2000
<PRE>[DOCID: f:h1003enr.txt]
        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.

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 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 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 construction 
and treatment of certain services), no funds appropriated by Congress 
may be used to a
2000
ssist 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 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 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 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 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.--
     
2000
   (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 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 (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 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 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 he
810
alth 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 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.

                               Speaker of the House of Representatives.

                            Vice President of the United States and    
                                               President of the Senate.

0