New Hampshire
House Bill 1659-FN (2020)
New Chapter 137-L: Death with Dignity Act
Check on the status of this bill at the New Hampshire General Court.
Sean Murphy*
This is a bill to legalize assisted suicide [Full
Text]. Parts of the bill relevant to protection of conscience are reproduced below.
The bill permits physician assisted suicide for New Hampshire residents 18 years of age and older who have been diagnosed with a terminal illness likely to cause death within six months. Candidates who are capable of making and communicating health care decisions must apply in writing for a lethal prescription (137-M:3); the application must be witnessed by two independent witnesses (137-M:4). The candidate must apply personally; substitute medical decision makers cannot apply on behalf of a patient (137-M:3.III).
The bill imposes a number of obligations on physicians primarily responsible for treating a patient's terminal illness (137-M:5) and upon physicians consulted by them about the illness (137-M:6). These would be unacceptable to physicians who refuse to participate in assisted suicide for reasons of conscience.
Section 137-M:14 (Immunities) is the provision that is intended to protect objecting health care providers, which includes individuals and health care facilities. The protection offered is biased in favour of those willing to participate in assisted suicide and insufficient to protect those unwilling to do so. Specifically:
139-M:14.I limits protection against civil, criminal and professional liability to persons willing to participate in assisted suicide; no protection is provided for those who refuse. It also prevents objecting institutional health care providers from taking action against employees who participate in assisted suicide on their premises.
139-M:14.II protects both participants and non-participants equally, but also prevents objecting institutional health care providers from taking action against individuals who ignore prohibitions against assisted suicide on their premises.
139-M14.III protects those providing assisted suicide drugs against negligence complaints, but does not similarly protect those who refuse to provide assisted suicide drugs.
139-M14.IV declares that no health care provider is under a duty to participate in assisted suicide. However, the provision is ambiguous because it is inconsistent with the lack of protection noted in 139-M4.I and III.
AN ACT relative to patient directed care and patient's rights with regard to end-of-life decisions.
Be it Enacted by the Senate and House of Representatives in General Court convened:
137-M:2 Definitions.
In this chapter:
. . .
II. "Attending physician" means the physician who has primary responsibility for treatment and care of the patient’s terminal disease.
. . .
IV. “Consulting physician” means a physician who is qualified by specialty or experience to make a professional diagnosis and prognosis regarding the patient’s disease.
. . .
VII. "Health care provider" means a person licensed, certified, or otherwise authorized or permitted by the law of this state to administer health care in the ordinary course of business or practice of a profession, and includes a health care facility.
. . .
137-M:5 Attending Physician Responsibilities.
The attending physician shall:
I. Make the initial determination of whether a patient has a terminal disease and is in a condition of severe, unrelenting suffering; is capable; and has made the request voluntarily.
II. Inform the patient of the:
(a) Medical diagnosis.
(b) Prognosis.
(c) Potential risks associated with taking the medication to be prescribed.
(d) Probable result of taking the medication to be prescribed.
(e) Feasible alternatives, including, but not limited to, comfort care, hospice care, palliative treatment, and pain control.
III. Refer the patient to a consulting physician for medical confirmation of the diagnosis, and for a determination that the patient is capable and acting voluntarily.
IV. Refer the patient for counseling, if appropriate, pursuant to RSA 137-M:7.
V. Recommend that the patient notify next of kin.
VI. Counsel the patient about the importance of having another person present when the patient takes the medication prescribed pursuant to this chapter and of not taking the medication in a public place.
VII. Inform the patient that the patient has an opportunity to rescind the request at any time and in any manner, and offer the patient an opportunity to rescind at the end of the 15-day waiting period pursuant to RSA 137-M:9.
VIII. Verify, immediately prior to writing the prescription for medication under this chapter, that the patient is making an informed decision.
IX. Fulfill the medical record documentation requirements of RSA 137-M:10.
X. Ensure that all appropriate steps are carried out in accordance with this chapter prior to writing a prescription for medication to enable a qualified patient to end the patient’s life in a humane and dignified manner.
137-M:6 Consulting Physician Confirmation.
Before a patient is qualified under this chapter, a consulting physician shall examine the patient and the patient’s relevant medical records and confirm, in writing, the attending physician’s diagnosis that the patient is in a condition of severe, unrelenting suffering from a terminal disease and verify that the patient is capable, is acting voluntarily, and has made an informed decision.
. . .
Except as provided in RSA 137-M:15:
I. No person shall be subject to civil or criminal liability or professional disciplinary action for participating in good faith compliance with this chapter. This includes being present when a qualified patient takes the prescribed medication to end the patient’s life in a humane and dignified manner.
II. No professional organization or association, or health care provider, may subject a person to censure, discipline, suspension, loss of license, loss of privileges, loss of membership, or other penalty for participating or refusing to participate in good faith compliance with this chapter.
III. No request by a patient for or provision by an attending physician of medication in good faith compliance with the provisions of this chapter shall constitute neglect for any purpose of law or provide the sole basis for the appointment of a guardian or conservator.
IV. No health care provider shall be under any duty, whether by contract, by statute or by any other legal requirement to participate in the provision to a qualified patient of medication to end the patient’s life in a humane and dignified manner. If a health care provider is unable or unwilling to carry out a patient’s request under this chapter, and the patient transfers such patient’s care to a new health care provider, the prior health care provider shall transfer, upon request, a copy of the patient’s relevant medical records to the new health care provider.
. . .