H.B. 780
GENERAL ASSEMBLY OF NORTH CAROLINA
May 3, 2021
SESSION 2021 HOUSE PRINCIPAL CLERK
H D
HOUSE BILL DRH30044-MG-21B
Short Title: End of Life Option Act. (Public)
Sponsors: Representative Harrison.
Referred to:
1 A BILL TO BE ENTITLED
2 AN ACT ESTABLISHING AN END OF LIFE OPTION ACT TO ALLOW QUALIFIED
3 INDIVIDUALS DIAGNOSED WITH A TERMINAL DISEASE TO END LIFE IN A
4 HUMANE AND DIGNIFIED MANNER.
5 The General Assembly of North Carolina enacts:
6 SECTION 1. Chapter 90 of the General Statutes is amended by adding a new Article
7 to read:
8 "Article 23B.
9 "End of Life Option Act.
10 "§ 90-326. Definitions.
11 The following definitions apply in this Article:
12 (1) Adult. – An individual who is 18 years of age or older.
13 (2) Attending physician. – A North Carolina licensed physician who meets the
14 following requirements: (i) has established a bona fide physician-patient
15 relationship with an individual with a terminal disease, (ii) has the requisite
16 experience to confirm the individual's terminal disease diagnosis and to fulfill
17 the responsibilities of an attending physician under this Article, and (iii) has
18 primary responsibility for supervising the individual's terminal disease under
19 the provisions of this Article. The attending physician need not be the
20 individual's primary care physician.
21 (3) Attending Physician Checklist and Compliance Form. – The form published
22 by the Department pursuant to G.S. 90-326.17 identifying each and every
23 requirement that must be fulfilled by an attending physician in order to be in
24 good-faith compliance with this Article.
25 (4) Attending witness. – An individual nominated by the qualified individual to
26 be present if and when the qualified individual self-administers the terminal
27 comfort care drug and who undertakes to do the following:
28 a. Complete the Attending Witness Completion Form confirming
29 self-administration of the terminal comfort care drug and that the
30 qualified individual died as a result of such self-administration.
31 b. Return the Attending Witness Completion Form to the attending
32 physician within 48 hours after the death of the qualified individual.
33 The attending witness may, but need not, be (i) related to the qualified
34 individual by blood, adoption, or marriage, or (ii) a health care
35 provider. At the discretion of the qualified individual, the attending
36 witness may be the attending physician.
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1 (5) Bona fide physician-patient relationship. – A treating relationship in the
2 course of which a physician has completed an assessment of a patient's
3 medical history and current medical condition, including a personal physical
4 examination.
5 (6) Capacity to make medical decisions. – In the opinion of an individual's
6 attending physician or mental health specialist, the individual has the ability
7 to understand the nature and consequences of a health care decision; the ability
8 to understand its significant benefits, risks, and alternatives; and the ability to
9 make and communicate an informed decision to health care providers,
10 including communication through persons familiar with the qualified
11 individual's manner or language of communication, if those persons are
12 required.
13 (7) Department. – The North Carolina Department of Health and Human
14 Services.
15 (8) Health care provider. – An individual who is licensed, certified, or otherwise
16 authorized under Chapter 90 of the General Statutes to provide health care
17 services in the ordinary course of business or practice of a profession or a
18 health care facility licensed under Chapter 131E of the General Statutes,
19 where health care services are provided to patients. The term includes all of
20 the following:
21 a. An agent, officer, director, or employee of a health care facility that is
22 licensed, certified, or otherwise authorized to provide health care
23 services.
24 b. An agent or employee of a health care provider who is licensed,
25 certified, or otherwise authorized to provide health care services.
26 (9) Hospice. – As defined in G.S. 131E-176(13a).
27 (10) Hospice evaluation. – A written assessment by a qualified hospice physician
28 or a qualified hospice nurse practitioner of an individual's eligibility for
29 hospice, regardless of whether the individual meets the criteria for admission
30 into hospice. The term includes a certification of terminal illness that meets
31 the requirements of 42 C.F.R. § 418.22.
32 (11) Informed decision. – A decision by a qualified individual to request and obtain
33 a prescription for a terminal comfort care drug that the qualified individual
34 may self-administer to hasten the qualified individual's death, that is based on
35 an understanding and acknowledgement of the relevant facts, and that is made
36 after being fully informed by the attending physician of all of the following:
37 a. The medical diagnosis and prognosis.
38 b. The risks associated with taking the terminal comfort care drug.
39 c. The probable result of taking the terminal comfort care drug.
40 d. The right to change the decision at any time by discontinuing
41 proceedings under this Article and by choosing not to obtain the
42 terminal comfort care drug or, after obtaining the terminal comfort
43 care drug, by deciding not to proceed with self-administration.
44 e. The feasible alternatives or additional end-of-life options.
45 (12) Mental health specialist assessment. – One or more consultations between an
46 individual and a mental health specialist for the purpose of determining that
47 the qualified individual has the capacity to make medical decisions and is not
48 suffering from impaired judgment.
49 (13) Mental health specialist. – A psychiatrist or a psychologist licensed to practice
50 in North Carolina.
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1 (14) Physician. – An individual licensed to practice medicine by the North Carolina
2 Medical Board under Article 1 of Chapter 90 of the General Statutes.
3 (15) Public place. – Any street, alley, park, public building, place of business, or
4 assembly open to or frequented by the public, and any other place that is open
5 to public view or to which the public has access.
6 (16) Qualified individual. – An adult who meets all the following qualifications:
7 a. Is a resident of North Carolina.
8 b. Has the capacity to make medical decisions.
9 c. Has the physical and mental ability to self-administer a terminal
10 comfort care drug.
11 d. Has been diagnosed by the attending physician as suffering from a
12 terminal disease.
13 e. Has undergone a hospice evaluation.
14 f. Has expressed verbally and in writing the desire to receive a
15 prescription for a terminal comfort care drug.
16 g. Is acting voluntarily and without coercion or duress.
17 h. Has documented a request pursuant to the requirements of
18 G.S. 90-326.3 on the form specified in G.S. 90-326.3A.
19 i. Has satisfied the requirements of this Article to obtain a terminal
20 comfort care drug.
21 An individual shall not be deemed a qualified individual under this Article
22 solely on the basis of age or disability.
23 (17) Self-administer. – A qualified individual's affirmative, voluntary, conscious,
24 and physical act of self-administering the terminal comfort care drug.
25 (18) Terminal comfort care drug. – A controlled substance determined and
26 prescribed by a physician licensed in this State for a qualified individual with
27 the purpose of hastening the qualified individual's death due to a terminal
28 disease.
29 (19) Terminal disease. – An incurable and irreversible disease that, having
30 previously been determined, has been medically confirmed by the attending
31 physician and will, within reasonable medical judgment, result in death within
32 six months.
33 "§ 90-326.1. Right to information.
34 An individual suffering from a terminal disease has a right to be informed of all available
35 end-of-life options related to terminal care and to receive answers to any specific question about
36 the foreseeable risks and benefits of medication without the physician withholding any requested
37 information, regardless of the purpose of the inquiry or the nature of the information. A physician
38 who engages in discussions with an individual related to such risks and benefits shall not be
39 construed as assisting in, or contributing to, an individual's independent decision to
40 self-administer a lethal dose of medication, and such discussions shall not be used to establish
41 civil or criminal liability or professional disciplinary action.
42 "§ 90-326.2. Initiation of request for terminal comfort care drug.
43 (a) A qualified individual may request a prescription for a terminal comfort care drug in
44 accordance with the requirements of this Article.
45 (b) A request under this Article for a terminal comfort care drug is subject to all the
46 following:
47 (1) Shall not be made by (i) a proxy of, or on behalf of, the qualified individual
48 or (ii) any of the following:
49 a. An advanced directive for a natural death.
50 b. A health care power of attorney.
51 c. A guardian.
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1 d. A conservator.
2 e. A health care agent.
3 f. A surrogate.
4 g. Any other legally recognized health care decision maker.
5 (2) Shall be made solely and directly by the qualified individual.
6 "§ 90-326.3. Form of request for terminal comfort care drug.
7 (a) A qualified individual seeking to obtain a prescription for a terminal comfort care
8 drug pursuant to this Article shall make a verbal request, followed by a written request no sooner
9 than 7 days after the verbal request, that meets the requirements of subsection (b) of this section
10 directly to his or her attending physician and not to a designee of the physician. The attending
11 physician shall directly, and not through a designee, receive all requests required by this section.
12 The attending physician shall keep records of the verbal and written requests in the qualified
13 individual's medical file. The record of any verbal request must include the date and time of the
14 request as well as a summary of the request.
15 (b) In order to be valid, a written request for a terminal comfort care drug must meet all
16 of the following criteria:
17 (1) The request shall be in the form specified in G.S. 90-326.3A.
18 (2) The request shall be signed and dated by the qualified individual seeking the
19 terminal comfort care drug in the presence of two adult witnesses, who, in the
20 presence of the qualified individual, shall attest that to the best of their
21 knowledge and belief the individual is all of the following:
22 a. An individual who is personally known to them or has provided proof
23 of identity.
24 b. An individual who voluntarily signed this request in their presence.
25 c. An individual whom they believe to be mentally capable and not acting
26 under duress, fraud, or undue influence.
27 d. An individual for whom not more than one of them is the attending
28 physician or mental health specialist.
29 e. An individual for whom not more than one of them is related by blood
30 or marriage, or is otherwise expecting to inherit real or personal
31 property from the individual.
32 "§ 90-326.3A. Request for Terminal Comfort Care Drug Form.
33 A request for a terminal comfort care drug, as authorized by this Article, shall be in the
34 following form:
35 "REQUEST FOR A TERMINAL COMFORT CARE DRUG
36 I, ………………………………………………, am an adult of sound mind and a resident of
37 the State of North Carolina.
38 I have been diagnosed as suffering from ……………., which my attending physician has
39 determined is in its terminal phase and which has been medically confirmed as leaving me less
40 than six months to live.
41 I have undergone a hospice evaluation and released the records of that evaluation to my
42 attending physician.
43 I have been fully informed of my diagnosis and prognosis, the nature of the terminal comfort
44 care drug to be prescribed and potential associated risks, the expected result, and the feasible
45 alternatives or additional treatment options.
46 I request that my attending physician prescribe a terminal comfort care drug that will end my
47 life in a humane and dignified manner if I choose to take it, and I authorize my attending
48 physician to contact my pharmacist to fill my request.
49 INITIAL ONE:
50 ………… I have informed one or more members of my family of my decision and have taken
51 their opinions into consideration.
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1 ………… I have decided not to inform my family of my decision.
2 ………… I have no family to inform of my decision.
3 INITIAL ONE:
4 ………… I nominate ……………… to be my attending witness should I decide to
5 self-administer the prescribed terminal comfort care drug and authorize ……………… to
6 transmit the final confirmation of my death by self-administration to my attending physician; or
7 ………… I have chosen not to nominate an attending witness, and have been informed of the
8 risks of not having a witness to attend my self-administration of the terminal comfort care drug.
9 I understand that I have the right to change my mind at any time and to withdraw or rescind
10 this request and not to self-administer the terminal comfort care drug once prescribed.
11 I undertake to keep the terminal comfort care drug in a safe and secure place until such time,
12 if ever, when I decide to self-administer it.
13 I undertake not to take the terminal comfort care drug in a public place, or on the premises of
14 any hospice, hospital, or other licensed medical or assisted living facility, except with the written
15 consent of the hospice, hospital, or other licensed medical or assisted living facility.
16 I understand that if I decide to take the terminal comfort care drug, it is my responsibility to
17 self-administer it, although someone may assist me in preparing the terminal comfort care drug
18 for immediate consu