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An Act Regarding Patient-directed Care at the End of Life
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.  "End-of-life care document" means a document signed by a patient that meets the requirements of subsection 3.
 
B.  "Medical director" means a licensed physician who oversees the medical components of hospice services and serves on the interdisciplinary team, as defined in Title 22, section 8621, subsection 12, for the patient.
 
C.  "Palliative care" means care that eases or relieves pain or discomfort.
 
D.  "Patient" means a person who is terminally ill and has a limited life expectancy in the opinion of the person's physician.
 
E.  "Physician" means the physician or medical director as defined in this subsection who provides care for the patient and who signs a physician document with regard to the patient.
 
F.  "Physician document" means a document signed by a physician that meets the requirements of subsection 4.
 
2.  Agreement.     A patient and physician may enter into an agreement for patient-directed end-of-life care by signing an end-of-life care document in accordance with subsection 3 and a physician document in accordance with subsection 4.
 
3.  Choice and directive by patient.     A patient may make choices for health care and direct care toward the end of the patient's life in accordance with this section.
 
A.  The patient may sign an end-of-life care document that states that the patient has thoroughly discussed the patient's medical condition and options and choices for care with the patient's physician and that the patient has made the following informed decisions:
 
(1) The decision to reject curative or life-extending care;
 
(2) The decision to accept palliative care; and
 
(3) The decision to accept care that is ordered or delivered by the physician that may hasten or bring about the patient's death.
 
B.  The end-of-life care document must state that the patient is directing the physician to provide care in conformance with the end-of-life care document and the companion physician document and in conformance with the professional and legal obligations of the physician.
 
4.  Commitment by physician.     A physician who signs a physician document in accordance with this subsection may provide care in conformance with the physician document for a patient who has signed an end-of-life care document in accordance with subsection 3.
 
A.  The physician may sign a physician document that states that the physician has thoroughly discussed the patient's medical condition and options and choices for care with the patient and that the patient has made the following informed decisions:
 
(1) The decision to reject curative or life-extending care;
 
(2) The decision to accept palliative care; and
 
(3) The decision to accept care that is ordered or delivered by the physician that may hasten or bring about the patient's death.
 
B.  The physician document must state:
 
(1) That the patient has directed the physician to provide care in conformance with the end-of-life care document and the professional and legal obligations of the physician; and
 
(2) That the physician is committed to provide care as directed by the end-of-life care document.
 
5.  Immunity.     A physician who has signed a physician document in accordance with subsection 4 with regard to a patient who has signed a companion end-of-life care document in accordance with subsection 3 and who provides care in accordance with both documents is not civilly or criminally liable for damages alleged to have been sustained by the patient nor for the death of the patient alleged to have occurred by reason of an act or omission in providing care in accordance with both documents.
 
6.  Professional and licensure obligations.     A physician who has signed a physician document in accordance with subsection 4 with regard to a patient who has signed a companion end-of-life care document in accordance with subsection 3 and who provides care in accordance with both documents is not subject to professional discipline under Title 32, chapters 36 and 48 for providing care to the patient in accordance with both documents.
 
SUMMARY
This bill authorizes a patient who is terminally ill and the patient's physician or the medical director of the patient's hospice care provider to sign companion documents that will guide the provision of health care to the patient and the provision of care at the end of life. The companion documents establish the choices and directives of the patient and the responsibilities of the physician or medical director. This bill shields physicians and medical directors from liability or disciplinary sanctions so that the physicians and medical directors may provide care in conformance with patients' choices and directives.