H-1039.1
SUBSTITUTE HOUSE BILL 1281
State of Washington 68th Legislature 2023 Regular Session
By House Health Care & Wellness (originally sponsored by
Representatives Rude, Peterson, Harris, Macri, Riccelli, Stonier,
Fitzgibbon, Senn, Simmons, Tharinger, Kloba, Reeves, Reed, Walen,
Gregerson, Ormsby, Bateman, Doglio, Alvarado, Ramel, Santos, and
Pollet)
READ FIRST TIME 02/07/23.
1 AN ACT Relating to increasing access to the provisions of the
2 Washington death with dignity act; amending RCW 70.245.010,
3 70.245.020, 70.245.030, 70.245.040, 70.245.050, 70.245.060,
4 70.245.070, 70.245.080, 70.245.090, 70.245.100, 70.245.110,
5 70.245.120, 70.245.150, 70.245.180, 70.245.190, 70.245.220, and
6 70.41.520; adding new section to chapter 70.245 RCW; and adding a new
7 section to chapter 70.127 RCW.
8 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
9 Sec. 1. RCW 70.245.010 and 2009 c 1 s 1 are each amended to read
10 as follows:
11 The definitions in this section apply throughout this chapter
12 unless the context clearly requires otherwise.
13 (1) "Adult" means an individual who is ((eighteen)) 18 years of
14 age or older.
15 (2) "Attending ((physician)) qualified medical provider" means
16 the ((physician)) qualified medical provider who has primary
17 responsibility for the care of the patient and treatment of the
18 patient's terminal disease.
19 (3) "Competent" means that, in the opinion of a court or in the
20 opinion of the patient's attending ((physician or)) qualified medical
21 provider, consulting ((physician)) qualified medical provider,
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 1 psychiatrist, or psychologist, a patient has the ability to make and
2 communicate an informed decision to health care providers, including
3 communication through persons familiar with the patient's manner of
4 communicating if those persons are available.
5 (4) "Consulting ((physician)) qualified medical provider" means a
6 ((physician)) qualified medical provider who is qualified by
7 specialty or experience to make a professional diagnosis and
8 prognosis regarding the patient's disease.
9 (5) "Counseling" means one or more consultations as necessary
10 between a state licensed psychiatrist ((or)), psychologist,
11 independent clinical social worker, advanced social worker, mental
12 health counselor, or psychiatric advanced registered nurse
13 practitioner and a patient for the purpose of determining that the
14 patient is competent and not suffering from a psychiatric or
15 psychological disorder or depression causing impaired judgment.
16 (6) "Health care provider" means a person licensed, certified, or
17 otherwise authorized or permitted by law to administer health care or
18 dispense medication in the ordinary course of business or practice of
19 a profession, and includes a health care facility.
20 (7) "Informed decision" means a decision by a qualified patient,
21 to request and obtain a prescription for medication that the
22 qualified patient may self-administer to end his or her life in a
23 humane and dignified manner, that is based on an appreciation of the
24 relevant facts and after being fully informed by the attending
25 ((physician)) qualified medical provider of:
26 (a) His or her medical diagnosis;
27 (b) His or her prognosis;
28 (c) The potential risks associated with taking the medication to
29 be prescribed;
30 (d) The probable result of taking the medication to be
31 prescribed; and
32 (e) The feasible alternatives including, but not limited to,
33 comfort care, hospice care, and pain control.
34 (8) "Intractable suffering" means pain or other physical symptoms
35 related to a patient's terminal disease that cannot be reasonably
36 managed by palliative care.
37 (9) "Medically confirmed" means the medical opinion of the
38 attending ((physician)) qualified medical provider has been confirmed
39 by a consulting ((physician)) qualified medical provider who has
40 examined the patient and the patient's relevant medical records.
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 1 (((9))) (10) "Patient" means a person who is under the care of
2 ((a physician.
3 (10) "Physician" means a doctor of medicine or osteopathy
4 licensed to practice medicine in the state of Washington.
5 (11))) an attending qualified medical provider.
6 (11) "Qualified medical provider" means a physician licensed
7 under chapter 18.57 or 18.71 RCW, a physician assistant licensed
8 under chapter 18.71A RCW, or an advanced registered nurse
9 practitioner licensed under chapter 18.79 RCW.
10 (12) "Qualified patient" means a competent adult who is a
11 resident of Washington state and has satisfied the requirements of
12 this chapter in order to obtain a prescription for medication that
13 the qualified patient may self-administer to end his or her life in a
14 humane and dignified manner.
15 (((12))) (13) "Self-administer" means a qualified patient's act
16 of ingesting medication to end his or her life in a humane and
17 dignified manner.
18 (((13))) (14) "Terminal disease" means an incurable and
19 irreversible disease that has been medically confirmed and will,
20 within reasonable medical judgment, produce death within six months.
21 NEW SECTION. Sec. 2. A new section is added to chapter 70.245
22 RCW to read as follows:
23 (1) Subject to the provisions in subsection (2) of this section,
24 a qualified patient may select the attending or consulting qualified
25 medical provider of the qualified patient's choosing.
26 (2)(a) If a qualified patient selects an attending qualified
27 medical provider who is a licensed professional other than a
28 physician, the qualified patient must select a physician to serve as
29 the qualified patient's consulting qualified medical provider.
30 (b) A qualified patient may select a consulting qualified medical
31 provider who is a licensed professional other than a physician, only
32 if the qualified patient's attending qualified medical provider is a
33 physician.
34 (c) The attending qualified medical provider and the consulting
35 qualified medical provider selected by the qualified patient may not
36 have a supervisory relationship with each other.
37 Sec. 3. RCW 70.245.020 and 2009 c 1 s 2 are each amended to read
38 as follows:
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 1 (1) An adult patient who is competent, is a resident of
2 Washington state, and has been determined by the attending
3 ((physician and consulting physician)) qualified medical provider to
4 be suffering from a terminal disease, and who has voluntarily
5 expressed his or her wish to die, may make a written request for
6 medication that the patient may self-administer to end ((his or her))
7 the patient's life in a humane and dignified manner in accordance
8 with this chapter.
9 (2) A person does not qualify under this chapter solely because
10 of age or disability.
11 Sec. 4. RCW 70.245.030 and 2009 c 1 s 3 are each amended to read
12 as follows:
13 (1) A valid request for medication under this chapter shall be in
14 substantially the form described in RCW 70.245.220, signed and dated
15 by the patient and witnessed by at least two individuals who, in the
16 presence of the patient, attest that to the best of their knowledge
17 and belief the patient is competent, acting voluntarily, and is not
18 being coerced to sign the request.
19 (2) One of the witnesses shall be a person who is not:
20 (a) A relative of the patient by blood((, marriage, or adoption))
21 or by law;
22 (b) A person who at the time the request is signed would be
23 entitled to any portion of the estate of the qualified patient upon
24 death under any will or by operation of law; or
25 (c) An owner, operator, or employee of a health care facility
26 where the qualified patient is receiving medical treatment or is a
27 resident.
28 (3) The patient's attending ((physician)) qualified medical
29 provider at the time the request is signed shall not be a witness.
30 (((4) If the patient is a patient in a long-term care facility at
31 the time the written request is made, one of the witnesses shall be
32 an individual designated by the facility and having the
33 qualifications specified by the department of health by rule.))
34 Sec. 5. RCW 70.245.040 and 2009 c 1 s 4 are each amended to read
35 as follows:
36 (1) The attending ((physician)) qualified medical provider shall:
37 (a) Make the ((initial)) determination of whether a patient has a
38 terminal disease, is competent, and has made the request voluntarily;
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 1 (b) Request that the patient demonstrate Washington state
2 residency under RCW 70.245.130;
3 (c) To ensure that the patient is making an informed decision,
4 inform the patient of:
5 (i) ((His or her)) The patient's medical diagnosis;
6 (ii) ((His or her)) The patient's prognosis;
7 (iii) The potential risks associated with taking the medication
8 to be prescribed;
9 (iv) The probable result of taking the medication to be
10 prescribed; and
11 (v) The feasible alternatives including, but not limited to,
12 comfort care, hospice care, and pain control;
13 (d) Refer the patient to a consulting ((physician)) qualified
14 medical provider for medical confirmation of the diagnosis, and for a
15 determination that the patient is competent and acting voluntarily;
16 (e) Refer the patient for counseling if appropriate under RCW
17 70.245.060;
18 (f) Recommend that the patient notify next of kin;
19 (g) Counsel the patient about the importance of having another
20 person present when the patient takes the medication prescribed under
21 this chapter and of not taking the medication in a public place;
22 (h) Inform the patient that he or she has an opportunity to
23 rescind the request at any time and in any manner, and offer the
24 patient an opportunity to rescind at the end of the ((fifteen-day))
25 relevant waiting period under RCW 70.245.090;
26 (i) Verify, immediately before writing the prescription for
27 medication under this chapter, that the patient is making an informed
28 decision;
29 (j) Fulfill the medical record documentation requirements of RCW
30 70.245.120;
31 (k) Ensure that all appropriate steps are carried out in
32 accordance with this chapter before writing a prescription for
33 medication to enable a qualified patient to end his or her life in a
34 humane and dignified manner; and
35 (l)(i) Dispense medications directly, including ancillary
36 medications intended to facilitate the desired effect to minimize the
37 patient's discomfort, if the attending ((physician)) qualified
38 medical provider is authorized under statute and rule to dispense and
39 has a current drug enforcement administration certificate; or
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 1 (ii) ((With the patient's written consent:)) (A) Contact a
2 pharmacist and inform the pharmacist of the prescription; and
3 (B) Deliver the written prescription personally, by mail ((or)),
4 facsimile, or electronically to the pharmacist, who will dispense the
5 medications directly to either the patient, the attending
6 ((physician)) qualified medical provider, or ((an expressly
7 identified agent of the patient. Medications dispensed pursuant to
8 this subsection shall not be dispensed by mail or other form of
9 courier)) another person as requested by the qualified patient.
10 (2) The attending ((physician)) qualified medical provider may
11 sign the patient's death certificate which shall list the underlying
12 terminal disease as the cause of death.
13 (3) Delivery of the dispensed drug to the qualified patient, the
14 attending qualified medical provider, or another person as requested
15 by the qualified patient may be made only:
16 (a) By personal delivery, messenger service, or the United States
17 postal service or a similar private parcel delivery entity; and
18 (b) Upon the receipt of the signature of the addressee or an
19 authorized person at the time of delivery by an entity listed in (a)
20 of this subsection.
21 Sec. 6. RCW 70.245.050 and 2009 c 1 s 5 are each amended to read
22 as follows:
23 Before a patient is qualified under this chapter, a consulting
24 ((physician)) qualified medical provider shall examine the patient
25 and his or her relevant medical records and confirm, in writing, the
26 attending ((physician's)) qualified medical provider's diagnosis that
27 the patient is suffering from a terminal disease, and verify that the
28 patient is competent, is acting voluntarily, and has made an informed
29 decision.
30 Sec. 7. RCW 70.245.060 and 2009 c 1 s 6 are each amended to read
31 as follows:
32 If, in the opinion of either the attending ((physician))
33 qualified medical provider or the consulting ((physician)) qualified
34 medical provider, a patient may be suffering from a psychiatric or
35 psychological disorder or depression causing impaired judgment,
36 ((either physician)) the qualified medical provider shall refer the
37 patient for counseling. Medication to end a patient's life in a
38 humane and dignified manner shall not be prescribed until the person
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 1 performing the counseling determines that the patient is not
2 suffering from a psychiatric or psychological disorder or depression
3 causing impaired judgment.
4 Sec. 8. RCW 70.245.070 and 2009 c 1 s 7 are each amended to read
5 as follows:
6 A person shall not receive a prescription for medication to end
7 his or her life in a humane and dignified manner unless he or she has
8 made an informed decision. Immediately before writing a prescription
9 for medication under this chapter, the attending ((physician))
10 qualified medical provider shall verify that the qualified patient is
11 making an informed decision.
12 Sec. 9. RCW 70.245.080 and 2009 c 1 s 8 are each amended to read
13 as follows:
14 The attending ((physician)) qualified medical provider shall
15 recommend that the patient notify the next of kin of his or her
16 request for medication under this chapter. A patient who declines or
17 is unable to notify next of kin shall not have his or her request
18 denied for that reason.
19 Sec. 10. RCW 70.245.090 and 2009 c 1 s 9 are each amended to
20 read as follows:
21 (1) To receive a prescription for medication that the qualified
22 patient may self-administer to end his or her life in a humane and
23 dignified manner, a qualified patient shall have made an oral request
24 and a written request, and reiterate the oral request to his or her
25 attending ((physician)) qualified medical provider at least
26 ((fifteen)) seven days after making the initial oral request.
27 (2) Notwithstanding subsection (1) of this section, if, at the
28 time of the qualified patient's initial oral request in subsection
29 (1) of this section, the attending qualified medical provider
30 determines that the qualified patient (a) is not expected to survive
31 for seven days, or (b) is experiencing intractable suffering, then
32 the qualified patient may receive the prescription upon making the
33 second oral request sooner than seven days. At the time the qualified
34 patient makes his or her second oral request, the attending
35 ((physician)) qualified medical provider shall offer the qualified
36 patient an opportunity to rescind the request.
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 1 (3) A transfer of care or medical records does not restart any
2 waiting period under this section.
3 Sec. 11. RCW 70.245.100 and 2009 c 1 s 10 are each amended to
4 read as follows:
5 A patient may rescind his or her request at any time and in any
6 manner without regard to his or her mental state. No prescription for
7 medication under this chapter may be written without the attending
8 ((physician)) qualified medical provider offering the qualified
9 patient an opportunity to rescind the request.
10 Sec. 12. RCW 70.245.110 and 2009 c 1 s 11 are each amended to
11 read as follows:
12 (((1))) At least ((fifteen)) seven days shall elapse between the
13 patient's initial oral request and the writing of a prescription
14 under this chapter((.
15 (2) At least forty-eight hours shall elapse between the date the
16 patient signs the written request and the writing of a prescription
17 under this chapter)), unless the conditions in RCW 70.245.090(2)
18 allow for a period of less than seven days.
19 Sec. 13. RCW 70.245.120 and 2009 c 1 s 12 are each amended to
20 read as follows:
21 The following shall be documented or filed in the patient's
22 medical record:
23 (1) All oral requests by a patient for medication to end his or
24 her life in a humane and dignified manner;
25 (2) All written requests by a patient for medication to end his
26 or her life in a humane and dignified manner;
27 (3)