H.F. _____ Section 1. LEGISLATIVE FINDINGS. The general assembly 1 recognizes the importance of encouraging individuals to discuss 2 and make health care decisions before a situation necessitates 3 an actual decision. The general assembly also recognizes 4 that health care planning is a process, rather than a single 5 decision, based upon the individual’s values and personal 6 health status. Advance directives provide the opportunity for 7 an individual to enunciate and document the individual’s wishes 8 and to identify the person authorized to make decisions for 9 the individual if the individual is unable to make decisions. 10 The general assembly recognizes that the physician order for 11 scope of treatment form, modeled after the national physician 12 orders for life-sustaining treatment paradigm initiative, 13 complements advance directives by converting individual wishes 14 contained in advance directives into medical orders that are 15 actionable across medical settings, thereby enhancing the 16 ability of medical providers to understand and honor patients’ 17 wishes. An Iowa physician order for scope of treatment form is 18 intended for individuals who are frail and elderly or who have 19 a chronic, critical medical condition or a terminal illness. 20 Sec. 2. NEW SECTION . 144D.1 Physician orders for scope of 21 treatment. 22 As used in this chapter, unless the context otherwise 23 requires: 24 1. “Advanced registered nurse practitioner” means an advanced 25 registered nurse practitioner licensed pursuant to chapter 152 26 or 152E. 27 2. “Department” means the department of public health. 28 3. “Emergency medical care provider” means emergency medical 29 care provider as defined in section 147A.1. 30 4. “Health care facility” means health care facility as 31 defined in section 135C.1, an elder group home as defined in 32 section 231B.1, and an assisted living program as defined in 33 section 231C.2. 34 5. “Health care provider” means an individual, including 35 -1- LSB 5495YC (2) 84 pf/nh 1/ 8

H.F. _____ an emergency medical care provider and an individual providing 1 home and community-based services, who is licensed, certified, 2 or otherwise authorized or permitted by the law of this state 3 to administer health care in the ordinary course of business or 4 in the practice of a profession. 5 6. “Hospital” means hospital as defined in section 135B.1. 6 7. “Physician” means a person licensed to practice medicine 7 and surgery or osteopathic medicine and surgery in this state. 8 8. “Physician assistant” means a person licensed as a 9 physician assistant under chapter 148C. 10 9. “Physician orders for scope of treatment form” or “POST 11 form” means a document containing medical orders actionable 12 across medical settings that consolidates and summarizes 13 an individual’s preferences for life-sustaining treatments 14 and interventions and acts as a complement to and does not 15 supersede any valid advance directive. 16 Sec. 3. NEW SECTION . 144D.2 Physician orders for scope of 17 treatment (POST) form. 18 1. The POST form shall be a uniform form based upon the 19 national physician orders for life-sustaining treatment 20 paradigm form. The form shall have all of the following 21 characteristics: 22 a. The form shall include the patient’s name and date of 23 birth. 24 b. The form shall be signed by the patient or the patient’s 25 legal representative. 26 c. The form shall be signed by the patient’s physician, 27 advanced registered nurse practitioner, or physician assistant. 28 d. If preparation of the form was facilitated by another 29 individual, the facilitator shall also sign the form. 30 e. The form shall include the patient’s wishes regarding the 31 care of the patient, including but not limited to all of the 32 following: 33 (1) The administration of cardiopulmonary resuscitation. 34 (2) The level of medical interventions in the event of a 35 -2- LSB 5495YC (2) 84 pf/nh 2/ 8

H.F. _____ medical emergency. 1 (3) The use of medically administered nutrition by tube. 2 (4) The rationale for the orders. 3 f. The form shall be easily distinguishable to facilitate 4 recognition by health care providers, hospitals, and health 5 care facilities. 6 g. An incomplete section on the form shall imply the 7 patient’s wishes for full treatment for the type of treatment 8 addressed in that section. 9 2. The department shall post the form on the department’s 10 website for public availability. 11 Sec. 4. NEW SECTION . 144D.3 Compliance with POST form. 12 1. A POST form executed in this state or another state 13 or jurisdiction in compliance with the law of that state or 14 jurisdiction shall be deemed valid and enforceable in this 15 state to the extent the form is consistent with the laws of 16 this state, and may be accepted by a health care provider, 17 hospital, or health care facility. 18 2. A health care provider, hospital, or health care facility 19 may accept and shall comply with an accepted POST form, 20 notwithstanding that the physician, advanced registered nurse 21 practitioner, or physician assistant who signed the POST form 22 does not have admitting privileges at the hospital or health 23 care facility providing health care or treatment. 24 3. In the absence of actual notice of the revocation of 25 a POST form, a health care provider, hospital, health care 26 facility, or any other person who complies with a POST form 27 shall not be subject to civil or criminal liability for 28 actions taken under this chapter which are in accordance 29 with reasonable medical standards. A health care provider, 30 hospital, health care facility, or other person against whom 31 criminal or civil liability is asserted because of conduct in 32 compliance with this chapter may interpose the restriction on 33 liability in this paragraph as an absolute defense. 34 4. A health care provider, hospital, or health care facility 35 -3- LSB 5495YC (2) 84 pf/nh 3/ 8

H.F. _____ that is unwilling to comply with an executed POST form shall 1 take all reasonable steps to transfer the patient to another 2 health care provider, hospital, or health care facility. 3 Sec. 5. NEW SECTION . 144D.4 General provisions. 4 1. If an individual is a qualified patient as defined in 5 section 144A.2, the individual’s declaration executed under 6 chapter 144A shall control health care decision making for the 7 individual in accordance with chapter 144A. If an individual 8 has not executed a declaration pursuant to chapter 144A, health 9 care decision making relating to life-sustaining procedures for 10 the individual shall be governed by section 144A.7. A POST 11 form shall not supersede a declaration executed pursuant to 12 chapter 144A. 13 2. If an individual has executed a durable power of attorney 14 for health care pursuant to chapter 144B, the individual’s 15 durable power of attorney for health care shall control health 16 care decision making for the individual in accordance with 17 chapter 144B. A POST form shall not supersede a durable power 18 of attorney for health care executed pursuant to chapter 144B. 19 3. Death resulting from the withholding or withdrawal of 20 life-sustaining procedures pursuant to an executed POST form 21 and in accordance with this chapter does not, for any purpose, 22 constitute a suicide, homicide, or dependent adult abuse. 23 4. The executing of a POST form does not affect in any 24 manner the sale, procurement, or issuance of any policy of 25 life insurance, nor shall it be deemed to modify the terms 26 of an existing policy of life insurance. A policy of life 27 insurance is not legally impaired or invalidated in any manner 28 by the withholding or withdrawal of life-sustaining procedures 29 pursuant to this chapter notwithstanding any term of the policy 30 to the contrary. 31 5. A health care provider, hospital, health care facility, 32 health care service plan, insurer issuing disability insurance, 33 self-insured employee welfare benefit plan, or nonprofit 34 hospital plan shall not require any person to execute a POST 35 -4- LSB 5495YC (2) 84 pf/nh 4/ 8

H.F. _____ form as a condition of being insured for, or receiving, health 1 care services. 2 6. This chapter does not create a presumption concerning 3 the intention of an individual who has not executed a POST 4 form with respect to the use, withholding, or withdrawal 5 of life-sustaining procedures in the event of a terminal 6 condition. 7 7. This chapter shall not be interpreted to affect the right 8 of a patient to make decisions regarding use of life-sustaining 9 procedures as long as the patient is able to do so, nor to 10 impair or supersede any right or responsibility that any person 11 has to effect the withholding or withdrawal of medical care in 12 any lawful manner. In that respect, the provisions of this 13 chapter are cumulative. 14 8. This chapter shall not be construed to condone, 15 authorize, or approve mercy killing or euthanasia, or to permit 16 any affirmative or deliberate act or omission to end life other 17 than to permit the natural process of dying. 18 EXPLANATION 19 This bill provides for the use of physician orders for scope 20 of treatment (POST). 21 The bill provides legislative findings that provide that 22 the general assembly recognizes the importance of encouraging 23 individuals to discuss and make health care decisions before an 24 actual decision is necessary; that health care planning is a 25 process based upon the individual’s values and personal health 26 status; and that advance directives provide the opportunity 27 for an individual to enunciate and document their wishes and 28 to identify the person authorized to make decisions for the 29 individual. The general assembly also recognizes that the 30 POST form, modeled after the national physician orders for 31 life-sustaining treatment paradigm initiative, complements 32 advance directives by converting individual wishes contained 33 in advance directives into medical orders that are actionable 34 across medical settings, thereby enhancing the ability of 35 -5- LSB 5495YC (2) 84 pf/nh 5/ 8

H.F. _____ medical providers to understand and honor patients’ wishes. 1 The POST form is intended for individuals who are frail and 2 elderly or who have a chronic, critical medical condition or a 3 terminal illness. 4 The bill provides definitions used in the chapter, including 5 the physician order for scope of treatment POST form, which 6 means a document containing medical orders actionable 7 across medical settings that consolidates and summarizes 8 an individual’s preferences for life-sustaining treatments 9 and interventions and acts as a complement to but does not 10 supersede any valid advance directive. 11 The bill specifies the content of the POST form and that 12 the department of public health is to post the form on the 13 department’s website for public availability. 14 The bill specifies compliance requirements for the POST 15 form. A POST form executed in this state or another state 16 or jurisdiction in compliance with the law of the applicable 17 state or jurisdiction shall be deemed valid and enforceable in 18 this state to the extent the form is consistent with the laws 19 of this state, and may be accepted by a health care provider, 20 hospital, or health care facility. A health care provider, 21 hospital, or health care facility may accept and shall comply 22 with an accepted POST form, even if the physician, advanced 23 registered nurse practitioner, or physician assistant who 24 signed the POST form does not have admitting privileges at 25 the hospital or health care facility providing health care or 26 treatment. The bill provides an absolute defense to civil or 27 criminal liability for a health care provider, hospital, health 28 care facility, or any other person who complies with a POST 29 form if the actions are in accordance with reasonable medical 30 standards. The bill requires a health care provider, hospital, 31 or health care facility that is unwilling to comply with an 32 executed POST form to take all reasonable steps to transfer the 33 patient to another health care provider, hospital, or health 34 care facility. 35 -6- LSB 5495YC (2) 84 pf/nh 6/ 8

H.F. _____ The bill provides for the relation of an executed POST form 1 to a declaration under the life-sustaining procedures Act and a 2 durable power of attorney for health care. In both cases, the 3 declaration and the durable power of attorney control health 4 care decision making and the POST form does not supersede them. 5 The bill provides that death resulting from the withholding 6 or withdrawal of life-sustaining procedures pursuant to an 7 executed POST form and in accordance with the bill does not 8 constitute a suicide, homicide, or dependent adult abuse and 9 that executing a POST form does not affect in any manner 10 the sale, procurement, or issuance of any policy of life 11 insurance; modify the terms of an existing policy of life 12 insurance; or legally impair or invalidate the policy. The 13 bill prohibits the execution of a POST form as a condition for 14 being insured or receiving health care services and provides 15 that not executing a POST form does not create a presumption 16 concerning the intention of an individual with respect to the 17 use, withholding, or withdrawal of life-sustaining procedures 18 in the event of a terminal condition. 19 The bill is not to be interpreted to affect the right of 20 a patient to make decisions regarding use of life-sustaining 21 procedures as long as the patient is able to do so, nor to 22 impair or supersede any right or responsibility that any person 23 has to effect the withholding or withdrawal of medical care in 24 any lawful manner. The bill is not to be construed to condone, 25 authorize, or approve mercy killing or euthanasia, or to permit 26 any affirmative or deliberate act or omission to end life other 27 than to permit the natural process of dying. 28 The general assembly in 2008 Iowa Acts, chapter 1188, 29 section 36, established a two-year pilot project in Linn county 30 and in 2010 Iowa Acts, chapter 1192, section 58, expanded 31 the pilot project to Jones county and extended the duration 32 until June 30, 2012, to pilot the use of the POST form. The 33 legislation also directed the department to convene an advisory 34 council for the pilot project and directed the advisory council 35 -7- LSB 5495YC (2) 84 pf/nh 7/ 8