DBQ-End of Life Policy

Second Regular Session Seventieth General Assembly STATE OF COLORADO INTRODUCED LLS NO. 16-0867.01 Christy Chase x2008 SENATE BILL 16-025 Senate Committees House Committees State, Veterans, & Military Affairs A BILL FOR AN ACT C ONCERNING END -OF -LIFE OPTIONS FOR INDIVIDUALS WITH A 101 TERMINAL ILLNESS . 102 Bill Summary (Note: This summary applies to this bill as introduced and does not reflect any amendments that may be subsequently adopted. If this bill passes third reading in the house of introduction, a bill summary that applies to the reengrossed version of this bill will be available at http://www.leg.state.co.us/billsummaries .) The bill enacts the "Colorado End-of-life Options Act" (act), which authorizes an individual with a terminal illness to request, and the individual's attending physician to prescribe to the individual, medication to hasten the individual's death. To be qualified to request aid-in-dying medication, an individual must be a capable adult resident of Colorado who has a terminal illness and has voluntarily expressed the wish to SENATE SPONSORSHIP Merrifield, HOUSE SPONSORSHIP Court and Ginal, Shading denotes HOUSE amendment. Double underlining denotes SENATE amendment. Capital letters indicate new material to be added to existing statute.

Dashes through the words indicate deletions from existing statute. receive a prescription for aid-in-dying medication by making 2 oral requests and a written request to his or her attending physician. An individual who requests aid-in-dying medication may rescind the request at any time, regardless of his or her mental state.

The act outlines the responsibilities of the attending physician, including:

!Determining whether the requesting individual has a terminal illness, is capable of making an informed decision, and is making the request for aid-in-dying medication voluntarily; !Requesting the individual to demonstrate proof of Colorado residency; !Referring the individual to a consulting physician to confirm that the individual is qualified to request aid-in-dying medication; !Providing full disclosures to ensure that the individual is making an informed decision; and !Informing the individual of the right to rescind the request at any time.

An attending physician cannot write a prescription for aid-in-dying medication unless at least 2 health care providers determine that the individual is capable of making an informed decision. The attending or consulting physician is to refer the individual to a licensed mental health professional if he or she believes the individual's ability to make an informed decision is compromised. The attending physician cannot write a prescription unless the mental health professional communicates, in writing, that the individual is capable.

The bill grants immunity from civil and criminal liability and from professional discipline to a person who participates in good faith under the act. The bill also specifies that actions taken in accordance with the act do not constitute suicide, assisted suicide, mercy killing, homicide, or elder abuse.

A health care provider is not obligated to prescribe aid-in-dying medication, and a health care facility may prohibit a physician from writing a prescription for a resident of the facility who intends to use aid-in-dying medication on the facility's premises.

A person commits a class 2 felony if the person purposely or knowingly:

!Alters or forges an aid-in-dying medication request without the terminally ill individual's authorization; !Conceals or destroys a rescission of a request for aid-in-dying medication; or !Coerces or exerts undue influence to get a terminally ill individual to request, or to destroy a rescission of a request for, aid-in-dying medication.

SB16-025 -2- Be it enacted by the General Assembly of the State of Colorado: 1 SECTION 1. In Colorado Revised Statutes, add article 48 to title 2 25 as follows: 3 ARTICLE 48 4 End-of-life Options 5 25-48-101. Short title. T HE SHORT TITLE OF THIS ARTICLE IS THE 6 "C OLORADO END -OF -LIFE OPTIONS ACT ". 7 25-48-102. Definitions. A S USED IN THIS ARTICLE , UNLESS THE 8 CONTEXT OTHERWISE REQUIRES : 9 (1) "A DULT " MEANS AN INDIVIDUAL WHO IS EIGHTEEN YEARS OF 10 AGE OR OLDER . 11 (2) "A ID IN DYING " M E A N S T H E M E D I C A L P R A C T I C E O F A P H Y S I C I A N 12 PRESCRIBING MEDICATION TO A QUALIFIED INDIVIDUAL THAT THE 13 QUALIFIED INDIVIDUAL MAY CHOOSE TO SELF -ADMINISTER TO BRING 14 ABOUT HIS OR HER DEATH . 15 (3) "A ID -IN -DYING MEDICATION " MEANS MEDICATION PRESCRIBED 16 BY A PHYSICIAN PURSUANT TO THIS ARTICLE TO PROVIDE AID IN DYING TO 17 A QUALIFIED INDIVIDUAL . 18 (4) "A TTENDING PHYSICIAN " MEANS A COLORADO -LICENSED 19 PHYSICIAN WHO HAS PRIMARY RESPONSIBILITY FOR THE CARE OF A 20 TERMINALLY ILL INDIVIDUAL AND THE TREATMENT OF THE INDIVIDUAL 'S 21 TERMINAL ILLNESS . 22 (5) "C APABLE " MEANS THAT , IN THE OPINION OF A TERMINALLY ILL 23 INDIVIDUAL 'S ATTENDING PHYSICIAN , CONSULTING PHYSICIAN , 24 PSYCHIATRIST , OR LICENSED MENTAL HEALTH PROFESSIONAL , A 25 TERMINALLY ILL INDIVIDUAL HAS THE ABILITY TO MAKE AND 26 SB16-025 -3- COMMUNICATE AN INFORMED DECISION TO HEALTH CARE PROVIDERS , 1 INCLUDING COMMUNICATION THROUGH A PERSON FAMILIAR WITH THE 2 INDIVIDUAL 'S MANNER OF COMMUNICATING IF THAT PERSON IS AVAILABLE . 3 (6) "C ONSULTING PHYSICIAN " MEANS A COLORADO -LICENSED 4 PHYSICIAN WHO IS QUALIFIED BY SPECIALTY OR EXPERIENCE TO MAKE A 5 PROFESSIONAL DIAGNOSIS AND PROGNOSIS REGARDING A TERMINALLY ILL 6 INDIVIDUAL 'S ILLNESS . 7 (7) "H EALTH CARE PROVIDER " OR "PROVIDER " MEANS A PERSON 8 WHO IS LICENSED , CERTIFIED , REGISTERED , OR OTHERWISE AUTHORIZED OR 9 PERMITTED BY LAW TO ADMINISTER HEALTH CARE OR DISPENSE 10 MEDICATION IN THE ORDINARY COURSE OF BUSINESS OR PRACTICE OF A 11 PROFESSION . THE TERM INCLUDES A HEALTH CARE FACILITY , INCLUDING 12 A LONG -TERM CARE FACILITY AS DEFINED IN SECTION 25-3-103.7 (1) (f.3). 13 (8) "I NFORMED DECISION " MEANS A DECISION THAT IS : 14 (a) M ADE BY A QUALIFIED INDIVIDUAL TO REQUEST AND OBTAIN 15 A PRESCRIPTION FOR MEDICATION THAT THE QUALIFIED INDIVIDUAL MAY 16 SELF -ADMINISTER TO END HIS OR HER LIFE IN A PEACEFUL MANNER ; 17 (b) B ASED ON AN UNDERSTANDING AND ACKNOWLEDGMENT OF 18 THE RELEVANT FACTS ; AND 19 (c) M ADE AFTER THE ATTENDING PHYSICIAN FULLY INFORMS THE 20 QUALIFIED INDIVIDUAL OF : 21 (I) H IS OR HER MEDICAL DIAGNOSIS AND PROGNOSIS ; 22 (II) T HE POTENTIAL RISKS ASSOCIATED WITH TAKING THE 23 MEDICATION TO BE PRESCRIBED ; 24 (III) T HE PROBABLE RESULT OF TAKING THE MEDICATION TO BE 25 PRESCRIBED ; 26 (IV) T HE CHOICES AVAILABLE TO AN INDIVIDUAL THAT 27 SB16-025 -4- DEMONSTRATE HIS OR HER SELF -DETERMINATION AND INTENT TO END HIS 1 OR HER LIFE IN A PEACEFUL MANNER , INCLUDING THE ABILITY TO CHOOSE 2 WHETHER TO : 3 (A) R EQUEST AID IN DYING ; 4 (B) O BTAIN A PRESCRIPTION FOR MEDICATION TO END HIS OR HER 5 LIFE ; 6 (C) F ILL AND POSSESS A PRESCRIPTION FOR MEDICATION TO END 7 HIS OR HER LIFE ; AND 8 (D) U LTIMATELY SELF -ADMINISTER THE MEDICATION TO BRING 9 ABOUT A PEACEFUL DEATH ; AND 10 (V) F EASIBLE ALTERNATIVES OR ADDITIONAL TREATMENT 11 OPPORTUNITIES , INCLUDING COMFORT CARE , PALLIATIVE CARE , HOSPICE 12 CARE , AND PAIN CONTROL . 13 (9) "L ICENSED MENTAL HEALTH PROFESSIONAL " MEANS A 14 PSYCHIATRIST LICENSED UNDER ARTICLE 36 OF TITLE 12, C.R.S., OR A 15 PERSON LICENSED UNDER ARTICLE 43 OF TITLE 12, C.R.S., TO PRACTICE A 16 PARTICULAR MENTAL HEALTH PROFESSION . 17 (10) "M EDICALLY CONFIRMED " MEANS THAT A CONSULTING 18 PHYSICIAN WHO HAS EXAMINED THE TERMINALLY ILL INDIVIDUAL AND THE 19 INDIVIDUAL 'S RELEVANT MEDICAL RECORDS HAS CONFIRMED THE MEDICAL 20 OPINION OF THE ATTENDING PHYSICIAN . 21 (11) "Q UALIFIED INDIVIDUAL " MEANS A TERMINALLY ILL ADULT 22 WHO IS CAPABLE , IS A RESIDENT , AND HAS SATISFIED THE REQUIREMENTS 23 OF THIS ARTICLE IN ORDER TO OBTAIN A PRESCRIPTION FOR AID -IN -DYING 24 MEDICATION TO END HIS OR HER LIFE . 25 (12) "R ESIDENT " MEANS AN INDIVIDUAL WHO IS ABLE TO 26 DEMONSTRATE RESIDENCY IN COLORADO BY PROVIDING ANY OF THE 27 SB16-025 -5- FOLLOWING DOCUMENTATION TO HIS OR HER ATTENDING PHYSICIAN : 1 (a) A COLORADO DRIVER 'S LICENSE OR IDENTIFICATION CARD 2 ISSUED PURSUANT TO ARTICLE 2 OF TITLE 42, C.R.S.; 3 (b) A COLORADO VOTER REGISTRATION CARD OR OTHER 4 DOCUMENTATION SHOWING THE INDIVIDUAL IS REGISTERED TO VOTE IN 5 C OLORADO ; 6 (c) E VIDENCE THAT THE INDIVIDUAL OWNS OR LEASES PROPERTY 7 IN COLORADO ; OR 8 (d) A COLORADO INCOME TAX RETURN FOR THE MOST RECENT TAX 9 YEAR . 10 (13) "S ELF -ADMINISTRATION " MEANS , IF A QUALIFIED INDIVIDUAL , 11 TO ENGAGE IN AN AFFIRMATIVE AND VOLUNTARY ACT TO USE PRESCRIBED 12 MEDICATION TO BRING ABOUT HIS OR HER OWN PEACEFUL AND HUMANE 13 DEATH . 14 (14) "T ERMINAL ILLNESS " MEANS AN INCURABLE AND 15 IRREVERSIBLE ILLNESS THAT HAS BEEN MEDICALLY CONFIRMED AND WILL , 16 WITHIN REASONABLE MEDICAL JUDGMENT , RESULT IN DEATH WITHIN SIX 17 MONTHS . 18 25-48-103. Right to request aid-in-dying medication. (1) A 19 CAPABLE , ADULT RESIDENT OF COLORADO MAY MAKE A REQUEST , IN 20 ACCORDANCE WITH SECTIONS 25-48-104 AND 25-48-111, TO RECEIVE A 21 PRESCRIPTION FOR AID -IN -DYING MEDICATION IF : 22 (a) T HE INDIVIDUAL 'S ATTENDING PHYSICIAN HAS DIAGNOSED THE 23 INDIVIDUAL WITH A TERMINAL ILLNESS ; AND 24 (b) T HE INDIVIDUAL HAS VOLUNTARILY EXPRESSED THE WISH TO 25 RECEIVE A PRESCRIPTION FOR AID -IN -DYING MEDICATION . 26 (2) A PERSON DOES NOT QUALIFY TO RECEIVE A PRESCRIPTION FOR 27 SB16-025 -6- AID -IN -DYING MEDICATION SOLELY BECAUSE OF AGE OR DISABILITY . 1 25-48-104. Request process - witness requirements. (1) I N 2 ORDER TO RECEIVE A PRESCRIPTION FOR AID -IN -DYING MEDICATION 3 PURSUANT TO THIS ARTICLE , AN INDIVIDUAL WHO SATISFIES THE 4 REQUIREMENTS IN SECTION 25-48-103 MUST MAKE TWO ORAL REQUESTS , 5 SEPARATED BY AT LEAST FIFTEEN DAYS , AND A VALID WRITTEN REQUEST 6 TO HIS OR HER ATTENDING PHYSICIAN . 7 (2) (a) T O BE VALID , A WRITTEN REQUEST FOR AID -IN -DYING 8 MEDICATION MUST BE : 9 (I) S UBSTANTIALLY IN THE SAME FORM AS SET FORTH IN SECTION 10 25-48-111; 11 (II) S IGNED AND DATED BY THE INDIVIDUAL SEEKING THE 12 MEDICATION ; AND 13 (III) W ITNESSED BY AT LEAST TWO INDIVIDUALS WHO , IN THE 14 PRESENCE OF THE INDIVIDUAL , ATTEST TO THE BEST OF THEIR KNOWLEDGE 15 AND BELIEF THAT THE INDIVIDUAL IS : 16 (A) C APABLE ; 17 (B) A CTING VOLUNTARILY ; AND 18 (C) N OT BEING COERCED TO SIGN THE REQUEST . 19 (b) O F THE TWO WITNESSES TO THE WRITTEN REQUEST , AT LEAST 20 ONE MUST NOT BE : 21 (I) R ELATED TO THE INDIVIDUAL BY BLOOD , MARRIAGE , CIVIL 22 UNION , OR ADOPTION ; 23 (II) A N INDIVIDUAL WHO , AT THE TIME THE REQUEST IS SIGNED , IS 24 ENTITLED , UNDER A WILL OR BY OPERATION OF LAW , TO ANY PORTION OF 25 THE INDIVIDUAL 'S ESTATE UPON HIS OR HER DEATH ; OR 26 (III) A N OWNER , OPERATOR , OR EMPLOYEE OF A HEALTH CARE 27 SB16-025 -7- FACILITY WHERE THE INDIVIDUAL IS RECEIVING MEDICAL TREATMENT OR 1 IS A RESIDENT . 2 (c) T HE INDIVIDUAL 'S ATTENDING PHYSICIAN SHALL NOT SERVE AS 3 A WITNESS TO THE WRITTEN REQUEST . 4 25-48-105. Right to rescind request - requirement to offer 5 opportunity to rescind. (1) A T ANY TIME , AN INDIVIDUAL MAY RESCIND 6 HIS OR HER REQUEST FOR AID -IN -DYING MEDICATION WITHOUT REGARD TO 7 THE INDIVIDUAL 'S MENTAL STATE . 8 (2) A N ATTENDING PHYSICIAN SHALL NOT WRITE A PRESCRIPTION 9 FOR AID -IN -DYING MEDICATION UNDER THIS ARTICLE UNLESS THE 10 ATTENDING PHYSICIAN OFFERS THE QUALIFIED INDIVIDUAL AN 11 OPPORTUNITY TO RESCIND THE REQUEST FOR THE MEDICATION . 12 25-48-106. Attending physician responsibilities. (1) T HE 13 ATTENDING PHYSICIAN SHALL : 14 (a) M AKE THE INITIAL DETERMINATION OF WHETHER AN 15 INDIVIDUAL REQUESTING AID -IN -DYING MEDICATION HAS A TERMINAL 16 ILLNESS , IS CAPABLE OF MAKING AN INFORMED DECISION , AND HAS MADE 17 THE REQUEST VOLUNTARILY ; 18 (b) R EQUEST THAT THE INDIVIDUAL DEMONSTRATE COLORADO 19 RESIDENCY BY PROVIDING DOCUMENTATION AS DESCRIBED IN SECTION 20 25-48-102 (12); 21 (c) P ROVIDE A STANDARD OF CARE UNDER ACCEPTED MEDICAL 22 GUIDELINES ; 23 (d) R EFER THE INDIVIDUAL TO A CONSULTING PHYSICIAN OF THE 24 INDIVIDUAL 'S CHOOSING FOR MEDICAL CONFIRMATION OF THE DIAGNOSIS 25 AND PROGNOSIS AND FOR A DETERMINATION OF WHETHER THE INDIVIDUAL 26 IS CAPABLE AND ACTING VOLUNTARILY ; 27 SB16-025 -8- (e) P ROVIDE FULL , INDIVIDUAL -CENTERED DISCLOSURES TO 1 ENSURE THAT THE INDIVIDUAL IS MAKING AN INFORMED DECISION BY 2 DISCUSSING WITH THE INDIVIDUAL : 3 (I) H IS OR HER MEDICAL DIAGNOSIS AND PROGNOSIS ; 4 (II) T HE FEASIBLE ALTERNATIVES OR ADDITIONAL TREATMENT 5 OPPORTUNITIES , INCLUDING COMFORT CARE , PALLIATIVE CARE , HOSPICE 6 CARE , AND PAIN CONTROL ; 7 (III) T HE POTENTIAL RISKS ASSOCIATED WITH TAKING THE 8 AID -IN -DYING MEDICATION TO BE PRESCRIBED ; 9 (IV) T HE PROBABLE RESULT OF TAKING THE AID -IN -DYING 10 MEDICATION TO BE PRESCRIBED ; AND 11 (V) T HE POSSIBILITY THAT THE INDIVIDUAL CAN OBTAIN THE 12 MEDICATION BUT CHOOSE NOT TO USE IT ; 13 (f) R EFER THE INDIVIDUAL TO A LICENSED MENTAL HEALTH 14 PROFESSIONAL PURSUANT TO SECTION 25-48-108 IF , IN THE ATTENDING 15 PHYSICIAN 'S OPINION , THE INDIVIDUAL 'S ABILITY TO MAKE AN INFORMED 16 DECISION IS COMPROMISED FOR ANY REASON ; 17 (g) C ONFIRM THAT THE INDIVIDUAL 'S REQUEST DOES NOT ARISE 18 FROM COERCION OR UNDUE INFLUENCE BY ANOTHER PERSON BY 19 DISCUSSING WITH THE INDIVIDUAL , WITHOUT THE PRESENCE OF OTHER 20 PERSONS , WHETHER THE INDIVIDUAL IS FEELING COERCED OR UNDULY 21 INFLUENCED BY ANOTHER PERSON ; 22 (h) C OUNSEL THE INDIVIDUAL ABOUT THE IMPORTANCE OF : 23 (I) H AVING ANOTHER PERSON PRESENT WHEN THE INDIVIDUAL 24 SELF -ADMINISTERS THE AID -IN -DYING MEDICATION PRESCRIBED PURSUANT 25 TO THIS ARTICLE ; 26 (II) N OT TAKING THE AID -IN -DYING MEDICATION IN A PUBLIC 27 SB16-025 -9- PLACE ; 1 (III) S AFE -KEEPING AND PROPER DISPOSAL OF UNUSED 2 MEDICATION IN ACCORDANCE WITH SECTION 25-48-119; AND 3 (IV) N OTIFYING HIS OR HER NEXT OF KIN OF THE REQUEST FOR 4 AID -IN -DYING MEDICATION ; 5 (i) I NFORM THE INDIVIDUAL THAT HE OR SHE MAY RESCIND THE 6 REQUEST FOR AID -IN -DYING MEDICATION AT ANY TIME AND IN ANY 7 MANNER ; 8 (j) V ERIFY , IMMEDIATELY PRIOR TO WRITING THE PRESCRIPTION 9 FOR AID -IN -DYING MEDICATION , THAT THE INDIVIDUAL IS MAKING AN 10 INFORMED DECISION ; 11 (k) E NSURE THAT ALL APPROPRIATE STEPS ARE CARRIED OUT IN 12 ACCORDANCE WITH THIS ARTICLE BEFORE WRITING A PRESCRIPTION FOR 13 AID -IN -DYING MEDICATION ; AND 14 (l) (I) D ISPENSE AID -IN -DYING MEDICATIONS DIRECTLY TO THE 15 QUALIFIED INDIVIDUAL , INCLUDING ANCILLARY MEDICATIONS INTENDED 16 TO MINIMIZE THE INDIVIDUAL 'S DISCOMFORT , IF THE ATTENDING 17 PHYSICIAN HAS A CURRENT DRUG ENFORCEMENT ADMINISTRATION 18 CERTIFICATE AND COMPLIES WITH ANY APPLICABLE ADMINISTRATIVE 19 RULE ; OR 20 (II) W ITH THE QUALIFIED INDIVIDUAL 'S WRITTEN CONSENT : 21 (A) C ONTACT A LICENSED PHARMACIST AND INFORM THE 22 PHARMACIST OF THE PRESCRIPTION ; AND 23 (B) D ELIVER THE WRITTEN PRESCRIPTION PERSONALLY , BY MAIL , 24 OR THROUGH AUTHORIZED ELECTRONIC TRANSMISSION IN THE MANNER 25 PERMITTED UNDER ARTICLE 42.5 OF TITLE 12, C.R.S., TO THE PHARMACIST , 26 WHO SHALL DISPENSE THE MEDICATION TO THE QUALIFIED INDIVIDUAL , 27 SB16-025 -10- THE ATTENDING PHYSICIAN , OR AN INDIVIDUAL EXPRESSLY DESIGNATED 1 BY THE QUALIFIED INDIVIDUAL . 2 25-48-107. Consulting physician responsibilities. (1) B EFORE 3 AN INDIVIDUAL WHO IS REQUESTING AID -IN -DYING MEDICATION CAN 4 RECEIVE A PRESCRIPTION FOR THE MEDICATION , A CONSULTING PHYSICIAN 5 OF THE INDIVIDUAL 'S CHOOSING MUST : 6 (a) E XAMINE THE INDIVIDUAL AND HIS OR HER RELEVANT MEDICAL 7 RECORDS ; 8 (b) C ONFIRM , IN WRITING , TO THE ATTENDING PHYSICIAN : 9 (I) T HAT THE INDIVIDUAL IS SUFFERING FROM A TERMINAL 10 ILLNESS ; 11 (II) T HE INDIVIDUAL 'S PROGNOSIS ; AND 12 (III) T HAT THE INDIVIDUAL IS CAPABLE OF MAKING AN INFORMED 13 DECISION , OR PROVIDE DOCUMENTATION THAT THE CONSULTING 14 PHYSICIAN HAS REFERRED THE INDIVIDUAL FOR FURTHER EVALUATION IN 15 ACCORDANCE WITH SECTION 25-48-108. 16 25-48-108. Confirmation that individual is capable - referral 17 to mental health professional. ( 1 ) A N ATTENDING PHYSICIAN SHALL NOT 18 PRESCRIBE AID -IN -DYING MEDICATION UNDER THIS ARTICLE FOR AN 19 INDIVIDUAL WITH A TERMINAL ILLNESS UNTIL THE INDIVIDUAL IS 20 DETERMINED TO BE CAPABLE OF MAKING AN INFORMED DECISION AND 21 THAT DETERMINATION IS CONFIRMED IN ACCORDANCE WITH THIS SECTION . 22 (2) T HE DETERMINATION OF WHETHER AN INDIVIDUAL WITH A 23 TERMINAL ILLNESS WHO IS REQUESTING AID -IN -DYING MEDICATION IS 24 CAPABLE OF MAKING AN INFORMED DECISION AND CONFIRMATION OF THAT 25 DETERMINATION MUST BE MADE BY TWO OF THE FOLLOWING : 26 (a) T HE ATTENDING PHYSICIAN ; 27 SB16-025 -11- (b) T HE CONSULTING PHYSICIAN ; OR 1 (c) A LICENSED MENTAL HEALTH PROFESSIONAL . 2 (3) I F, IN THE OPINION OF THE ATTENDING PHYSICIAN OR THE 3 CONSULTING PHYSICIAN , THE INDIVIDUAL 'S ABILITY TO MAKE AN 4 INFORMED DECISION IS COMPROMISED , THE ATTENDING PHYSICIAN OR 5 CONSULTING PHYSICIAN SHALL REFER THE INDIVIDUAL TO A LICENSED 6 MENTAL HEALTH PROFESSIONAL FOR A DETERMINATION OF WHETHER THE 7 INDIVIDUAL IS CAPABLE OF MAKING AN INFORMED DECISION . 8 (4) A LICENSED MENTAL HEALTH PROFESSIONAL WHO EVALUATES 9 AN INDIVIDUAL UNDER THIS SECTION SHALL COMMUNICATE , IN WRITING , 10 TO THE ATTENDING OR CONSULTING PHYSICIAN WHO REQUESTED THE 11 EVALUATION , HIS OR HER CONCLUSIONS ABOUT WHETHER THE INDIVIDUAL 12 IS CAPABLE OF MAKING AN INFORMED DECISION . IF THE LICENSED MENTAL 13 HEALTH PROFESSIONAL DETERMINES THAT THE INDIVIDUAL IS NOT 14 CAPABLE OF MAKING AN INFORMED DECISION , THE ATTENDING PHYSICIAN 15 SHALL NOT PRESCRIBE AID -IN -DYING MEDICATION TO THE INDIVIDUAL . 16 25-48-109. Death certificate. (1) U NLESS OTHERWISE 17 PROHIBITED BY LAW , THE ATTENDING PHYSICIAN MAY SIGN THE DEATH 18 CERTIFICATE OF A QUALIFIED INDIVIDUAL WHO OBTAINS AND 19 SELF -ADMINISTERS AID -IN -DYING MEDICATION . 20 (2) I F A QUALIFIED INDIVIDUAL DIES AFTER USING AID -IN -DYING 21 MEDICATION , THE QUALIFIED INDIVIDUAL 'S TERMINAL ILLNESS SHALL BE 22 LISTED AS THE CAUSE OF DEATH ON HIS OR HER DEATH CERTIFICATE . 23 W HEN AN ATTENDING PHYSICIAN CERTIFIES THAT A DEATH OCCURRED IN 24 ACCORDANCE WITH THIS ARTICLE , THE DEATH IS NOT REPORTABLE AND 25 DOES NOT CONSTITUTE GROUNDS FOR POSTMORTEM INQUIRY UNDER 26 SECTION 30-10-606 (1), C.R.S. 27 SB16-025 -12- 25-48-110. Informed decision required. (1) A N INDIVIDUAL 1 WITH A TERMINAL ILLNESS IS NOT A QUALIFIED INDIVIDUAL AND MAY NOT 2 RECEIVE A PRESCRIPTION FOR AID -IN -DYING MEDICATION UNLESS HE OR 3 SHE HAS MADE AN INFORMED DECISION . 4 (2) I MMEDIATELY BEFORE WRITING A PRESCRIPTION FOR 5 AID -IN -DYING MEDICATION UNDER THIS ARTICLE , THE ATTENDING 6 PHYSICIAN SHALL VERIFY THAT THE INDIVIDUAL WITH A TERMINAL 7 ILLNESS IS A QUALIFIED INDIVIDUAL AND IS MAKING AN INFORMED 8 DECISION . 9 25-48-111. Form of written request. A REQUEST FOR 10 AID -IN -DYING MEDICATION AUTHORIZED BY THIS ARTICLE MUST BE IN 11 SUBSTANTIALLY THE FOLLOWING FORM : 12 REQUEST FOR MEDICATION TO END MY LIFE 13 IN A HUMANE AND DIGNIFIED MANNER 14 I, ________________, AM AN ADULT OF SOUND MIND . I AM SUFFERING 15 FROM _______, WHICH MY ATTENDING PHYSICIAN HAS DETERMINED IS A 16 TERMINAL ILLNESS AND WHICH HAS BEEN MEDICALLY CONFIRMED . I HAVE 17 BEEN FULLY INFORMED OF MY DIAGNOSIS AND PROGNOSIS , THE NATURE OF 18 THE AID -IN -DYING MEDICATION TO BE PRESCRIBED AND POTENTIAL 19 ASSOCIATED RISKS , THE EXPECTED RESULT , AND THE FEASIBLE 20 ALTERNATIVES OR ADDITIONAL TREATMENT OPPORTUNITIES , INCLUDING 21 COMFORT CARE , PALLIATIVE CARE , HOSPICE CARE , AND PAIN CONTROL . 22 I REQUEST THAT MY ATTENDING PHYSICIAN PRESCRIBE AID -IN -DYING 23 MEDICATION THAT WILL END MY LIFE IN A HUMANE AND DIGNIFIED 24 MANNER IF I CHOOSE TO TAKE IT , AND I AUTHORIZE MY ATTENDING 25 PHYSICIAN TO CONTACT ANY PHARMACIST ABOUT MY REQUEST . 26 I UNDERSTAND THAT I HAVE THE RIGHT TO RESCIND THIS REQUEST AT ANY 27 SB16-025 -13- TIME . 1 I UNDERSTAND THE SERIOUSNESS OF THIS REQUEST , AND I EXPECT TO DIE 2 IF I TAKE THE AID -IN -DYING MEDICATION PRESCRIBED . I FURTHER 3 UNDERSTAND THAT ALTHOUGH MOST DEATHS OCCUR WITHIN THREE 4 HOURS , MY DEATH MAY TAKE LONGER , AND MY ATTENDING PHYSICIAN 5 HAS COUNSELED ME ABOUT THIS POSSIBILITY . 6 I MAKE THIS REQUEST VOLUNTARILY , WITHOUT RESERVATION , AND 7 WITHOUT BEING COERCED , AND I ACCEPT FULL RESPONSIBILITY FOR MY 8 ACTIONS . 9 S IGNED : ___________ 10 D ATED : ___________ 11 DECLARATION OF WITNESSES 12 W E DECLARE THAT THE INDIVIDUAL SIGNING THIS REQUEST : 13 (a) I S PERSONALLY KNOWN TO US OR HAS PROVIDED PROOF OF 14 IDENTITY ; 15 (b) S IGNED THIS REQUEST IN OUR PRESENCE ; 16 (c) A PPEARS TO BE OF SOUND MIND AND NOT UNDER DURESS , 17 FRAUD , OR UNDUE INFLUENCE ; AND 18 (d) I S NOT AN INDIVIDUAL FOR WHOM EITHER OF US IS THE 19 ATTENDING PHYSICIAN . 20 __________ W ITNESS 1/D ATE 21 __________ W ITNESS 2/D ATE 22 NOTE: ONLY ONE OF THE TWO WITNESSES MAY : BE A RELATIVE (BY 23 BLOOD , MARRIAGE , CIVIL UNION , OR ADOPTION ) OF THE INDIVIDUAL 24 SIGNING THIS REQUEST ; BE ENTITLED TO ANY PORTION OF THE 25 INDIVIDUAL 'S ESTATE UPON DEATH ; OR OWN , OPERATE , OR BE EMPLOYED 26 AT A HEALTH CARE FACILITY WHERE THE INDIVIDUAL IS A PATIENT OR 27 SB16-025 -14- RESIDENT . 1 25-48-112. Standard of care. ( 1 ) P HYSICIANS AND HEALTH CARE 2 PROVIDERS SHALL PROVIDE MEDICAL SERVICES UNDER THIS ARTICLE THAT 3 MEET OR EXCEED THE STANDARD OF CARE FOR END -OF -LIFE MEDICAL 4 CARE . 5 (2) W HEN A HEALTH CARE PROVIDER MAKES A DIAGNOSIS THAT AN 6 INDIVIDUAL HAS A TERMINAL ILLNESS , THE HEALTH CARE PROVIDER , U P O N 7 THE INDIVIDUAL 'S REQUEST , SHALL PROVIDE THE INDIVIDUAL WITH 8 COMPREHENSIVE INFORMATION AND COUNSELING , IN ACCORDANCE WITH 9 THIS SECTION , REGARDING LEGAL END -OF -LIFE MEDICAL CARE OPTIONS . 10 25-48-113. Effect on wills, contracts, and statutes. (1) A 11 PROVISION IN A CONTRACT , WILL , OR OTHER AGREEMENT , WHETHER 12 WRITTEN OR ORAL , THAT WOULD AFFECT WHETHER A QUALIFIED 13 INDIVIDUAL MAY MAKE OR RESCIND A REQUEST FOR AID IN DYING 14 PURSUANT TO THIS ARTICLE IS INVALID . 15 (2) A N OBLIGATION OWING UNDER ANY CURRENTLY EXISTING 16 CONTRACT MUST NOT BE CONDITIONED UPON , OR AFFECTED BY , A 17 QUALIFIED INDIVIDUAL 'S ACT OF MAKING OR RESCINDING A REQUEST FOR 18 AID -IN -DYING MEDICATION PURSUANT TO THIS ARTICLE . 19 25-48-114. Insurance or annuity policies. (1) T HE SALE , 20 PROCUREMENT , OR ISSUANCE OF , OR THE RATE CHARGED FOR , ANY LIFE , 21 HEALTH , OR ACCIDENT INSURANCE OR ANNUITY POLICY MUST NOT BE 22 CONDITIONED UPON , OR AFFECTED BY , A QUALIFIED INDIVIDUAL 'S ACT OF 23 MAKING OR RESCINDING A REQUEST FOR AID -IN -DYING MEDICATION IN 24 ACCORDANCE WITH THIS ARTICLE . 25 (2) A QUALIFIED INDIVIDUAL 'S ACT OF SELF -ADMINISTERING 26 AID -IN -DYING MEDICATION PURSUANT TO THIS ARTICLE DOES NOT AFFECT 27 SB16-025 -15- A LIFE , HEALTH , OR ACCIDENT INSURANCE OR ANNUITY POLICY , OTHER 1 THAN THAT THE DEATH IS A NATURAL DEATH RESULTING FROM THE 2 QUALIFIED INDIVIDUAL 'S TERMINAL ILLNESS . 3 25-48-115. Immunity for good-faith participation - prohibition 4 against reprisals. (1) A PERSON IS NOT SUBJECT TO CIVIL OR CRIMINAL 5 LIABILITY OR PROFESSIONAL DISCIPLINARY ACTION FOR PARTICIPATING I N 6 GOOD FAITH UNDER THIS ARTICLE , WHICH INCLUDES BEING PRESENT WHEN 7 A QUALIFIED INDIVIDUAL SELF -ADMINISTERS THE PRESCRIBED 8 AID -IN -DYING MEDICATION . 9 (2) A HEALTH CARE PROVIDER OR PROFESSIONAL ORGANIZATION 10 OR ASSOCIATION SHALL NOT SUBJECT AN INDIVIDUAL TO ANY OF THE 11 FOLLOWING FOR PARTICIPATING OR REFUSING TO PARTICIPATE IN 12 GOOD -FAITH COMPLIANCE UNDER THIS ARTICLE : 13 (a) C ENSURE ; 14 (b) D ISCIPLINE ; 15 (c) S USPENSION ; 16 (d) L OSS OF LICENSE , PRIVILEGES , OR MEMBERSHIP ; OR 17 (e) A NY OTHER PENALTY . 18 (3) A REQUEST BY A QUALIFIED INDIVIDUAL FOR , OR THE 19 PROVISION BY AN ATTENDING PHYSICIAN OF , AID -IN -DYING MEDICATION 20 IN GOOD -FAITH COMPLIANCE WITH THIS ARTICLE DOES NOT : 21 (a) C ONSTITUTE NEGLECT OR ELDER ABUSE FOR ANY PURPOSE OF 22 LAW ; OR 23 (b) P ROVIDE THE SOLE BASIS FOR THE APPOINTMENT OF A 24 GUARDIAN OR CONSERVATOR . 25 25-48-116. No duty to prescribe or dispense. (1) A HEALTH 26 CARE PROVIDER MAY CHOOSE WHETHER TO PARTICIPATE IN PROVIDING 27 SB16-025 -16- AID -IN -DYING MEDICATION TO A QUALIFIED INDIVIDUAL IN ACCORDANCE 1 WITH THIS ARTICLE . 2 (2) I F A HEALTH CARE PROVIDER IS UNABLE OR UNWILLING TO 3 CARRY OUT A QUALIFIED INDIVIDUAL 'S REQUEST FOR AID -IN -DYING 4 MEDICATION MADE IN ACCORDANCE WITH THIS ARTICLE , AND THE 5 QUALIFIED INDIVIDUAL TRANSFERS HIS OR HER CARE TO A NEW HEALTH 6 CARE PROVIDER , THE PRIOR HEALTH CARE PROVIDER SHALL TRANSFER , 7 UPON REQUEST , A COPY OF THE QUALIFIED INDIVIDUAL 'S RELEVANT 8 MEDICAL RECORDS TO THE NEW HEALTH CARE PROVIDER . 9 25-48-117. Health care facility may prohibit participation - 10 sanctions if provider violates policy. ( 1 ) A HEALTH CARE FACILITY MAY 11 PROHIBIT A PHYSICIAN FROM WRITING A PRESCRIPTION FOR AID -IN -DYING 12 MEDICATION FOR A QUALIFIED INDIVIDUAL WHO IS A RESIDENT IN THE 13 FACILITY AND WHO INTENDS TO USE THE AID -IN -DYING MEDICATION ON 14 THE FACILITY 'S PREMISES . THE HEALTH CARE FACILITY MUST NOTIFY THE 15 PHYSICIAN IN WRITING OF ITS POLICY WITH REGARD TO PRESCRIPTIONS F O R 16 AID -IN -DYING MEDICATION . 17 (2) A HEALTH CARE FACILITY OR HEALTH CARE PROVIDER SHALL 18 NOT SUBJECT A PHYSICIAN , NURSE , PHARMACIST , OR OTHER PERSON TO 19 DISCIPLINE , SUSPENSION , LOSS OF LICENSE OR PRIVILEGES , OR ANY OTHER 20 PENALTY OR SANCTION FOR ACTIONS TAKEN IN GOOD -FAITH RELIANCE ON 21 THIS ARTICLE OR FOR REFUSING TO ACT UNDER THIS ARTICLE . 22 (3) N OTHING IN THIS SECTION OR IN SECTION 25-48-115 OR 23 25-48-116 PREVENTS A HEALTH CARE PROVIDER FROM PROVIDING TO AN 24 INDIVIDUAL HEALTH CARE SERVICES THAT DO NOT CONSTITUTE 25 PARTICIPATION UNDER THIS ARTICLE . 26 25-48-118. Liabilities. ( 1 ) A PERSON COMMITS A CLASS 2 FELONY 27 SB16-025 -17- AND IS SUBJECT TO PUNISHMENT IN ACCORDANCE WITH SECTION 1 18-1.3-401, C.R.S., IF THE PERSON , WITH INTENT OR THE EFFECT OF 2 CAUSING AN INDIVIDUAL 'S DEATH , PURPOSELY OR KNOWINGLY : 3 (a) A LTERS OR FORGES A REQUEST FOR AID -IN -DYING MEDICATION 4 TO END AN INDIVIDUAL 'S LIFE WITHOUT THE INDIVIDUAL 'S 5 AUTHORIZATION ; OR 6 (b) C ONCEALS OR DESTROYS A RESCISSION OF A REQUEST FOR 7 AID -IN -DYING MEDICATION . 8 (2) A PERSON COMMITS A CLASS 2 FELONY AND IS SUBJECT TO 9 PUNISHMENT IN ACCORDANCE WITH SECTION 18-1.3-401, C.R.S., IF THE 10 PERSON PURPOSELY OR KNOWINGLY COERCES OR EXERTS UNDUE 11 INFLUENCE ON AN INDIVIDUAL WITH A TERMINAL ILLNESS TO : 12 (a) R EQUEST AID -IN -DYING MEDICATION FOR THE PURPOSE OF 13 ENDING THE TERMINALLY ILL INDIVIDUAL 'S LIFE ; OR 14 (b) D ESTROY A RESCISSION OF A REQUEST FOR AID -IN -DYING 15 MEDICATION . 16 (3) N OTHING IN THIS ARTICLE LIMITS FURTHER LIABILITY FOR CIVIL 17 DAMAGES RESULTING FROM OTHER NEGLIGENT CONDUCT OR INTENTIONAL 18 MISCONDUCT BY ANY PERSON . 19 (4) T HE PENALTIES SPECIFIED IN THIS ARTICLE DO NOT PRECLUDE 20 CRIMINAL PENALTIES APPLICABLE UNDER OTHER LAW FOR CONDUCT THAT 21 IS INCONSISTENT WITH THIS ARTICLE . 22 25-48-119. Safe disposal of unused medications. A PERSON WHO 23 HAS CUSTODY OR CONTROL OF AID -IN -DYING MEDICATION DISPENSED 24 UNDER THIS ARTICLE THAT THE TERMINALLY ILL INDIVIDUAL DECIDES NOT 25 TO USE OR THAT REMAINS UNUSED AFTER THE TERMINALLY ILL 26 INDIVIDUAL 'S DEATH SHALL DISPOSE OF THE UNUSED AID -IN -DYING 27 SB16-025 -18- MEDICATION BY LAWFUL MEANS IN ACCORDANCE WITH SECTION 25-15-328 1 OR ANY OTHER STATE OR FEDERALLY APPROVED MEDICATION TAKE -BACK 2 PROGRAM AUTHORIZED UNDER THE FEDERAL "S ECURE AND RESPONSIBLE 3 D RUG DISPOSAL ACT OF 2010", PUB .L. 111-273, AS AMENDED , AND 4 REGULATIONS ADOPTED PURSUANT TO THE FEDERAL ACT . 5 25-48-120. Actions complying with article not a crime. 6 N OTHING IN THIS ARTICLE AUTHORIZES A PHYSICIAN OR ANY OTHER 7 PERSON TO END AN INDIVIDUAL 'S LIFE BY LETHAL INJECTION , MERCY 8 KILLING , OR EUTHANASIA . ACTIONS TAKEN IN ACCORDANCE WITH THIS 9 ARTICLE DO NOT , FOR ANY PURPOSE , CONSTITUTE SUICIDE , ASSISTED 10 SUICIDE , MERCY KILLING , HOMICIDE , OR ELDER ABUSE UNDER THE 11 "C OLORADO CRIMINAL CODE ", TITLE 18, C.R.S. 12 25-48-121. Claims by government entity for costs. A 13 GOVERNMENT ENTITY THAT INCURS COSTS RESULTING FROM AN 14 INDIVIDUAL TERMINATING HIS OR HER LIFE PURSUANT TO THIS ARTICLE IN 15 A PUBLIC PLACE HAS A CLAIM AGAINST THE ESTATE OF THE INDIVIDUAL T O 16 RECOVER THE COSTS AND REASONABLE ATTORNEY FEES RELATED TO 17 ENFORCING THE CLAIM . 18 25-48-122. No effect on advance medical directives. 19 (1) N OTHING IN THIS ARTICLE AFFECTS OR NEGATES : 20 (a) A DECLARATION MADE UNDER ARTICLE 18 OF TITLE 15, C.R.S., 21 DIRECTING THAT LIFE -SUSTAINING PROCEDURES BE WITHHELD OR 22 WITHDRAWN ; 23 (b) A CPR DIRECTIVE EXECUTED UNDER ARTICLE 18.6 OF TITLE 15, 24 C.R.S.; OR 25 (c) A N ADVANCE MEDICAL DIRECTIVE EXECUTED UNDER ARTICLE 26 18.7 OF TITLE 15, C.R.S. 27 SB16-025 -19- SECTION 2. Applicability. This act applies to conduct occurring 1 on or after the effective date of this act. 2 SECTION 3. Safety clause. The general assembly hereby finds, 3 determines, and declares that this act is necessary for the immediate 4 preservation of the public peace, health, and safety. 5 SB16-025 -20-