[Second Reprint]

ASSEMBLY, No. 2270

STATE OF NEW JERSEY

216th LEGISLATURE

 

INTRODUCED FEBRUARY 6, 2014

 


 

Sponsored by:

Assemblyman  JOHN J. BURZICHELLI

District 3 (Cumberland, Gloucester and Salem)

Assemblyman  TIMOTHY J. EUSTACE

District 38 (Bergen and Passaic)

 

Co-Sponsored by:

Assemblymen Cryan, McKeon, Assemblywoman Jasey and Assemblyman Wilson

 

 

 

 

SYNOPSIS

     “Aid in Dying for the Terminally Ill Act”; permits qualified terminally ill patient to self-administer medication to end life in humane and dignified manner.

 

CURRENT VERSION OF TEXT

     As amended by the General Assembly on June 16, 2014.

 


An Act concerning 1[death with dignity] aid in dying for the terminally ill1, supplementing Titles 45 and 26 of the Revised Statutes, and amending P.L.1991, c.270 and N.J.S.2C:11-6.

 

     Be It Enacted by the Senate and General Assembly of the State of New Jersey:

 

     1.    (New section)  Sections 1 through 21 of 2[this act] P.L.      , c.      (C.       ) (pending before the Legislature as this bill)2 shall be known and may be cited as the 1[“New Jersey Death with Dignity Act.”] “Aid in Dying for the Terminally Ill Act.”1

 

     2.    (New section)  The Legislature finds and declares that:

     a.    2[The public welfare requires a defined and safeguarded process, with procedural safeguards to protect the interests of patients and health care providers, by which a patient who is an adult New Jersey resident with the capacity to make health care decisions, and who has been determined by that individual’s attending physician and consulting physician to be suffering from a terminal disease that will cause death within six months, may obtain medication that the patient may self-administer to end his life in a humane and dignified manner] Recognizing New Jersey’s long-standing commitment to individual dignity, informed consent, and the fundamental right of competent adults to make health care decisions about whether to have life-prolonging medical or surgical means or procedures provided, withheld, or withdrawn, this State affirms the right of a qualified terminally ill patient, protected by appropriate safeguards, to obtain medication that the patient may choose to self-administer in order to bring about the patient’s humane and dignified death2;

     b.    2Statistics from other states that have enacted laws to provide compassionate aid in dying for terminally ill patients indicate that the great majority of patients who requested medication under the laws of those states, including more than 90% of patients in Oregon since 1998 and between 72% and 86% of patients in Washington in each year since 2009, were enrolled in hospice care at the time of death, suggesting that those patients had availed themselves of available treatment and comfort care options available to them at the time they requested compassionate aid in dying;

     c.The public welfare requires 2[that such a process be entirely voluntary on the part of all participants, including the patient, the patient’s physicians, and any other health care provider furnishing services or care to the patient] a defined and safeguarded process in order to effectuate the purposes of this act, which will:

     (1)   guide health care providers and patient advocates who provide support to dying patients;

     (2)   assist capable, terminally ill patients who request compassionate aid in dying;

     (3)   protect vulnerable adults from abuse; and

     (4)   ensure that the process is entirely voluntary on the part of all participants, including patients and those health care providers that are providing care to dying patients2; and

     2[c.]  d.2  This act is 2in the public interest and is2 necessary for the welfare of the State and its residents 2[, and it is intended that it be liberally construed to effectuate its purposes]2.

 

     3.    (New section)  As used in 2[this act] P.L.      , c.      (C.       ) (pending before the Legislature as this bill)2:

     “Adult” means an individual who is 18 years of age or older.

     “Attending physician” means 2[the] a2 physician 2licensed pursuant to Title 45 of the Revised Statutes2 who has primary responsibility for the 2treatment and2 care of a 2qualified terminally ill2 patient and treatment of the patient's 2[terminal] illness,2 disease 2, or condition2.

     “Capable” means having the capacity to make health care decisions and to communicate them to a health care 2[professional] provider2, including communication through persons familiar with the patient’s manner of communicating if those persons are available.

     “Consulting physician” means a physician 2licensed pursuant to Title 45 of the Revised Statutes2 who is qualified by specialty or experience to make a professional diagnosis and prognosis regarding a patient's 2illness,2 disease 2, or condition2.

     “Counseling” means one or more consultations as necessary between a psychiatrist or psychologist licensed pursuant to Title 45 of the Revised Statutes and a patient for the purpose of determining that the patient is capable and not suffering from a psychiatric or psychological disorder or depression causing impaired judgment.

     “Health care facility” means a health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.) 2.2

     “Health care professional” means a person licensed to practice a health care profession pursuant to Title 45 of the Revised Statutes.

     2Health care provider” means a health care professional or health care facility.2

     “Informed decision” means a decision by a qualified 2terminally ill2 patient to request and obtain a prescription for medication that the 2[qualified]2 patient may 2choose to2 self-administer to end the patient’s life in a humane and dignified manner, which is based on an appreciation of the relevant facts and after being fully informed by the attending physician of:

     (1)   the patient’s medical diagnosis;

     (2)   the patient’s prognosis;

     (3)   the potential risks associated with taking the medication to be prescribed;

     (4)   the probable result of taking the medication to be prescribed; and

     (5)   the feasible alternatives to taking the medication, including, but not limited to, 2additional treatment opportunities,2 palliative care, 2comfort care,2 hospice care, and pain control.

     “Medically confirmed” means that the medical opinion of the attending physician has been confirmed 2pursuant to section 7 of P.L.      , c.      (C.       ) (pending before the Legislature as this bill)2 by a consulting physician who has examined the patient and the patient's relevant medical records.

     2[“Participating in this act” or “participation in this act”] “Participate in this act”2 means to perform the duties of 2[an attending physician or consulting physician, a psychiatrist or psychologist providing counseling, or a pharmacist dispensing medication,] a health care provider2 in accordance with the provisions of 2[this act] P.L.      , c.      (C.       ) (pending before the Legislature as this bill)2, but does not include: making an initial determination that a patient 2[has a terminal disease] is terminally ill2 and informing the patient of the medical prognosis; providing information about the provisions of 2[this act] P.L.    , c.    (C.       ) (pending before the Legislature as this bill)2 to a patient upon the patient’s request; or providing a patient, upon the patient’s request, with a referral to another 2[physician] health care provider2.

     “Patient” means a person who is under the care of a physician.

     2[“Physician” means a doctor of medicine or osteopathy licensed to practice medicine in New Jersey by the State Board of Medical Examiners.]2

     “Qualified 2terminally ill2 patient” means a capable adult who is a resident of New Jersey and has satisfied the requirements 2[of this act in order]2 to obtain a prescription for medication 2[that the qualified patient may self-administer to end the patient’s life in a humane and dignified manner] pursuant to P.L.      , c.      (C.       ) (pending before the Legislature as this bill)2.  A person shall not be considered to be a qualified 2terminally ill2 patient solely because of the person’s age or disability 2or a diagnosis of any specific illness, disease, or condition2.

     “Self-administer” means a qualified 2terminally ill2 patient's act of ingesting medication 2[to end that individual’s life in a humane and dignified manner] that has been prescribed pursuant to P.L.      , c.      (C.       ) (pending before the Legislature as this bill)2.

     2[“Terminal disease” means an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, result in a patient’s death within six months.] “Terminally ill” means that the patient is in the terminal stage of an irreversibly fatal illness, disease, or condition.  A determination of a specific life expectancy is not required as a precondition for a diagnosis that the patient is “terminally ill,” but a prognosis, based upon reasonable medical certainty, of a life expectancy of six months or less, with or without the provision of life-sustaining treatment, shall be deemed to constitute evidence that the patient is “terminally ill” for the purposes of P.L.      , c.      (C.       ) (pending before the Legislature as this bill).2

 

     4.    (New section)  A 2terminally ill2 patient may make a written request for medication that the patient may 2choose to2 self-administer 2[in order to end that individual’s life in a humane and dignified manner in accordance with the provisions of this act] pursuant to P.L.      , c.      (C.       ) (pending before the Legislature as this bill)2, if the patient:

     a.    is an adult resident of New Jersey 2as demonstrated pursuant to section 11 of P.L.      , c.      (C.       ) (pending before the Legislature as this bill)2;

     b.    is capable and has been determined by the patient’s attending physician and 2a2 consulting physician to be 2[suffering from a terminal disease] terminally ill2; and

     c.    has voluntarily expressed a wish to 2[die] receive a prescription for medication pursuant to P.L.      , c.      (C.       ) (pending before the Legislature as this bill)2.

 

     5.    (New section)  a.  A valid 2written2 request for medication under 2[this act] P.L.      , c.      (C.       ) (pending before the Legislature as this bill)2 shall be in substantially the form set forth in section 20 of 2[this act] P.L.      , c.      (C.       ) (pending before the Legislature as this bill)2, signed and dated by the patient and witnessed by at least two individuals who, in the patient’s presence, attest that, to the best of their knowledge and belief, the patient is capable and is acting voluntarily to sign the request.

     b.    At least one of the witnesses shall 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 of the 2patient’s2 estate 2[of the qualified patient]2 upon the patient’s death under any will or by operation of law; and

     (3)   an owner, operator, or employee of a health care facility where the 2[qualified]2 patient is receiving medical treatment or is a resident.

     c.    The patient's attending physician at the time the request is signed shall not serve as a witness.

     d.    If, at the time the written request is made, the patient is a resident of a long-term care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.), one of the witnesses shall be an individual designated by the facility.

 

     6.    (New section)  a.  The attending physician shall ensure that all appropriate steps are carried out in accordance with the provisions of 2[this act] P.L.      , c.      (C.       ) (pending before the Legislature as this bill)2 before writing a prescription for medication 2[to enable] that2 a qualified 2terminally ill2 patient 2[to end the patient’s life in a humane and dignified manner, for which purpose that physician shall] may choose to self-administer pursuant to P.L.      , c.     (C.       ) (pending before the Legislature as this bill), including such actions as are necessary to2:

     (1)   make the initial determination of whether a patient 2[has a terminal disease] is terminally ill2, is capable, and has 2voluntarily2 made the request for medication 2[voluntarily] pursuant to P.L.      , c.      (C.       ) (pending before the Legislature as this bill)2;

     (2)   require that the patient demonstrate New Jersey residency 2pursuant to section 11 of P.L.      , c.      (C.       ) (pending before the Legislature as this bill)2;

     (3)   inform the patient of: the patient’s medical diagnosis 2[; the patient’s] and2 prognosis; the potential risks associated with taking the medication to be prescribed; the probable result of taking the medication to be prescribed; and the feasible alternatives to taking the medication, including, but not limited to, 2additional treatment opportunities,2 palliative care, 2comfort care,2 hospice care, and pain control;

     (4)   refer the patient to a consulting physician for medical confirmation of the diagnosis 2and prognosis2, and for a determination that the patient is capable and acting voluntarily;

     (5)   refer the patient for counseling, if appropriate, pursuant to 2[this act] section 8 of P.L.      , c.      (C.       ) (pending before the Legislature as this bill);

     (6)   recommend that the patient participate in a consultation concerning additional treatment opportunities, palliative care, comfort care, hospice care, and pain control options for the patient, and provide the patient with a referral to a health care professional qualified to discuss these options with the patient2;

     2[(6)] (7)recommend that the patient notify the patient’s next of kin of the patient’s decision to request the medication;

     2[(7)] (8)advise the patient about the importance of having another person present 2if and2 when the patient 2[takes the] chooses to self-administer2 medication prescribed under 2[this act] P.L.      , c.      (C.       ) (pending before the Legislature as this bill)2 and of not taking the medication in a public place;

     2[(8)] (9)2  inform the patient of the patient’s opportunity to rescind the request at any time and in any manner, and offer the patient an opportunity to rescind the request at the 2[end of the 15-day waiting period required by this act] time the patient makes a second oral request as provided in section 10 of P.L.      , c.      (C.       ) (pending before the Legislature as this bill)2;

     2[(9)] (10)verify, immediately before writing the prescription for medication under 2[this act] P.L.      , c.      (C.       ) (pending before the Legislature as this bill)2, that the patient is making an informed decision to request the medication; and

     2[(10)] (11)2 fulfill the medical record documentation requirements of 2[this act] P.L.      , c.      (C.       ) (pending before the Legislature as this bill)2.

     b.    The attending physician shall:

     (1)   dispense medication directly, including ancillary medication intended to facilitate the desired effect to minimize the patient's discomfort, if the attending physician is authorized under law to dispense and has a current federal Drug Enforcement Administration certificate of registration; or

     (2)   with the patient's written consent:

     (a)   contact a pharmacist to inform the latter of the prescription; and

     (b)   transmit the written prescription personally, by mail, or by 2[otherwise]2 permissible electronic communication to the pharmacist, who shall dispense the medication directly to either the patient, the attending physician, or an expressly identified agent of the patient.

     Medication dispensed pursuant to this subsection shall not be dispensed to the patient by mail or other form of courier.

     2[c. The attending physician may sign the patient's death certificate, which shall list the underlying terminal disease as the cause of death.]2

 

     7.    (New section)  A 2[person] patient2 shall not be considered a qualified 2terminally ill2 patient until a consulting physician has:

     a.    examined that 2[person] patient2 and the 2[person’s] patient’s2 relevant medical records;

     b.    confirmed, in writing, the attending physician's diagnosis that the 2[person is suffering from a terminal disease] patient is terminally ill2; and

     c.    verified that the 2[person] patient2 is capable, is acting voluntarily, and has made an informed decision to request medication 2[to end the person's life in a humane and dignified manner] that, if prescribed, the patient may choose to self-administer pursuant to P.L.      , c.      (C.       ) (pending before the Legislature as this bill)2.

 

     8.    (New section) 2a.2 If, in the 2medical2 opinion of the attending physician or the consulting physician, a patient 2requesting medication that the patient may choose to self-administer pursuant to P.L.      , c.      (C.       ) (pending before the Legislature as this bill) may not be capable because the patient2 may 2[be suffering from] have2 a psychiatric or psychological disorder or depression 2[causing] that causes2 impaired judgment, 2[either] the2 physician shall refer the patient 2to a licensed psychiatrist or psychologist2 for counseling 2to determine whether the patient is capable.  A consulting physician who refers a patient to a licensed psychiatrist or psychologist for counseling pursuant to this subsection shall provide written notice of the referral to the attending physician22[Medication to end a patient's life in a humane and dignified manner shall not be prescribed unless the person performing the counseling determines that the patient is not suffering from a psychiatric or psychological disorder or depression causing impaired judgment.] 

     b.  If a patient has been referred to a licensed psychiatrist or psychologist for counseling pursuant to subsection a. of this section, the attending physician shall not write a prescription for medication  that the patient may choose to self-administer pursuant to P.L.      , c.      (C.       ) (pending before the Legislature as this bill) unless the attending physician has been notified in writing by the licensed psychiatrist or psychologist of that individual’s determination that the patient is capable.2

 

     2[9.  (New section)  A patient shall not receive a prescription for medication to end the patient’s life in a humane and dignified manner unless the patient has made an informed decision.  Immediately before writing a prescription for medication pursuant to this act, the attending physician shall verify that the patient is making an informed decision.]2

 

     2[10.] 9.(New section)  A 2qualified terminally ill2 patient shall not receive a prescription for medication 2[to end the patient’s life in a humane and dignified manner] that the patient may choose to self-administer pursuant to P.L.      , c.      (C.       ) (pending before the Legislature as this bill)2 unless the attending physician has recommended that the patient notify the patient’s next of kin of the patient’s request for medication 2[pursuant to this act]2, except that a patient who declines or is unable to notify the patient’s next of kin shall not have the request for medication denied for that reason.

 

     2[11.] 10.2  (New section)  a.  2[In order to receive a prescription for medication that a qualified patient may self-administer to end the patient’s life in a humane and dignified manner, the patient shall make an oral request and a written request for the medication, and reiterate the oral request to the patient’s attending physician at least 15 days after making the initial oral request.  At the time the patient makes a second oral request, the attending physician shall offer the patient an opportunity to rescind the request.

     (1)   At least 15 days shall elapse between the patient's initial oral request and the writing of a prescription pursuant to this act.

     (2)   At least 48 hours shall elapse between the time the patient signs the written request and the writing of a prescription pursuant to this act.]  In order to receive a prescription for medication that a qualified terminally ill patient may choose to self-administer pursuant to P.L.      , c.      (C.       ) (pending before the Legislature as this bill), the patient shall make two oral requests and one written request for the medication to the patient’s attending physician, subject to the following requirements:

     (1)   at least 15 days shall elapse between the initial oral request and the second oral request;

     (2)   at the time the patient makes a second oral request, the attending physician shall offer the patient an opportunity to rescind the request;

     (3)   the patient may submit the written request to the attending physician when the patient makes the initial oral request or at any time thereafter;

     (4)   the written request shall meet the requirements of section 5 of P.L.      , c.      (C.       ) (pending before the Legislature as this bill);

     (5)  at least 15 days shall elapse between the patient's initial oral request and the writing of a prescription pursuant to P.L.      , c.      (C.       ) (pending before the Legislature as this bill) ; and

     (6)  at least 48 hours shall elapse between the attending physician’s receipt of the patient’s written request and the writing of a prescription pursuant to P.L.      , c.      (C.       ) (pending before the Legislature as this bill)2.

     b.    A qualified 2terminally ill2 patient may rescind the request at any time and in any manner without regard to the patient’s mental state.  2[The attending physician shall not write a prescription for medication pursuant to this act without offering the patient an opportunity to rescind the request.]2

     c.    2At the time the patient makes an initial oral request for medication that the patient may choose to self-administer pursuant to P.L.      , c.      (C.       ) (pending before the Legislature as this bill), the patient’s attending physician shall recommend to the patient that the patient participate in a consultation concerning additional treatment opportunities, palliative care, comfort care, hospice care, and pain control options, and provide the patient with a referral to a health care professional qualified to discuss these options with the patient.  If the patient chooses to participate in such consultation, the consultation shall include, to the extent the patient consents to share such information, consideration of: the patient’s terminal illness; the patient’s prognosis; current and past courses of treatment prescribed for the patient in connection with the patient’s terminal illness, including the results of any such treatment; and any palliative care, comfort care, hospice care, and pain control treatment the patient is currently receiving or has received in the past.

     d.2   The 2attending physician shall ensure that the2 following items 2[shall be documented] are included2 in the patient's medical record 2[for the purposes of this act]2:

     (1)   2the determination that the patient is a qualified terminally ill patient and the basis for that determination;

     (2)2  2[the oral requests and the written request] all oral and written requests2 by the patient to the attending physician for medication 2[to end the patient’s life in a humane and dignified manner] that the patient may choose to self-administer pursuant to P.L.      , c.      (C.       ) (pending before the Legislature as this bill)2;

     2[(2)]  (3)2  the attending physician's diagnosis and prognosis, and determination that the patient is capable, is acting voluntarily, and has made an informed decision;

     2[(3)]  (4)2  the consulting physician's diagnosis and prognosis, and verification that the patient is capable, is acting voluntarily, and has made an informed decision;

     2[(4)  a report of the outcome and determinations made during counseling of the patient pursuant to this act;]2

     (5)  2if applicable, a report of the determination made by a licensed psychiatrist or psychologist as to whether the patient is capable pursuant to section 8 of P.L.      , c.      (C.        ) (pending before the Legislature as this bill);

     (6)   the attending physician’s recommendation that the patient participate in a consultation concerning additional treatment opportunities, palliative care, comfort care, hospice care, and pain control options; the referral provided to the patient with a referral to a health care professional qualified to discuss these options with the patient; an indication as to whether the patient participated in the consultation; and an indication as to whether the patient is currently receiving palliative care, comfort care, hospice care, or pain control treatments;

     (7)2  the attending physician's offer to the patient to rescind the patient’s request at the time of the patient's second oral request; and

     2[(6)]  (8)2  a note by the attending physician indicating that all requirements under 2[this act] P.L.      , c.      (C.       ) (pending before the Legislature as this bill)2 have been met and indicating the steps taken to carry out the patient’s request for medication, including a notation of the medication prescribed.

 

     2[12.]  11.2  (New section)  A request for medication pursuant to 2[this act] P.L.      , c.      (C.       ) (pending before the Legislature as this bill)2 shall not be granted unless the qualified 2terminally ill2 patient has documented that individual’s New Jersey residency by furnishing to the attending physician a copy of one of the following 2[as applies to that individual]2:

     a.    a driver's license or non-driver identification card issued by the New Jersey Motor Vehicle Commission;

     b.    proof that the person is registered to vote in New Jersey;

     c.    a New Jersey resident gross income tax return filed for the most recent tax year; or

     d.    any other government record that the attending physician reasonably believes to demonstrate the individual’s current residency in this State.

 

     2[13.]  12.2  (New section)  Any medication dispensed pursuant to 2[this act that is not self-administered by a qualified patient] P.L.      , c.      (C.       ) (pending before the Legislature as this bill) that a qualified terminally ill patient chooses not to self-administer2 shall be disposed of by lawful means.

 

     2[14.] 13.2  (New section)  a.  The Director of the Division of Consumer Affairs in the Department of Law and Public Safety shall require that a health care professional report the following information to the division on a form and in a manner prescribed by regulation of the director 2, in consultation with the Commissioner of Health2:

     (1)   No later than 30 days after the dispensing of medication pursuant to 2[this act] P.L.      , c.      (C.       ) (pending before the Legislature as this bill)2, the health care professional who dispensed the medication shall file a copy of the dispensing record with the division, and shall otherwise facilitate the collection of such information as the director may require regarding compliance with 2[this act] P.L.      , c.      (C.       ) (pending before the Legislature as this bill)2.

     (2)   No later than 30 days after the date of the 2qualified terminally ill2 patient’s death, the 2attending2 physician 2[who prescribed the medication]2 shall transmit to the division such documentation of the patient’s death as the director shall require.

     (3)   In the event that anyone required to report information to the division pursuant to 2[this act] P.L.      , c.      (C.       ) (pending before the Legislature as this bill)2 provides an inadequate or incomplete report, the division shall contact the person to request a complete report.

     2(4)  To the maximum extent practicable and consistent with the purposes of this section, the division shall seek to coordinate the process for reporting information pursuant to this subsection with the process for reporting prescription monitoring information by a pharmacy permit holder pursuant to sections 25 through 30 of P.L.2007, c.244 (C.45:1-45 through C.45:1-50).2

     b.    Any information collected pursuant to subsection a. of this section that contains material or data that could be used to identify an individual patient or health care professional shall not be included under materials available to public inspection pursuant to P.L.1963, c.73 (C.47:1A-1 et seq.) and P.L.2001, c.404 (C.47:1A-5 et al.).

     c.    The division shall prepare and make available to the public on its Internet website an annual statistical report of information collected pursuant to subsection a. of this section.

 

     2[15.] 14.2  (New section)  a.  A provision in a contract, will, insurance policy, annuity, or other agreement, whether written or oral, made on or after the effective date of 2[this act] P.L.      , c.      (C.       ) (pending before the Legislature as this bill)2, shall not be valid to the extent that the provision would condition or restrict a person’s decision to make or rescind a request for medication 2[to end the person’s life in a humane and dignified manner] pursuant to P.L.      , c.      (C.       ) (pending before the Legislature as this bill)2.

     b.    An obligation owing under a contract, will, insurance policy, annuity, or other agreement, made before the effective date of 2[this act] P.L.      , c.      (C.       ) (pending before the Legislature as this bill)2, shall not be affected by:  the provisions of 2[this act] P.L.      , c.      (C.       ) (pending before the Legislature as this bill)2; a person’s making or rescinding a request for medication 2[to end the person’s life in a humane and dignified manner] pursuant to P.L.      , c.      (C.       ) (pending before the Legislature as this bill)2; or any other action taken pursuant to 2[this act] P.L.      , c.      (C.       ) (pending before the Legislature as this bill)2.

     c.    On or after the effective date of 2[this act] P.L.      , c.      (C.       ) (pending before the Legislature as this bill)2, procurement or issuance of a life, health, or accident insurance policy or annuity 2,2 or the premium or rate charged for the policy or annuity 2,2 shall not be conditioned upon or otherwise take into account the making or rescinding of a request for medication pursuant to 2[this act] P.L.      , c.      (C.       ) (pending before the Legislature as this bill)2 by any person.

 

     2[16.]  15.2  (New section)  Nothing in 2[this act] P.L.      , c.      (C.       ) (pending before the Legislature as this bill)2 shall be construed to:

     a.    authorize a physician or any other person to end a patient's life by lethal injection, active euthanasia, or mercy killing 2, or any act that constitutes assisted suicide under any law of this State2; or

     b.    lower the applicable standard of care to be provided by a health care professional who participates in 2[this act] P.L.      , c.      (C.       ) (pending before the Legislature as this bill)2.

 

     216.  (New section)  A person shall not be authorized to take any action on behalf of a patient for the purposes of P.L.    , c.    (C.      ) (pending before the Legislature as this bill) by virtue of that person’s designation as a guardian pursuant to N.J.S.3B:12-1 et seq., a conservator pursuant to N.J.S.3B:13A-1 et seq., a health care representative pursuant to P.L.1991, c.201 (C.26:2H-53 et seq.), or a patient’s representative pursuant to P.L.2011, c.145 (C.26:2H-129 et al.), except for communicating the patient’s health care decisions to a health care provider if the patient so requests.2

 

     17.  (New section)  a.  (1)  2[A] Except as provided in section 19 of P.L.      , c.      (C.       ) (pending before the Legislature as this bill), a2 person shall not be subject to civil or criminal liability or professional disciplinary action for any action taken in compliance with the provisions of 2[this act] P.L.      , c.      (C.       ) (pending before the Legislature as this bill)2, including being present when a qualified 2terminally ill2 patient 2[takes] self-administers2 medication 2[to end the patient’s life in a humane and dignified manner] prescribed2 pursuant to 2[this act] P.L.      , c.      (C.       ) (pending before the Legislature as this bill)2.  A person who substantially complies in good faith with the provisions of 2[this act] P.L.      , c.      (C.       ) (pending before the Legislature as this bill)2 shall be deemed to be in compliance with 2[the act] its provisions2.

     (2)   Any action taken in accordance with the provisions of 2[this act] P.L.      , c.      (C.       ) (pending before the Legislature as this bill)2 shall not constitute 2patient abuse or neglect,2 suicide, assisted suicide, mercy killing, or homicide under any 2[criminal]2 law of this State.

     (3)   A patient's request for, or the provision of, medication in compliance with the provisions of 2[this act] P.L.    , c.      (C.       ) (pending before the Legislature as this bill)2 shall not 2[constitute neglect for any purpose of law or]2 provide the sole basis for the appointment of a guardian or conservator.

     b.    Any action taken by a health care professional to participate in 2[this act] P.L.      , c.      (C.       ) (pending before the Legislature as this bill)2 shall be voluntary on the part of that individual.  If a health care professional is unable or unwilling to carry out a patient's request under 2[this act] P.L.     , c.      (C.       ) (pending before the Legislature as this bill)2, and the patient transfers 2[his] the patient’s2 care to a new health care professional 2or health care facility2, the prior health care professional shall transfer, upon request, a copy of the patient's relevant records to the new health care professional 2or health care facility2.

 

     18.  (New section)  a.  A person who, without authorization of the patient, 2and with the intent or effect of causing the patient’s death,2 willfully alters or forges a request for medication pursuant to 2[this act,] P.L.      , c.      (C.       ) (pending before the Legislature as this bill)2 or conceals or destroys a rescission of that request 2[with the intent or effect of causing the patient's death]2, is guilty of a crime of the second degree.

     b.    A person who coerces or exerts undue influence on a patient to request medication 2[to end the patient's life,] pursuant to P.L.      , c.      (C.       ) (pending before the Legislature as this bill)2 or to destroy a rescission of a request 2[,]2 is guilty of a crime of the third degree.

     c.    2Theft of medication prescribed to a qualified terminally ill patient pursuant to P.L.      , c.      (C.        ) (pending before the Legislature as this bill) shall constitute an offense involving theft of a controlled dangerous substance as set forth in N.J.S.2C:20-2.

     d.2   Nothing in 2[this act] P.L.      , c.      (C.       ) (pending before the Legislature as this bill)2 shall limit liability for civil damages resulting from the negligence or intentional misconduct of any person.

     2[d.]  e.2  The penalties set forth in this section shall not preclude the imposition of any other criminal penalty applicable under law for conduct that is inconsistent with the provisions of 2[this act] P.L.      , c.      (C.       ) (pending before the Legislature as this bill)2.


     19.  (New section)  Any governmental entity that incurs costs resulting from a 2[person terminating his life] qualified terminally ill patient choosing to self-administer medication prescribed2 pursuant to 2[this act] P.L.      , c.      (C.       ) (pending before the Legislature as this bill)2 in a public place has a claim against the estate of the 2[person] patient2 to recover 2[such] those2 costs and reasonable attorneys' fees related to enforcing the claim.

 

     20.  (New section)  A 2written2 request for a medication as authorized by 2[this act] P.L.      , c.      (C.       ) (pending before the Legislature as this bill)2 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 and a resident of New Jersey.

     I am suffering from . . . . . . . . . . . . . . . , which my attending physician has determined is a terminal 2illness,2 disease 2, or condition2 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 palliative care, 2comfort care,2 hospice care, and pain control.

     I request that my attending physician prescribe medication that I may self-administer to end my life in a humane and dignified manner and to contact any pharmacist 2as necessary2 to fill the prescription.

 

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 inform of my decision.

 

2INITIAL ALL THAT APPLY:

 

     . . . . . My attending physician has recommended that I participate in a consultation concerning additional treatment opportunities, palliative care, comfort care, hospice care, and pain control options, and provided me with a referral to a health care professional qualified to discuss these options with me.

     . . . . . I have participated in a consultation concerning additional treatment opportunities, palliative care, comfort care, hospice care, and pain control options.

     . . . . . I am currently receiving palliative care, comfort care, or hospice care.2

 

     I understand that I have the right to rescind this request at any time.

     I understand the full import of this request 2,2 and I expect to die if and when I take the medication to be prescribed.  I further understand that 2,2 although most deaths occur 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 2[moral]2 responsibility for my 2[actions] decision2.

 

Signed:. . . . . . . . . . . . . . .

 

Dated:. . . . . . . . . . . . . . .

 

DECLARATION OF WITNESSES

 

     By initialing and signing below on or after the date the person named above signs, we declare that the person making and signing the above request:

 

Witness 1        Witness 2

Initials             Initials

. . . . . . . . .       . . . . . . . . .      

1.  Is personally known to us or has provided proof of identity.

. . . . . . . . .       . . . . . . . . .

2.  Signed this request in our presence on the date of the person's signature.

. . . . . . . . .       . . . . . . . . .

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 the attending physician.

. . . . . . . . .       . . . . . . . . .

 

Printed Name of Witness 1: . . . . . . . . . . . . .

Signature of Witness 1/Date: . . . . . . . . . . . .

 

Printed Name of Witness 2: . . . . . . . . . . . . .

Signature of Witness 2/Date: . . . . . . . . . . . .

 

NOTE:  At least 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 a resident of a long-term care facility, one of the witnesses shall be an individual designated by the facility.

 

     21.  (New section)  The Director of the Division of Consumer Affairs in the Department of Law and Public Safety, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), shall adopt such rules and regulations as are necessary to implement the provisions of sections 1 through 20 of 2[this act] P.L.      , c.      (C.        ) (pending before the Legislature as this bill)2, including the required reporting of information to the division by health care 2[providers] professionals2 pursuant to section 2[14] 132 of 2[this act] P.L.      , c.      (C.        ) (pending before the Legislature as this bill)2.

 

     22.  (New section)  The State Board of Medical Examiners, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), shall adopt such rules and regulations as are necessary to implement the provisions of sections 1 through 20 of P.L.    , c.     (C.     ) (pending before the Legislature as this bill) concerning the duties of a licensed physician pursuant thereto. 

 

     23.   (New section)  The New Jersey State Board of Pharmacy, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), shall adopt such rules and regulations as are necessary to implement the provisions of sections 1 through 20 of P.L.    , c.     (C.     ) (pending before the Legislature as this bill) concerning the duties of a licensed pharmacist pursuant thereto.

 

     24   New section)  The State Board of Psychological Examiners, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), shall adopt such rules and regulations as are necessary to implement the provisions of sections 1 through 20 of P.L.    , c.     (C.     ) (pending before the Legislature as this bill) concerning the duties of a licensed psychologist pursuant thereto.

 

     25.  (New section)  a.  As used in this section:

     “Health care facility” or “facility” means a health care facility licensed pursuant to P.L.1971, c.,136 (C.26:2H-1 et seq.).

     “Health care professional” means a person licensed to practice a health care profession pursuant to Title 45 of the Revised Statutes.

     b.    2[A health care facility may adopt a written policy to prohibit a health care professional from taking] (1)  The existing policies and procedures utilized by a health care facility shall, to the maximum extent possible, govern the taking of2 any action 2by a health care professional2 pursuant to sections 1 through 20 of P.L.    , c.     (C.     ) (pending before the Legislature as this bill) on the premises owned by, or under the direct control of, the facility 2[if the facility has given prior written notice of the written policy to all health care professionals with privileges to practice on those premises] , except as otherwise prescribed by regulation of the Commissioner of Health pursuant to paragraph (4) of this subsection.

     (2)   Any action taken by a health care facility to participate in P.L.      , c.      (C.       ) (pending before the Legislature as this bill) shall be voluntary on the part of the facility.

     (3)   A health care facility shall not be subject to a licensure enforcement action by the Department of Health for any action taken in compliance with the provisions of P.L.      , c.      (C.       ) (pending before the Legislature as this bill).

     (4)   The Commissioner of Health, pursuant to the “Administrative Procedure Act,” P.L.1968, c.410 (C.52:14B-1 et seq.), shall adopt such rules and regulations as are necessary to implement the provisions of sections 1 through 20 of P.L.      , c.       (C.        ) (pending before the Legislature as this bill), concerning their application to a health care facility and any action taken by a health care professional on the premises owned by, or under the direct control of, the facility2.

     2(5)2  The provisions of this subsection shall not preclude a 2health care facility or2 health care professional from providing to a patient any health care services to which the provisions of sections 1 through 20 of P.L.    , c.     (C.     ) (pending before the Legislature as this bill) do not apply.

     2[c.  A health care professional who violates a written policy as set forth in subsection b. of this section, after being notified in writing of that policy, is subject to such of the following actions as the health care facility deems appropriate:

     (1)   the loss of privileges or membership, or other sanctions provided under the medical staff bylaws, policies, and procedures of the facility if the health care professional is a member of the medical staff at the facility and takes the prohibited action while on the premises of that facility, but not including the private medical office of a physician or other provider; and

     (2)   the termination of a lease or other contract for the occupancy of real property or other nonmonetary remedy provided by the lease or contract if the health care professional takes the prohibited action while on the premises of the health care facility or on property that is owned by or under the direct control of the facility; provided, however, that no lease or other contract made on or after the effective date of this act shall authorize or permit any nonmonetary remedy for taking the prohibited action in the form of loss or restriction of medical staff privileges or exclusion from a managed care plan health care provider network; or

     (3)   the termination of a contract or other nonmonetary remedy provided by contract if the health care professional takes the prohibited action while acting in the course and scope of that individual’s capacity as an employee or independent contractor of the health care facility, except that nothing in this subparagraph shall preclude:

     (a)   a health care professional from taking the prohibited action while acting outside the course and scope of that individual’s capacity as an employee or independent contractor; or

     (b)   a patient from contracting with the patient’s attending physician and consulting physician to act outside the course and scope of either physician’s capacity as an employee or independent contractor of the health care facility.

     (4)   A health care facility shall follow all otherwise applicable due process and other procedures that the facility may have in place relating to the imposition of sanctions on a health care professional.]2

 

     26.  Section 1 of P.L.1991, c.270 (C.2A:62A-16) is amended to read as follows:

     1.    a.  Any person who is licensed in the State of New Jersey to practice psychology, psychiatry, medicine, nursing, clinical social work, or marriage counseling, whether or not compensation is received or expected, is immune from any civil liability for a patient's violent act against another person or against himself unless the practitioner has incurred a duty to warn and protect the potential victim as set forth in subsection b. of this section and fails to discharge that duty as set forth in subsection c. of this section. 

     b.    A duty to warn and protect is incurred when the following conditions exist: 

     (1)   The patient has communicated to that practitioner a threat of imminent, serious physical violence against a readily identifiable individual or against himself and the circumstances are such that a reasonable professional in the practitioner's area of expertise would believe the patient intended to carry out the threat; or 

     (2)   The circumstances are such that a reasonable professional in the practitioner's area of expertise would believe the patient intended to carry out an act of imminent, serious physical violence against a readily identifiable individual or against himself. 

     A duty to warn and protect shall not be incurred when a qualified 2terminally ill2 patient requests medication that the patient may 2choose to2 self-administer 2[in order to end the patient’s life in a humane and dignified manner]2 in accordance with the provisions of P.L.   , c.     (C.     ) (pending before the Legislature as this bill).

     c.    A licensed practitioner of psychology, psychiatry, medicine, nursing, clinical social work, or marriage counseling shall discharge the duty to warn and protect as set forth in subsection b. of this section by doing [any] one or more of the following: 

     (1)   Arranging for the patient to be admitted voluntarily to a psychiatric unit of a general hospital, a short-term care facility, a special psychiatric hospital, or a psychiatric facility, under the provisions of P.L.1987, c.116 (C.30:4-27.1 et seq.); 

     (2)   Initiating procedures for involuntary commitment to treatment of the patient to an outpatient treatment provider, a short-term care facility, a special psychiatric hospital 2,2 or a psychiatric facility, under the provisions of P.L.1987, c.116 (C.30:4-27.1 et seq.); 

     (3)   Advising a local law enforcement authority of the patient's threat and the identity of the intended victim;

     (4)   Warning the intended victim of the threat, or, in the case of an intended victim who is under the age of 18, warning the parent or guardian of the intended victim; or

     (5)   If the patient is under the age of 18 and threatens to commit suicide or bodily injury upon himself, warning the parent or guardian of the patient.

     d.    A practitioner who is licensed in the State of New Jersey to practice psychology, psychiatry, medicine, nursing, clinical social work, or marriage counseling who, in complying with subsection c. of this section, discloses a privileged communication, is immune from civil liability in regard to that disclosure.

(cf: P.L.2009, c.112, s.21)

 

     27.  N.J.S.2C:11-6  is amended to read as follows:

     2C:11-6.  1Aiding Suicide.1  A person who purposely aids another to commit suicide is guilty of a crime of the second degree if his conduct causes such suicide or an attempted suicide, and otherwise of a crime of the fourth degree.  Any action taken in accordance with the provisions of P.L.   , c.     (C.     ) (pending before the Legislature as this bill) shall not constitute suicide or assisted suicide.

(cf: P.L.1978, c.95, s.2C:11-6)

 

     1[28.  This act shall be submitted to the people for their approval or rejection at the next general election to be held at least 70 days following the date of its enactment for the purpose of complying with Article II, Section I, paragraph 2 of the New Jersey Constitution.]1

 

     1[29.  This voter referendum shall be submitted to the people in the following manner and form:

     There shall be printed on each official ballot to be used at the general election, the following:

     a.    In every municipality in which voting machines are not used, a legend which shall immediately precede the question as follows:

     If you favor the proposition printed below make a cross (X), plus (+), or check (a) in the square opposite the word "Yes." If you are opposed thereto make a cross (X), plus (+) or check (a) in the square opposite the word "No."

     b.    In every municipality the following question:

 

 

 

AUTHORIZATION TO ALLOW CERTAIN PERSONS TO USE MEDICATION TO END THEIR LIFE

IN A HUMANE AND DIGNIFIED WAY

 

YES

Do you approve allowing an adult who is able to make health care decisions and has a terminal disease that will cause death within six months to use a prescribed drug to end his life in a humane and dignified way? 

 

 

INTERPRETIVE STATEMENT

 

NO

 

 

 

 

Voter approval of P. L.    , c. (C.      ) (pending before the Legislature as this bill) will permit an adult who is able to make health care decisions and has a terminal disease that will cause death within six months to use a prescribed drug to end his life in a humane and dignified way. ]1

 

     1[30.] 28.1  This act shall take effect on the first day of the 1[third] fourth1 month next following 1[voter approval of this act at the designated general election] the date of enactment, but the Director of the Division of Consumer Affairs in the Department of Law and Public Safety, the Commissioner of Health, the State Board of Medical Examiners, the New Jersey State Board of Pharmacy, and the State Board of Psychological Examiners may take such anticipatory administrative action in advance thereof as shall be necessary for the implementation of this act1.