H. R. 1003
One Hundred Fifth Congress
of the
United States of America
AT THE FIRST SESSION
Begun and held at the City of Washington on Tuesday,
the seventh day of January, one thousand nine hundred and ninety-seven
An Act
To clarify Federal law with respect to restricting the use of Federal funds in
support of assisted suicide.
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) SHORT TITLE.—This Act may be cited as the ‘‘Assisted
Suicide Funding Restriction Act of 1997’’.
(b) TABLE OF CONTENTS.—The table of contents of this Act
is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Findings and purpose.
Sec. 3. Restriction on use of Federal funds under health care programs.
Sec. 4. Restriction on use of Federal funds under certain grant programs under the
Developmental Disabilities Assistance and Bill of Rights Act.
Sec. 5. Restriction on use of Federal funds by advocacy programs.
Sec. 6. Restriction on use of other Federal funds.
Sec. 7. Clarification with respect to advance directives.
Sec. 8. Application to District of Columbia.
Sec. 9. Conforming amendments.
Sec. 10. Relation to other laws.
Sec. 11. Effective date.
Sec. 12. Suicide prevention (including assisted suicide).
SEC. 2. FINDINGS AND PURPOSE.
(a) FINDINGS.—Congress finds the following:
(1) The Federal Government provides financial support for
the provision of and payment for health care services, as well
as for advocacy activities to protect the rights of individuals.
(2) Assisted suicide, euthanasia, and mercy killing have
been criminal offenses throughout the United States and, under
current law, it would be unlawful to provide services in support
of such illegal activities.
(3) Because of recent legal developments, it may become
lawful in areas of the United States to furnish services in
support of such activities.
(4) Congress is not providing Federal financial assistance
in support of assisted suicide, euthanasia, and mercy killing
and intends that Federal funds not be used to promote such
activities.
(b) PURPOSE.—It is the principal purpose of this Act to continue
current Federal policy by providing explicitly that Federal funds
may not be used to pay for items and services (including assistance)
the purpose of which is to cause (or assist in causing) the suicide,
euthanasia, or mercy killing of any individual.
H. R. 1003—2
SEC. 3. RESTRICTION ON USE OF FEDERAL FUNDS UNDER HEALTH
CARE PROGRAMS.
(a) RESTRICTION
ON
FEDERAL
FUNDING
OF
HEALTH
CARE
SERVICES.—Subject to subsection (b), no funds appropriated by
Congress for the purpose of paying (directly or indirectly) for the
provision of health care services may be used—
(1) to provide any health care item or service furnished
for the purpose of causing, or for the purpose of assisting
in causing, the death of any individual, such as by assisted
suicide, euthanasia, or mercy killing;
(2) to pay (directly, through payment of Federal financial
participation or other matching payment, or otherwise) for such
an item or service, including payment of expenses relating
to such an item or service; or
(3) to pay (in whole or in part) for health benefit coverage
that includes any coverage of such an item or service or of
any expenses relating to such an item or service.
(b) CONSTRUCTION AND TREATMENT OF CERTAIN SERVICES.—
Nothing in subsection (a), or in any other provision of this Act
(or in any amendment made by this Act), shall be construed to
apply to or to affect any limitation relating to—
(1) the withholding or withdrawing of medical treatment
or medical care;
(2) the withholding or withdrawing of nutrition or
hydration;
(3) abortion; or
(4) the use of an item, good, benefit, or service furnished
for the purpose of alleviating pain or discomfort, even if such
use may increase the risk of death, so long as such item,
good, benefit, or service is not also furnished for the purpose
of causing, or the purpose of assisting in causing, death, for
any reason.
(c) LIMITATION
ON FEDERAL FACILITIES
AND EMPLOYEES.—
Subject to subsection (b), with respect to health care items and
services furnished—
(1) by or in a health care facility owned or operated by
the Federal government, or
(2) by any physician or other individual employed by the
Federal government to provide health care services within the
scope of the physician’s or individual’s employment,
no such item or service may be furnished for the purpose of causing,
or for the purpose of assisting in causing, the death of any individ-
ual, such as by assisted suicide, euthanasia, or mercy killing.
(d) LIST OF PROGRAMS TO WHICH RESTRICTIONS APPLY.—
(1) FEDERAL HEALTH CARE FUNDING PROGRAMS.—Subsection
(a) applies to funds appropriated under or to carry out the
following:
(A) MEDICARE
PROGRAM.—Title XVIII of the Social
Security Act.
(B) MEDICAID
PROGRAM.—Title XIX of the Social
Security Act.
(C) TITLE
XX
SOCIAL
SERVICES
BLOCK
GRANT.—Title
XX of the Social Security Act.
(D) MATERNAL
AND
CHILD
HEALTH
BLOCK
GRANT
PROGRAM.—Title V of the Social Security Act.
(E) PUBLIC HEALTH SERVICE ACT.—The Public Health
Service Act.
H. R. 1003—3
(F) INDIAN
HEALTH
CARE
IMPROVEMENT
ACT.—The
Indian Health Care Improvement Act.
(G) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM.—
Chapter 89 of title 5, United States Code.
(H) MILITARY
HEALTH
CARE
SYSTEM
(INCLUDING
TRICARE AND CHAMPUS PROGRAMS).—Chapter 55 of title 10,
United States Code.
(I) VETERANS MEDICAL CARE.—Chapter 17 of title 38,
United States Code.
(J) HEALTH SERVICES FOR PEACE CORPS VOLUNTEERS.—
Section 5(e) of the Peace Corps Act (22 U.S.C. 2504(e)).
(K) MEDICAL
SERVICES
FOR
FEDERAL
PRISONERS.—
Section 4005(a) of title 18, United States Code.
(2) FEDERAL FACILITIES AND PERSONNEL.—The provisions
of subsection (c) apply to facilities and personnel of the
following:
(A) MILITARY HEALTH CARE SYSTEM.—The Department
of Defense operating under chapter 55 of title 10, United
States Code.
(B) VETERANS MEDICAL CARE.—The Veterans Health
Administration of the Department of Veterans Affairs.
(C) PUBLIC
HEALTH
SERVICE.—The Public Health
Service.
(3) NONEXCLUSIVE LIST.—Nothing in this subsection shall
be construed as limiting the application of subsection (a) to
the programs specified in paragraph (1) or the application of
subsection (c) to the facilities and personnel specified in para-
graph (2).
SEC. 4. RESTRICTION ON USE OF FEDERAL FUNDS UNDER CERTAIN
GRANT 
PROGRAMS 
UNDER 
THE 
DEVELOPMENTAL
DISABILITIES ASSISTANCE AND BILL OF RIGHTS ACT.
Subject to section 3(b) (relating to construction and treatment
of certain services), no funds appropriated by Congress to carry
out part B, D, or E of the Developmental Disabilities Assistance
and Bill of Rights Act may be used to support or fund any program
or service which has a purpose of assisting in procuring any item,
benefit, or service furnished for the purpose of causing, or the
purpose of assisting in causing, the death of any individual, such
as by assisted suicide, euthanasia, or mercy killing.
SEC. 5. RESTRICTION ON USE OF FEDERAL FUNDS BY ADVOCACY
PROGRAMS.
(a) IN GENERAL.—Subject to section 3(b) (relating to construc-
tion and treatment of certain services), no funds appropriated by
Congress may be used to assist in, to support, or to fund any
activity or service which has a purpose of assisting in, or to bring
suit or provide any other form of legal assistance for the purpose
of—
(1) securing or funding any item, benefit, program, or
service furnished for the purpose of causing, or the purpose
of assisting in causing, the suicide, euthanasia, or mercy killing
of any individual;
(2) compelling any person, institution, governmental entity
to provide or fund any item, benefit, program, or service for
such purpose; or
H. R. 1003—4
(3) asserting or advocating a legal right to cause, or to
assist in causing, the suicide, euthanasia, or mercy killing
of any individual.
(b) LIST OF PROGRAMS TO WHICH RESTRICTIONS APPLY.—
(1) IN GENERAL.—Subsection (a) applies to funds appro-
priated under or to carry out the following:
(A) PROTECTION AND ADVOCACY SYSTEMS UNDER THE
DEVELOPMENTAL
DISABILITIES
ASSISTANCE
AND
BILL
OF
RIGHTS
ACT.—Part C of the Developmental Disabilities
Assistance and Bill of Rights Act.
(B) PROTECTION AND ADVOCACY SYSTEMS UNDER THE
PROTECTION AND ADVOCACY FOR MENTALLY ILL INDIVIDUALS
ACT.—The Protection and Advocacy for Mentally Ill Individ-
uals Act of 1986.
(C) PROTECTION AND ADVOCACY SYSTEMS UNDER THE
REHABILITATION ACT OF 1973.—Section 509 of the Rehabilita-
tion Act of 1973 (29 U.S.C. 794e).
(D) 
OMBUDSMAN
PROGRAMS
UNDER
THE
OLDER
AMERICANS ACT OF 1965.—Ombudsman programs under the
Older Americans Act of 1965.
(E) LEGAL
ASSISTANCE.—Legal assistance programs
under the Legal Services Corporation Act.
(2) NONEXCLUSIVE LIST.—Nothing in this subsection shall
be construed as limiting the application of subsection (a) to
the programs specified in paragraph (1).
SEC. 6. RESTRICTION ON USE OF OTHER FEDERAL FUNDS.
(a) IN GENERAL.—Subject to section 3(b) (relating to construc-
tion and treatment of certain services) and subsection (b) of this
section, no funds appropriated by the Congress shall be used to
provide, procure, furnish, or fund any item, good, benefit, activity,
or service, furnished or performed for the purpose of causing, or
assisting in causing, the suicide, euthanasia, or mercy killing of
any individual.
(b) NONDUPLICATION.—Subsection (a) shall not apply to funds
to which section 3, 4, or 5 applies, except that subsection (a),
rather than section 3, shall apply to funds appropriated to carry
out title 10, United States Code (other than chapter 55), title
18, United States Code (other than section 4005(a)), and chapter
37 of title 28, United States Code.
SEC. 7. CLARIFICATION WITH RESPECT TO ADVANCE DIRECTIVES.
Subject to section 3(b) (relating to construction and treatment
of certain services), sections 1866(f) and 1902(w) of the Social
Security Act shall not be construed—
(1) to require any provider or organization, or any employee
of such a provider or organization, to inform or counsel any
individual regarding any right to obtain an item or service
furnished for the purpose of causing, or the purpose of assisting
in causing, the death of the individual, such as by assisted
suicide, euthanasia, or mercy killing; or
(2) to apply to or to affect any requirement with respect
to a portion of an advance directive that directs the purposeful
causing of, or the purposeful assisting in causing, the death
of any individual, such as by assisted suicide, euthanasia, or
mercy killing.
H. R. 1003—5
SEC. 8. APPLICATION TO DISTRICT OF COLUMBIA.
For purposes of this Act, the term ‘‘funds appropriated by
Congress’’ includes funds appropriated to the District of Columbia
pursuant to an authorization of appropriations under title V of
the District of Columbia Self-Government and Governmental
Reorganization Act and the term ‘‘Federal government’’ includes
the government of the District of Columbia.
SEC. 9. CONFORMING AMENDMENTS.
(a) MEDICARE PROGRAM.—
(1) FUNDING.—Section 1862(a) of the Social Security Act
(42 U.S.C. 1395y(a)) is amended—
(A) by striking ‘‘or’’ at the end of paragraph (14);
(B) by striking the period at the end of paragraph
(15) and inserting ‘‘; or’’; and
(C) by inserting after paragraph (15) the following
new paragraph:
‘‘(16) in the case in which funds may not be used for
such items and services under the Assisted Suicide Funding
Restriction Act of 1997.’’.
(2) ADVANCE DIRECTIVES.—Section 1866(f) of such Act (42
U.S.C. 1395cc(f)) is amended by adding at the end the following
new paragraph:
‘‘(4) For construction relating to this subsection, see section
7 of the Assisted Suicide Funding Restriction Act of 1997 (relating
to clarification respecting assisted suicide, euthanasia, and mercy
killing).’’.
(b) MEDICAID PROGRAM.—
(1) FUNDING.—Section 1903(i) of the Social Security Act
(42 U.S.C. 1396b(i)) is amended—
(A) by striking ‘‘or’’ at the end of paragraph (14);
(B) by striking the period at the end of paragraph
(15) and inserting ‘‘; or’’; and
(C) by inserting after paragraph (15) the following
new paragraph:
‘‘(16) with respect to any amount expended for which funds
may not be used under the Assisted Suicide Funding Restriction
Act of 1997.’’.
(2) ADVANCE DIRECTIVES.—Section 1902(w) of such Act (42
U.S.C. 1396a(w)) is amended by adding at the end the following
new paragraph:
‘‘(5) For construction relating to this subsection, see section
7 of the Assisted Suicide Funding Restriction Act of 1997 (relating
to clarification respecting assisted suicide, euthanasia, and mercy
killing).’’.
(c) TITLE XX BLOCK GRANT PROGRAM.—Section 2005(a) of the
Social Security Act (42 U.S.C. 1397d(a)) is amended—
(1) by striking ‘‘or’’ at the end of paragraph (8);
(2) by striking the period at the end of paragraph (9)
and inserting ‘‘; or’’; and
(3) by adding at the end the following:
‘‘(10) in a manner inconsistent with the Assisted Suicide
Funding Restriction Act of 1997.’’.
(d) MATERNAL AND CHILD HEALTH BLOCK GRANT PROGRAM.—
Section 501(a) of the Social Security Act (42 U.S.C. 701(a)) is
amended by adding at the end the following:
H. R. 1003—6
‘‘Funds appropriated under this section may only be used in a
manner consistent with the Assisted Suicide Funding Restriction
Act of 1997.’’.
(e) PUBLIC HEALTH SERVICE ACT.—Title II of the Public Health
Service Act (42 U.S.C. 201 et seq.) is amended by adding at the
end thereof the following new section:
‘‘SEC. 246. RESTRICTION ON USE OF FUNDS FOR ASSISTED SUICIDE,
EUTHANASIA, AND MERCY KILLING.
‘‘Appropriations for carrying out the purposes of this Act shall
not be used in a manner inconsistent with the Assisted Suicide
Funding Restriction Act of 1997.’’.
(f) INDIAN HEALTH CARE IMPROVEMENT ACT.—Title II of the
Indian Health Care Improvement Act (25 U.S.C. 1621 et seq.)
is amended by adding at the end the following new section:
‘‘LIMITATION ON USE OF FUNDS
‘‘SEC. 225. Amounts appropriated to carry out this title may
not be used in a manner inconsistent with the Assisted Suicide
Funding Restriction Act of 1997.’’.
(g) FEDERAL EMPLOYEES HEALTH BENEFIT PROGRAM.—Section
8902 of title 5, United States Code, is amended by adding at
the end the following:
‘‘(o) A contract may not be made or a plan approved which
includes coverage for any benefit, item, or service for which funds
may not be used under the Assisted Suicide Funding Restriction
Act of 1997.’’.
(h) MILITARY HEALTH CARE PROGRAM.—Section 1073 of title
10, United States Code, is amended by adding at the end the
following: ‘‘This chapter shall be administered consistent with
the Assisted Suicide Funding Restriction Act of 1997.’’.
(i) VETERANS’ MEDICAL CARE PROGRAM.—
(1) IN GENERAL.—Subchapter I of chapter 17 of title 38,
United States Code, is amended by adding at the end the
following new section:
‘‘§ 1707. Restriction on use of funds for assisted suicide,
euthanasia, or mercy killing
‘‘Funds appropriated to carry out this chapter may not be
used for purposes that are inconsistent with the Assisted Suicide
Funding Restriction Act of 1997.’’.
(2) CLERICAL AMENDMENT.—The table of sections at the
beginning of such chapter is amended by inserting after the
item relating to section 1706 the following new item:
‘‘1707. Restriction on use of funds for assisted suicide, euthanasia, or mercy killing.’’.
(j) HEALTH CARE PROVIDED FOR PEACE CORPS VOLUNTEERS.—
Section 5(e) of the Peace Corps Act (22 U.S.C. 2504(e)) is amended
by adding at the end the following: ‘‘Health care may not be provided
under this subsection in a manner inconsistent with the Assisted
Suicide Funding Restriction Act of 1997.’’.
(k) MEDICAL
SERVICES
FOR
FEDERAL
PRISONERS.—Section
4005(a) of title 18, United States Code, is amended by inserting
‘‘and to the extent consistent with the Assisted Suicide Funding
Restriction Act of 1997’’ after ‘‘Upon request of the Attorney
General’’.
(l) DEVELOPMENTAL DISABILITIES AND BILL OF RIGHTS ACT.—
H. R. 1003—7
(1) STATE PLANS REGARDING DEVELOPMENTAL DISABILITIES
COUNCILS.—Section 122(c)(5)(A) of the Developmental Disabil-
ities Assistance and Bill of Rights Act (42 U.S.C. 6022(c)(5)(A))
is amended—
(A) in clause (vi), by striking ‘‘and’’ after the semicolon
at the end;
(B) in clause (vii), by striking the period at the end
and inserting ‘‘; and’’; and
(C) by adding at the end the following clause:
‘‘(viii) such funds will be used consistent with
section 4 of the Assisted Suicide Funding Restriction
Act of 1997.’’.
(2) 
LEGAL
ACTIONS
BY
PROTECTION
AND
ADVOCACY
SYSTEMS.—Section 142(h) of such Act (42 U.S.C. 6042(h)) is
amended by adding at the end the following new paragraph:
‘‘(3) LIMITATION.—The systems may only use assistance
provided under this chapter consistent with section 5 of the
Assisted Suicide Funding Restriction Act of 1997.’’.
(3) UNIVERSITY AFFILIATED PROGRAMS.—Section 152(b)(5)
of such Act (42 U.S.C. 6062(b)(5)) is amended by adding at
the end the following: ‘‘Such grants shall not be used in a
manner inconsistent with section 4 of the Assisted Suicide
Funding Restriction Act of 1997.’’.
(4) GRANTS OF NATIONAL SIGNIFICANCE.—Section 162(c) of
such Act (42 U.S.C. 6082(c)) is amended—
(A) by striking ‘‘and’’ at the end of paragraph (4);
(B) by striking the period at the end of paragraph
(5) and inserting ‘‘; and’’; and
(C) by adding at the end the following new paragraph:
‘‘(6) the applicant provides assurances that the grant will
not be used in a manner inconsistent with section 4 of the
Assisted Suicide Funding Restriction Act of 1997.’’.
(m) PROTECTION AND ADVOCACY FOR MENTALLY ILL INDIVIDUALS
ACT OF 1986.—Section 105(a) of the Protection and Advocacy for
Mentally Ill Individuals Act of 1986 (42 U.S.C. 10805(a)) is
amended—
(1) in paragraph (8), by striking ‘‘and’’ at the end;
(2) in paragraph (9), by striking the period and inserting
‘‘; and’’; and
(3) by adding at the end thereof the following new para-
graph:
‘‘(10) not use allotments provided to a system in a manner
inconsistent with section 5 of the Assisted Suicide Funding
Restriction Act of 1997.’’.
(n) 
PROTECTION
AND
ADVOCACY
SYSTEMS
UNDER
THE
REHABILITATION ACT OF 1973.—Section 509(f) of the Rehabilitation
Act of 1973 (29 U.S.C. 794e(f)) is amended—
(1) in paragraph (6), by striking ‘‘and’’ after the semicolon
at the end;
(2) in paragraph (7), by striking the period at the end
and inserting ‘‘; and’’; and
(3) by adding at the end the following paragraph:
‘‘(8) not use allotments provided under this section in a
manner inconsistent with section 5 of the Assisted Suicide
Funding Restriction Act of 1997.’’.
(o) LEGAL SERVICES PROGRAM.—Section 1007(b) of the Legal
Services Corporation Act (42 U.S.C. 2996f(b)) is amended—
H. R. 1003—8
(1) by striking ‘‘or’’ at the end of paragraph (9);
(2) by striking the period at the end of paragraph (10)
and inserting ‘‘; or’’; and
(3) by adding after paragraph (10) the following:
‘‘(11) to provide legal assistance in a manner inconsistent
with the Assisted Suicide Funding Restriction Act of 1997.’’.
(p) CONSTRUCTION ON CONFORMING AMENDMENTS.—The fact
that a law is not amended under this section shall not be construed
as indicating that the provisions of this Act do not apply to such
a law.
SEC. 10. RELATION TO OTHER LAWS.
The provisions of this Act supersede other Federal laws (includ-
ing laws enacted after the date of the enactment of this Act)
except to the extent such laws specifically supersede the provisions
of this Act.
SEC. 11. EFFECTIVE DATE.
(a) IN GENERAL.— The provisions of this Act (and the amend-
ments made by this Act) take effect upon its enactment and apply,
subject to subsection (b), to Federal payments made pursuant to
obligations incurred after the date of the enactment of this Act
for items and services provided on or after such date.
(b) APPLICATION TO CONTRACTS.—Such provisions shall apply
with respect to contracts entered into, renewed, or extended after
the date of the enactment of this Act and shall also apply to
a contract entered into before such date to the extent permitted
under such contract.
SEC. 12. SUICIDE PREVENTION (INCLUDING ASSISTED SUICIDE).
(a) PURPOSE.—The purpose of this section is to reduce the
rate of suicide (including assisted suicide) among persons with
disabilities or terminal or chronic illness by furthering knowledge
and practice of pain management, depression identification and
treatment, and issues related to palliative care and suicide preven-
tion.
(b) RESEARCH AND DEMONSTRATION PROJECTS.—Section 781 of
the Public Health Service Act (42 U.S.C. 295) is amended—
(1) by redesignating subsection (e) as subsection (f); and
(2) by inserting after subsection (d) the following new
subsection:
‘‘(e) RESEARCH
AND DEMONSTRATION PROJECTS
ON SUICIDE
PREVENTION (INCLUDING ASSISTED SUICIDE).—
‘‘(1) RESEARCH.—The Secretary may make grants to and
enter into contracts with public and private entities for conduct-
ing research intended to reduce the rate of suicide (including
assisted suicide) among persons with disabilities or terminal
or chronic illness. The Secretary shall give preference to
research that aims—
‘‘(A) to assess the quality of care received by patients
with disabilities or terminal or chronic illness by measuring
and reporting specific outcomes;
‘‘(B) to compare coordinated health care (which may
include coordinated rehabilitation services, symptom con-
trol, psychological support, and community-based support
services) to traditional health care delivery systems; or
‘‘(C) 
to 
advance 
biomedical 
knowledge 
of 
pain
management.
H. R. 1003—9
‘‘(2) TRAINING.—The Secretary may make grants and enter
into contracts to assist public and private entities, schools,
academic health science centers, and hospitals in meeting the
costs of projects intended to reduce the rate of suicide (including
assisted suicide) among persons with disabilities or terminal
or chronic illness. The Secretary shall give preference to
qualified projects that will—
‘‘(A) train health care practitioners in pain manage-
ment, depression identification and treatment, and issues
related to palliative care and suicide prevention;
‘‘(B) train the faculty of health professions schools in
pain management, depression identification and treatment,
and 
issues 
related 
to 
palliative 
care 
and 
suicide
prevention; or
‘‘(C) develop and implement curricula regarding disabil-
ity issues, including living with disabilities, living with
chronic or terminal illness, attendant and personal care,
assistive technology, and social support services.
‘‘(3) DEMONSTRATION PROJECTS.—The Secretary may make
grants to and enter into contracts with public and nonprofit
private entities for the purpose of conducting demonstration
projects that will—
‘‘(A) 
reduce 
restrictions 
on 
access 
to 
hospice
programs; or
‘‘(B) fund home health care services, community living
arrangements, and attendant care services.
‘‘(4) PALLIATIVE MEDICINE.—The Secretary shall emphasize
palliative medicine among its funding and research priorities.’’.
(c) REPORT BY GENERAL ACCOUNTING OFFICE.—Not later than
1 year after the date of enactment of this Act, the Comptroller
General of the United States shall submit to the Congress a report
providing an assessment of programs under subsection (e) of section
781 of the Public Health Service Act (as added by subsection (b)
of this section) to conduct research, provide training, and develop
curricula and of the curricula offered and used by schools of medi-
cine and osteopathic medicine in pain management, depression
identification and treatment, and issues related to palliative care
and suicide prevention. The purpose of the assessment shall be
to determine the extent to which such programs have furthered