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90_HB0691
New Act
Creates the Dignity in Dying Act. Establishes procedures
by which terminally ill patients may request and obtain the
medical means to end their lives. Authorizes physicians to
provide those means after following certain procedures
including discussion with the patient and professional
consultation. Makes failure to follow the required
procedures a Class 4 felony. Effective immediately.
LRB9002097DJcd
LRB9002097DJcd
1 AN ACT to provide for the authorization by terminally ill
2 persons to obtain physician assistance in dying.
3 Be it enacted by the People of the State of Illinois,
4 represented in the General Assembly:
5 Section 1. Short title. This Act may be cited as the
6 Dignity in Dying Act.
7 Section 5. Purposes. The General Assembly recognizes
8 the right of individuals to control the decisions relating to
9 their own medical care, including the right to receive, if
10 they so request, assistance from a physician in obtaining the
11 medical means to end their life when they are suffering from
12 a terminal condition.
13 This Act is intended to ensure that a request for such
14 assistance is complied with only when it is fully informed,
15 reasoned, free of undue influence from any person, and not
16 the result of a distortion of judgment due to clinical
17 depression or any other mental illness.
18 This Act is intended to protect, and expand the options
19 of, terminally ill individuals by establishing and regulating
20 a process by which physicians may lawfully comply with
21 requests for such assistance.
22 This Act is not intended to condone, authorize, or
23 approve mercy killing, nor it is intended to condone,
24 authorize, or approve assisted suicide that is not performed
25 in accordance with this Act.
26 Section 10. Definitions. In this Act:
27 "Adult" means a person who is (i) 18 years of age or
28 older or (ii) an emancipated minor under the Emancipation of
29 Mature Minors Act.
30 "Department" means the Department of Public Health.
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1 "Director" means the Director of Public Health.
2 "Health care facility" means a type of health care
3 provider commonly known by a wide variety of titles,
4 including, but not limited to, hospitals, medical centers,
5 nursing homes, rehabilitation centers, long-term or tertiary
6 care facilities, and other facilities established to
7 administer health care and provide overnight stays in their
8 ordinary course of business or practice.
9 "Health care provider" means a person that is licensed,
10 certified, or otherwise authorized or permitted by the law of
11 this State to administer health care in the ordinary course
12 of business or practice of a profession, including, but not
13 limited to, physicians, nurses, health care facilities, and
14 any employee, officer, director, agent, or person under
15 contract with such a person.
16 "Imminent" (as in "death is imminent") means a
17 determination made by the responsible physician according to
18 accepted medical standards that death will occur in a
19 relatively short period of time, even if life-sustaining
20 treatment is initiated or continued.
21 "Life-sustaining treatment" means any medical treatment,
22 procedure, or intervention that, in the judgment of the
23 responsible physician, when applied to a patient who is
24 terminally ill, would serve only to prolong the dying
25 process.
26 "Medical means of hastened death" means substances or
27 medical devices that the responsible physician prescribes for
28 or supplies to a patient for the purpose of enabling the
29 patient to end his or her own life. "Providing medical means
30 of hastened death" includes providing a prescription
31 therefor.
32 "Patient" means an adult under the care or treatment of
33 licensed physician or other health care provider.
34 "Patient's medical record" means (i) in the case of a
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1 patient who is in a health care facility, the record of the
2 patient's medical care that the facility is required by law
3 or professional standards to compile and maintain and (ii) in
4 the case of a patient who is not in such a facility, the
5 record of the patient's medical care that the responsible
6 physician is required by law or professional standards to
7 compile and maintain.
8 "Person" means an individual, a corporation, a business
9 trust, a trust, a partnership, an association, a government,
10 a governmental subdivision or agency, or any other legal
11 entity.
12 "Responsible physician" means the physician, licensed to
13 practice medicine in Illinois, selected or assigned to the
14 patient who is terminally ill, who (i) has full or partial
15 responsibility for treatment and care of the patient and (ii)
16 takes responsibility for providing medical means of hastened
17 death to the patient.
18 "Terminal condition" means an illness or injury for which
19 there is no reasonable prospect of cure or recovery, death is
20 imminent, and the application of life-sustaining treatment
21 would only prolong the dying process.
22 Section 15. Authorization to provide assistance.
23 (a) It is lawful for a responsible physician who
24 complies in all material respects with Sections 20, 25, and
25 30 of this Act to provide a patient with medical means of
26 hastened death, provided that the responsible physician acts
27 on the basis of an honest belief that:
28 (1) the patient is an adult;
29 (2) the patient has a terminal condition; and
30 (3) the patient has made a request of the
31 responsible physician to provide medical means of
32 hastened death, which request:
33 (A) is not the result of a distortion of the
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1 patient's judgment due to clinical depression or any
2 other mental illness;
3 (B) represents the patient's reasoned choice
4 based on an understanding of the information that
5 the responsible physician has provided to the
6 patient pursuant to subdivision (4) of Section 20 of
7 this Act concerning the patient's medical condition
8 and medical options;
9 (C) has been made free of undue influence by
10 any person; and
11 (D) has been repeated without
12 self-contradiction by the patient on 2 separate
13 occasions at least 14 days apart, the last of which
14 is no more than 72 hours before the responsible
15 physician provides the patient with the medical
16 means of hastened death.
17 (b) A responsible physician who has provided a patient
18 with medical means of hastened death in accordance with the
19 provisions of this Act may, if the patient so requests, be
20 present and assist the patient at the time that the patient
21 makes use of those means, provided that the actual use of
22 those means is the knowing, intentional, and voluntary
23 physical act of the patient.
24 Section 20. Discussion with patient and documentation.
25 Before providing medical means of hastened death to a patient
26 pursuant to Section 15 of this Act, the responsible physician
27 shall do all of the following:
28 (1) Offer to the patient all medical care,
29 including hospice care if available, that is consistent
30 with accepted clinical practice and that can practicably
31 be made available to the patient for the purpose of
32 curing or palliating the patient's illness or alleviating
33 symptoms, including pain and other discomfort.
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1 (2) Offer the patient the opportunity to consult
2 with a social worker or other individual trained and
3 experienced in providing social services to determine
4 whether services are available to the patient that could
5 improve the patient's circumstances sufficiently to cause
6 the patient to reconsider his or her request for medical
7 means of hastened death.
8 (3) Counsel the patient to inform the patient's
9 family of the request if the patient has not already done
10 so and the responsible physician believes that doing so
11 would be in the patient's interest.
12 (4) Supply to and discuss with the patient all
13 available medical information that is necessary to
14 provide the basis for a reasoned decision concerning a
15 request for medical means of hastened death, including
16 all such information regarding the patient's diagnosis
17 and prognosis, the medical treatment options and the
18 medical means of hastened death that can be made
19 available to the patient, and their benefits and burdens,
20 all in accordance with the following procedures:
21 (A) At least 2 individuals must witness the
22 discussion required by this subdivision (4). At
23 least one those individuals (i) must not be
24 affiliated with any person that is involved in the
25 care of the patient and (ii) must not stand to
26 benefit personally in any way from the patient's
27 death.
28 (B) The responsible physician shall inform
29 each witness that he or she may question the
30 responsible physician and the patient to ascertain
31 that the patient has, in fact, heard and understood
32 all of the material information discussed pursuant
33 to this subdivision (4).
34 (C) The responsible physician shall document the
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1 discussion with the patient held pursuant to this
2 subdivision (4), using one of the following methods:
3 (i) An audio tape or a video tape of the
4 discussion, during which the witnesses
5 acknowledge their presence.
6 (ii) A written summary of the discussion,
7 which the patient reads and signs and which the
8 witnesses attest in writing to be accurate.
9 (D) The responsible physician shall document
10 the request and the consent of the patient by use of
11 a form substantially like the form described in
12 Section 75 of this Act which the patient reads,
13 completes, and signs and which the witnesses
14 co-sign.
15 The documentation required by subdivisions (4)(C)
16 and (4)(D) must be included and retained with the
17 patient's medical record, and access to and disclosure of
18 those records and copies of them are governed by the
19 provisions of Section 50 of this Act.
20 Section 25. Professional consultation and documentation.
21 Before providing medical means of hastened death to a patient
22 pursuant to Section 15 of this Act, the responsible physician
23 shall do all of the following:
24 (1) Secure a written opinion from a consulting
25 physician who has examined the patient and is qualified
26 to make such an assessment that the patient is suffering
27 from a terminal illness.
28 (2) Secure a written opinion from a licensed
29 psychiatrist, clinical psychologist, or psychiatric
30 social worker who has examined the patient and is
31 qualified to make such an assessment that the patient has
32 requested medical means of hastened death and that the
33 patient's request meets the criteria set forth in
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1 subdivisions (a)(3)(A), (a)(3)(B), and (a)(3)(C) of
2 Section 15 of this Act to the effect that the request is
3 not the result of a distortion of the patient's judgment
4 due to clinical depression or any other mental illness,
5 is reasoned, is fully informed, and is free of undue
6 influence by any person.
7 (3) Place the written opinions described in
8 paragraphs (1) and (2) of this Section in the patient's
9 medical record.
10 Section 30. Recording and reporting by the responsible
11 physician. Promptly after providing medical means of
12 hastened death to a patient, the responsible physician shall
13 (i) record the provision of those means in the patient's
14 medical record (ii) submit a report to the Director on the
15 form the Director requires pursuant to subsection (a) of
16 Section 40 of this Act, and (iii) place a copy of the report
17 in the patient's medical record.
18 Section 35. Actions by persons other than the
19 responsible physician.
20 (a) An individual who acts on the basis of an honest
21 belief that the requirements of this Act have been or are
22 being met may, if the patient so requests, be present at the
23 time that the patient makes use of medical means of hastened
24 death, provided that the actual use of those means is the
25 knowing, intentional, and voluntary physical act of the
26 patient.
27 (b) A licensed pharmacist, acting in accordance with the
28 laws and regulations of this State and the United States that
29 govern the dispensing of prescription drugs and devices and
30 controlled substances, may dispense medical means of hastened
31 death to a person who the pharmacist reasonably believes
32 presents a valid prescription for those means.
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1 (c) An individual who acts on the basis of an honest
2 belief that the requirements of this Act have been or are
3 being met may counsel or assist the responsible physician in
4 providing medical means of hastened death to a patient.
5 Section 40. Record keeping by the Department.
6 (a) The Director shall by regulation specify a form of
7 report to be submitted by physicians pursuant to Section 30
8 of this Act in order to provide the Department with the data
9 regarding the provision of medical means of hastened death
10 that the Director determines to be necessary or appropriate
11 to enable effective oversight and regulation of the operation
12 of this Act. The report shall include, at a minimum, the
13 following information:
14 (1) The patient's diagnosis and prognosis and the
15 alternative medical treatments, consistent with accepted
16 clinical practice, that the responsible physician advised
17 the patient were practicably available.
18 (2) The date on which and the name of the health
19 care facility or other place where the responsible
20 physician complied with the patient's request for medical
21 means of hastened death, the medical means of hastened
22 death that were prescribed or provided, and the method of
23 recording the discussion required to subdivision (4) of
24 Section 20 of this Act.
25 (3) The patient's vital statistics, including
26 county of residence, age, sex, race, and marital status.
27 (4) The type of medical insurance and name of
28 insurer of the patient, if any.
29 (5) The names of the responsible physician, the
30 medical and mental health consultants who delivered
31 opinions pursuant to Section 25 of this Act, and the
32 witnesses required by subdivision (4) of Section 20 of
33 this Act.
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1 (6) The location of the patient's medical record.
2 (b) The Director shall require that the report described
3 in subsection (a) of this Section not include the name of the
4 patient but shall provide by regulation for an anonymous
5 coding or reference system that enables the Director or the
6 responsible physician to associate the report with the
7 patient's medical record.
8 Section 45. Enforcement and reporting by the Department.
9 (a) The Director shall enforce the provisions of this
10 Act and shall report to the Attorney General or the
11 appropriate professional licensing board any violation of its
12 provisions.
13 (b) The Director shall adopt the rules and regulations
14 the Director determines to be necessary or appropriate to
15 implement and achieve the purposes of this Act and shall, at
16 least 90 days before adopting any rule or regulation
17 affecting the conduct of a physician acting under the
18 provisions of this Act, submit the proposed rule or
19 regulation to the Medical Licensing and Disciplinary Board
20 for the Board's review and advice.
21 (c) The Medical Licensing and Disciplinary Board may not
22 adopt any rule or regulation inconsistent with the provisions
23 of this Act or with the rules and regulations of the
24 Department adopted under it and shall, at least 90 days
25 before adopting any rule or regulation affecting the conduct
26 of a physician acting under the provisions of this Act,
27 submit the proposed rule or regulation to the Director for
28 the Director's review and advice.
29 (d) The Director shall report to the General Assembly
30 annually concerning the operation of this Act and the
31 achievement of its stated purposes. The report of the
32 Director shall be made available to the public upon its
33 submission to the General Assembly. In order to facilitate
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1 this annual reporting, the Director may collect and review
2 the information that the Director determines to be helpful to
3 the Department, the Medical Licensing and Disciplinary Board,
4 or the General Assembly and may by regulation require the
5 submission of that information to the Department.
6 Section 50. Confidentiality of records and reports.
7 (a) The information that a person acting under this Act
8 obtains from or about a patient is confidential and may not
9 be disclosed to any other person without the patient's
10 consent or the consent of a person with lawful authority to
11 act on the patient's behalf, except as this Act or any other
12 provision of law may otherwise require.
13 (b) The report that a responsible physician files with
14 the Department pursuant to Section 30 of this Act is
15 confidential, is not a public record, and is not subject to
16 the provisions of the Freedom of Information Act.
17 Section 55. Provider's freedom of conscience.
18 (a) No individual who is conscientiously opposed to
19 providing a patient with medical means of hastened death may
20 be required to do so or to assist a responsible physician in
21 doing so.
22 (b) A health care facility that has adopted a policy
23 opposed to providing patients with medical means of hastened
24 death and has given reasonable notice of that policy to its
25 staff members may prohibit its staff members from providing
26 those means to a patient who is within its facilities or
27 under its care.
28 Section 60. Patient's freedom from discrimination.
29 (a) No physician, health care facility, health care
30 service plan, provider of health or disability insurance,
31 self-insured employee health care benefit plan, or hospital
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1 service plan may require any individual to request medical
2 means of hastened death as a condition of eligibility for
3 service, benefits, or insurance. No such physician or entity
4 may refuse to provide medical services or medical benefits to
5 an individual because the individual has requested medical
6 means of hastened death, except as Section 55 of this Act
7 permits.
8 (b) A patient's use of medical means of hastened death
9 to end the patient's life in compliance with this Act shall
10 not be considered suicide for the purpose of voiding a policy
11 of insurance on the life of the patient.
12 Section 65. Liability.
13 (a) No person who has acted in compliance with the
14 applicable provisions of this Act in providing medical means
15 of hastened death to an individual shall be subject to civil
16 or criminal liability therefor.
17 (b) No individual who has acted in compliance with the
18 applicable provisions of this Act in providing medical means
19 of hastened death to a patient shall be subject therefor to
20 professional sanction, loss of employment, or loss of
21 privileges, provided that the action does not violate a
22 policy of a health care facility that complies with
23 subsection (b) of Section 55 of this Act.
24 (c) Except as provided in subsections (a) and (b) of
25 this Section, this Act does not limit the civil, criminal, or
26 disciplinary liability of any person for intentional or
27 negligent misconduct.
28 Section 70. Criminal penalties. In addition to any
29 other civil, criminal, or disciplinary liability that he or
30 she may otherwise incur thereby, an individual who willfully
31 violates Section 15, 20, 25, 30, or 35 of this Act is guilty
32 of a Class 4 felony.
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1 Section 75. Form of written request. A request for
2 medical means of hastened death to satisfy subdivision (4)(D)
3 of Section 20 of this Act shall be in substantially the
4 following form:
5 REQUEST FOR ASSISTANCE TO END MY
6 LIFE IN A HUMANE AND DIGNIFIED MANNER
7 I, .........., am an adult of sound mind.
8 I am suffering from .........., which my responsible
9 physician has determined is a terminal condition and which
10 has been medically confirmed by a consulting physician.
11 I have been fully informed of my diagnosis and prognosis,
12 the nature of the medical means of suicide to be prescribed
13 and potential associated risks, the expected result, and the
14 feasible alternatives, including comfort care, hospice care
15 and pain control.
16 I request that my responsible physician prescribe a
17 medical means that will end my life in a humane and dignified
18 manner.
19 INITIAL ONE:
20 ..... I have informed my family of my decision and taken
21 their opinions into consideration.
22 ..... I have decided not to inform my family of my decision.
23 ..... I have no family to inform of my decision.
24 I understand that I have the right to rescind this
25 request at any time.
26 I understand the full import of this request and I expect
27 to die when I use the medical means of suicide to be
28 prescribed.
29 I make this request voluntarily and without reservation,
30 and I accept full moral responsibility for my actions.
31 Signed: .................... Dated: ....................
32 DECLARATION OF WITNESSES
33 We declare that the person signing this request:
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1 (1) is personally known to us or has provided proof of
2 identity;
3 (2) signed this request in our presence;
4 (3) appears to be of sound mind and not under duress,
5 fraud or undue influence; and
6 (4) is not a patient for whom either of us serves as a
7 physician.
8 .................... Witness 1 Date ....................
9 .................... Witness 2 Date ....................
10 Section 99. Effective date. This Act takes effect upon
11 becoming law.