Existing law authorizes a patient who has been diagnosed with a terminal condition to refuse life-resuscitating or life-sustaining treatment in certain circumstances and establishes certain requirements relating to controlled substances. (NRS 449A.400-449A.581, 450B.400-450B.590, chapter 453 of NRS) Sections 5-31 of this bill authorize a patient, under certain circumstances, to self-administer a controlled substance that is designed to end the life of the patient. Sections 6-12 of this bill define relevant terms. Section 14 of this bill authorizes a patient to request that his or her physician prescribe a controlled substance that is designed to end the life of the patient if the patient: (1) is at least 18 years of age; (2) has been diagnosed with a terminal condition by at least two physicians; (3) is a resident of this State; (4) has made an informed and voluntary decision to end his or her own life; (5) is competent; and (6) is not requesting the controlled substance because of coercion or undue influence. Section 15 of this bill prescribes certain requirements concerning the manner in which a patient may request a controlled substance designed to end the life of the patient, including that the patient must make two verbal requests and one written request for the controlled substance, and that the written request for the controlled substance must be signed by two witnesses. Section 16 of this bill prescribes the form for the written request for the controlled substance. Section 17 of this bill imposes certain requirements before a physician is allowed to prescribe a controlled substance designed to end the life of a patient, including that the physician: (1) inform the patient of his or her right to revoke a request for the controlled substance at any time; (2) determine and verify that the patient meets the requirements for making such a request; (3) refer the patient to a consulting physician who can confirm the diagnosis, prognosis and competence of the patient; (4) instruct the patient against self-administering the controlled substance in public; and (5) recommend that the patient notify his or her next of kin of the patient's decision to end his or her life. Section 18 of this bill requires a physician who determines that a patient who has requested a prescription for a controlled substance that is designed to end his or her life may not be competent to refer the patient to a psychiatrist or psychologist and to receive confirmation about the patient's competence. Sections 19 and 38 of this bill provide that only an attending physician or pharmacist may dispense a controlled substance that is designed to end the life of a patient. Section 19 also prescribes the manner in which such a controlled substance is to be dispensed. Section 20 of this bill prohibits an attending physician from prescribing a controlled substance that is designed to end the life of a patient based solely on the age or disability of the patient. Section 21 of this bill requires certain providers of health care to include certain information concerning requests and prescriptions for and the dispensing of a controlled substance that is designed to end the life of a patient in the medical record of the patient. Section 21 also requires any interaction between a patient and a physician, psychiatrist or psychologist relating to the prescription of a controlled substance designed to end the life of the patient to take place in person. Section 24 of this bill prescribes certain information that must be reported to the Division of Public and Behavioral Health of the Department of Health and Human Services relating to a patient who has self-administered such a controlled substance. Section 25 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 controlled substance that is designed to end the life of the patient. Sections 24, 37 and 40 of this bill provide that such information is otherwise confidential when reported to the Division. Section 22 of this bill allows a patient, at any time, to revoke a request for a controlled substance that is designed to end his or her life. Sections 23 and 34 of this bill provide that only the patient to whom a controlled substance designed to end his or her life is prescribed may administer the controlled substance. Section 23 provides for the disposal of any unused portion of the controlled substance. Section 26 of this bill makes certain providers of health care exempt from professional discipline, immune from civil and criminal liability and provides that such providers do not violate any applicable standard of care for taking certain actions to assist a patient in acquiring a controlled substance designed to end the life of the patient. Section 27 of this bill provides that a death resulting from the self-administration of a controlled substance that is designed to end the life of a patient is not suicide or homicide when done in accordance with the provisions of this bill, and section 2 of this bill requires a death certificate to list the terminal condition of the patient as the cause of death of the patient. Sections 1 and 3 of this bill provide that a coroner, coroner's deputy or local health officer is not required to: (1) certify the cause of such a death; or (2) investigate such a death under certain circumstances. Sections 28 and 35 of this bill prohibit a person from preventing or requiring a person to make or revoke a request for a controlled substance 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. Existing law makes it a category A felony to administer poison or cause poison to be administered with the intention of causing the death of a person. (NRS 200.390) Such a crime is punishable by imprisonment for life with eligibility for parole after 5 years, or by a definite term of 15 years with eligibility for parole after 5 years. Section 29 of this bill makes it a category A felony with the same punishment to engage in certain fraudulent or coercive acts intended to cause a person to self-administer a controlled substance that is designed to end the life of the person. Section 30 of this bill clarifies that a physician is not required to prescribe a controlled substance that is designed to end the life of a patient and remains responsible for treating the patient's pain. Section 30 also provides that a pharmacist is not required to fill a prescription for or dispense such a controlled substance. Section 31 of this bill allows the owner or operator of a health care facility to prohibit an employee or independent contractor of a 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 controlled substance 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. Sections 32 and 33 of this bill make conforming changes to clarify that a physician or pharmacist may dispense a controlled substance that is designed to end the life of a patient and a patient may self-administer such a controlled substance in accordance with other provisions governing controlled substances designed to end the life of a patient. Section 36 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 controlled substance designed to end his or her life or revoked such a request. Section 39 of this bill clarifies that an advanced practice registered nurse is not authorized to prescribe a controlled substance that is designed to end the life of a patient. Sections 41 and 42 of this bill prohibit insurers from: (1) refusing to sell, provide or issue a policy of life insurance or group life insurance or annuity contract or charging a higher rate because a person makes or revokes a request for a controlled substance designed to end the life of the person or self-administers such a controlled substance; or (2) 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 controlled substance designed to end the life of the insured or self-administers such a controlled substance. Section 43 of this bill makes a conforming change to reflect this prohibition on a policy of group life insurance.

Statutes affected:
As Introduced: 440.380, 440.420, 453.256, 453.321, 453.375, 133.065, 159.054, 239.010, 639.1375, 639.2351, 639.238, 688B.040