[105th Congress Public Law 12]
[From the U.S. Government Printing Office]


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[DOCID: f:publ12.105]

  
  
  
  
  
  
Public Law 105-12
105th Congress

                                 An Act


 
 To clarify Federal law with respect to restricting the use of Federal 
  funds in support of assisted suicide. <<NOTE: Apr. 30, 1997 -  [H.R. 
                                1003]>> 

    Be it enacted by the Senate and House of Representatives of the 
United States of America <<NOTE: Assisted Suicide Funding Restriction 
Act of 1997. 42 USC 14401 note.>>  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. <<NOTE: 42 USC 14401.>>  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.

SEC. 3. RESTRICTION <<NOTE: 42 USC 14402.>>  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 individual, 
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.
                    (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 
        paragraph (2).

SEC. 4. RESTRICTION <<NOTE: 42 USC 14403.>>  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 <<NOTE: 42 USC 14404.>>  ON USE OF FEDERAL FUNDS BY 
            ADVOCACY 
            PROGRAMS.

    (a) In General.--Subject to section 3(b) (relating to construction 
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
            (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 
        appropriated 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 
                Individuals Act of 1986.
                    (C) Protection and advocacy systems under the 
                rehabilitation act of 1973.--Section 509 of the 
                Rehabilitation 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 <<NOTE: 42 USC 14405.>>  ON USE OF OTHER FEDERAL 
            FUNDS.

    (a) In General.--Subject to section 3(b) (relating to construction 
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 <<NOTE: 42 USC 14406.>>  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.

SEC. 8. APPLICATION <<NOTE: 42 USC 14407.>>  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:
``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 <<NOTE: 42 USC 238o.>>  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 <<NOTE: 25 USC 1621x.>>  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:

``Sec. 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.--
            (1) State plans regarding developmental disabilities 
        councils.--Section 122(c)(5)(A) of the Developmental 
        Disabilities 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 
        paragraph:
            ``(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--
            (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 <<NOTE: 42 USC 14401 note.>>  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 <<NOTE: 42 USC 14408.>>  TO OTHER LAWS.

    The provisions of this Act supersede other Federal laws (including 
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 <<NOTE: 42 USC 14401 note.>>  DATE.

    (a) In General.-- The provisions of this Act (and the amendments 
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 <<NOTE: 42 USC 295 note.>>  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 prevention.

    (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 conducting 
        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 
                control, psychological support, and community-based 
                support services) to traditional health care delivery 
                systems; or
                    ``(C) to advance biomedical knowledge of pain 
                management.
            ``(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 
                management, 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 
                disability 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 <<NOTE: 42 USC 295 note.>>  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 medicine 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 knowledge and practice 
of pain management, depression identification and treatment, and issues 
related to palliative care and suicide prevention.

    Approved April 30, 1997.

LEGISLATIVE HISTORY--H.R. 1003:
---------------------------------------------------------------------------

HOUSE REPORTS: No. 105-46, Pt. 1 (Comm. on Commerce).
CONGRESSIONAL RECORD, Vol. 143 (1997):
            Apr. 10, considered and passed House.
            Apr. 16, considered and passed Senate.
WEEKLY COMPILATION OF PRESIDENTIAL DOCUMENTS, Vol. 33 (1997):
            Apr. 30, Presidential statement.

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