The Aid in Dying Bill: What is it and When Can it be Used?

By: Mark Pancrazio
June 6, 2014

The February 2014 Session of the General Assembly saw the proposal of House Bill 5326, popularly known as the Aid in Dying Bill.  The technical title of this proposed legislation is An Act Concerning Compassionate Aid in Dying for Terminally Ill Patients.  If the bill becomes law, it could become effective on October 1, 2014.  The purpose of the legislation is to allow a physician to prescribe medication – at the request of a mentally competent patient that has a terminal illness – such that the patient may self-administer that medication to bring about his or her own death.  Specifically, section two of the proposal states that a person who is an adult, is competent, is a resident of the State of Connecticut, has been determined by that person’s attending physician to have terminal illness and has voluntarily expressed his or her wish to receive aid in dying, may request that aid by making two written requests pursuant to other sections of the proposed legislation.

This requires us to dig deeper into the bill to define what is meant by certain terms buried within the language.  For starters, “adult” means you have to be 18 years of age or older.  “Competent” means that you must have the capacity to understand and acknowledge the nature and consequences of health care decisions, including the benefits and disadvantages of treatment, in order to make an informed decision and to communicate that decision to a health care provider.  The decision as to whether you are deemed to be competent rests with your attending physician, a consulting physician, a psychiatrist, a psychologist or the court.  Further, if you have a certain manner in which you communicate your decisions, the communication must be made to a person who is familiar with your manner of communicating.  “Terminal illness” means the final stage of an incurable and irreversible medical condition that an attending physician anticipates – within reasonable medical judgment – will produce a patient’s death within six months.  Finally, “attending physician” means the physician who has primary responsibility for the medical care of a given patient and treatment of that patient’s terminal illness.

So what exactly is aid in dying?  Under the bill, “aid in dying” is defined to mean the medical practice of a physician prescribing medication to a qualified patient who is terminally ill, which medication a qualified patient may self-administer to bring about his or her death.  “Self-administer” means a qualified patient’s act of ingesting medication.  “Qualified patient” means a competent adult who is a resident of the State of Connecticut, has a terminal illness and who has satisfied other provisions of this proposed legislation.

One of the most important provisions of the proposal is that the qualified patient make two written requests for aid.  Let’s now look at the what comprises a written request.  Section three of the bill provides that the written requests must be signed and dated by the patient and the patient’s signature must be witnessed by two people in the presence of the patient, attesting that to the best of their knowledge and belief the patient is of sound mind, acting voluntarily and not under the threat of coercion.  The first request must be submitted to the patient’s attending physician.  The second request must also be submitted to the attending physician no sooner than 15 days after the first request has been submitted.

So who can act as a witness to such a request?  The proposed legislation states that at least one of the two witnesses must be a person who is not a relative of the patient by blood, marriage or adoption.  In addition, that witness cannot be entitled to any portion of the patient’s estate upon his or her death, whether under a will or pursuant to the laws of intestate succession.  Finally, that same witness cannot be an owner, operator or employee of a health care facility where the patient is either a resident or is receiving treatment.  Noteworthy is that a patient’s attending physician is strictly prohibited from acting as a witness.  Last, if the patient is a resident of a residential care home, a nursing home or a rest home, the second witness must be a person designated by that home to serve as a witness.

Some may ask whether a qualified patient is entitled to rescind a written request for aid in dying?  The short answer is yes.  First, that rescission can be made at any time and in any manner, regardless of the patient’s mental state at the time of the rescission.  Also, an attending physician must offer a qualified patient the opportunity to rescind his or her written request at the time that the patient submits their second request to the physician.  In fact, no medication for aid in dying is permitted to be prescribed to the patient, unless the attending physician first offers the patient the opportunity to rescind at the time of the patient’s submission of the second request.

For more on the Aid in Dying Bill, see my next article entitled The Aid in Dying Bill: The Physician’s Rose and Responsibilities.  If you have any questions related to the Aid in Dying bill – House Bill 5326 – please feel free to call me at (203) 744-0004 or email me at mpancrazio@mixgoldman.com.