Existing law authorizes a patient who has been diagnosed with a terminal condition to refuse life-resuscitating or life-sustaining treatment in certain circumstances. (NRS 449A.400-449A.581, 450B.400-450B.590) Sections 10-39 of this bill authorize a patient, under certain circumstances, to self-administer a medication that is designed to end the life of the patient. Section 20 of this bill defines “practitioner” to mean a physician, osteopathic physician or advanced practice registered nurse. Sections 11-18, 21 and 22 of this bill define other relevant terms. Section 23 of this bill authorizes a patient to request that his or her attending practitioner prescribe a medication that is designed to end his or her life if the patient: (1) is at least 18 years of age; (2) has been diagnosed with a terminal condition by at least two practitioners; (3) has made an informed and voluntary decision to end his or her own life; (4) is mentally capable of making such a decision; and (5) is not requesting the medication because of coercion, deception or undue influence. Section 24 of this bill prescribes certain requirements concerning the manner in which a patient may request a medication that is designed to end the life of the patient, including that the patient make two verbal requests and one written request for the medication, and that the written request for the medication be signed by a witness. Section 25 of this bill prescribes the form for the written request for the medication. Section 26 of this bill imposes certain requirements before a practitioner is authorized to prescribe a medication that is designed to end the life of a patient, including that the practitioner: (1) inform the patient of his or her right to revoke a request for the medication at any time; (2) determine and verify that the patient meets the requirements for making such a request; (3) discuss certain relevant factors with the patient, including the diagnosis and prognosis of the patient and alternative options for care; (4) refer the patient to a consulting practitioner who can confirm the diagnosis, prognosis and mental capability of the patient and that the patient has not been coerced or unduly influenced; and (5) instruct the patient against self-administering the medication in public. Section 27 of this bill requires a practitioner who determines that a patient who has requested a prescription for a medication that is designed to end his or her life may not be mentally capable to refer the patient to a qualified mental health professional and to receive confirmation about the patient's mental capability. Section 28 of this bill: (1) prescribes procedures for the issuance of a prescription for a medication that is designed to end the life of the patient; and (2) provides that only an attending practitioner or a pharmacist may dispense such a medication. Section 29 of this bill prohibits an attending practitioner from prescribing a medication that is designed to end the life of a patient based solely on the age or disability of the patient. Section 30 of this bill requires certain providers of health care to include certain information concerning requests and prescriptions for and the dispensing of a medication that is designed to end the life of a patient in the medical record of the patient. If a patient who has requested a medication that is designed to end the life of a patient transfers care to another practitioner or health care facility, sections 30 and 37 of this bill require the practitioner or health care facility that previously provided care to the patient to forward the patient's medical records to the new practitioner or health care facility. Section 33 of this bill prescribes certain information that must be reported by an attending practitioner to the Division of Public and Behavioral Health of the Department of Health and Human Services relating to a patient who has been prescribed or self-administered such a medication. Section 34 of this bill requires the Division to compile an annual report concerning the implementation of the provisions of this bill authorizing a patient to request a prescription for a medication that is designed to end the life of the patient. Sections 33, 46 and 47 of this bill provide that such information is otherwise confidential when reported to the Division. Section 31 of this bill authorizes a patient, at any time, to revoke a request for a medication that is designed to end his or her life. Sections 32 and 41 of this bill provide that only the patient to whom a medication that is designed to end his or her life is prescribed may administer the medication. Section 32 establishes requirements for the disposal of any unused portion of the medication. Section 39 of this bill makes certain persons exempt from professional discipline and immune from civil and criminal penalties and provides that such persons do not violate any applicable standard of care for taking actions authorized by this bill to assist a patient in acquiring a medication that is designed to end the life of the patient. Section 35 of this bill provides that a death resulting from the self-administration of a medication that is designed to end the life of a patient is not mercy killing, euthanasia, assisted suicide, suicide or homicide when done in accordance with the provisions of this bill, and section 4 of this bill requires a death certificate to list the terminal condition of the patient as the cause of death of the patient. Sections 3 and 7 of this bill provide that a coroner, coroner's deputy or local health officer is not required to certify the cause of such a death. Section 46.5 of this bill: (1) authorizes a coroner to make an appropriate investigation after discovering that a person has self-administered a medication designed to end the life of the person, to the extent necessary to determine the cause of the terminal condition with which the person was diagnosed; and (2) requires a coroner to cease such an investigation after determining that the terminal condition resulted from a natural cause. Section 46.2 of this bill makes a conforming change to revise certain internal references. Sections 36 and 44 of this bill prohibit a person from preventing or requiring a person to make or revoke a request for a medication that is designed to end the life of the person as a condition to receiving health care or as a condition in an agreement, contract or will. Section 37 of this bill clarifies that a practitioner is not required to prescribe a medication that is designed to end the life of a patient and remains responsible for treating the patient's pain. However, if a patient who is diagnosed with a terminal condition requests information concerning the prescription and self-administration of a medication that is designed to end the life of the patient, section 37 requires a practitioner to provide that information or facilitate the transfer of the patient to another provider of health care. Section 37 also provides that a pharmacist is not required to fill a prescription for or dispense such a medication. Section 38 of this bill allows the owner or operator of a health care facility to prohibit an employee or independent contractor of the health care facility or any person who provides services on the premises of the health care facility from providing any services relating to prescribing a medication that is designed to end the life of a patient while acting within the scope of his or her employment or contract with the facility or while on the premises of the facility. Section 39 prohibits a health care facility or provider of health care from taking certain actions against an employee or independent contractor who: (1) provides accurate, scientific information concerning end-of-life care to a patient; or (2) facilitates the prescription or self-administration of a medication that is designed to end the life of the patient. Sections 40-43 of this bill make conforming changes to clarify that a practitioner or pharmacist is authorized to dispense a medication that is designed to end the life of a patient that is a controlled substance or dangerous drug and a patient may self-administer such a medication in accordance with other provisions governing medications designed to end the life of a patient. Section 45 of this bill provides that a proposed protected person shall not be deemed to be in need of a general or special guardian solely because the proposed protected person requested a medication that is designed to end his or her life or revoked such a request. Sections 48 and 49 of this bill prohibit insurers from conditioning life insurance benefits, group life insurance benefits or the payment of claims on whether the insured makes, fails to make or revokes a request for a medication that is designed to end the life of the insured or self-administers such a medication. Section 50 of this bill makes a conforming change to reflect this prohibition on a policy of group life insurance.

Statutes affected:
As Introduced: 440.380, 440.400, 440.415, 440.420, 440.470, 453.256, 453.375, 454.213, 454.215, 133.065, 159.054, 239.010, 639.238, 688B.040
Reprint 1: 440.380, 440.420, 453.256, 453.375, 454.213, 454.215, 133.065, 159.054, 239.010, 259.010, 259.050, 639.238, 688B.040
Reprint 2: 440.380, 440.420, 453.256, 453.375, 454.213, 454.215, 133.065, 159.054, 239.010, 259.010, 259.050, 639.238, 688B.040
As Enrolled: 440.380, 440.420, 453.256, 453.375, 454.213, 454.215, 133.065, 159.054, 239.010, 259.010, 259.050, 639.238, 688B.040
BDR: 440.380, 440.400, 440.415, 440.420, 440.470, 453.256, 453.375, 454.213, 454.215, 133.065, 159.054, 239.010, 639.238, 688B.040