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 5-30 of this bill authorize a patient, under certain circumstances, to self-administer a medication that is designed to end the life of the patient. Sections 6-12 of this bill define relevant terms. Section 13 of this bill authorizes a patient to request that his or her physician 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 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 medication because of coercion or undue influence. Section 14 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 must make two verbal requests and one written request for the medication, and that the written request for the medication must be signed by a witness. Section 15 of this bill prescribes the form for the written request for the medication. Section 16 of this bill imposes certain requirements before a physician is allowed to prescribe a medication that is 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 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 physician who can confirm the diagnosis, prognosis and competence 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 17 of this bill requires a physician 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 competent to refer the patient to a qualified mental health professional and to receive confirmation about the patient's competence. Section 18 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 physician or pharmacist may dispense such a medication. Section 19 of this bill prohibits an attending physician 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 20 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 physician or health care facility, sections 20 and 28 of this bill require the physician or health care facility that previously provided care to the patient to transfer the patient's medical records to the new physician or health care facility. Section 23 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 been prescribed or self-administered such a medication. Section 24 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 23, 24, 37 and 41 of this bill provide that such information is otherwise confidential when reported to the Division. Section 21 of this bill allows a patient, at any time, to revoke a request for a medication that is designed to end his or her life. Sections 22 and 32 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 22 establishes requirements for the disposal of any unused portion of the medication. Section 30 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 25 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 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: (1) not required to certify the cause of such a death; and (2) prohibited from investigating such a death under certain circumstances. Sections 26 and 35 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. 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. 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. (NRS 200.390) Section 27 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 medication that is designed to end the life of the person. Section 28 of this bill clarifies that a physician 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 28 requires a physician to provide that information or refer the patient to another provider of health care who is willing to do so. Section 28 also provides that a pharmacist is not required to fill a prescription for or dispense such a medication. Section 29 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 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 30 of this bill prohibits a health care facility, provider of health care or professional association from taking certain actions against an employee, independent contractor or member who: (1) provides accurate information concerning end-of-life care to a patient within or outside the scope of employment, contract or membership, as applicable; or (2) facilitates the prescription or self-administration of a medication that is designed to end the life of the patient outside the scope of the employment, contract or membership, as applicable. Sections 31-34 of this bill make conforming changes to clarify that a physician or pharmacist may 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 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 medication that is designed to end his or her life or revoked such a request. Existing law creates certain civil and criminal penalties for willfully engaging in a deceptive trade practice. (NRS 598.0973, 598.0999) Section 38 of this bill makes it a deceptive trade practice for a provider of health care or an owner, officer, employee or independent contractor of a health care facility to knowingly engage in any false, misleading or deceptive conduct concerning the willingness of the provider or health care facility to take certain actions relating to the prescription and self-administration of a medication that is designed to end the life of the patient. Sections 39 and 40 of this bill clarify that an advanced practice registered nurse is not authorized to prescribe a medication that is designed to end the life of a patient. Sections 42 and 43 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 medication that is designed to end the life of the person or self-administers such a medication; 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 medication that is designed to end the life of the insured or self-administers such a medication. Section 44 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, 453.375, 454.213, 454.215, 133.065, 159.054, 239.010, 598.0923, 639.1375, 639.2351, 639.238, 688B.040