Florida Senate - 2020 SB 1800 By Senator Rader 29-00350A-20 20201800__ 1 A bill to be entitled 2 An act relating to death with dignity; creating ch. 3 764, F.S., relating to personal autonomy; creating s. 4 764.101, F.S.; providing a short title; creating s. 5 764.102, F.S.; defining terms; creating s. 764.103, 6 F.S.; providing legislative findings and intent; 7 creating s. 764.104, F.S.; providing criteria for 8 qualified patients; providing factors to demonstrate 9 residency; requiring qualified patients to make oral 10 and written requests for medication; requiring waiting 11 periods before such requests may be made and such 12 medication may be prescribed; providing a form for 13 written requests; specifying requirements for the 14 valid execution of such form; authorizing a qualified 15 patient to rescind a request at any time and in any 16 manner; creating s. 764.105, F.S.; specifying 17 requirements for attending physicians; authorizing the 18 attending physician to sign the qualified patient’s 19 death certificate; specifying requirements for 20 consulting physicians; specifying recordkeeping 21 requirements; requiring certain health care providers 22 to report certain information to the Department of 23 Health; requiring the department to annually review 24 certain records for compliance and publish a report on 25 activities and compliance; providing the department 26 rulemaking authority for a specified purpose; creating 27 s. 764.106, F.S.; making certain provisions of legal 28 instruments void and unenforceable under certain 29 circumstances; prohibiting an individual’s 30 participation in certain provisions from affecting the 31 sale, procurement, or issuance of certain insurance 32 policies or the rates charged for such policies; 33 creating s. 764.107, F.S.; providing criminal 34 penalties and immunities; defining terms; providing 35 grounds for prohibiting certain providers from 36 participating in certain provisions; providing 37 permissible sanctions; requiring certain providers to 38 use due process procedures when imposing certain 39 sanctions; providing that certain sanctions may not be 40 the sole basis for certain disciplinary action against 41 a health care provider’s license; providing 42 construction; creating s. 764.108, F.S.; authorizing 43 claims for costs and attorney fees in certain 44 circumstances; creating s. 764.109, F.S.; providing 45 construction and severability; providing an effective 46 date. 47 48 Be It Enacted by the Legislature of the State of Florida: 49 50 Section 1. Chapter 764, Florida Statutes, consisting of 51 sections 764.101-764.109, Florida Statutes, entitled “Personal 52 Autonomy,” is created. 53 Section 2. Section 764.101, Florida Statutes, is created to 54 read: 55 764.101 Short title.—Sections 764.101-764.109 may be cited 56 as the “Death with Dignity Act.” 57 Section 3. Section 764.102, Florida Statutes, is created to 58 read: 59 764.102 Definitions.—As used in this chapter, the term: 60 (1) “Attending physician” means the physician who has 61 primary responsibility for the care of the patient and treatment 62 of the patient’s terminal condition. 63 (2) “Competent” means that in the opinion of a court or in 64 the opinion of the patient’s attending physician, consulting 65 physician, psychiatrist, or psychologist, a patient has the 66 ability to make and communicate health care decisions to health 67 care providers, including communication through individuals 68 familiar with the patient’s manner of communicating if those 69 individuals are available. 70 (3) “Consulting physician” means a physician who is 71 qualified by specialty or experience to make a professional 72 diagnosis and prognosis regarding the patient’s medical 73 condition. 74 (4) “Counseling” means one or more consultations as 75 necessary between a psychiatrist or psychologist and a patient 76 for the purpose of determining whether the patient is competent 77 and whether the patient is suffering from a psychiatric or 78 psychological disorder or depression causing impaired judgment. 79 (5) “Department” means the Department of Health. 80 (6) “Health care provider” means a health care 81 practitioner, health care facility, or entity licensed or 82 certified to provide health services in this state. 83 (7) “Informed decision” means a decision voluntarily made 84 by a qualified patient to request and obtain a prescription to 85 end his or her life after a sufficient explanation and 86 disclosure of the subject matter to enable the qualified patient 87 to appreciate the relevant facts, including the qualified 88 patient’s medical diagnosis and prognosis, the potential risks 89 associated with taking the medication to be prescribed, the 90 probable results of taking the medication, and the feasible 91 alternatives to taking the medication, and to make a knowing 92 health care decision without coercion or undue influence. 93 (8) “Medically confirmed” means the medical opinion of the 94 attending physician has been confirmed by a consulting physician 95 who has examined the patient and the patient’s relevant medical 96 records. 97 (9) “Medication” means a drug as defined in s. 465.003 98 which an attending physician prescribes to a qualified patient 99 under this chapter to end his or her life in a humane and 100 dignified manner. 101 (10) “Physician” means a person who is licensed to practice 102 medicine under chapter 458 or osteopathic medicine under chapter 103 459. 104 (11) “Psychiatrist” means a physician who has primarily 105 diagnosed and treated nervous and mental disorders for a period 106 of at least 3 years inclusive of a psychiatric residency. 107 (12) “Psychologist” means a person who is licensed to 108 practice psychology under chapter 490. 109 (13) “Qualified patient” means an individual who has 110 satisfied the requirements of this chapter to obtain a 111 prescription for medication to end his or her life in a humane 112 and dignified manner. 113 (14) “Terminal condition” means a medically confirmed 114 condition caused by an injury, illness, or disease which is 115 incurable and irreversible and which will, within reasonable 116 medical judgment, cause the patient’s death within 6 months. 117 Section 4. Section 764.103, Florida Statutes, is created to 118 read: 119 764.103 Legislative findings and intent.—The Legislature 120 finds that every competent adult has the fundamental right of 121 self-determination regarding decisions pertaining to his or her 122 own health, and recognizes that for some faced with a terminal 123 condition, prolonging life may result in a painful or burdensome 124 existence. It is the intent of the Legislature to establish a 125 procedure to allow a competent individual who has a terminal 126 condition, and who makes a fully informed decision that he or 127 she no longer wants to live, to obtain medication to end his or 128 her life in a humane and dignified manner. 129 Section 5. Section 764.104, Florida Statutes, is created to 130 read: 131 764.104 Qualified patients; residency requirements; written 132 and oral requests for medication; waiting periods; form 133 requirements; right to rescind requests.— 134 (1)(a) An individual may request medication for the purpose 135 of ending his or her life in a humane and dignified manner if 136 the individual: 137 1. Is 18 years of age or older; 138 2. Is a resident of Florida; 139 3. Has been clinically diagnosed with a terminal condition 140 by his or her attending physician which has been medically 141 confirmed by a consulting physician; 142 4. Is competent; 143 5. Is making an informed decision; and 144 6. Has voluntarily expressed his or her wish to die. 145 (b) An individual may not qualify for medication under this 146 chapter solely because of age or disability. 147 (2) Factors demonstrating Florida residency include, but 148 are not limited to: 149 (a) Possession of a Florida driver license; 150 (b) Registration to vote in Florida; or 151 (c) Evidence that the individual owns or leases property in 152 Florida. 153 (3) To obtain medication under this chapter, a qualified 154 patient must first make two oral requests and then one written 155 request for the medication. 156 (a) A qualified patient may not make the second oral 157 request until at least 15 days after making the first oral 158 request. However, if the qualified patient’s attending physician 159 has medically confirmed that the qualified patient will, within 160 reasonable medical judgment, die within 15 days after making the 161 first oral request, the qualified patient may make the oral 162 request to his or her attending physician at any time after 163 making the first oral request. 164 (b) After a qualified patient makes a second oral request, 165 the attending physician must give the qualified patient an 166 opportunity to rescind the request. 167 (c) A qualified patient may make a written request for 168 medication under this chapter after he or she has made a second 169 oral request for the medication and has been offered the 170 opportunity to rescind the request. 171 (d) An attending physician may not prescribe medication to 172 a qualified patient under this chapter until at least 48 hours 173 after the qualified patient makes a written request for the 174 medication. 175 (4)(a) A written request for medication under this chapter 176 must be in a form substantially similar to the following: 177 REQUEST FOR MEDICATION 178 TO END MY LIFE IN A HUMANE 179 AND DIGNIFIED MANNER 180 I, ...(name of qualified patient)..., am an adult of sound mind. 181 182 I am suffering from ...(medical condition)..., which my 183 attending physician has determined is a terminal condition and 184 which has been medically confirmed by a consulting physician. 185 186 I have been fully informed of my diagnosis, prognosis, the 187 nature of the medication to be prescribed and potential 188 associated risks, the expected result of taking the medication, 189 and the feasible alternatives, including comfort care, hospice 190 care, and pain control. 191 192 Pursuant to chapter 764, Florida Statutes, I request that my 193 attending physician prescribe medication that will end my life 194 in a humane and dignified manner. 195 196 INITIAL ONE: 197 [....] I have informed my family members of my decision and 198 taken their opinions into consideration. 199 [....] I have decided not to inform my family members of my 200 decision. 201 [....] I have no family members to inform of my decision. 202 203 PURSUANT TO SECTION 764.104, FLORIDA STATUTES, I UNDERSTAND THAT 204 I HAVE THE RIGHT TO RESCIND THIS REQUEST AT ANY TIME AND IN ANY 205 MANNER, REGARDLESS OF MY MENTAL STATE. 206 207 I understand the full import of this request and I expect to die 208 when I take the medication to be prescribed. I further 209 understand that although most deaths occur within 3 hours, my 210 death may take longer and my physician has counseled me about 211 this possibility. 212 213 I make this request voluntarily and without reservation, and I 214 accept full moral responsibility for my actions. 215 216 Signed: ...( signature of qualified patient)... 217 Dated: ...( date)... 218 219 DECLARATION OF WITNESSES 220 We declare that the person signing this request: 221 1. Is personally known to us or has provided proof of 222 identity; 223 2. Signed this request in our presence; 224 3. Appears to be of sound mind and not under duress, fraud, 225 or undue influence; and 226 4. Is not a patient for whom either of us is the attending 227 physician. 228 229 First witness Second witness 230 ...(print name)... ...(print name)... 231 ...(signature)... ...(signature)... 232 ...(date)... ...(date)... 233 234 NOTE: At least one witness may not be a relative (by blood, 235 marriage, or adoption) of the person signing this request, may 236 not be entitled to any portion of the person’s estate upon 237 death, and may not be an owner, operator, or employee of a 238 health care facility where the person is a patient or resident. 239 (b) To be valid, the written request must be signed by the 240 qualified patient and witnessed by at least two individuals who, 241 in the presence of the qualified patient, attest that to the 242 best of their knowledge and belief, the qualified patient is 243 competent, is acting voluntarily, and is not being coerced to 244 sign the request. At least one of the witnesses must be a person 245 who is not: 246 1. A relative of the patient by blood, marriage, or 247 adoption; 248 2. A person who at the time the request is signed would be 249 entitled to any portion of the estate of the qualified patient 250 upon death under any will or by operation of law; or 251 3. An owner, operator, or employee of a health care 252 facility where the qualified patient is receiving medical 253 treatment or is a resident. 254 (c) The qualified patient’s attending physician at the time 255 the request is signed may not serve as a witness. 256 (5) A qualified patient may rescind his or her request at 257 any time and in any manner without regard to his or her mental 258 state. 259 Section 6. Section 764.105, Florida Statutes, is created to 260 read: 261 764.105 Attending physician responsibilities; consulting 262 physician responsibilities; reporting requirements.— 263 (1) The attending physician shall do all of the following: 264 (a) Make the initial determination of whether a patient has 265 a terminal condition, is competent, and has voluntarily made the 266 request for medication to end his or her life. 267 (b) Refer the patient to a consulting physician for medical 268 confirmation of the diagnosis, and for a determination that the 269 patient is competent and acting voluntarily. 270 (c) Ensure that the patient is making an informed decision 271 by fully informing the patient of the facts relevant to all of 272 the following: 273 1. The patient’s medical diagnosis. 274 2. The patient’s prognosis. 275 3. The potential risks associated with taking the 276 medication to be prescribed. 277 4. The probable result of taking the medication to be 278 prescribed. 279 5. The feasible alternatives, including, but not limited 280 to, comfort care, hospice care, and pain control. 281 (d) Verify the patient’s Florida residency. 282 (e) Refer the patient to a psychiatrist or psychologist for 283 counseling if the physician believes the patient may be 284 suffering from a psychiatric or psychological disorder or 285 depression causing impaired judgment. The physician may not 286 prescribe medication under this chapter until the psychiatrist 287 or psychologist counseling the patient determines that the 288 patient is not suffering from a psychiatric or psychological 289 disorder or depression causing impaired judgment. 290 (f) Recommend that a patient notify next of kin of the 291 patient’s decision. The physician may not refuse to prescribe 292 medication to a qualified patient because he or she declines or 293 is unable to notify next of kin. 294 (g) Inform the qualified patient that he or she has an 295 opportunity to rescind the request at any time and in any 296 manner, and offer the qualified patient an opportunity to 297 rescind the request after the qualified patient’s second oral 298 request at the end of the 15-day waiting period pursuant to s. 299 764.104. 300 (h) Immediately before writing a prescription for 301 medication under this chapter, verify that the qualified patient 302 is making an informed decision. 303 (i) Counsel the patient about the importance of having 304 another person present when the patient takes the medication 305 prescribed under this chapter and of not taking the medication 306 in a public place. 307 (j) Comply with the medical record documentation 308 requirements of this section. 309 (k) Ensure that all appropriate steps are carried out in 310 accordance with this chapter before writing a prescription for 311 medication to enable a qualified patient to end his or her life 312 in a humane and dignified manner. 313 (l)1. Dispense medications directly, including ancillary 314 medications intended to minimize the patient’s discomfort, 315 provided the attending physician is registered as a dispensing 316 practitioner under s. 465.0276, has a current Drug Enforcement 317 Administration number, and complies with applicable laws and 318 rules; or 319 2. With the patient’s written consent: 320 a. Contact a pharmacist and inform the pharmacist of the 321 prescription; and 322 b. Deliver the written prescription personally or by mail 323 to the pharmacist, who will dispense the medications to either 324 the patient, the attending physician, the patient’s legal 325 representative, or an individual whom the patient designates in 326 writing. 327 (2) Notwithstanding any other law, the attending physician 328 may sign the patient’s death certificate. 329 (3) A consulting physician shall examine the patient and 330 his or her relevant medical records to confirm, in writing, 331 whether the consulting physician agrees with the attending 332 physician’s diagnosis that the patient is suffering from a 333 terminal condition, and verify whether the patient is competent, 334 is acting voluntarily, and has made an informed decision. A 335 consulting physician must refer the patient to a psychiatrist or 336 psychologist for counseling if the physician believes the 337 patient may be suffering from a psychiatric or psychological 338 disorder or depression causing impaired judgment. 339 (4) An attending physician is responsible for ensuring that 340 all of the following is documented or filed in the patient’s 341 medical record: 342 (a) All oral requests by a patient for medication under 343 this chapter. 344 (b) All written requests by a patient for medication under 345 this chapter. 346 (c) The attending physician’s diagnosis, prognosis, and 347 determination that the patient is competent, is acting 348 voluntarily, and has made an informed decision. 349 (d) The consulting physician’s diagnosis, prognosis, and 350 verification that the patient is competent, is acting 351 voluntarily, and has made an informed decision. 352 (e) A report of the outcome and determinations made during 353 counseling, if performed. 354 (f) The attending physician’s offer to the patient to 355 rescind his or her request at the time of the patient’s second 356 oral request. 357 (g) A note by the attending physician indicating that all 358 requirements under this chapter have been met and indicating the 359 steps taken to carry out the request, including a notation of 360 the medication prescribed. 361 (5) A health care provider who dispenses medication 362 prescribed under this chapter must file a copy of the dispensing 363 record with the department. 364 (6) The department shall annually review a sample of 365 records maintained under this chapter for compliance and 366 annually publish a statistical report on activities and 367 compliance pursuant to this chapter. The department shall adopt 368 rules to collect information for this purpose. 369 Section 7. Section 764.106, Florida Statutes, is created to 370 read: 371 764.106 Effect on construction of wills, contracts, and 372 statutes; insurance or annuity policies.— 373 (1) A provision in a contract, will, or other agreement, 374 whether written or oral, to the extent the provision would 375 affect whether a person may make or rescind a request for 376 medication under this chapter, is void and unenforceable. 377 (2) An obligation owed under any existing contract may not 378 be conditioned or affected by a person making or rescinding a 379 request for medication under this chapter. 380 (3) The sale, procurement, or issuance of any life, health, 381 or accident insurance or annuity policy, or the rate charged for 382 any policy, may not be conditioned upon or affected by a person 383 making or rescinding a request for medication under this 384 chapter. A qualified patient’s act of ingesting medication 385 prescribed under this chapter may not affect a life, health, or 386 accident insurance or annuity policy. 387 Section 8. Section 764.107, Florida Statutes, is created to 388 read: 389 764.107 Penalties; liabilities; immunities; grounds for 390 prohibiting health care provider participation; notification; 391 permissible sanctions.— 392 (1) A person who: 393 (a) Without authorization of the patient, willfully alters 394 or forges a request for medication under this chapter or 395 conceals or destroys a rescission of that request with the 396 intent or effect of causing the patient’s death commits a felony 397 of the first degree, punishable as provided in s. 775.082, s. 398 775.083, or s. 775.084. 399 (b) Coerces or exerts undue influence on a patient to 400 request medication under this chapter for the purpose of ending 401 the patient’s life or to destroy a rescission of a medication 402 request commits a felony of the first degree, punishable as 403 provided in s. 775.082, s. 775.083, or s. 775.084. 404 (2) This chapter does not limit further liability for civil 405 damages resulting from other negligent conduct or intentional 406 misconduct by any person. 407 (3) The penalties in this chapter do not preclude criminal 408 penalties applicable under other law for conduct that is 409 inconsistent with this chapter. 410 (4) Except as provided in subsections (1) and (5): 411 (a) A person is not subject to civil or criminal liability 412 or professional disciplinary action for participating in good 413 faith compliance with this chapter. This includes being present 414 when a qualified patient takes the medication prescribed under 415 this chapter. 416 (b) A professional organization or association, or a health 417 care provider, may not subject a person to censure, discipline, 418 suspension, loss of license, loss of privileges, loss of 419 membership, or other penalty solely for refusing to participate 420 in this chapter or for participating in good faith compliance 421 with this chapter. 422 (c) A request by a patient for, or provision by an 423 attending physician of, medication in good faith compliance with 424 this chapter does not constitute neglect for any purpose of law 425 or provide the sole basis for the appointment of a guardian or 426 conservator. 427 (d) A health care provider is not under any duty, whether 428 by contract, by statute, or by any other legal requirement, to 429 participate in the provision of medication prescribed under this 430 chapter to a qualified patient. If a health care provider is 431 unable or unwilling to carry out a patient’s request under this 432 chapter, and the patient transfers his or her care to a new 433 health care provider, the prior health care provider shall 434 transfer, upon request, a copy of the patient’s relevant medical 435 records to the new health care provider. 436 (5)(a) As used in this subsection, the term: 437 1. “Notify” means a separate statement in writing to the 438 health care provider specifically informing the health care 439 provider before the provider’s participation in this chapter of 440 the sanctioning health care provider’s policy about 441 participation in activities covered by this chapter. 442 2. “Participation in this chapter” means to perform the 443 duties of an attending physician, the consulting physician 444 function, or the counseling function pursuant to s.764.105. The 445 term does not include: 446 a. Making an initial determination that a patient has a 447 terminal disease and informing the patient of the medical 448 prognosis; 449 b. Providing information about the Death with Dignity Act 450 to a patient upon the request of the patient; 451 c. Providing a patient, upon the request of the patient, 452 with a referral to another physician; or 453 d. A patient contracting with his or her attending 454 physician and consulting physician to act outside of the course 455 and scope of the provider’s capacity as an employee or 456 independent contractor of the sanctioning health care provider. 457 (b) Notwithstanding any other law, a health care provider 458 may prohibit participation in this chapter on the premises of 459 facilities that it owns or operates if it first notifies the 460 health care providers practicing in its facilities of its 461 policy. This paragraph does not prevent a health care provider 462 from providing health care services to a patient which do not 463 constitute participation in this chapter. 464 (c) Notwithstanding subsection (4), if a health care 465 provider has a policy prohibiting its facilities, operators, or 466 employees from participation in this chapter and has notified 467 them of the policy, then the prohibiting health care provider 468 may subject its facilities, operators, or employees to the 469 following sanctions for participating in this chapter in 470 violation of that policy: 471 1. Loss of privileges, loss of membership, or other 472 sanction provided under the medical staff bylaws, policies, and 473 procedures of the sanctioning health care provider if the 474 sanctioned health care provider is a member of the sanctioning 475 health care provider’s medical staff and participates in this 476 chapter while on the facility premises of the sanctioning health 477 care provider, but not including the private medical office of a 478 physician or other provider; 479 2. Termination of lease or other property contract or other 480 nonmonetary remedies provided by lease contract, not including 481 loss or restriction of medical staff privileges or exclusion 482 from a provider panel, if the sanctioned provider participates 483 in this chapter while on the premises of the sanctioning health 484 care provider or on property that is owned by or under the 485 direct control of the sanctioning health care provider; or 486 3. Termination of contract or other nonmonetary remedies 487 provided by contract if the sanctioned provider participates in 488 this chapter while acting in the course and scope of the 489 sanctioned health care provider’s capacity as an employee or 490 independent contractor of the sanctioning health care provider. 491 This subparagraph may not be construed to prevent: 492 a. A health care provider from participating in carrying 493 out the provisions of this chapter while acting outside the 494 course and scope of the provider’s capacity as an employee or 495 independent contractor; or 496 b. A patient from contracting with his or her attending 497 physician and consulting physician to act outside the course and 498 scope of the provider’s capacity as an employee or independent 499 contractor of the sanctioning health care provider. 500 (d) A health care provider that imposes sanctions under 501 paragraph (c) must follow all due process and other procedures 502 the sanctioning health care provider may have which are related 503 to the imposition of sanctions on another health care provider. 504 (6) Suspension or termination of staff membership or 505 privileges under subsection (5) may not be the sole basis for a 506 disciplinary complaint or investigation against a health care 507 provider’s license. 508 (7) This chapter may not be construed to allow a lower 509 standard of care for patients. 510 Section 9. Section 764.108, Florida Statutes, is created to 511 read: 512 764.108 Claims by governmental entity for costs incurred. 513 Any governmental entity that incurs costs resulting from a 514 person terminating his or her life pursuant to this chapter in a 515 public place shall have a claim against the estate of the person 516 to recover the costs and reasonable attorney fees related to 517 enforcing the claim. 518 Section 10. Section 764.109, Florida Statutes, is created 519 to read: 520 764.109 Construction; severability.— 521 (1) This chapter may not be construed to authorize a 522 physician or any other person to end a patient’s life by lethal 523 injection, mercy killing, or active euthanasia. Actions taken in 524 accordance with this chapter do not constitute suicide, assisted 525 suicide, mercy killing, or homicide for any purpose under the 526 law. 527 (2) Any section of this chapter being held invalid as to 528 any person or circumstance does not affect the application of 529 any other section of this chapter which can be given full effect 530 without the invalid section or application, and to this end the 531 provisions of this chapter are severable. 532 Section 11. This act shall take effect July 1, 2020.