House
File
662
-
Introduced
HOUSE
FILE
662
BY
BENNETT
,
MASCHER
,
McCONKEY
,
B.
MEYER
,
EHLERT
,
HUNTER
,
STAED
,
and
BROWN-POWERS
A
BILL
FOR
An
Act
relating
to
treatment
or
intervention
involving
an
1
intersex
minor.
2
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
3
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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
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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,
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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.
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(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
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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
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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
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