Senate File 2156 - Introduced SENATE FILE 2156 BY BOLKCOM , T. TAYLOR , R. TAYLOR , DOTZLER , WAHLS , and CELSI A BILL FOR An Act creating the our care, our options Act, and providing 1 penalties. 2 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 3 TLSB 5355XS (17) 88 pf/rh

S.F. 2156 Section 1. NEW SECTION . 142E.1 Findings. 1 1. The state of Iowa has long recognized that mentally 2 capable adults have a fundamental right to determine their own 3 medical treatment options in accordance with their own values, 4 beliefs, and personal preferences. 5 2. The state of Iowa wants to uphold both the highest 6 standard of medical care and the full range of options for each 7 individual, particularly at the end of life. 8 3. Terminally ill individuals may undergo unremitting 9 pain, agonizing discomfort, and a sudden, continuing, and 10 irreversible reduction in their quality of life at the end of 11 life. 12 4. The availability of medical aid in dying provides 13 an additional palliative care option for terminally ill 14 individuals who seek to retain their autonomy and some level of 15 control over the progression of the illness as they near the 16 end of life or to ease unnecessary pain and suffering. 17 5. Integration of medical aid in dying into standard 18 end-of-life care has demonstrably improved the quality of 19 services delivered to terminally ill individuals by enhancing 20 palliative care training of providers, prompting development 21 and enhancement of palliative care service delivery systems, 22 and promoting more in-depth conversations between providers 23 and terminally ill individuals about the full range of care 24 options leading to more appropriate end-of-life care planning, 25 including increased hospice use. 26 6. The state of Iowa affirms that an attending provider 27 who respects and honors a terminally ill patient’s values 28 and priorities for that terminally ill patient’s last days 29 of life and prescribes or dispenses medication for any such 30 qualified patient pursuant to this chapter is practicing lawful 31 patient-directed care. 32 Sec. 2. NEW SECTION . 142E.2 Short title. 33 This chapter shall be known and may be cited as the “Iowa Our 34 Care, Our Options Act” . 35 -1- LSB 5355XS (17) 88 pf/rh 1/ 24

S.F. 2156 Sec. 3. NEW SECTION . 142E.3 Definitions. 1 As used in this chapter, unless the context otherwise 2 requires: 3 1. “Adult” means an individual eighteen years of age or 4 older. 5 2. “Attending provider” means a health care provider 6 who a patient determines has primary responsibility for the 7 patient’s health care and treatment of the patient’s terminal 8 illness, and who provides medical care to a patient with a 9 terminal illness in the normal course of the provider’s medical 10 practice. 11 3. “Coercion or undue influence” means the willful attempt, 12 whether by deception, intimidation, or any other means, to 13 cause a terminally ill patient to request, or a qualified 14 patient to obtain or self-administer, medication pursuant 15 to this chapter with the intent to cause the death of the 16 terminally ill patient or qualified patient, or to prevent a 17 terminally ill patient from requesting, or a qualified patient 18 from obtaining or self-administering, medication pursuant to 19 this chapter against the wishes of the terminally ill patient 20 or qualified patient. 21 4. “Consulting provider” means a health care provider who 22 is qualified by specialty or experience to make a professional 23 diagnosis and prognosis regarding a patient’s terminal illness. 24 5. “Department” means the department of public health. 25 6. “Health care facility” means a hospital licensed pursuant 26 to chapter 135B, a nursing facility licensed pursuant to 27 chapter 135C, an inpatient hospice program as defined in 28 section 135J.1, an elder group home as defined in section 29 231B.1, or an assisted living program as defined in section 30 231C.2, but does not include the location of an individual 31 health care provider. 32 7. “Health care provider” means a person who is licensed, 33 certified, or otherwise authorized or permitted by the laws 34 of this state to administer health care, diagnose and treat 35 -2- LSB 5355XS (17) 88 pf/rh 2/ 24

S.F. 2156 medical conditions, and prescribe and dispense medications, 1 including controlled substances. “Health care provider” does 2 not include a health care facility. 3 8. “Informed decision” means a voluntary, affirmative 4 decision by a terminally ill patient to request and obtain a 5 prescription for medication pursuant to this chapter that the 6 terminally ill patient may self-administer to bring about a 7 peaceful death, after being fully informed by the attending 8 provider of all of the following: 9 a. The patient’s medical diagnosis. 10 b. The patient’s prognosis. 11 c. The feasible end-of-life care and treatment options for 12 the patient’s terminal illness, including but not limited to 13 comfort care, palliative care, hospice care, and pain control, 14 and the risks and benefits of each option. 15 d. The patient’s right to withdraw consent at any time, 16 and that the patient is not under any obligation to continue a 17 previously chosen end-of-life care option or treatment. 18 9. “Licensed mental health provider” means a psychiatrist 19 licensed pursuant to chapter 148, a psychologist licensed 20 pursuant to chapter 154B, or a licensed independent social 21 worker licensed pursuant to chapter 154C. 22 10. “Medical aid in dying” means the medical practice 23 authorized under this chapter and established standards 24 of medical care to determine a terminally ill patient’s 25 qualifications, evaluate a terminally ill patient’s request 26 for medication, and provide a terminally ill patient with 27 a prescription for medication or dispense the prescribed 28 medication to bring about the terminally ill patient’s peaceful 29 death. 30 11. “Medical confirmation” means the medical opinion of the 31 attending provider has been confirmed by a consulting provider 32 who has examined the patient and the patient’s relevant medical 33 records. 34 12. “Mentally capable” means that in the opinion of the 35 -3- LSB 5355XS (17) 88 pf/rh 3/ 24

S.F. 2156 attending provider, a consulting provider, and a licensed 1 mental health care provider, as applicable, the patient 2 requesting medical aid in dying has the ability to make and 3 communicate an informed decision. 4 13. “Patient” means an adult who is under the care of a 5 health care provider. 6 14. “Patient-directed care” means patient-centered care that 7 is not only respectful of and responsive to individual patient 8 preferences, needs, and values, but also ensures that patient 9 values guide all clinical decisions and that patients are fully 10 informed of and able to access all legal end-of-life options. 11 15. “Prognosis of six months or less” with reference to 12 a terminal illness means the terminal illness will, within 13 reasonable medical judgment, result in a patient’s death within 14 six months. 15 16. “Qualified patient” means a mentally capable, terminally 16 ill patient, who is a resident of Iowa and has satisfied 17 the requirements of this chapter in order to obtain and 18 self-administer a prescription for medication to bring about 19 the terminally ill patient’s peaceful death. 20 17. “Self-administer” or “self-administration” means a 21 qualified patient’s affirmative, conscious, voluntary act to 22 ingest medication prescribed pursuant to this chapter to bring 23 about the patient’s own peaceful death. “Self-administration” 24 does not include administration of medication via injection or 25 intravenous infusion. 26 18. “Terminal illness” or “terminally ill” means an 27 incurable illness with a prognosis of six months or less. 28 19. “Terminally ill patient” means a patient who has been 29 certified by a health care provider to be terminally ill. 30 Sec. 4. NEW SECTION . 142E.4 Process for requesting 31 medication for medical aid in dying. 32 1. A patient who is mentally capable, is a resident of this 33 state, and has been certified by a health care provider to be 34 terminally ill, may request medication that the patient may 35 -4- LSB 5355XS (17) 88 pf/rh 4/ 24

S.F. 2156 self-administer to end the patient’s life as follows: 1 a. By making two oral requests to the terminally 2 ill patient’s attending provider separated by a 3 fifteen-calendar-day waiting period, beginning from the 4 day the first request is made. 5 b. By providing one written request to the terminally ill 6 patient’s attending provider. 7 2. A written request made under this section shall be in 8 substantially the form described in section 142E.5, shall be 9 signed and dated, or attested to, by the terminally ill patient 10 requesting medical aid in dying, and shall be signed and dated, 11 or attested to, by one witness. 12 3. Oral and written requests made under this section must be 13 made by the terminally ill patient and shall not be made by any 14 other individual including the terminally ill patient’s agent 15 under a power of attorney executed pursuant to chapter 633B, an 16 attorney in fact under a durable power of attorney for health 17 care pursuant to chapter 144B, or via a health care declaration 18 relating to use of life-sustaining procedures pursuant to 19 chapter 144A. 20 4. A patient shall not qualify to make a request under this 21 section solely based on age or disability. 22 5. Notwithstanding subsection 1, if a terminally ill 23 patient’s attending provider attests that the terminally ill 24 patient will, within reasonable medical judgment, die within 25 fifteen days after the terminally ill patient’s initial oral 26 request is made under this section, the terminally ill patient 27 may reiterate the oral request to the attending provider at any 28 time after making the initial oral request and the fifteen-day 29 waiting period shall be waived. 30 Sec. 5. NEW SECTION . 142E.5 Form of written request —— 31 requirements. 32 1. A written request for medication that a terminally ill 33 patient may self-administer to end the terminally ill patient’s 34 life as authorized by this chapter shall be in substantially 35 -5- LSB 5355XS (17) 88 pf/rh 5/ 24

S.F. 2156 the following form: 1 Request for Medication 2 to End My Life in 3 a Peaceful Manner 4 I, ___________________________________ am an adult of sound 5 mind. I have been diagnosed with 6 _______________________________________________, and given a 7 prognosis of six months or less to live. 8 I have been fully informed of the feasible alternatives, 9 and the concurrent or additional treatment opportunities for 10 my terminal illness, including but not limited to comfort 11 care, palliative care, hospice care, and pain control, and the 12 potential risks and benefits of each. I have been offered or 13 received resources or referrals to pursue these alternative 14 and concurrent or additional treatment opportunities for my 15 terminal illness. 16 I have been fully informed of the nature of the medication to 17 be prescribed, the risks and benefits, and the probable result 18 of self-administering the medication, should I decide to do 19 so. I understand that I can rescind this request at any time, 20 and that I am under no obligation to fill the prescription once 21 provided nor to self-administer the medication if I obtain the 22 medication. 23 I request that my attending provider furnish a prescription 24 for medication that will end my life in a peaceful manner if 25 I choose to self-administer it, and I authorize my attending 26 provider to contact a pharmacist to dispense the prescription 27 at a time of my choosing. 28 I make this request voluntarily, free from coercion and 29 undue influence, and I accept full responsibility for my 30 actions. 31 ________________________________________ _____________ 32 Requestor Signature Date 33 ________________________________________ _____________ 34 Witness Signature Date 35 -6- LSB 5355XS (17) 88 pf/rh 6/ 24

S.F. 2156 2. A witness shall not be any of the following: 1 a. A relative of the terminally ill patient by blood, 2 marriage, or adoption. 3 b. A person who at the time the request is signed would 4 be entitled to any portion of the estate of the terminally 5 ill patient upon death under any will, trust, or other legal 6 instrument, or by operation of law. 7 Sec. 6. NEW SECTION . 142E.6 Attending provider duties. 8 1. An attending provider shall do all of the following: 9 a. Provide care that conforms to accepted medical standards. 10 b. After confirming that a patient is terminally ill, 11 determine whether the patient requesting medical aid in dying 12 meets all of the following criteria: 13 (1) Is mentally capable. 14 (2) Has made the request for medication voluntarily and free 15 from coercion or undue influence. 16 (3) Is a resident of the state. 17 c. In confirming that the terminally ill patient’s request 18 does not arise from coercion or undue influence by another 19 person, discuss with the terminally ill patient, outside the 20 presence of other persons with the exception of an interpreter 21 if necessary, whether the terminally ill patient feels coerced 22 or unduly influenced by another person. 23 d. Thoroughly educate the terminally ill patient about all 24 of the following: 25 (1) The feasible alternatives and concurrent or additional 26 treatment opportunities for the patient’s terminal illness, 27 including but not limited to comfort care, palliative care, 28 hospice care, or pain control, and the potential risks and 29 benefits of each. 30 (2) The potential risks, benefits, and probable result of 31 self-administering the medication to be prescribed to bring 32 about a peaceful death. 33 (3) The choices available to the terminally ill patient 34 that reflect the terminally ill patient’s self-determination, 35 -7- LSB 5355XS (17) 88 pf/rh 7/ 24

S.F. 2156 including that the terminally ill patient is under no 1 obligation to fill the prescription once provided nor to 2 self-administer the medication if the medication is obtained. 3 (4) The terminally ill patient’s right to rescind the 4 request for medication pursuant to this chapter at any time and 5 in any manner. 6 (5) The benefits of notifying family of the terminally 7 ill patient’s decision to request medication pursuant to this 8 chapter as an end-of-life care option. 9 (6) With regard to a terminally ill patient’s 10 self-administration of the medication: 11 (a) The recommended methods for self-administering the 12 medication to be prescribed. 13 (b) The safekeeping and proper disposal of any unused 14 medication in accordance with federal and state law. 15 (c) The importance of having another individual present 16 when the terminally ill patient self-administers the medication 17 to be prescribed. 18 (d) The importance of not taking the medication in a public 19 place. 20 e. Provide the terminally ill patient with a referral for 21 comfort care, palliative care, hospice care, pain control, or 22 other end-of-life treatment opportunities as requested or as 23 clinically indicated. 24 f. (1) Refer the terminally ill patient to a consulting 25 provider for medical confirmation that the patient requesting 26 medication pursuant to this chapter is eligible. 27 (2) The attending provider shall add the medical 28 confirmation provided under subparagraph (1) to the terminally 29 ill patient’s medical record. 30 g. Refer the terminally ill patient to a licensed mental 31 health provider for evaluation in accordance with section 32 142E.8 if the attending provider observes signs that the 33 terminally ill patient may not be mentally capable of making 34 an informed decision, and add the licensed mental health 35 -8- LSB 5355XS (17) 88 pf/rh 8/ 24

S.F. 2156 provider’s written determination to the terminally ill 1 patient’s medical record. 2 h. Ensure that all appropriate steps are carried out in 3 accordance with this chapter before providing a prescription 4 for medication pursuant to this chapter to a terminally ill 5 patient. 6 i. Once the terminally ill patient is determined to be a 7 qualified patient, do either of the following: 8 (1) Deliver the prescription for the requested medication 9 personally, by mail, or through an authorized electronic 10 transmission to a licensed pharmacist who will dispense 11 the medication, including ancillary medications intended 12 to minimize the qualified patient’s discomfort, to the 13 attending provider, to the qualified patient, or to a person 14 expressly designated by the qualified patient, in person or 15 with a signature required on delivery, by mail service, or by 16 messenger service. 17 (2) Dispense the prescribed requested medication, including 18 ancillary medications intended to minimize the qualified 19 patient’s discomfort, to the qualified patient or to a person 20 expressly designated by the qualified patient in person, 21 if the attending provider has a current drug enforcement 22 administration number if required under chapter 124. 23 j. Document in the qualified patient’s medical record the 24 qualified patient’s diagnosis and prognosis, determination of 25 mental capability, the dates of the qualified patient’s oral 26 requests, a copy of the written request, and a notation that 27 all the requirements under this chapter have been completed 28 including a description of the medication and ancillary 29 medications prescribed to the qualified patient pursuant to 30 this chapter. 31 Sec. 7. NEW SECTION . 142E.7 Consulting provider duties. 32 1. A terminally ill patient requesting medical aid in dying 33 under this chapter shall receive medical confirmation from a 34 consulting provider prior to being deemed a qualified patient. 35 -9- LSB 5355XS (17) 88 pf/rh 9/ 24

S.F. 2156 2. A consulting provider shall do all of the following: 1 a. Evaluate the terminally ill patient and the terminally 2 ill patient’s relevant medical records. 3 b. Confirm, in writing, all of the following to the 4 attending provider: 5 (1) That the patient has a terminal illness. 6 (2) That the terminally ill patient has made the request 7 for medical aid in dying voluntarily and free from coercion or 8 undue influence. 9 (3) That the terminally ill patient is mentally capable, or 10 provide documentation that the consulting provider has referred 11 the terminally ill patient to a licensed mental health provider 12 for further evaluation in accordance with section 142E.8. 13 Sec. 8. NEW SECTION . 142E.8 Confirmation —— determination 14 of mental capability —— referral to licensed mental health 15 provider. 16 1. If either the attending provider or the consulting 17 provider is unable to confirm that the terminally ill patient 18 requesting medication for medical aid in dying under this 19 chapter is mentally capable, the attending provider or 20 consulting provider shall refer the terminally ill patient to a 21 licensed mental health provider for a determination of mental 22 capability. 23 2. A licensed mental health provider who evaluates a 24 terminally ill patient under this section shall communicate in 25 writing to the attending provider or consulting provider who 26 requested the evaluation the licensed mental health provider’s 27 conclusions about whether the terminally ill patient is 28 mentally capable. 29 3. If the licensed mental health provider determines 30 that the terminally ill patient is not currently mentally 31 capable, the licensed mental health provider shall not deem the 32 terminally ill patient to be mentally capable and the attending 33 provider shall not determine the terminally ill patient to be a 34 qualified patient and prescribe medication to the terminally 35 -10- LSB 5355XS (17) 88 pf/rh 10/ 24

S.F. 2156 ill patient under this chapter. 1 Sec. 9. NEW SECTION . 142E.9 Reporting requirements. 2 1. The department shall create and make available to all 3 attending providers a prescribing provider checklist form 4 and prescribing provider follow-up form for the purposes of 5 reporting the information as specified under this section to 6 the department. 7 2. Within thirty calendar days of providing a prescription 8 to a qualified patient for medication pursuant to this chapter, 9 the attending provider shall submit to the department a 10 completed prescribing provider checklist form with all of the 11 following information regarding a qualified patient: 12 a. The qualified patient’s name and date of birth. 13 b. The qualified patient’s terminal diagnosis and prognosis. 14 c. A notation that all the requirements under this chapter 15 have been completed. 16 d. A notation that medication has been prescribed pursuant 17 to this chapter. 18 3. Within sixty calendar days of notification of a qualified 19 patient’s death from self-administration of medication 20 prescribed pursuant to this chapter, the attending provider 21 shall submit to the department a completed prescribing provider 22 follow-up form with all of the following information: 23 a. The qualified patient’s name, date of birth, age at 24 death, education level, race, sex, type of insurance, if any, 25 and underlying illness. 26 b. The date of the qualified patient’s death. 27 c. A notation of whether or not the qualified patient was 28 enrolled in and receiving hospice services at the time of the 29 qualified patient’s death. 30 4. The department shall annually review a sample of records 31 maintained pursuant to this section to ensure compliance 32 and shall generate and make available to the public a 33 statistical report of nonidentifying information collected. 34 The statistical report shall be limited to the following 35 -11- LSB 5355XS (17) 88 pf/rh 11/ 24

S.F. 2156 information: 1 a. The number of prescriptions for medication written 2 pursuant to this chapter. 3 b. The number of attending providers who wrote prescriptions 4 for medication pursuant to this chapter. 5 c. The number of qualified patients who died following 6 self-administration of medication prescribed and dispensed 7 pursuant to this chapter. 8 5. Except as otherwise required by law, the information 9 collected by the department shall not be a public record and 10 shall not be made available for public inspection. 11 Sec. 10. NEW SECTION . 142E.10 Safe disposal of unused 12 medications. 13 A person who has custody or control of medication prescribed 14 and dispensed pursuant to this chapter that remains unused 15 after a qualified patient’s death shall dispose of the 16 medication by lawful means in accordance with state and federal 17 guidelines. 18 Sec. 11. NEW SECTION . 142E.11 Use of interpreters. 19 1. An interpreter whose services are provided to a patient 20 requesting information or services under this chapter shall 21 meet the standards promulgated by the Iowa interpreters and 22 translators association or the national board of certification 23 for medical interpreters, or other standard deemed acceptable 24 by the department. 25 2. An interpreter providing services pursuant to this 26 chapter shall not be related to a qualified patient by blood, 27 marriage, or adoption, or be entitled to a portion of the 28 qualified patient’s estate by will, trust, or other legal 29 instrument, or by operation of law upon the qualified patient’s 30 death. 31 Sec. 12. NEW SECTION . 142E.12 Effect on construction of 32 wills, contracts, and statutes. 33 1. A provision in a contract, will, or other agreement, 34 whether written or oral, to the extent the provision would 35 -12- LSB 5355XS (17) 88 pf/rh 12/ 24

S.F. 2156 affect whether a patient may make or rescind a request for 1 medication pursuant to this chapter, shall not be valid. 2 2. An obligation owing under any currently existing 3 contract shall not be conditioned or affected by the making or 4 rescinding of a request by a patient for medication pursuant to 5 this chapter. 6 Sec. 13. NEW SECTION . 142E.13 Insurance or annuity 7 policies. 8 1. The sale, procurement, or issuance of a life, health, 9 or accident insurance or annuity policy, or the rate charged 10 for any such policy shall not be conditioned upon or affected 11 by the making or rescinding of a request by a patient for 12 medication pursuant to this chapter. 13 2. A qualified patient’s act of self-administering 14 medication pursuant to this chapter shall not have an effect on 15 or invalidate any part of a life, health, or accident insurance 16 or annuity policy. 17 3. A terminally ill patient who is a covered beneficiary 18 of a health insurance policy shall not be subject to denial 19 or alteration of such benefits based on the availability of 20 medical aid in dying or the patient’s request or absence of a 21 request for medication pursuant to this chapter. 22 4. A terminally ill patient who is a recipient of Medicaid 23 coverage shall not be subject to denial or alteration of such 24 benefits based on the availability of medical aid in dying or 25 the patient’s request or absence of request for medication 26 pursuant to this chapter. 27 Sec. 14. NEW SECTION . 142E.14 Death certificate. 28 1. Unless otherwise prohibited by law, the attending 29 provider or the hospice medical director shall sign the 30 death certificate of a qualified patient who obtained and 31 self-administered a prescription for medication pursuant to 32 this chapter. 33 2. When a death has occurred in accordance with this 34 chapter: 35 -13- LSB 5355XS (17) 88 pf/rh 13/ 24

S.F. 2156 a. The manner of death of the qualified patient on a death 1 certificate shall not be listed as suicide or homicide. 2 b. The cause of death of a qualified patient on a death 3 certificate shall be listed as the qualified patient’s 4 underlying terminal illness. 5 c. The qualified patient’s act of self-administering 6 medication prescribed pursuant to this chapter shall not be 7 indicated on the death certificate. 8 3. A death that occurs in accordance with this chapter does 9 not alone constitute a person’s death that affects the public 10 interest as described pursuant to section 331.802. 11 a. If a death that occurs in accordance with this chapter 12 is referred to the state medical examiner or a county medical 13 examiner, a preliminary investigation may be conducted to 14 determine whether the person received a prescription for 15 medication under this chapter. 16 b. Any inquiry or investigation conducted by the state 17 medical examiner or a county medical examiner relating to 18 deaths that occur pursuant to this chapter shall not require 19 the state medical examiner or a county medical examiner to 20 sign the death certificate if the state medical examiner or a 21 county medical examiner identifies the attending provider that 22 prescribed the qualified patient medication pursuant to this 23 chapter. 24 Sec. 15. NEW SECTION . 142E.15 Construction of chapter. 25 1. Nothing in this chapter shall be interpreted to lessen 26 the applicable standard of care, including the standard of care 27 for the treatment of terminally ill patients and medical aid in 28 dying, for an attending provider, consulting provider, licensed 29 mental health provider, or any other health care provider 30 acting under this chapter. 31 2. Nothing in this chapter shall be construed to limit the 32 information or counseling a health care provider must provide 33 to a patient in order to comply with informed consent laws and 34 requirements to meet a medical standard of care. 35 -14- LSB 5355XS (17) 88 pf/rh 14/ 24

S.F. 2156 3. Nothing in this chapter shall be construed to authorize a 1 health care provider or any other person to end an individual’s 2 life by infusion, intravenous injection, mercy killing, or 3 euthanasia. Actions taken in accordance and compliance with 4 this chapter shall not, for any purposes, constitute suicide, 5 assisted suicide, euthanasia, mercy killing, homicide, or elder 6 abuse under the law. 7 4. A request by a patient for and the provision of 8 medication pursuant to this chapter do not solely constitute 9 neglect or elder abuse for any purpose of law, or provide the 10 sole basis for the appointment of a guardian or conservator. 11 Sec. 16. NEW SECTION . 142E.16 No duty to provide medical 12 aid in dying. 13 1. A health care provider shall provide sufficient 14 information to a terminally ill patient regarding available 15 options, alternatives, and the foreseeable risks and benefits 16 of each option or alternative, so that the patient is able 17 to make a fully informed, voluntary, affirmative decision 18 regarding the patient’s end-of-life health care. 19 2. A health care provider may choose whether or not to 20 practice medical aid in dying pursuant to this chapter and 21 shall not be under any duty, whether by contract, statute, or 22 any other legal requirement, to participate in the practice of 23 medical aid in dying or to provide a qualified patient with 24 medication pursuant to this chapter. 25 3. If an attending provider is unable or unwilling to 26 determine a terminally ill patient’s qualification for medical 27 aid in dying, evaluate a terminally ill patient’s request for 28 medication, or provide a qualified patient with a prescription 29 for medication or dispense prescribed medication to a qualified 30 patient pursuant to this chapter, the attending provider shall 31 do all of the following: 32 a. Accurately document the terminally ill patient’s request 33 in the terminally ill patient’s medical record. 34 b. Make reasonable efforts to accommodate the terminally 35 -15- LSB 5355XS (17) 88 pf/rh 15/ 24

S.F. 2156 ill patient’s request including by transferring the care and 1 medical records of the terminally ill patient to another 2 attending provider upon the terminally ill patient’s request 3 so that the terminally ill patient is able to make a voluntary 4 affirmative decision regarding the terminally ill patient’s 5 end-of-life health care. 6 4. Failure to inform a terminally ill patient who requests 7 information about available end-of-life options including 8 medical aid in dying, or failure to refer the terminally ill 9 patient to another attending provider who can provide the 10 information, is considered a failure to obtain informed consent 11 for subsequent medical treatments. 12 5. An attending provider shall not engage in false, 13 misleading, or deceptive practices relating to the attending 14 provider’s willingness to determine the qualification of a 15 terminally ill patient for medical aid in dying, to evaluate 16 a terminally ill patient’s request for medication, or to 17 provide a prescription for medication to a qualified patient 18 or dispense a prescribed medication to a qualified patient 19 pursuant to this chapter. 20 Sec. 17. NEW SECTION . 142E.17 Health care facility —— 21 permissible prohibitions and duties. 22 1. A health care facility that has adopted a policy 23 prohibiting health care providers in the course of performing 24 duties for the health care facility from determining the 25 qualification of a terminally ill patient for medical aid 26 in dying, evaluating a terminally ill patient’s request 27 for medication, or providing a qualified patient with a 28 prescription for medication or dispensing prescribed medication 29 to a qualified patient, shall provide advance notice in 30 writing to the health care facility’s patients and health care 31 providers that the health care facility is a nonparticipating 32 health care facility under this chapter. 33 2. A nonparticipating health care facility that fails to 34 provide explicit, advance notice in writing to the health care 35 -16- LSB 5355XS (17) 88 pf/rh 16/ 24

S.F. 2156 facility’s patients and health care providers shall not enforce 1 such a policy. 2 3. If a terminally ill patient wishes to transfer the 3 patient’s care from a nonparticipating health care facility to 4 another health care facility, the nonparticipating health care 5 facility shall coordinate a timely transfer, including transfer 6 of the terminally ill patient’s medical records that include 7 notation of the date the terminally ill patient first requested 8 medical aid in dying. 9 4. A nonparticipating health care facility shall not 10 prohibit a health care provider from providing services 11 consistent with the applicable standard of medical care 12 including all of the following: 13 a. Providing information to a patient about the availability 14 of medical aid in dying pursuant to this chapter. 15 b. Prescribing medication pursuant to this chapter for 16 a qualified patient outside the scope of the health care 17 provider’s employment or contract with the nonparticipating 18 health care facility and off the premises of the 19 nonparticipating health care facility. 20 c. Being present at the time a qualified patient 21 self-administers medication prescribed pursuant to this chapter 22 or at the time of the patient’s death, if requested by the 23 qualified patient or the qualified patient’s representative 24 outside the scope of the health care provider’s employment or 25 contractual duties. 26 5. A health care facility shall not engage in false, 27 misleading, or deceptive practices relating to the health 28 care facility’s policy regarding end-of-life care services, 29 including whether the health care facility has a policy which 30 prohibits affiliated health care providers from determining 31 a terminally ill patient’s qualification for medical aid in 32 dying, evaluating a terminally ill patient’s request for 33 medication, or providing a prescription for or dispensing 34 medication to a qualified patient pursuant to this chapter; 35 -17- LSB 5355XS (17) 88 pf/rh 17/ 24

S.F. 2156 or intentionally denying a terminally ill patient access to 1 medication pursuant to this chapter by failing to transfer a 2 terminally ill patient and the terminally ill patient’s medical 3 records to another health care facility in a timely manner. 4 Sec. 18. NEW SECTION . 142E.18 Immunities for actions in 5 good faith —— prohibition against reprisals. 6 1. A health care provider or health care facility shall 7 not be subject to civil or criminal liability, professional 8 disciplinary action, or any other penalty for engaging in 9 the practice of medical aid in dying in accordance with 10 the standard of care and in good faith compliance with this 11 chapter. 12 2. A health care provider, health care facility, or 13 professional organization or association shall not subject 14 a health care provider or health care facility to censure, 15 discipline, the denial, suspension, or revocation of licensure, 16 loss of privileges, loss of membership, or any other penalty 17 for providing medical aid in dying in accordance with the 18 standard of care and in good faith compliance with this 19 chapter or for providing scientific and accurate information 20 about medical aid in dying to a terminally ill patient when 21 discussing end-of-life care options. 22 3. A health care provider shall not be subject to civil 23 or criminal liability or professional discipline if, with the 24 consent of the qualified patient or the qualified patient’s 25 representative, the health care provider is present outside the 26 scope of the health care provider’s professional duties when 27 the qualified patient self-administers medication prescribed 28 pursuant to this chapter or at the time of the qualified 29 patient’s death. 30 4. This section shall not be interpreted to limit civil or 31 criminal liability of a health care provider who intentionally 32 or knowingly fails or refuses to timely submit records required 33 pursuant to section 142E.9. 34 5. This section shall not be interpreted to limit civil or 35 -18- LSB 5355XS (17) 88 pf/rh 18/ 24

S.F. 2156 criminal liability for intentional violations of this chapter. 1 Sec. 19. NEW SECTION . 142E.19 Liabilities and penalties. 2 1. A person who without authorization of a patient 3 intentionally or knowingly alters or forges a request for 4 medication pursuant to this chapter with the intent or effect 5 of causing the patient’s death, or conceals or destroys a 6 patient’s rescission of a request for medication pursuant to 7 this chapter, is guilty of a class “A” felony. 8 2. A person who coerces or exerts undue influence over 9 a patient to request or utilize medication pursuant to this 10 chapter, with the intent or effect of causing the patient’s 11 death, is guilty of a class “A” felony. 12 3. A person who intentionally or knowingly coerces or 13 exerts undue influence over a terminally ill patient to forgo a 14 request for or to obtain medication pursuant to this chapter, 15 or who intentionally or knowingly denies a qualified patient 16 access to medication under this chapter as an end-of-life care 17 option is guilty of a serious misdemeanor. 18 4. Nothing in this section shall be interpreted to limit 19 liability for civil damages resulting from negligent conduct or 20 intentional misconduct applicable under other law for conduct 21 which is inconsistent with the provisions of this chapter. 22 5. The penalties specified in this chapter shall not 23 preclude application of criminal penalties applicable under 24 other law for conduct which is inconsistent with this chapter. 25 Sec. 20. NEW SECTION . 142E.20 Claims by governmental entity 26 for costs incurred. 27 A governmental entity that incurs costs resulting from a 28 qualified patient self-administering medication prescribed 29 pursuant to this chapter in a public place shall have a claim 30 against the estate of the qualified patient to recover such 31 costs and reasonable attorney fees related to enforcing the 32 claim. 33 EXPLANATION 34 The inclusion of this explanation does not constitute agreement with 35 -19- LSB 5355XS (17) 88 pf/rh 19/ 24

S.F. 2156 the explanation’s substance by the members of the general assembly. 1 This bill creates the our care, our options Act. The bill 2 includes findings relating to end-of-life options and provides 3 definitions of terms used in the bill. 4 The bill provides a process for an adult patient who is 5 mentally capable, is a resident of the state, and has been 6 determined by the patient’s attending provider and consulting 7 provider to be terminally ill, to request medication that the 8 patient may self-administer to end the patient’s life. Such 9 patient must make two oral requests to the patient’s attending 10 provider, followed by one written request to the patient’s 11 attending provider to request the medication. 12 The bill provides the form in which the written request 13 must be substantially made, and requires that oral and written 14 requests must be made by the terminally ill patient. Under 15 the bill, a patient shall not qualify to make a request solely 16 based on age or disability. The bill also provides that 17 notwithstanding other provisions of the bill, if a terminally 18 ill patient’s attending provider attests that the terminally 19 ill patient will, within reasonable medical judgment, die 20 within 15 days after making the initial oral request, the 21 terminally ill patient may reiterate the oral request to the 22 attending provider at any time after making the initial oral 23 request and the 15-day waiting period shall be waived. 24 The bill specifies the duties of the attending provider and 25 the consulting provider, and provides for the referral of a 26 terminally ill patient by either an attending provider or a 27 consulting provider to a licensed mental health provider to 28 confirm that the terminally ill patient requesting medication 29 for medical aid in dying is mentally capable. 30 The bill requires the department of public health (DPH) 31 to create and make available to all attending providers a 32 prescribing provider checklist form and prescribing provider 33 follow-up form for the purposes of reporting the information 34 specified under the bill to DPH. DPH is required to annually 35 -20- LSB 5355XS (17) 88 pf/rh 20/ 24