An Act Regarding Patient-directed Care at the End of Life
Maine Legislature, Session 127, LD 1270
Committee: Health and Human Services
Sponsors: KATZ, BEAVERS, WOOD, JORGENSEN, HILL, CAMPBELL, DILLINGHAM, HARLOW, HUBBELL, RUSSELL
Amends: 24 MRSA §2908

Legislative Document 
No. 1270 
S.P. 452 
In Senate, April 7, 2015 
An Act Regarding Patient-directed Care at the End of Life 
Reference to the Committee on Health and Human Services suggested and ordered printed. 
HEATHER J.R. PRIEST 
Secretary of the Senate 
Presented by Senator KATZ of Kennebec. 
Cosponsored by Representatives: BEAVERS of South Berwick, WOOD of Greene, 
Representative JORGENSEN of Portland and 
Senator: HILL of York, Representatives: CAMPBELL of Orrington, DILLINGHAM of 
Oxford, HARLOW of Portland, HUBBELL of Bar Harbor, RUSSELL of Portland. 
Be it enacted by the People of the State of Maine as follows: 
Sec. 1.  24 MRSA §2908 is enacted to read: 
§2908.  Patient-directed care at the end of life 
1.  Definitions.  As used in this section, unless the context otherwise indicates, the 
following terms have the following meanings. 
A.  "Bona fide physician-patient relationship" means a treating or consulting 
relationship in the course of which a physician has completed a full assessment of a 
patient's medical history and current medical condition, including a personal physical 
examination. 
B.  "Capable" means that a patient has the ability to make and communicate health 
care decisions to a physician, including communication through persons familiar with 
the patient's manner of communicating if those persons are available. 
C.  "Health care facility" means a hospital, psychiatric hospital or nursing facility 
licensed under Title 22, chapter 405 or a residential care facility licensed under Title 
22, chapter 1663. 
D.  "Health care provider" means a person licensed by this State to provide health 
care or administer health care or dispense medication, a partnership or corporation 
made up of such persons or an officer, employee or agent of such a person acting in 
the course and scope of employment, agency or contract.  "Health care provider" 
includes a physician. 
E.  "Impaired judgment" means the inability of a person to sufficiently understand or 
appreciate the relevant facts necessary to make an informed decision. 
F.  "Interested person" means a patient's physician; a person who is a relative of a 
patient by blood, marriage or adoption; a person who knows that the person would be 
entitled upon a patient's death to any portion of the estate or assets of the patient 
under any will or trust, by operation of law or by contract; or an owner, operator or 
employee of a health care facility where a patient is receiving medical treatment or is 
a resident. 
G.  "Palliative care" means care that eases or relieves pain or discomfort. 
H.  "Patient" means an adult who is a resident of this State and who is terminally ill 
and has a limited life expectancy in the opinion of the person's physician. 
I.  "Physician" means an individual licensed to practice medicine under Title 32, 
chapter 36 or 48. 
J.  "Terminal condition" means an incurable and irreversible disease that will, within 
reasonable medical judgment, result in death within 6 months. 
2.  Right to information.  A patient has a right to information regarding all treatment 
options reasonably available for the care of the patient, including, but not limited to, 
information in response to specific questions about the foreseeable risks and benefits of 
medication, without the physician withholding requested information regardless of the 
purpose of the questions or the nature of the information. 
3.  Patient-physician communication.  A physician who provides information to a 
patient under subsection 2 may not, because of providing that information, be considered 
to be assisting in or contributing to a patient's independent decision to self-administer a 
lethal dose of medication.  An exchange of information between a patient and a physician 
under subsection 2 may not be used to establish civil or criminal liability or professional 
disciplinary action under Title 32, chapter 36 or 48. 
4.  Requirements for prescription and documentation; immunity.  A physician 
who complies with the requirements of this section is not subject to any civil or criminal 
liability or professional disciplinary action if the physician in good faith prescribes to a 
patient with whom the physician has a bona fide physician-patient relationship 
medication that the patient subsequently self-administers for the purpose of hastening the 
patient's death.  In order for a physician to prescribe the medication under this subsection, 
all of the actions set out in paragraphs A and B must be taken by the patient and the 
physician and documented as set out in this subsection. 
A.  The patient shall complete the following actions: 
(1)  Make an initial oral request to the physician while in the physician's physical 
presence for medication to be self-administered for the purpose of hastening the 
patient's death; 
(2)  At least 15 days after the initial request, make a 2nd request to the physician 
while in the physician's physical presence for medication to be self-administered 
for the purpose of hastening the patient's death, at which time the physician must 
offer the patient an opportunity to rescind the request; 
(3)  At least one day after the 2nd request, make a written request for medication 
to be self-administered for the purpose of hastening the patient's death.  The 
request must be signed by the patient in the presence of 2 or more witnesses who 
are adults and are not interested persons and who must sign the document and 
affirm that the patient appears to understand the nature of the document and 
appears to be free from duress or undue influence at the time of signing the 
document; and 
(4)  If the physician plans to submit the prescription for medication to a 
pharmacist, sign a statement of written consent to the action and direct the 
pharmacist to deliver the medication to the patient or to a person whom the 
patient names to receive the medication from the pharmacist. 
B.  The physician shall complete the following actions: 
(1)  Determine, based on physical examination of the patient and review of the 
patient's medical records, that the patient meets the definition of "patient" as 
provided in subsection 1, paragraph H, is capable and is making a voluntary 
request and an informed decision; 
(2) Include in the patient's medical record the following: 
(a)  Documentation of the initial and 2nd oral requests made under paragraph 
A, subparagraphs (1) and (2), including the wording of the requests; 
(b)  A statement that the physician offered the patient an opportunity to 
rescind the 2nd oral request made under paragraph A, subparagraph (2) and 
the opportunity to rescind the written request at any time, including the 
wording of the offers of opportunities to rescind; 
(c)  A statement that the physician has informed the patient orally and in 
writing of the following: 
(i)  The patient's medical diagnosis; 
(ii)  The patient's medical prognosis, including acknowledgment that the 
physician's prediction of the patient's life expectancy is an estimate based 
on the physician's best medical judgment and is not a guarantee of the 
actual time remaining in the patient's life and that the patient could live 
longer than the time predicted; 
(iii)  The range of treatment options appropriate for the patient and the 
patient's diagnosis; 
(iv)  If the patient is not enrolled in hospice care, all feasible end-of-life 
services, including palliative care, comfort care, hospice care and pain 
control; 
(v)  The range of possible results, including, but not limited to, potential 
risks associated with taking the medication to be prescribed; and 
(vi)  The probable result of taking the medication to be prescribed; 
(d)  A statement that the physician referred the patient to a 2nd physician for 
medical confirmation of the diagnosis and prognosis; 
(e)  A statement that the patient meets the definition of "patient" as provided 
in subsection 1, paragraph H, is capable and is making a voluntary request 
and an informed decision; 
(f)  A statement that the physician has determined that the patient does not 
have impaired judgment or, in the alternative, that the physician has referred 
the patient for an evaluation by a licensed psychiatrist, psychologist or 
clinical social worker and that that person has determined that the patient is 
capable and does not have impaired judgment; 
(g)  A statement that the physician, after obtaining the consent of the patient, 
consulted with the patient's primary care physician if the patient has a 
primary care physician; 
(h)  A statement that the requirements of divisions (a) to (g) were completed 
immediately prior to writing the prescription and that the prescription was 
written no earlier than 48 hours after the patient's written request under 
paragraph A; 
(i)  A statement that the physician is licensed to dispense medication or 
submitted the prescription to a licensed pharmacist as directed by the patient 
under paragraph A, subparagraph (4); and 
(j)  A statement that the physician has fully complied with the requirements 
of this subparagraph; and 
(3) Promptly notify the Department of Health and Human Services regarding 
compliance with the requirements of this section, the patient's compliance with 
paragraph A and the physician's compliance with this paragraph. 
5.  Construction.  This section may not be construed to limit civil or criminal 
liability for gross negligence, recklessness or intentional misconduct of a person who acts 
in accordance with this section. 
6.  No duty to aid or participate.  A patient who acts to self-administer a lethal dose 
of medication in accordance with this section is not, as a result of taking those actions, a 
dependent adult as defined in Title 22, section 3472, subsection 6, an incapacitated adult 
as defined in Title 22, section 3472, subsection 10 or in need of protective services as 
defined in Title 22, section 3472, subsection 12.  A person who is present when a patient, 
having followed the procedures required by this section, self-administers a lethal dose of 
medication does not have a duty to aid the patient and is not subject to civil or criminal 
liability solely for being present or solely for not acting to prevent the patient from self-
administering the medication.  A person does not have a duty, by law or contract, to 
participate in the provision of a lethal dose of medication to a patient. 
7.  Prohibition allowed.  With regard to a patient who is a resident or inpatient in a 
health care facility, the facility may adopt a policy that prohibits a health care provider 
from issuing a prescription to the patient for medication or providing medication that the 
health care provider knows the patient intends to self-administer in a lethal dose while in 
the health care facility.  A health care facility that adopts a policy pursuant to this 
subsection shall provide a copy of the policy to all health care providers employed in or 
by the facility.  A health care provider who violates a policy of a health care facility 
prohibiting issuing a prescription or providing medication as authorized by this 
subsection may be sanctioned by the health care facility for the violation of policy. 
8.  Protection from disciplinary and other actions.  A health care facility or health 
care provider is not subject to disciplinary action, loss of professional privileges or 
professional licensing, certification, registration or other action or penalty for actions 
taken in good faith reliance on the provisions of this section or for refusal to take action 
that is authorized by this section.  A physician who has a bona fide physician-patient 
relationship with a patient may not be considered to have engaged in unprofessional 
conduct for the purposes of professional licensure under Title 32, chapter 36 or 48 if the 
physician participates in the provision of medication to a patient in accordance with this 
section. 
9.  Insurance policy prohibitions.  A patient whose life is insured under a life 
insurance policy issued under the provisions of Title 24-A, chapter 29 and the 
beneficiaries of the policy may not be denied benefits on the basis of self-administration 
of medication by the patient in accordance with this section.  The sale, procurement or 
issuance of any medical professional liability insurance policy issued under the 
provisions of Title 24-A and the rate charged by the insurer for the policy may not be 
conditioned upon or affected by the participation by the health care provider in the 
provision of medication to a patient in accordance with this section. 
10.  Palliative care.  The participation of a health care provider in the provision of 
medication to a patient in accordance with this section may not limit or otherwise affect 
the provision, administration or receipt of palliative care to the patient consistent with 
accepted medical standards. 
11.  Rulemaking for disposal of unused medications.  The Department of Health 
and Human Services shall adopt rules to provide for the safe disposal of medications 
prescribed under this section that are not used by the patient.  Rules adopted under this 
subsection are routine technical rules as defined in Title 5, chapter 375, subchapter 2-A. 
12.  Statutory construction.  Nothing in this section may be construed to authorize a 
physician or any other person to end a patient's life by lethal injection, mercy killing or 
active euthanasia.  Action taken in accordance with this section may not be construed for 
any purpose to constitute suicide, assisted suicide, mercy killing or homicide.  This 
section may not be construed to conflict with Section 1553 of the federal Patient 
Protection and Affordable Care Act, Public Law No. 111-148, 124 Stat. 119 (2010), as 
amended by the federal Health Care and Education Reconciliation Act of 2010, Public 
Law No. 111-152, 124 Stat. 1029 (2010). 
SUMMARY 
This bill enacts a process for patient-directed care at the end of life for Maine 
residents who are adults who are terminally ill and who have been determined to have a 
limited life expectancy.  The bill provides that such a patient has a right to information 
and includes requirements for patient and physician action and documentation in the 
patient's medical records of the steps taken.  The bill authorizes a physician to prescribe a 
medication that the patient may self-administer for the purpose of hastening the patient's 
death.  The bill provides protections for the physician, the patient's health care facility and 
health care providers.  The bill protects the patient's life insurance and the health care 
providers' medical professional liability insurance.  The bill protects the patient's right to 
palliative care.  The bill requires rulemaking by the Department of Health and Human 
Services to provide for safe disposal of medications that are prescribed for end-of-life 
care and that are not used by the patient.  The bill specifically states that nothing in the 
provisions of the bill may be construed to authorize a physician or other person to end a 
patient's life by lethal injection, mercy killing or active euthanasia. The bill specifically 
states that the provisions of the bill may not be construed to conflict with Section 1553 of 
the federal Patient Protection and Affordable Care Act, as amended by the federal Health 
Care and Education Reconciliation Act of 2010.