care facility where the qualified patient is receiving medical treatment or is a resident.
(6) (3) The patient's attending physician at th e time the request is signed shall not be a witness.
(4) If the patient is a patient in a long term care facility at the time the written request is made, one of the witnesses shall be an individual designated by the facility.
(7) Section 3. Attending physi cian responsibilities.
(1) The attending physician shall:
(2) (a) Make the initial determination of whether a patient has a terminal disease, is capable, and has made the request voluntarily;
(3) (b) Request that the patient demonstrate Massachusetts residenc y;
(c) To ensure that the patient is making an informed decision, inform the patient of:
(A) His or her medical diagnosis;
(B) His or her prognosis;
(C) The potential risks associated with taking the medication to be prescribed;
(D) The probab le result of taking the medication to be prescribed; and
(E) The feasible alternatives, including, but not limited to, comfort care, hospice care and pain control;
(d) Refer the patient to a consulting physician for medical confirmation of the diagno sis, and for a determination that the patient is capable and acting voluntarily;
(e) Refer the patient for counseling if appropriate pursuant to Section 3B;
(f) Recommend that the patient notify next of kin;
(g) Counsel the patient about the importan ce of having another person present when the patient takes the medication prescribed pursuant to this act and of not taking the medication in a public place;
(h) Inform the patient that he or she has an opportunity to rescind the request at any time and in any manner, and offer the patient an opportunity to rescind at the end of the 15 day waiting period pursuant to Section 3E;
(i) Verify, immediately prior to writing the prescription for medication under this act, that the patient is making an informed decision;
(j) Fulfill the medical record documentation requirements of Section 3H;
(k) Ensure that all appropriate steps are carried out in accordance with this act prior to writing a prescription for medication to enable a qualified patient to end his or her life in a humane and dignified manner; and
(l)(A) Dispense medications directly, including ancillary medications intended to facilitate the desired effect to minimize the patient's discomfort, provided the attending physician is registered as a d ispensing physician with the Board of Medical Examiners, has a current Drug Enforcement Administration certificate and complies with any applicable administrative rule; or
(B) With the patient's written consent:
(i) Contact a pharmacist and inform t he pharmacist of the prescription; and
(ii) Deliver the written prescription personally or by mail to the pharmacist, who will dispense the medications to either the patient, the attending physician or an expressly identified agent of the patient.
(2) Notwithstanding any other provision of law, the attending physician may sign the patient's death certificate.
Section 3A. Consulting physician confirmation.
Before a patient is qualified under this act, a consulting physician shall examine the patient a nd his or her relevant medical records and confirm, in writing, the attending physician's diagnosis that the patient is suffering from a terminal disease, and verify that the patient is capable, is acting voluntarily and has made an informed decision.
Sec tion 3B. Counseling referral.
If in the opinion of the attending physician or the consulting physician a patient may be suffering from a psychiatric or psychological disorder or depression causing impaired judgment, either physician shall refer the patien t for counseling. No medication to end a patient's life in a humane and dignified manner shall be prescribed until the person performing the counseling determines that the patient is not suffering from a psychiatric or psychological disorder or depression causing impaired judgment.
Section 3C. Informed decision.
No person shall receive a prescription for medication to end his or her life in a humane and dignified manner unless he or she has made an informed decision as defined in Section 1 (7). Immediately prior to writing a prescription for medication under this act, the attending physician shall verify that the patient is making an informed decision.
Section 3D. Family notification.
The attending physician shall recommend that the patient not ify the next of kin of his or her request for medication pursuant to this act. A patient who declines or is unable to notify next of kin shall not have his or her request denied for that reason.
Section 3E. Written and oral requests.
In order to receive a prescription for medication to end his or her life in a humane and dignified manner, a qualified patient shall have made an oral request and a written request, and reiterate the oral request to his or her attending physician no less than fifteen (15) day s after making the initial oral request. At the time the qualified patient makes his or her second oral request, the attending physician shall offer the patient an opportunity to rescind the request.
Section 3F. Right to rescind request.
A patient may re scind his or her request at any time and in any manner without regard to his or her mental state. No prescription for medication under this act may be written without the attending physician offering the qualified patient an opportunity to rescind the requ est.
Section 3G. Waiting periods.
No less than fifteen (15) days shall elapse between the patient's initial oral request and the writing of a prescription under this act. No less than 48 hours shall elapse between the patient's written request and the wr iting of a prescription under this act.
Section 3H. Medical record documentation requirements.
The following shall be documented or filed in the patient's medical record:
(1) All oral requests by a patient for medication to end his or her life in a huma ne and dignified manner;
(2) All written requests by a patient for medication to end his or her life in a humane and dignified manner;
(3) The attending physician's diagnosis and prognosis, determination that the patient is capable, acting voluntarily an d has made an informed decision;
(4) The consulting physician's diagnosis and prognosis, and verification that the patient is capable, acting voluntarily and has made an informed decision;
(5) A report of the outcome and determinations made during counse ling, if performed;
(6) The attending physician's offer to the patient to rescind his or her request at the time of the patient's second oral request pursuant to Section 3E; and
(7) A note by the attending physician indicating that all requirements under this act have been met and indicating the steps taken to carry out the request, including a notation of the medication prescribed.
Section 3I. Residency requirement.
Only requests made by Massachusetts residents under this act shall be granted. Factors demonstrating Massachusetts residency include but are not limited to :
(1) Possession of a Massachusetts driver license;
(2) Registration to vote in Massachusetts;
(3) Evidence that the person owns or leases property in Massachusetts; or
(4) Filing of an Massachusetts tax return for the most recent tax year.
Section 3J. Reporting requirements.
(1)(a) The Department of Public Health shall annually review a sample of records maintained pursuant to this act.
(b) The department shall require any health care provider upon dispensing medication pursuant to this act to file a copy of the dispensing record with the division.
(2) The department shall make rules to facilitate the collection of information regarding compliance with this act. Except as otherwis e required by law, the information collected shall not be a public record and may not be made available for inspection by the public.
(3) The department shall generate and make available to the public an annual statistical report of information collected under subsection (2) of this section.
Section 3K. Effect on construction of wills, contracts and statutes.
(1) No provision in a contract, will or other agreement, whether written or oral, to the extent the provision would affect whether a person may mak e or rescind a request for medication to end his or her life in a humane and dignified manner, shall be valid.
(2) No obligation owing under any currently existing contract shall be conditioned or affected by the making or rescinding of a request, by a pe rson, for medication to end his or her life in a humane and dignified manner.
Section 3L. Insurance or annuity policies.
The sale, procurement, or issuance of any life, health, or accident insurance or annuity policy or the rate charged for any policy sh all not be conditioned upon or affected by the making or rescinding of a request, by a person, for medication to end his or her life in a humane and dignified manner. Neither shall a qualified patient's act of ingesting medication to end his or her life in a humane and dignified manner have an effect upon a life, health, or accident insurance or annuity policy.
Section 3M. Construction of Act.
Nothing in this act shall 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 shall not, for any purpose, constitute suicide, assisted suicide, mercy killing or homicide, under the law.
Section 4. Immunities; basis for prohibiting health care provider from participation; notification; permissible sanctions.
Except as provided in Section 4B :
(1) No person shall be subject to civil or criminal liability or professional disciplinary action for participating in good faith compliance with th is act. This includes being present when a qualified patient takes the prescribed medication to end his or her life in a humane and dignified manner.
(2) No professional organization or association, or health care provider, may subject a person to censure , discipline, suspension, loss of license, loss of privileges, loss of membership or other penalty for participating or refusing to participate in good faith compliance with this act.
(3) No request by a patient for or provision by an attending physician of medication in good faith compliance with the provisions of this act shall constitute neglect for any purpose of law or provide the sole basis for the appointment of a guardian or conservator.
(4) No health care provider shall be under any duty, whether by contract, by statute or by any other legal requirement to participate in the provision to a qualified patient of medication to end his or her 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 his or her 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.
(5)(a) Notwi thstanding any other provision of law, a health care provider may prohibit another health care provider from participating in this act on the premises of the prohibiting provider if the prohibiting provider has notified the health care provider of the proh ibiting provider's policy regarding participating in this act. Nothing in this paragraph prevents a health care provider from providing health care services to a patient that do not constitute participation in this act.
(b) Notwithstanding the provisions of subsections (1) to (4) of this section, a health care provider may subject another health care provider to the sanctions stated in this paragraph if the sanctioning health care provider has notified the sanctioned provider prior to participation in thi s act that it prohibits participation in this act:
(A) Loss of privileges, loss of membership or other sanction provided pursuant to the medical staff bylaws, policies and procedures of the sanctioning health care provider if the sanctioned provider is a member of the sanctioning provider's medical staff and participates in this act while on the health care facility premises, as defined in M.G.L. Ch. 111, S.25B, of the sanctioning health care provider, but not including the private medical office of a ph ysician or other provider;
(B) Termination of lease or other property contract or other nonmonetary remedies provided by lease contract, not including loss or restriction of medical staff privileges or exclusion from a provider panel, if the sanctioned provider participates in this act while on the premises of the sanctioning health care provider or on property that is owned by or under the direct control of the sanctioning health care provider; or
(C) Termination of contract or other nonmonetary reme dies provided by contract if the sanctioned provider participates in this act while acting in the course and scope of the sanctioned provider's capacity as an employee or independent contractor of the sanctioning health care provider. Nothing in this subpa ragraph shall be construed to prevent:
(i) A health care provider from participating in this act while acting outside the course and scope of the provider's capacity as an employee or independent contractor; or
(ii) A patient from contracting with his or her attending physician and consulting physician to act outside the course and scope of the provider's capacity as an employee or independent contractor of the sanctioning health care provider.
(c) A health care provider that imposes sanctions pur suant to paragraph (b) of this subsection must follow all due process and other procedures the sanctioning health care provider may have that are related to the imposition of sanctions on another health care provider.
(d) For purposes of this subsection:
(A) "Notify" means a separate statement in writing to the health care provider specifically informing the health care provider prior to the provider's participation in this act of the sanctioning health care provider's policy about participation in act ivities covered by this act.
(B) "Participate in this act" means to perform the duties of an attending physician pursuant to Section 3, the consulting physician function pursuant to Section 3A or the counseling function pursuant to Section 3B. "Particip ate in this act " does not include:
(i) Making an initial determination that a patient has a terminal disease and informing the patient of the medical prognosis;
(ii) Providing information about the Massachusetts Death with Dignity Act to a patient upon the request of the patient;
(iii) Providing a patient, upon the request of the patient, with a referral to another physician; or
(iv) A patient contracting with his or her attending physician and consulting physician to act outside of the cou rse and scope of the provider's capacity as an employee or independent contractor of the sanctioning health care provider.
(6) Action taken pursuant to Sections 3, 3A, 3B, and 3C shall not be the sole basis for a report of unprofessional or dishonorable c onduct under M.G.L. Ch. 112, S. 5.
(7) No provision of this act shall be construed to allow a lower standard of care for patients in the community where the patient is treated or a similar community.
Section 4B. Liabilities.
(1) A person who without aut horization of the patient willfully alters or forges a request for medication or conceals or destroys a rescission of that request with the intent or effect of causing the patient's death shall be guilty of a felony.
(2) A person who coerces or exerts und ue influence on a patient to request medication for the purpose of ending the patient's life, or to destroy a rescission of such a request, shall be guilty of a felony.
(3) Nothing in this act limits further liability for civil damages resulting from othe r negligent conduct or intentional misconduct by any person.
(4) The penalties in this act do not preclude criminal penalties applicable under other law for conduct which is inconsistent with the provisions of this act.
Section 4C. Claims by governmenta l entity for costs incurred.
Any governmental entity that incurs costs resulting from a person terminating his or her life pursuant to the provisions of this act in a public place shall have a claim against the estate of the person to recover such costs a nd reasonable attorney fees related to enforcing the claim.
Section 5. Severability.
Any section of this act being held invalid as to any person or circumstance shall not affect the application of any other section of this act which can be given full effect without the invalid section or application.
Section 6. Form of the request.
A request for a medication as authorized by this act shall be in substantially 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, prognosis, the nature of medication to be prescribed and potential associated risks, the expected result, and the feasible alternatives, including comfort care, hospice care and pain control.
I request that my attending physician prescribe medication th at will end my life in a humane and dignified manner.
INITIAL ONE :
_____ I have informed my family of my decision and taken their opinions into consideration.
_____ I have decided not to inform my family of my decision.
_____ I have no family to in form 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 expect to die when I take the medication to be prescribed. I further understand that although most deaths oc cur within three hours, my death may take longer and my physician has counseled me about this possibility.
I make this request voluntarily and without reservation, and I accept full moral responsibility for my actions.
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 under duress, fraud o r undue influence;
(d) 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 upon death and shall not own, operate or be employed at a health care facility where the person is a patient or resident. If the patient is an inpatient at a health care facility, one of the witn esses shall be an individual designated by the facility.
Section 7. Penalties.
(1) It shall be considered a felony for a person without authorization of the principal to willfully alter, forge, conceal or destroy an instrument, the reinstatement or revoc ation of an instrument or any other evidence or document reflecting the principal's desires and interests, with the intent and effect of causing a withholding or withdrawal of life-sustaining procedures or of artificially administered nutrition and hydrati on which hastens the death of the principal.
(2) Except as provided in subsection (1) of this section, it shall be considered misdemeanor for a person without authorization of the principal to willfully alter, forge, conceal or destroy an instrument, the reinstatement or revocation of an instrument, or any other evidence or document reflecting the principal's desires and interests with the intent or effect of affecting a health care decision.
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