Senate File 471 H-1271 Amend the Committee amendment, H-1251, to Senate File 471, 1 as amended, passed, and reprinted by the Senate, as follows: 2 1. Page 1, after line 4 by inserting: 3 << DIVISION I 4 RIGHTS AND PROTECTIONS BEGINNING AT FETAL HEARTBEAT DETECTION 5 Section 1. NEW SECTION . 1.19 Rights and protections 6 beginning at fetal heartbeat detection —— construction. 7 1. The sovereign state of Iowa recognizes that life is 8 valued and protected, and each life, from the moment the fetal 9 heartbeat is detected in accordance with section 146A.1, is 10 accorded the same rights and protections, including the right 11 to life, guaranteed to all persons by the Constitution of the 12 United States, the Constitution of the State of Iowa, and the 13 laws of this state. 14 2. This section shall not be construed to create or 15 recognize a right to an abortion, to impose civil or criminal 16 liability on a woman upon whom an abortion is performed, or to 17 prohibit the use of any means of contraception. 18 3. Nothing in this section shall be construed to alter 19 existing provisions of law relating to inheritance, taxation, 20 or in vitro fertilization. 21 DIVISION ___ 22 PREREQUISITES FOR ABORTION 23 Sec. ___. NEW SECTION . 146A.01 Definitions. 24 As used in this chapter, unless the context otherwise 25 requires: 26 1. “Abortion” means the termination of a human pregnancy 27 with the intent other than to produce a live birth or to remove 28 a dead fetus. 29 2. “Fetal heartbeat” means cardiac activity, the steady and 30 repetitive rhythmic contraction of the fetal heart within the 31 gestational sac. 32 3. “Major bodily function” includes but is not limited 33 to functions of the immune system, normal cell growth, and 34 digestive, bowel, bladder, neurological, brain, respiratory, 35 -1- H1251.1915 (3) 87 pf/nh 1/ 13 #1.

circulatory, endocrine, and reproductive functions. 1 4. “Medical emergency” means a situation in which an 2 abortion is performed to preserve the life of the pregnant 3 woman whose life is endangered by a physical disorder, physical 4 illness, or physical injury, including a life-endangering 5 physical condition caused by or arising from the pregnancy, or 6 when continuation of the pregnancy will create a serious risk 7 of substantial and irreversible impairment of a major bodily 8 function of the pregnant woman. 9 5. “Perform” , “performed” , or “performing” , relative to an 10 abortion, means the use of any means, including medical or 11 surgical, to terminate the pregnancy of a woman known to be 12 pregnant with the intent other than to produce a live birth or 13 to remove a dead fetus. 14 6. “Unborn child” means an individual organism of the 15 species homo sapiens from fertilization to live birth. 16 Sec. ___. Section 146A.1, Code 2017, is amended by striking 17 the section and inserting in lieu thereof the following: 18 146A.1 Prerequisites for abortion —— ultrasound —— 19 fetal heartbeat detection testing —— licensee discipline —— 20 interpretation. 21 1. A physician performing an abortion shall obtain written 22 certification from the pregnant woman of all of the following 23 at least seventy-two hours prior to performing an abortion: 24 a. That the woman has undergone an ultrasound imaging of the 25 unborn child that displays the approximate age of the fetus. 26 b. That the woman was given the opportunity to see the 27 unborn child by viewing the ultrasound image of the fetus. 28 c. That the woman was given the option of hearing a 29 description of the unborn child based on the ultrasound image 30 and hearing the heartbeat of the fetus. 31 d. (1) That the woman has been provided information 32 regarding all of the following, based upon the materials 33 developed by the department of public health pursuant to 34 subparagraph (2): 35 -2- H1251.1915 (3) 87 pf/nh 2/ 13

(a) The options relative to a pregnancy, including 1 continuing the pregnancy to term and retaining parental rights 2 following the child’s birth, continuing the pregnancy to 3 term and placing the child for adoption, and terminating the 4 pregnancy. 5 (b) The indicators, contra-indicators, and risk factors 6 including any physical, psychological, or situational factors 7 related to the abortion in light of the woman’s medical history 8 and medical condition. 9 (2) The department of public health shall make available to 10 physicians, upon request, all of the following information: 11 (a) Geographically indexed materials designed to inform the 12 woman about public and private agencies and services available 13 to assist a woman through pregnancy, at the time of childbirth, 14 and while the child is dependent. The materials shall include 15 a comprehensive list of the agencies available, categorized by 16 the type of services offered, and a description of the manner 17 by which the agency may be contacted. 18 (b) Materials that encourage consideration of placement for 19 adoption. The materials shall inform the woman of the benefits 20 of adoption, including the requirements of confidentiality in 21 the adoption process, the importance of adoption to individuals 22 and society, and the state’s interest in promoting adoption by 23 preferring adoption over abortion. 24 (c) Materials that contain objective information describing 25 the methods of abortion procedures commonly used, the medical 26 risks commonly associated with each such procedure, and the 27 possible detrimental physical and psychological effects of 28 abortion. 29 2. A physician shall test, and shall certify in the woman’s 30 medical record the testing of, a pregnant woman as specified 31 in this subsection, to determine if a fetal heartbeat is 32 detectable prior to performing an abortion. 33 a. In testing for a detectable fetal heartbeat, the 34 physician shall perform an abdominal ultrasound, necessary to 35 -3- H1251.1915 (3) 87 pf/nh 3/ 13

detect a fetal heartbeat according to standard medical practice 1 and including the use of medical devices, as determined by 2 standard medical practice and specified by rule of the board 3 of medicine. 4 b. (1) Following the testing of the pregnant woman for 5 a detectable fetal heartbeat, the physician shall inform the 6 pregnant woman, in writing, of all of the following: 7 (a) Whether a fetal heartbeat was detected. 8 (b) If a fetal heartbeat is detected, the statistical 9 probability of bringing the pregnancy to term based on the 10 postfertilization age of the fetus. 11 c. Upon receipt of the written information, the pregnant 12 woman shall sign a form acknowledging that the woman has 13 received the information as required under this subsection, and 14 a copy of the signed acknowledgment shall be included in the 15 woman’s medical record. 16 d. A physician does not violate this subsection if the 17 physician does any of the following: 18 (1) Tests the pregnant woman for a detectable fetal 19 heartbeat utilizing standard medical practice, but the test 20 does not detect a fetal heartbeat. 21 (2) Relies on information provided by a licensed medical 22 professional who performed the test to detect a fetal 23 heartbeat, and the information indicates the test did not 24 detect a fetal heartbeat. 25 3. Compliance with the prerequisites of this section shall 26 not apply to any of the following: 27 a. An abortion performed to save the life of a pregnant 28 woman. 29 b. An abortion performed in a medical emergency. 30 c. The performance of a medical procedure by a physician 31 that in the physician’s reasonable medical judgment is designed 32 to or intended to prevent the death or to preserve the life of 33 the pregnant woman. 34 4. A physician who violates this section is subject to 35 -4- H1251.1915 (3) 87 pf/nh 4/ 13

licensee discipline pursuant to section 148.6. 1 5. This section shall not be construed to impose civil 2 or criminal liability on a woman upon whom an abortion is 3 performed, or to prohibit the sale, use, prescription, or 4 administration of a measure, drug, or chemical designed for 5 contraceptive purposes. 6 6. The board of medicine shall adopt rules pursuant to 7 chapter 17A to administer this section. 8 Sec. ___. CODE EDITOR DIRECTIVE. 9 1. The Code editor is directed to make the following 10 transfers: 11 a. Section 146A.01 to section 146A.1. 12 b. Section 146A.1 to section 146A.2. 13 2. The Code editor shall correct internal references in the 14 Code and in any enacted legislation as necessary due to the 15 enactment and implementation of this section. 16 DIVISION ___ 17 PROHIBITIONS ON ABORTION —— TWENTY WEEKS POSTFERTILIZATION > 18 2. Page 7, by striking lines 3 through 12 and inserting: 19 < DIVISION ___ 20 PROHIBITIONS ON ABORTION —— FETAL HEARTBEAT DETECTED OR TWENTY 21 WEEKS POSTFERTILIZATION 22 Sec. ___. NEW SECTION . 146C.1 Definitions. 23 As used in this chapter, unless the context otherwise 24 requires: 25 1. “Abortion” means the termination of a human pregnancy 26 with the intent other than to produce a live birth or to remove 27 a dead fetus. 28 2. “Attempt to perform an abortion” means an act, or 29 an omission of a statutorily required act, that, under the 30 circumstances as the actor believes them to be, constitutes a 31 substantial step in a course of conduct planned to culminate in 32 the performing of an abortion. 33 3. “Department” means the department of public health. 34 4. “Fertilization” means the fusion of a human spermatozoon 35 -5- H1251.1915 (3) 87 pf/nh 5/ 13 #2.

with a human ovum. 1 5. “Fetal heartbeat” means cardiac activity, the steady and 2 repetitive rhythmic contraction of the fetal heart within the 3 gestational sac. 4 6. “Major bodily function” includes but is not limited 5 to functions of the immune system, normal cell growth, and 6 digestive, bowel, bladder, neurological, brain, respiratory, 7 circulatory, endocrine, and reproductive functions. 8 7. “Medical emergency” means a situation in which an 9 abortion is performed to preserve the life of the pregnant 10 woman whose life is endangered by a physical disorder, physical 11 illness, or physical injury, including a life-endangering 12 physical condition caused by or arising from the pregnancy, or 13 when continuation of the pregnancy will create a serious risk 14 of substantial and irreversible impairment of a major bodily 15 function of the pregnant woman. 16 8. “Medical facility” means any public or private hospital, 17 clinic, center, medical school, medical training institution, 18 health care facility, physician’s office, infirmary, 19 dispensary, ambulatory surgical center, or other institution or 20 location where medical care is provided to any person. 21 9. “Perform” , “performed” , or “performing” , relative to an 22 abortion, means the use of any means, including medical or 23 surgical, to terminate the pregnancy of a woman known to be 24 pregnant with the intent other than to produce a live birth or 25 to remove a dead fetus. 26 10. “Physician” means a person licensed under chapter 148. 27 11. “Postfertilization age” means the age of the unborn 28 child as calculated from fertilization. 29 12. “Probable postfertilization age” means what, in 30 reasonable medical judgment, will with reasonable probability 31 be the postfertilization age of the unborn child at the time 32 the abortion is to be performed. 33 13. “Reasonable medical judgment” means a medical judgment 34 made by a reasonably prudent physician who is knowledgeable 35 -6- H1251.1915 (3) 87 pf/nh 6/ 13

about the case and the treatment possibilities with respect to 1 the medical conditions involved. 2 14. “Unborn child” means an individual organism of the 3 species homo sapiens from fertilization until live birth. 4 Sec. ___. NEW SECTION . 146C.2 Detection of fetal 5 heartbeat and determination of postfertilization age —— abortion 6 prohibited at detection of heartbeat or twenty or more weeks 7 postfertilization age —— exceptions —— reporting requirements —— 8 penalties. 9 1. Except in the case of a medical emergency, in addition 10 to compliance with the prerequisites of chapter 146A, an 11 abortion shall not be performed or be attempted to be performed 12 unless the physician performing the abortion has first made 13 a determination of the probable postfertilization age of the 14 unborn child or relied upon such a determination made by 15 another physician. In making such a determination, a physician 16 shall make such inquiries of the pregnant woman and perform or 17 cause to be performed such medical examinations and tests the 18 physician considers necessary in making a reasonable medical 19 judgment to accurately determine the postfertilization age of 20 the unborn child. 21 2. a. A physician shall not perform or attempt to perform 22 an abortion upon a pregnant woman when a fetal heartbeat is 23 detectable pursuant to section 146A.1 or when it has been 24 determined, by the physician performing the abortion or by 25 another physician upon whose determination that physician 26 relies, that the probable postfertilization age of the unborn 27 child is twenty or more weeks, whichever occurs earlier in 28 the pregnancy, unless, in the physician’s reasonable medical 29 judgment, any of the following applies: 30 (1) The pregnant woman has a condition which the physician 31 deems a medical emergency. 32 (2) The abortion is necessary to preserve the life of an 33 unborn child. 34 b. If an abortion is performed under this subsection, the 35 -7- H1251.1915 (3) 87 pf/nh 7/ 13

physician shall terminate the human pregnancy in the manner 1 which, in the physician’s reasonable medical judgment, provides 2 the best opportunity for an unborn child to survive, unless, in 3 the physician’s reasonable medical judgment, termination of the 4 human pregnancy in that manner would pose a greater risk than 5 any other available method of the death of the pregnant woman 6 or of the substantial and irreversible physical impairment of a 7 major bodily function. A greater risk shall not be deemed to 8 exist if it is based on a claim or diagnosis that the pregnant 9 woman will engage in conduct which would result in the pregnant 10 woman’s death or in substantial and irreversible physical 11 impairment of a major bodily function. 12 3. A physician who performs or attempts to perform an 13 abortion shall report to the department, on a schedule and in 14 accordance with forms and rules adopted by the department, all 15 of the following: 16 a. Whether a fetal heartbeat was detected pursuant to 17 section 146A.1. 18 b. If a fetal heartbeat was detected, the basis of the 19 determination of a medical emergency, or the basis of the 20 determination that the abortion was necessary to preserve the 21 life of an unborn child. 22 c. If a determination of probable postfertilization age of 23 the unborn child was made, the probable postfertilization age 24 determined and the method and basis of the determination. 25 d. If a determination of probable postfertilization age of 26 the unborn child was not made, the basis of the determination 27 that a medical emergency existed. 28 e. If the probable postfertilization age of the unborn 29 child was determined to be twenty or more weeks, the basis of 30 the determination of a medical emergency, or the basis of the 31 determination that the abortion was necessary to preserve the 32 life of an unborn child. 33 f. The method used for the abortion and, in the case of 34 an abortion performed when the probable postfertilization age 35 -8- H1251.1915 (3) 87 pf/nh 8/ 13

was determined to be twenty or more weeks, whether the method 1 of abortion used was one that, in the physician’s reasonable 2 medical judgment, provided the best opportunity for an unborn 3 child to survive or, if such a method was not used, the basis 4 of the determination that termination of the human pregnancy 5 in that manner would pose a greater risk than would any other 6 available method of the death of the pregnant woman or of the 7 substantial and irreversible physical impairment of a major 8 bodily function. 9 4. a. By June 30, annually, the department shall issue a 10 public report providing statistics for the previous calendar 11 year, compiled from the reports for that year submitted in 12 accordance with subsection 3. The department shall ensure that 13 none of the information included in the public reports could 14 reasonably lead to the identification of any woman upon whom an 15 abortion was performed. 16 b. (1) A physician who fails to submit a report by the end 17 of thirty days following the due date shall be subject to a 18 late fee of five hundred dollars for each additional thirty-day 19 period or portion of a thirty-day period the report is overdue. 20 (2) A physician required to report in accordance with 21 subsection 3 who has not submitted a report or who has 22 submitted only an incomplete report more than one year 23 following the due date, may, in an action brought in the 24 manner in which actions are brought to enforce chapter 148, 25 be directed by a court of competent jurisdiction to submit a 26 complete report within a time period stated by court order or 27 be subject to contempt of court. 28 (3) A physician who intentionally or recklessly falsifies 29 a report required under this section is subject to a civil 30 penalty of one hundred dollars. 31 5. Any medical facility in which a physician is authorized 32 to perform an abortion shall implement written medical 33 policies and procedures consistent with the requirements and 34 prohibitions of this chapter. 35 -9- H1251.1915 (3) 87 pf/nh 9/ 13

6. The department shall adopt rules to implement this 1 section. 2 Sec. ___. NEW SECTION . 146C.3 Civil actions and penalties. 3 1. Failure of a physician to comply with any provision of 4 section 146C.2, with the exception of the late filing of a 5 report or failure to submit a complete report in compliance 6 with a court order, is grounds for licensee discipline under 7 chapter 148. 8 2. A woman upon whom an abortion has been performed in 9 violation of this chapter or the biological father may maintain 10 an action against the physician who performed the abortion in 11 intentional or reckless violation of this chapter for actual 12 damages. This subsection shall not be interpreted to apply to 13 a biological father when the pregnancy is the result of rape 14 or incest. 15 3. A woman upon whom an abortion has been attempted in 16 violation of this chapter may maintain an action against the 17 physician who attempted the abortion in intentional or reckless 18 violation of this chapter for actual damages. 19 4. A cause of action for injunctive relief to prevent a 20 physician from performing abortions may be maintained against 21 a physician who has intentionally violated this chapter by 22 the woman upon whom the abortion was performed or attempted, 23 by the spouse of the woman, by a parent or guardian of the 24 woman if the woman is less than eighteen years of age at the 25 time the abortion was performed or attempted, by a current or 26 former licensed health care provider of the woman, by a county 27 attorney with appropriate jurisdiction, or by the attorney 28 general. 29 5. If the plaintiff prevails in an action brought under 30 this section, the plaintiff shall be entitled to an award for 31 reasonable attorney fees. 32 6. If the defendant prevails in an action brought under 33 this section and the court finds that the plaintiff’s suit was 34 frivolous and brought in bad faith, the defendant shall be 35 -10- H1251.1915 (3) 87 pf/nh 10/ 13

entitled to an award for reasonable attorney fees. 1 7. Damages and attorney fees shall not be assessed against 2 the woman upon whom an abortion was performed or attempted 3 except as provided in subsection 6. 4 8. In a civil proceeding or action brought under this 5 chapter, the court shall rule whether the anonymity of any 6 woman upon whom an abortion has been performed or attempted 7 shall be preserved from public disclosure if the woman does not 8 provide consent to such disclosure. The court, upon motion 9 or on its own motion, shall make such a ruling and, upon 10 determining that the woman’s anonymity should be preserved, 11 shall issue orders to the parties, witnesses, and counsel 12 and shall direct the sealing of the record and exclusion of 13 individuals from courtrooms or hearing rooms to the extent 14 necessary to safeguard the woman’s identity from public 15 disclosure. Each such order shall be accompanied by specific 16 written findings explaining why the anonymity of the woman 17 should be preserved from public disclosure, why the order is 18 essential to that end, how the order is narrowly tailored to 19 serve that interest, and why no reasonable less restrictive 20 alternative exists. In the absence of written consent of the 21 woman upon whom an abortion has been performed or attempted, 22 anyone, other than a public official, who brings an action 23 under this section shall do so under a pseudonym. This 24 subsection shall not be construed to conceal the identity 25 of the plaintiff or of witnesses from the defendant or from 26 attorneys for the defendant. 27 9. This chapter shall not be construed to impose civil 28 or criminal liability on a woman upon whom an abortion is 29 performed or attempted. 30 Sec. ___. NEW SECTION . 146C.4 Construction. 31 1. Nothing in this chapter shall be construed as creating or 32 recognizing a right to an abortion. 33 2. Nothing in this chapter shall be construed as determining 34 life to begin when a fetal heartbeat is detectable or at twenty 35 -11- H1251.1915 (3) 87 pf/nh 11/ 13

weeks’ postfertilization. Instead, it is recognized that life 1 begins at fertilization. 2 DIVISION ___ 3 SEVERABILITY —— CONTINGENT IMPLEMENTATION —— EFFECTIVE DATES 4 Sec. ___. SEVERABILITY CLAUSE. If any provision of this Act 5 or its application to a person or circumstance is held invalid, 6 the invalidity does not affect other provisions of applications 7 of this Act which can be given effect without the invalid 8 provision or application, and to this end the provisions of 9 this Act are severable. 10 Sec. ___. CONTINGENT IMPLEMENTATION. The division of 11 this Act enacting chapter 146B, relating to twenty weeks 12 postfertilization relative to the performance of an abortion, 13 shall be implemented only if the implementation of the division 14 of this Act enacting chapter 146C, relating to fetal heartbeat 15 detection or twenty weeks postfertilization relative to the 16 performance of an abortion, is interrupted for any reason. 17 Sec. ___. EFFECTIVE UPON ENACTMENT. This Act, being deemed 18 of immediate importance, takes effect upon enactment. > 19 3. Title page, by striking lines 1 and 2 and inserting 20 < An Act relating to limitations on and prerequisites for 21 an abortion, providing for licensee discipline, providing 22 civil penalties, providing for contingent implementation, and 23 including effective date provisions. >> 24 ______________________________ SALMON of Black Hawk ______________________________ FISHER of Tama -12- H1251.1915 (3) 87 pf/nh 12/ 13 #3.

______________________________ CARLIN of Woodbury ______________________________ HAGER of Allamakee ______________________________ SHEETS of Appanoose ______________________________ HEARTSILL of Marion ______________________________ WHEELER of Sioux ______________________________ GASSMAN of Winnebago ______________________________ HOLT of Crawford ______________________________ WATTS of Dallas -13- H1251.1915 (3) 87 pf/nh 13/ 13