AB346 - Establishes provisions governing the prescribing, dispensing and administering of medication designed to end the life of a patient. (BDR 40-600)

(Reprinted with amendments adopted on April 15, 2025) FIRST REPRINT A.B. 346 - *AB346_R1* ASSEMBLY BILL NO. 346–ASSEMBLYMEMBERS DALIA AND GALLANT MARCH 3, 2025 ____________ JOINT SPONSOR: SENATOR FLORES ____________ Referred to Select Committee on End-of-Life Care SUMMARY—Establishes provisions governing the prescribing, dispensing and administering of medication designed to end the life of a patient. (BDR 40-600) FISCAL NOTE: Effect on Local Government: No. Effect on the State: Yes. ~ EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted. AN ACT relating to health care; revising provisions concerning medical certificates of death of persons who self-administer a medication that is designed to end the life of the person; authorizing a physician or advanced practice registered nurse to prescribe a medication that is designed to end the life of a patient under certain circumstances; prohibiting persons other than a patient from administering a medication that is designed to end the life of the patient; imposing requirements relating to the medical records of a patient who requests a medication that is designed to end the life of the patient; providing immunity to certain providers of health care and health care facilities for certain actions relating to prescribing or dispensing a medication that is designed to end the life of a patient; authorizing the owner or operator of a health care facility to prohibit the provision of certain services relating to a medication that is designed to end the life of a patient; prohibiting a person from including certain provisions in a will, contract, agreement or policy of life insurance; prohibiting certain actions on a policy of life insurance because the insured requested or revoked a request for a medication that is designed to end the life of the insured; and providing other matters properly relating thereto. – 2 – - *AB346_R1* Legislative Counsel’s Digest: Existing law authorizes a patient who has been diagnosed with a terminal 1 condition to refuse life-resuscitating or life-sustaining treatment in certain 2 circumstances. (NRS 449A.400-449A.581, 450B.400-450B.590) Sections 5-33 of 3 this bill authorize a patient, under certain circumstances, to self-administer a 4 medication that is designed to end the life of the patient. Section 14 defines 5 “practitioner” to mean a physician, osteopathic physician or advanced practice 6 registered nurse. Sections 6-13, 15 and 16 define other relevant terms. Section 17 7 authorizes a patient to request that his or her attending practitioner prescribe a 8 medication that is designed to end his or her life if the patient: (1) is at least 18 9 years of age; (2) has been diagnosed with a terminal condition by at least two 10 practitioners; (3) has made an informed and voluntary decision to end his or her 11 own life; (4) is mentally capable of making such a decision; and (5) is not 12 requesting the medication because of coercion, deception or undue influence. 13 Section 18 prescribes certain requirements concerning the manner in which a 14 patient may request a medication that is designed to end the life of the patient, 15 including that the patient make two verbal requests and one written request for the 16 medication, and that the written request for the medication be signed by a witness. 17 Section 19 prescribes the form for the written request for the medication. Section 18 20 imposes certain requirements before a practitioner is authorized to prescribe a 19 medication that is designed to end the life of a patient, including that the 20 practitioner: (1) inform the patient of his or her right to revoke a request for the 21 medication at any time; (2) determine and verify that the patient meets 22 the requirements for making such a request; (3) discuss certain relevant factors with 23 the patient, including the diagnosis and prognosis of the patient and alternative 24 options for care; (4) refer the patient to a consulting practitioner who can confirm 25 the diagnosis, prognosis and mental capability of the patient and that the patient has 26 not been coerced or unduly influenced; and (5) instruct the patient against self- 27 administering the medication in public. Section 21 requires a practitioner who 28 determines that a patient who has requested a prescription for a medication that is 29 designed to end his or her life may not be mentally capable to refer the patient to a 30 qualified mental health professional and to receive confirmation about the patient’s 31 mental capability. 32 Section 22: (1) prescribes procedures for the issuance of a prescription for a 33 medication that is designed to end the life of the patient; and (2) provides that only 34 an attending practitioner or a pharmacist may dispense such a medication. Section 35 22.5 of this bill prescribes the manner in which the attending practitioner may bill 36 the patient or the insurer of the patient for diagnosing the condition of the patient 37 and prescribing the medication. Section 23 prohibits an attending practitioner from 38 prescribing a medication that is designed to end the life of a patient based solely on 39 the age or disability of the patient. Section 24 requires certain providers of health 40 care to include certain information concerning requests and prescriptions for and 41 the dispensing of a medication that is designed to end the life of a patient in the 42 medical record of the patient. If a patient who has requested a medication that is 43 designed to end the life of a patient transfers care to another practitioner or health 44 care facility, sections 24 and 31 require the practitioner or health care facility that 45 previously provided care to the patient to forward the patient’s medical records to 46 the new practitioner or health care facility. Section 27 prescribes certain 47 information that must be reported by an attending practitioner to the Division of 48 Public and Behavioral Health of the Department of Health and Human Services 49 relating to a patient who has been prescribed or self-administered such a 50 medication. Section 28 requires the Division to compile an annual report 51 concerning the implementation of the provisions of this bill authorizing a patient to 52 request a prescription for a medication that is designed to end the life of the patient. 53 – 3 – - *AB346_R1* Sections 27, 40 and 43 of this bill provide that such information is otherwise 54 confidential when reported to the Division. 55 Section 25 authorizes a patient, at any time, to revoke a request for a 56 medication that is designed to end his or her life. Sections 26 and 35 of this bill 57 provide that only the patient to whom a medication that is designed to end his or 58 her life is prescribed may administer the medication. Section 26 establishes 59 requirements for the disposal of any unused portion of the medication. 60 Section 33 makes certain persons exempt from professional discipline and 61 immune from civil and criminal penalties and provides that such persons do not 62 violate any applicable standard of care for taking actions authorized by this bill to 63 assist a patient in acquiring a medication that is designed to end the life of the 64 patient. Section 33.3 of this bill requires a person who administers emergency 65 medical services to treat a prescription for a medication that is designed to end the 66 life of a patient as a written do-not-resuscitate order for the purpose of withholding 67 life-sustaining treatment. Section 33.6 of this bill requires a person who administers 68 emergency medical services who responds to a person who has self-administered a 69 medication that is designed to end his or her life to indicate “medical aid in dying” 70 in any report concerning the incident. Section 33.1 of this bill makes a conforming 71 change to include a patient who has self-administered a medication designed to end 72 his or her life in the definition of “qualified patient” for the purpose of provisions 73 governing the withholding of life-sustaining treatment. Section 29 provides that a 74 death resulting from the self-administration of a medication that is designed to end 75 the life of a patient is not mercy killing, euthanasia, assisted suicide, suicide or 76 homicide when done in accordance with the provisions of this bill, and section 2 of 77 this bill requires a death certificate to list the terminal condition of the patient as the 78 cause of death of the patient. However, section 1.5 of this bill requires a death 79 certificate to include a box that may be marked to indicate that a patient died from 80 the self-administration of a medication that is designed to end the life of a patient, 81 and section 2 requires the death certificate of such a patient to indicate that the 82 patient died in that manner through a mark in that box. Sections 1 and 3 of this bill 83 provide that a coroner, coroner’s deputy or local health officer is not required to 84 certify the cause of such a death. Section 42 of this bill: (1) authorizes a coroner to 85 make an appropriate investigation after discovering that a person has self- 86 administered a medication designed to end the life of the person, to the extent 87 necessary to determine the cause of the terminal condition with which the person 88 was diagnosed; and (2) requires a coroner to cease such an investigation after 89 determining that the terminal condition resulted from a natural cause. Section 41 of 90 this bill makes a conforming change to revise certain internal references. 91 Sections 30 and 38 of this bill prohibit a person from preventing or requiring a 92 person to make or revoke a request for a medication that is designed to end the life 93 of the person as a condition to receiving health care or as a condition in an 94 agreement, contract or will. 95 Section 31 clarifies that a practitioner is not required to prescribe a medication 96 that is designed to end the life of a patient and remains responsible for treating the 97 patient’s pain. However, if a patient who is diagnosed with a terminal condition 98 requests information concerning the prescription and self-administration of a 99 medication that is designed to end the life of the patient, section 31 requires a 100 practitioner to provide that information or facilitate the transfer of the patient to 101 another provider of health care. Section 31 also provides that a pharmacist is not 102 required to fill a prescription for or dispense such a medication. Section 32 103 authorizes the owner or operator of a health care facility to prohibit an employee or 104 independent contractor of the health care facility or any person who provides 105 services on the premises of the health care facility from providing any services 106 relating to prescribing a medication that is designed to end the life of a patient 107 while acting within the scope of his or her employment or contract with the facility 108 – 4 – - *AB346_R1* or while on the premises of the facility. Section 33 prohibits a health care facility or 109 provider of health care from taking certain actions against an employee or 110 independent contractor who: (1) provides accurate, scientific information 111 concerning end-of-life care to a patient; or (2) facilitates the prescription or self- 112 administration of a medication that is designed to end the life of the patient. 113 Sections 34-37 of this bill make conforming changes to clarify that a practitioner or 114 pharmacist is authorized to dispense a medication that is designed to end the life of 115 a patient that is a controlled substance or dangerous drug and a patient may self- 116 administer such a medication in accordance with other provisions governing 117 medications designed to end the life of a patient. 118 Section 39 of this bill provides that a proposed protected person shall not be 119 deemed to be in need of a general or special guardian solely because the proposed 120 protected person requested a medication that is designed to end his or her life or 121 revoked such a request. 122 Sections 44 and 45 of this bill prohibit insurers from conditioning life 123 insurance benefits, group life insurance benefits or the payment of claims on 124 whether the insured makes, fails to make or revokes a request for a medication that 125 is designed to end the life of the insured or self-administers such a medication. 126 Section 46 of this bill makes a conforming change to reflect this prohibition on a 127 policy of group life insurance. 128 WHEREAS, A mentally capable adult patient should have the 1 right to self-determination concerning his or her health care 2 decisions based on his or her values, beliefs or personal preferences; 3 and 4 WHEREAS, It is important that patients have the full range of 5 options for their care, especially at the end of their lives; and 6 WHEREAS, Patients with a terminal illness may undergo 7 unremitting pain, agonizing discomfort and a sudden, continuing 8 and irreversible reduction in their quality of life; and 9 WHEREAS, The availability of medical aid in dying provides an 10 additional palliative care option for persons with a terminal illness 11 who seek to retain their autonomy and some level of control over 12 the progression of their disease or ease unnecessary pain and 13 suffering; and 14 WHEREAS, The integration of medical aid in dying into standard 15 end-of-life care has demonstrably improved such care by 16 contributing to better conversations between providers of health care 17 and patients, earlier and more appropriate enrollment in hospice care 18 and better training concerning palliative care for providers; and 19 WHEREAS, Patient-directed care respects and responds to the 20 decisions, preferences, needs and values of individual patients, 21 ensures that the values of patients direct all clinical decisions 22 concerning their care and ensures that patients are fully informed of 23 and able to access the options for care that they desire; now, 24 therefore, 25 – 5 – - *AB346_R1* THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN 1 SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS: 2 3 Section 1. Chapter 440 of NRS is hereby amended by adding 4 thereto a new section to read as follows: 5 1. A coroner, coroner’s deputy or local health officer is not 6 required to certify the cause of death of a patient who dies after 7 self-administering a medication that is design [Text truncated for display. Full text available on LegiScan.]