H.F. 662 Section 1. NEW SECTION . 147.163 Legislative findings —— 1 treatment or intervention regarding intersex minors. 2 The general assembly finds and declares all of the 3 following: 4 1. The general assembly opposes all forms of prejudice, 5 bias, or discrimination and affirms the general assembly’s 6 commitment to the dignity and autonomy of all people, 7 including those born with variations in their physical sex 8 characteristics. 9 2. Intersex people are a part of the fabric of our state’s 10 diversity to be celebrated, rather than an aberration to be 11 corrected. 12 3. Intersex people should be free to choose whether to 13 undergo life-altering surgeries and other treatments or 14 interventions on their physical sexual characteristics that 15 irreversibly, and sometimes irreparably, cause harm. 16 4. The enactment of legislation is necessary to ensure 17 the ability of intersex people to participate in decisions 18 about surgery and other medical treatments or interventions 19 on their physical sex characteristics, and to guarantee the 20 rights of intersex people to bodily integrity, autonomy, and 21 self-determination. 22 Sec. 2. NEW SECTION . 147.164 Intersex minors —— informed 23 consent —— penalties. 24 1. As used in this section: 25 a. “Intersex minor” means a person during the period of 26 minority as specified in section 599.1 born with atypical 27 physical sex characteristics including but not limited to 28 chromosomes, genitals, or internal organs, and includes 29 differences in sex development resulting from androgen 30 insensitivity syndrome, congenital adrenal hyperplasia, and 31 hypospadias. 32 b. “Medically necessary” means that the treatment or 33 intervention on the sex characteristics of an intersex minor is 34 reasonable and necessary for the diagnosis or treatment of an 35 -1- LSB 2349YH (3) 89 pf/rh 1/ 6

H.F. 662 illness or injury and cannot be safely deferred. A “medically 1 necessary” treatment or intervention on the sex characteristics 2 of an intersex minor includes but is not limited to a procedure 3 to repair the bladder, a cloacal exstrophy, or any other 4 procedure intended to allow urine to exit the body absent a 5 urethral opening. 6 c. “Physician” means a person licensed as a physician 7 and surgeon or osteopathic physician and surgeon pursuant to 8 chapter 148. 9 d. “Treatment or intervention” means, but is not limited to 10 all of the following procedures: 11 (1) A clitorectomy, clitoroplasty, clitoral reduction, or 12 clitoral recession, including corporal-sparing procedures. 13 (2) A gonadectomy, including of testes, ovaries, ovotestes, 14 or streak gonads. 15 (3) Hypospadias surgery, relocation of the urethral meatus, 16 or chordee release. 17 (4) A labiaplasty or labial reduction. 18 (5) A phalloplasty. 19 (6) A vaginoplasty, introitoplasty, vaginal 20 exteriorization, or a partial or total urogenital sinus 21 mobilization. 22 2. A physician shall not perform any treatment or 23 intervention on the sex characteristics of an intersex minor, 24 which is not medically necessary and can be deferred, until the 25 intersex minor on whom the treatment or intervention is to be 26 performed can provide informed consent. The best interest of 27 the intersex minor shall be the paramount consideration. 28 3. a. Prior to performing any treatment or intervention 29 on the sex characteristics of an intersex minor which is not 30 medically necessary, a physician shall provide written and oral 31 disclosure to the intersex minor and informed consent shall be 32 obtained from the intersex minor as provided in this section. 33 b. The written and oral disclosure provided to the intersex 34 minor by the physician shall be provided in nontechnical, 35 -2- LSB 2349YH (3) 89 pf/rh 2/ 6

H.F. 662 age-appropriate terms, and shall include all of the following: 1 (1) A description of the treatment or intervention to be 2 performed, including any necessary health care management or 3 long-term follow-up care to be expected following the treatment 4 or intervention. 5 (2) A description of any attendant discomfort and risks to 6 the intersex minor in the short term and long term, including 7 but not limited to any irreparable or irreversible harm or 8 limitations regarding future fertility or development or 9 construction of female-typical or male-typical characteristics, 10 which may reasonably be expected following the treatment or 11 intervention. 12 (3) An explanation of any benefits that the intersex minor 13 may reasonably expect following the treatment or intervention. 14 (4) An explanation of any appropriate alternative 15 procedures, drugs, or devices, including any delay of the 16 procedure, that might be advantageous to the intersex minor, 17 and the relative risks and benefits of these alternatives. 18 (5) An offer to answer any inquiries concerning the 19 treatment or intervention involved. 20 4. a. Following receipt of the written and oral disclosure 21 provided by the physician described in subsection 3, and prior 22 to the treatment or intervention being performed, the physician 23 shall obtain informed consent to the treatment or intervention 24 from the intersex minor, which shall comply with all of the 25 following requirements: 26 (1) The consent shall be in writing and shall contain the 27 following statement: 28 “I (name of intersex minor) do hereby consent to 29 (description of treatment or intervention) to be performed by 30 (name of physician) on (date that the treatment or intervention 31 is to be performed on the intersex minor).” 32 (2) The written consent shall be signed by the intersex 33 minor and by the physician who will perform the treatment or 34 intervention. 35 -3- LSB 2349YH (3) 89 pf/rh 3/ 6

H.F. 662 (3) The written consent shall contain a notification to 1 the intersex minor that the written consent is an important 2 document that should be retained with other vital records. 3 b. The physician shall retain the original written consent 4 in the medical record of the intersex minor and shall provide a 5 copy of the written consent to the intersex minor. 6 c. If the treatment or intervention is performed in a 7 hospital, the physician shall provide a copy of the written 8 consent to the hospital. 9 5. This section shall not affect the obligation of a 10 physician under any other existing law to obtain the informed 11 consent of a patient before performing any other medical 12 procedure on a patient, including those that may significantly 13 affect the patient’s reproductive health, fertility, or ability 14 to conceive. 15 6. If a physician determines that it is medically 16 necessary to perform a treatment or intervention on the sex 17 characteristics of an intersex minor, and the physician is 18 not able to obtain the informed consent of the intersex minor 19 in accordance with this section, a physician may perform the 20 medical procedure only if the physician provides the written 21 and oral disclosure consistent with subsection 3 to the parent 22 or guardian of the intersex minor, and the parent or guardian 23 of the intersex minor provides written informed consent in a 24 manner consistent with subsection 3. 25 7. The board of medicine shall adopt rules pursuant to 26 chapter 17A to administer this section. The rules shall 27 provide evidence-based protocols to guide physicians in 28 ensuring that intersex minors and their parents are properly 29 informed of all options and alternatives, that an intersex 30 minor is to the greatest extent possible involved in the 31 decision making about any treatment or intervention, that 32 the intersex minor’s choices are fully respected, and that 33 any nonmedically necessary treatment or intervention is only 34 performed with the full, free, and informed consent of the 35 -4- LSB 2349YH (3) 89 pf/rh 4/ 6

H.F. 662 intersex minor. 1 Sec. 3. CODE EDITOR DIRECTIVE. The Code editor shall create 2 a new subchapter in chapter 147, codifying sections 147.163 3 and 147.164, as enacted in this Act, as “intersex minors —— 4 treatment and intervention”. 5 EXPLANATION 6 The inclusion of this explanation does not constitute agreement with 7 the explanation’s substance by the members of the general assembly. 8 This bill relates to treatment or intervention involving an 9 intersex minor. 10 The bill provides legislative findings relating to intersex 11 minors and treatments or interventions on their physical 12 sex characteristics. The legislative findings include that 13 enactment of legislation is necessary to ensure the ability of 14 intersex people to participate in decisions about surgery and 15 other medical treatments or interventions on their physical sex 16 characteristics, and to guarantee the rights of intersex people 17 to bodily integrity, autonomy, and self-determination. 18 The bill provides definitions used in the bill including 19 “intersex minor”, “medically necessary”, “physician”, and 20 “treatment or intervention”. 21 The bill prohibits a physician from performing any treatment 22 or intervention on the sex characteristics of an intersex 23 minor, which is not medically necessary and can be deferred, 24 until the person on whom the treatment or intervention is to be 25 performed can provide informed consent. The best interest of 26 the intersex minor shall be the paramount consideration. 27 The bill requires that prior to performing any treatment or 28 intervention on the sex characteristics of an intersex minor 29 which is not medically necessary, a physician shall provide 30 written and oral disclosure to the intersex minor and informed 31 consent shall be obtained from the intersex minor. The bill 32 specifies the parameters of the written and oral disclosure 33 and the obtaining of the informed consent. The bill provides 34 that the bill does not affect the obligation of a physician 35 -5- LSB 2349YH (3) 89 pf/rh 5/ 6

H.F. 662 under any other law to obtain the informed consent of a patient 1 before performing a medical procedure on the patient, including 2 those that may significantly affect the patient’s reproductive 3 health, fertility, or ability to conceive. 4 The bill provides that if a physician determines that it 5 is medically necessary to perform a treatment or intervention 6 on the sex characteristics of an intersex minor, and the 7 physician is not able to obtain the informed consent of the 8 intersex minor in accordance with the bill, the physician may 9 perform the medical procedure only if the physician provides 10 the written and oral disclosure to the parent or guardian of 11 the intersex minor, and the parent or guardian of the intersex 12 minor provides written informed consent in accordance with the 13 bill. 14 The bill requires the board of medicine to adopt 15 administrative rules to administer the bill. The rules 16 shall provide evidence-based protocols to guide physicians in 17 ensuring that intersex minors and their parents are properly 18 informed of all options and alternatives, that an intersex 19 minor is to the greatest extent possible involved in the 20 decision making about any treatment or intervention, that 21 the intersex minor’s choices are fully respected, and that 22 any nonmedically necessary treatment or intervention is only 23 performed with the full, free, and informed consent of the 24 intersex minor. 25 -6- LSB 2349YH (3) 89 pf/rh 6/ 6