House File 612 - Introduced HOUSE FILE 612 BY GJERDE A BILL FOR An Act relating to care and choices at the end of life, 1 providing penalties, and including effective date 2 provisions. 3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 4 TLSB 2327YH (1) 90 pf/rh

H.F. 612 Section 1. NEW SECTION . 142E.1 Findings. 1 1. The state of Iowa has long recognized that mentally 2 capable adult individuals have a fundamental right to determine 3 their own medical treatment options in accordance with their 4 own values, beliefs, or personal preferences. 5 2. It is important that the state of Iowa upholds both the 6 highest standard of medical care and the full range of options 7 for each 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 terminal disease as they 16 near the 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 end-of-life care 19 by contributing to better conversations between providers 20 and their patients, earlier and more appropriate enrollment 21 in hospice care, and better palliative care training for 22 providers. 23 6. The state of Iowa seeks to affirm that a provider who 24 respects and honors the values and priorities of individuals 25 with a terminal disease for their last days of life and 26 prescribes or dispenses medication for any such qualified 27 terminally ill individual who makes a request pursuant 28 to this chapter is practicing lawful patient-centered and 29 patient-directed care. 30 7. Patient-directed care differs from patient-centered 31 care in that it is not only respectful of and responsive to 32 individual patient decisions, preferences, needs, and values, 33 but also ensures that patient values direct all clinical 34 decisions and that patients are fully informed of and able to 35 -1- LSB 2327YH (1) 90 pf/rh 1/ 26

H.F. 612 access legal options they desire. 1 Sec. 2. NEW SECTION . 142E.2 Short title. 2 This chapter shall be known and may be cited as the “Iowa Our 3 Care, Our Options Act” . 4 Sec. 3. NEW SECTION . 142E.3 Definitions. 5 As used in this chapter, unless the context otherwise 6 requires: 7 1. “Adult” means an individual eighteen years of age or 8 older. 9 2. “Attending provider” means the provider who has primary 10 responsibility for the care of a patient and treatment of the 11 patient’s terminal disease. 12 3. “Coercion or undue influence” means the willful attempt, 13 whether by deception, intimidation, or any other means, to do 14 any of the following: 15 a. Cause a patient to request, obtain, or self-administer 16 medication pursuant to this chapter with the intent to cause 17 the death of the patient. 18 b. Prevent a qualified patient from obtaining or 19 self-administration of medication pursuant to this chapter. 20 4. “Consulting provider” means a provider who is qualified 21 by specialty or experience to make a professional diagnosis and 22 prognosis regarding a patient’s disease. 23 5. “Department” means the department of health and human 24 services. 25 6. “Health care entity” means a hospital licensed under 26 chapter 135B, a nursing facility licensed under chapter 135C, 27 an inpatient hospice program, a clinic, or any other facility 28 licensed by the state wherein medical care is provided. “Health 29 care entity” does not include a provider. 30 7. “Informed decision” means a decision by a medically 31 capable requesting patient to request and obtain a prescription 32 for medication pursuant to this chapter that the qualified 33 patient may self-administer to bring about a peaceful death 34 after being fully informed by the attending provider and 35 -2- LSB 2327YH (1) 90 pf/rh 2/ 26

H.F. 612 consulting provider of all of the following: 1 a. The requesting patient’s diagnosis and prognosis. 2 b. The potential risk associated with taking the medication 3 to be prescribed. 4 c. The probable result of taking the medication to be 5 prescribed. 6 d. The feasible end-of-life care and treatment options for 7 the requesting patient’s terminal disease, including but not 8 limited to comfort care, palliative care, hospice care, and 9 pain control, and the risks and benefits of each. 10 e. The requesting patient’s right to withdraw a request 11 pursuant to this chapter or consent for any other treatment, 12 at any time. 13 8. “Licensed mental health provider” means the same as a 14 “mental health professional” as defined in section 228.1. 15 9. “Medical aid in dying” means the practice of evaluating 16 a patient’s request for medication, determining if a patient 17 is qualified, performing the duties specified, and providing a 18 prescription to a qualified patient, pursuant to this chapter. 19 10. “Medical-aid-in-dying medication” or “medication” means 20 the medication prescribed and dispensed under this chapter to a 21 qualified patient to bring about a peaceful death. 22 11. “Medically confirmed” means the attending provider’s 23 medical opinion that the patient is eligible to receive 24 medication pursuant to this chapter has been confirmed by the 25 consulting provider after performing a medical evaluation. 26 12. “Mentally capable” means that in the opinion of the 27 provider or licensed mental health provider, if an opinion is 28 required under this chapter, the requesting patient has the 29 ability to make and communicate an informed decision. 30 13. “Oral request” means an affirmative statement that 31 demonstrates a contemporaneous affirmatively stated desire by 32 the requesting patient seeking medical aid in dying. 33 14. “Patient” means an adult who is under the care of a 34 provider. 35 -3- LSB 2327YH (1) 90 pf/rh 3/ 26

H.F. 612 15. “Prognosis of six months or less” means the terminal 1 disease of a patient will, within reasonable medical judgment, 2 result in the patient’s death within six months. 3 16. a. “Provider” means a person licensed, certified, or 4 otherwise authorized or permitted by the law of this state 5 to diagnose and treat medical conditions, and prescribe 6 and dispense medication, including controlled substances. 7 “Provider” includes all of the following: 8 (1) A physician licensed to practice medicine pursuant to 9 chapter 148. 10 (2) An advanced registered nurse practitioner licensed 11 under chapter 152 or an advanced practice registered nurse 12 under chapter 152E. 13 (3) A physician assistant licensed under chapter 148C. 14 b. “Provider” does not include a health care entity. 15 17. “Qualified patient” means a mentally capable patient 16 who has satisfied the requirements of this chapter in order 17 to obtain a prescription for medication to bring about a 18 peaceful death. A person shall not be considered a “qualified 19 patient” under this chapter solely because of advanced age or 20 disability. 21 18. “Requesting patient” means a patient with a terminal 22 disease. 23 19. “Self-administer” or “self-administration” means a 24 qualified patient’s performance of an affirmative, conscious, 25 voluntary act to ingest medication prescribed pursuant to 26 this chapter to bring about the qualified patient’s peaceful 27 death. “Self-administration” does not include administration by 28 parenteral injection or infusion. 29 20. “Terminal disease” means an incurable and irreversible 30 disease that has been medically confirmed and will, within 31 reasonable medical judgment, produce death within six months. 32 Sec. 4. NEW SECTION . 142E.4 Informed consent. 33 1. This chapter shall not be construed to limit the amount 34 of information provided to a patient to ensure the patient can 35 -4- LSB 2327YH (1) 90 pf/rh 4/ 26

H.F. 612 make an informed decision. 1 2. An attending provider shall provide sufficient 2 information to a patient regarding all appropriate end-of-life 3 care options, including hospice and palliative care, and the 4 foreseeable risks and benefits of each, so that the patient 5 can make a voluntary and affirmative decision regarding the 6 patient’s end-of-life care. 7 3. An attending provider is deemed to fail to obtain 8 informed consent for subsequent medical treatment if a 9 requesting patient requests information about medical aid in 10 dying and, within a reasonable time, the provider has failed, 11 at a minimum, to do either of the following: 12 a. Provide information to the requesting patient about 13 medical aid in dying and other legal end-of-life options. 14 b. Document the date of the requesting patient’s request 15 in the patient’s medical record and upon request transfer the 16 requesting patient’s medical records to an alternative provider 17 consistent with federal and state law. 18 4. If a requesting patient requests that the requesting 19 patient’s medical records be transferred to an alternative 20 provider, the requesting patient’s medical records shall be 21 transferred within two business days. 22 Sec. 5. NEW SECTION . 142E.5 Standard of care. 23 1. Care that complies with this chapter shall be deemed to 24 meet the medical standard of care. 25 2. This chapter shall not be construed to exempt a provider 26 or other medical personnel from meeting medical standards of 27 care for a patient’s treatment. 28 Sec. 6. NEW SECTION . 142E.6 Request for medical aid in 29 dying. 30 1. A mentally capable patient with a terminal disease may 31 request a prescription for medication under this chapter. The 32 requesting patient shall make an oral request and a written 33 request and shall reiterate the oral request to the requesting 34 patient’s attending provider no less than forty-eight hours 35 -5- LSB 2327YH (1) 90 pf/rh 5/ 26

H.F. 612 after making the initial oral request. An oral request charted 1 in the requesting patient’s medical record by a provider other 2 than the requesting patient’s attending provider satisfies the 3 oral request requirement under this section. 4 2. The attending and consulting providers of a qualified 5 patient shall meet all requirements of sections 142E.8 and 6 142E.9. 7 3. Notwithstanding any provision to the contrary under 8 subsection 1, if the requesting patient’s attending provider 9 has determined that the requesting patient will, based on 10 reasonable medical judgment, die within forty-eight hours 11 after making the initial oral request under this section, 12 the requesting patient may satisfy the requirements under 13 this section by reiterating the oral request to the attending 14 provider at any time after making the initial oral request. 15 4. At the time the requesting patient makes the second oral 16 request, the attending provider shall offer the requesting 17 patient an opportunity to rescind the request. 18 5. Oral and written requests for the requesting patient must 19 be made only by the requesting patient and shall not be made 20 by the requesting patient’s surrogate decision-maker, health 21 care proxy, attorney-in-fact for health care, or via an advance 22 health care directive. 23 6. If a requesting patient decides to transfer the 24 requesting patient’s care to an alternative provider, the 25 custodian of the requesting patient’s medical records shall 26 transfer all relevant medical records including written 27 documentation of the dates of any of the requesting patient’s 28 oral or written requests concerning medical aid in dying within 29 two business days. 30 7. The transfer of care or medical records of a requesting 31 patient does not toll or restart any waiting period under this 32 section. 33 Sec. 7. NEW SECTION . 142E.7 Form of written request —— 34 requirements. 35 -6- LSB 2327YH (1) 90 pf/rh 6/ 26

H.F. 612 1. A written request for medication under this chapter shall 1 be in substantially the following form, signed and dated by 2 the requesting patient, and witnessed by at least one person 3 who, in the presence of the requesting patient, attests that to 4 the best of the witness’s knowledge and belief the requesting 5 patient is mentally capable, acting voluntarily, and is not 6 being coerced nor unduly influenced to sign the request. 7 Request for Medication 8 to End My Life in 9 a Peaceful Manner 10 I, ___________________________________ am an adult of sound 11 mind. I have been diagnosed with 12 _______________________________________________, and given a 13 prognosis of six months or less to live. 14 I have been fully informed of the feasible alternatives, 15 and the concurrent or additional treatment opportunities for 16 my terminal disease, including but not limited to comfort 17 care, palliative care, hospice care, or pain control, and the 18 potential risks and benefits of each. I have been offered or 19 received resources or referrals to pursue these alternative, 20 or concurrent or additional treatment opportunities for my 21 terminal disease. 22 I have been fully informed of the nature of the medication to 23 be prescribed, including the risks and benefits, and understand 24 that the likely outcome of self-administration of medication 25 is death. I understand that I can rescind this request at any 26 time, that I am under no obligation to fill the prescription 27 once written nor to self-administer the medication if I obtain 28 the medication. 29 I request that my attending provider furnish a prescription 30 for medication that will end my life if I choose to 31 self-administer it, and I authorize my attending provider to 32 contact a pharmacist to dispense the prescription at a time of 33 my choosing. 34 I make this request voluntarily, free from coercion or undue 35 -7- LSB 2327YH (1) 90 pf/rh 7/ 26

H.F. 612 influence. 1 ________________________________________ _____________ 2 Requesting Patient Signature Date 3 ________________________________________ _____________ 4 Witness Signature Date 5 2. The witness required under this section shall not be any 6 of the following: 7 a. A relative of the requesting patient by blood, marriage, 8 or adoption. 9 b. A person who at the time the request is signed would be 10 entitled to any portion of the estate of the requesting patient 11 upon death, under any will or by operation of law. 12 c. An owner, operator, or employee of a health care entity 13 where the requesting patient is receiving medical treatment or 14 is a resident. 15 d. The requesting patient’s attending provider at the time 16 the request is signed. 17 e. An interpreter for the requesting patient, if the 18 requesting patient uses an interpreter. 19 Sec. 8. NEW SECTION . 142E.8 Attending provider 20 responsibilities. 21 The attending provider shall do all of the following: 22 1. Determine whether a requesting patient has a terminal 23 disease with a prognosis of six months or less and is mentally 24 capable. 25 2. Confirm that the requesting patient’s request does not 26 arise from coercion or undue influence. 27 3. Inform the requesting patient of all of the following: 28 a. The requesting patient’s diagnosis and prognosis. 29 b. The potential risks, benefits, and probable result of 30 self-administration of the prescribed medication to bring about 31 a peaceful death. 32 c. The potential benefits and risks of feasible alternatives 33 including but not limited to concurrent or additional treatment 34 options for the requesting patient’s terminal disease, 35 -8- LSB 2327YH (1) 90 pf/rh 8/ 26

H.F. 612 palliative care, comfort care, hospice care, and pain control. 1 d. The requesting patient’s right to rescind the request for 2 medication pursuant to this chapter at any time. 3 e. That there is no obligation to fill the prescription 4 nor an obligation to self-administer the medication, if the 5 medication is obtained. 6 4. Provide the requesting patient with a referral for 7 comfort care, palliative care, hospice care, pain control, or 8 other end-of-life treatment options as requested by the patient 9 and as clinically indicated. 10 5. Refer the requesting patient to a consulting provider for 11 medical confirmation that the requesting patient has a terminal 12 disease with a prognosis of six months or less to live and is 13 mentally capable. 14 6. Include the consulting provider’s written determination 15 in the requesting patient’s medical record. 16 7. Refer the requesting patient to a licensed mental health 17 provider if the attending provider observes signs that the 18 requesting patient may not be capable of making an informed 19 decision. 20 8. Include the licensed mental health provider’s written 21 determination in the requesting patient’s medical record, if 22 such determination was requested. 23 9. Inform the requesting patient of the benefits of 24 notifying the next of kin of the requesting patient’s decision 25 to request medication pursuant to this chapter. 26 10. Fulfill the medical record documentation requirements 27 under this chapter. 28 11. Ensure that all steps are carried out in accordance with 29 this chapter before providing a prescription to a requesting 30 patient for medication pursuant to this chapter including all 31 of the following: 32 a. Confirming that the requesting patient has made an 33 informed decision to obtain a prescription for medication 34 pursuant to this chapter. 35 -9- LSB 2327YH (1) 90 pf/rh 9/ 26

H.F. 612 b. Offering the requesting patient an opportunity to rescind 1 the request for medication pursuant to this chapter. 2 c. Educating the requesting patient on all of the following: 3 (1) The recommended procedure for self-administration of 4 the medication to be prescribed. 5 (2) The safe-keeping and proper disposal of unused 6 medication in accordance with state and federal law. 7 (3) The importance of having another individual present 8 when the requesting patient self-administers the medication to 9 be prescribed. 10 (4) Not taking the medication in a public place. 11 12. Once the requesting patient is determined to be a 12 qualified patient, in accordance with state and federal law, 13 do one of the following: 14 a. Deliver the prescription personally, by mail, or through 15 an authorized electronic transmission to a licensed pharmacist 16 who will dispense the medication including any ancillary 17 medications to the attending provider, to the qualified 18 patient, or to an individual expressly designated by the 19 qualified patient in person or with a signature required on 20 delivery, by mail service, or by messenger service. 21 b. If authorized by the federal drug enforcement agency, 22 dispense the prescribed medication including any ancillary 23 medications to the qualified patient or an individual 24 designated in person by the qualified patient. 25 13. Document in the qualified patient’s medical record the 26 qualified patient’s diagnosis and prognosis, determination 27 of mental capability, the date of any oral request, a copy 28 of the written request, a notation that the requirements 29 under this chapter have been completed, and identification of 30 the medication and ancillary medications prescribed to the 31 qualified patient pursuant to this chapter. 32 Sec. 9. NEW SECTION . 142E.9 Consulting provider 33 responsibilities. 34 A consulting provider shall do all of the following: 35 -10- LSB 2327YH (1) 90 pf/rh 10/ 26

H.F. 612 1. Evaluate the requesting patient and the requesting 1 patient’s relevant medical records. 2 2. Confirm all of the following to the attending provider 3 regarding the requesting patient: 4 a. That the requesting patient has requested a prescription 5 for medical-aid-in-dying medication. 6 b. That the requesting patient has a terminal disease with a 7 prognosis of six months or less to live. 8 c. That the requesting patient is mentally capable, or 9 provide documentation that the consulting provider has referred 10 the requesting patient for further evaluation in accordance 11 with section 142E.10. 12 d. That the requesting patient is acting voluntarily, free 13 from coercion or undue influence. 14 Sec. 10. NEW SECTION . 142E.10 Referral —— determination 15 that requesting patient is mentally capable. 16 1. If either the attending provider or the consulting 17 provider doubts whether the requesting patient is mentally 18 capable and is unable to confirm that the requesting patient is 19 capable of making an informed decision, the attending provider 20 or consulting provider shall refer the patient to a licensed 21 mental health provider for a determination regarding the 22 requesting patient’s mental capability. 23 2. The licensed mental health provider who evaluates the 24 requesting patient under this section shall submit to the 25 attending provider or consulting provider who made the referral 26 a written determination of whether the requesting patient is 27 mentally capable. 28 3. If the licensed mental health provider determines the 29 requesting patient is not mentally capable, the requesting 30 patient shall not be deemed a qualified patient and the 31 attending provider shall not prescribe medication to the 32 requesting patient under this chapter. 33 Sec. 11. NEW SECTION . 142E.11 Death certificate. 34 1. Unless otherwise prohibited by law, the attending 35 -11- LSB 2327YH (1) 90 pf/rh 11/ 26

H.F. 612 provider may sign the death certificate of a qualified 1 patient who obtained and self-administered a prescription for 2 medication pursuant to this chapter. 3 2. When a death has occurred in accordance with this 4 chapter, the death shall be attributed to the underlying 5 terminal disease, and all of the following shall apply: 6 a. A death following self-administration of medication under 7 this chapter does not alone constitute a person’s death that 8 affects the public interest as described pursuant to section 9 331.802. If a death that occurs in accordance with this 10 chapter is referred to the state medical examiner or a county 11 medical examiner, the state medical examiner or county medical 12 examiner may conduct a preliminary investigation to determine 13 whether an individual received a prescription for medication 14 under this chapter. 15 b. A death in accordance with this chapter shall not be 16 designated a suicide or homicide. 17 c. A qualified patient’s act of self-administration of 18 medication prescribed pursuant to this chapter shall not be 19 indicated on the death certificate. 20 Sec. 12. NEW SECTION . 142E.12 Reporting requirements —— 21 willful failure or refusal. 22 1. The department shall create and make available to all 23 attending providers a prescribing provider checklist form 24 and prescribing provider follow-up form for the purposes of 25 reporting the information as specified under this section to 26 the department. 27 2. Within thirty calendar days of providing a prescription 28 for medication pursuant to this chapter, the attending provider 29 shall submit to the department an attending provider checklist 30 form with all of the following information: 31 a. The qualifying patient’s name and date of birth. 32 b. The qualifying patient’s terminal diagnosis and 33 prognosis. 34 c. Notice that the requirements under this chapter were 35 -12- LSB 2327YH (1) 90 pf/rh 12/ 26

H.F. 612 completed. 1 d. Notice that medication has been prescribed pursuant to 2 this chapter. 3 3. Within sixty calendar days of notification of a qualified 4 patient’s death from self-administration of medication 5 prescribed pursuant to this chapter, the attending provider 6 shall submit to the department an attending provider follow-up 7 form with all of the following information: 8 a. The qualified patient’s name and date of birth. 9 b. The qualified patient’s date of death. 10 c. A notation of whether or not the qualified patient was 11 enrolled in hospice services at the time of the qualified 12 patient’s death. 13 4. The department shall annually review a sample of records 14 pursuant to this chapter to ensure compliance and issue a 15 public statistical report of nonidentifying information. The 16 report shall be limited to all of the following: 17 a. The number of prescriptions for medication written 18 pursuant to this chapter. 19 b. The number of attending providers who wrote prescriptions 20 for medication pursuant to this chapter. 21 c. The number of qualified patients who died following 22 self-administration of medication prescribed and dispensed 23 pursuant to this chapter. 24 5. Except as otherwise required by law, the information 25 collected by the department is not a public record and is not 26 available for public inspection. 27 6. Willful failure or refusal by an attending provider to 28 timely submit reports required under this section nullifies the 29 protections provided under section 142E.16. 30 Sec. 13. NEW SECTION . 142E.13 Safe disposal of unused 31 medications. 32 A person who has custody or control of medication prescribed 33 pursuant to this chapter after the qualified patient’s death 34 shall dispose of the medication by lawful means in accordance 35 -13- LSB 2327YH (1) 90 pf/rh 13/ 26

H.F. 612 with applicable state and federal guidelines. 1 Sec. 14. NEW SECTION . 142E.14 No duty to provide medical 2 aid in dying —— licensee discipline. 3 1. A provider shall provide sufficient information to a 4 patient with a terminal disease regarding available options, 5 alternatives, and the foreseeable risks and benefits of each, 6 so that the patient with a terminal disease is able to make 7 informed decisions regarding the patient’s end-of-life health 8 care. 9 2. A provider may choose whether or not to practice medical 10 aid in dying pursuant to this chapter. 11 3. If an attending provider is unable or unwilling to 12 fulfill a requesting patient’s request pursuant to this 13 chapter, the attending provider shall do all of the following: 14 a. Document in the requesting patient’s medical record the 15 date of the requesting patient’s oral or written request and 16 the attending provider’s notice to the requesting patient of 17 the attending provider’s inability or unwillingness to provide 18 medical aid in dying. 19 b. Upon the requesting patient’s request, transfer the 20 requesting patient’s medical records to an alternative 21 provider, consistent with federal and state law. 22 4. An attending provider shall not engage in false, 23 misleading, or deceptive practices relating to a willingness 24 to qualify a requesting patient or to provide medical aid in 25 dying. A provider who engages in such false, misleading, or 26 deceptive practices is subject to licensee discipline by the 27 applicable licensing board or entity. 28 Sec. 15. NEW SECTION . 142E.15 Health care entity —— 29 permissible prohibitions and duties —— penalties —— licensee 30 discipline. 31 1. A health care entity may prohibit providers from 32 practicing medical aid in dying in the course of performing 33 duties for the entity. A health care entity that prohibits 34 the practice of medical aid in dying shall provide advance 35 -14- LSB 2327YH (1) 90 pf/rh 14/ 26

H.F. 612 notice in writing to providers and staff at the initial time 1 of hiring, contracting, or privileging a provider, and on a 2 yearly basis thereafter. A health care entity that fails to 3 provide explicit, advance notice in writing to providers and 4 staff that the health care entity prohibits providers from 5 practicing medical aid in dying waives the right to enforce the 6 prohibition. 7 2. If a requesting patient wishes to transfer care from a 8 health care entity that prohibits the practice of medical aid 9 in dying to another health care entity, the prohibiting entity 10 shall coordinate a timely transfer of care including transfer 11 of the requesting patient’s medical records that includes a 12 notation of the date the requesting patient first made an oral 13 request or a written request concerning medical aid in dying 14 within two business days of the request for transfer by the 15 requesting patient. 16 3. A health care entity shall not prohibit a provider from 17 fulfilling the requirements of informed consent and meeting the 18 standard of medical care under this chapter by prohibiting the 19 provider from doing any of the following: 20 a. Providing information to a patient regarding the 21 patient’s health status including but not limited to a 22 diagnosis and prognosis, recommended treatment and treatment 23 alternatives, and the risks and benefits of each. 24 b. Providing information regarding health care services 25 available pursuant to this chapter, information about relevant 26 community resources, and how to access those resources to 27 obtain care of the patient’s choice. 28 c. Practicing medical aid in dying outside the scope of the 29 provider’s employment or contract with the prohibiting entity 30 and off the premises of the prohibiting entity. 31 d. Being present, if outside the scope of the provider’s 32 employment or contractual duties, when a qualified patient 33 self-administers medication prescribed pursuant to this 34 chapter or at the time of death of the qualified patient, if 35 -15- LSB 2327YH (1) 90 pf/rh 15/ 26

H.F. 612 requested by the qualified patient or the qualified patient’s 1 representative. 2 4. A prohibiting health care entity shall provide notice 3 to the public by posting on the health care entity’s internet 4 site that the health care entity prohibits attending providers 5 from qualifying patients for medical aid in dying and from 6 prescribing and dispensing medication pursuant to this chapter 7 while the provider is performing duties in the course of 8 performing duties for the health care entity. 9 5. A health care entity shall not engage in false, 10 misleading, or deceptive practices relating to the health care 11 entity’s policy regarding end-of-life care services, including 12 whether the health care entity has a policy which prohibits 13 affiliated providers from practicing medical aid in dying, or 14 intentionally denying a requesting patient access to medication 15 pursuant to this chapter by failing to transfer a requesting 16 patient and the requesting patient’s medical records to another 17 provider in a timely manner. The intentional misleading of 18 a patient or deploying of misinformation to obstruct access 19 to services pursuant to this chapter by a health care entity 20 constitutes coercion and undue influence which is an aggravated 21 misdemeanor and also subjects the health care entity to 22 licensee discipline. 23 6. If any portion of this section is found to be in conflict 24 with federal requirements which are a prescribed condition to 25 the receipt of federal funds, the conflicting part of this 26 section is inoperative solely to the extent of the conflict 27 with respect to the health care entity directly affected, and 28 such finding or determination shall not affect the operation of 29 the remainder of this section or this chapter. 30 Sec. 16. NEW SECTION . 142E.16 Immunities for actions in 31 good faith —— prohibition against reprisals. 32 1. A provider or health care entity shall not be subject to 33 criminal liability, licensing sanctions, or other professional 34 disciplinary action for actions taken in good-faith compliance 35 -16- LSB 2327YH (1) 90 pf/rh 16/ 26

H.F. 612 with this chapter. 1 2. A provider, health care entity, or professional 2 organization or association shall not subject a provider or 3 health care entity to censure, discipline, suspension, loss of 4 license, loss of privileges, loss of membership, or any other 5 penalty for engaging in good-faith compliance with this chapter 6 or for refusing to participate in accordance with this chapter. 7 3. A provider, health care entity, or professional 8 organization or association shall not subject a provider 9 to discharge, demotion, censure, discipline, suspension, 10 loss of license, loss of privileges, loss of membership, 11 discrimination, or any other penalty for providing medical 12 aid in dying in accordance with the standard of care and 13 in good faith under this chapter when the provider is 14 engaged in the outside practice of medicine and not on the 15 objecting provider’s, health care entity’s, or professional 16 organization’s or association’s premises, or when the provider 17 is providing scientific and accurate information about medical 18 aid in dying to a patient when discussing end-of-life care 19 options. 20 4. A provider is not subject to civil or criminal liability 21 or professional discipline if, at the request of a qualified 22 patient, the provider is present outside the scope of the 23 provider’s employment and not located on the health care 24 entity’s premises when the qualified patient self-administers 25 medication pursuant to this chapter or at the time of the 26 qualified patient’s death. 27 5. A person who is present at the time of 28 self-administration of medication pursuant to this chapter 29 may, without civil or criminal liability, assist the qualified 30 patient by preparing the medication prescribed pursuant to this 31 chapter. 32 6. The request alone by a patient for medical aid in dying 33 does not constitute grounds for neglect or elder abuse for any 34 purpose of law, nor shall it be the sole basis for appointment 35 -17- LSB 2327YH (1) 90 pf/rh 17/ 26

H.F. 612 of a guardian or conservator for the requesting patient. 1 7. This section does not limit civil liability of a provider 2 or a health care entity for an intentional or negligent 3 violation of this chapter. 4 Sec. 17. NEW SECTION . 142E.17 Effect on construction of 5 wills, contracts, or other agreements. 6 1. A provision in a contract, will, or other agreement, 7 whether written or oral, that would determine whether a 8 patient may make or rescind a request for medical-aid-in-dying 9 medication pursuant to this chapter is not valid. 10 2. An obligation owing under any currently existing 11 contract shall not be conditioned or affected by a patient’s 12 act of making or rescinding a request for medical-aid-in-dying 13 medication pursuant to this chapter. 14 3. It is unlawful for an insurer to deny or alter a health 15 care benefit otherwise available to a patient with a terminal 16 disease based on the availability of medical aid in dying or to 17 otherwise attempt to coerce a patient with a terminal disease 18 to make a request for medical-aid-in-dying medication. 19 Sec. 18. NEW SECTION . 142E.18 Insurance or annuity 20 policies, plans, contracts, or other agreements. 21 1. The sale, procurement, or issuance of a life, health, or 22 accident insurance policy, plan, contract, or other agreement, 23 or an annuity policy, plan, contract, or other agreement, 24 or the rate charged for such policy, plan, contract, or 25 other agreement shall not be conditioned upon or affected 26 by a patient’s act of making or rescinding a request for 27 medical-aid-in-dying medication pursuant to this chapter. 28 2. A qualified patient’s act of self-administration of 29 medical-aid-in-dying medication pursuant to this chapter 30 does not invalidate any part of a life, health, or accident 31 insurance policy, plan, contract, or other agreement, or an 32 annuity policy, plan, contract, or other agreement. 33 3. A carrier as defined in section 514C.13 shall not 34 deny or alter benefits to a patient with a terminal disease 35 -18- LSB 2327YH (1) 90 pf/rh 18/ 26

H.F. 612 who is a covered beneficiary of the health benefit plan as 1 defined in section 514C.13, based on the availability of 2 medical-aid-in-dying medication, the patient’s request for 3 medical-aid-in-dying medication pursuant to this chapter, or 4 the absence of a request by a patient for medical-aid-in-dying 5 medication pursuant to this chapter. A person who violates 6 this subsection is subject to regulation by the commissioner of 7 insurance under Title XIII, subtitle 1. 8 Sec. 19. NEW SECTION . 142E.19 Liabilities and penalties. 9 1. A person who intentionally or knowingly alters or 10 forges a patient’s request for medical-aid-in-dying medication 11 pursuant to this chapter or who conceals or destroys a 12 rescission of a patient’s request for medical-aid-in-dying 13 medication pursuant to this chapter is guilty of a class “A” 14 felony. 15 2. A person who intentionally or knowingly coerces or exerts 16 undue influence on a patient with a terminal disease to request 17 medical-aid-in-dying medication pursuant to this chapter or to 18 request or utilize medical-aid-in-dying medication pursuant to 19 this chapter is guilty of a class “A” felony. 20 3. Nothing in this section shall limit civil liability 21 or damages arising from negligent conduct or intentional 22 misconduct by a provider or health care entity. 23 4. The penalties specified in this chapter shall not 24 preclude application of criminal penalties applicable under 25 other laws for conduct inconsistent with this chapter. 26 Sec. 20. NEW SECTION . 142E.20 Claims by governmental entity 27 for costs incurred. 28 A governmental entity that incurs costs resulting from 29 a qualified patient’s self-administration of medication 30 prescribed under this chapter in a public place shall have a 31 claim against the estate of the qualified patient to recover 32 such costs and reasonable attorney fees related to enforcing 33 the claim. 34 Sec. 21. NEW SECTION . 142E.21 Construction. 35 -19- LSB 2327YH (1) 90 pf/rh 19/ 26

H.F. 612 1. Nothing in this chapter authorizes a provider or any 1 other person, including a qualified patient, to end the 2 qualified patient’s life by lethal injection, lethal infusion, 3 mercy killing, homicide, murder, manslaughter, euthanasia, or 4 any other criminal act. 5 2. Actions taken in accordance with this chapter do not for 6 any purpose constitute suicide, assisted suicide, euthanasia, 7 mercy killing, homicide, murder, manslaughter, elder abuse or 8 neglect, or any other civil or criminal violation under the 9 law. 10 Sec. 22. NEW SECTION . 142E.22 Severability. 11 If any provision of this chapter or its application to any 12 person or circumstance is held invalid, the invalidity does 13 not affect other provisions or applications of this chapter 14 which can be given effect without the invalid provision or 15 application, and to this end the provisions of this chapter are 16 severable. 17 Sec. 23. FORMS. Within forty-five days of enactment of 18 this Act, the department of health and human services shall 19 create an attending provider checklist form and an attending 20 provider follow-up form to facilitate collection of the 21 information described in this Act and shall post the forms on 22 the department’s internet site. 23 Sec. 24. EFFECTIVE DATE. 24 1. The following, being deemed of immediate importance, 25 takes effect upon enactment: 26 The portion of the section of this Act enacting section 27 142E.12, relating to the department of health and human 28 services creating and making available to all attending 29 providers a prescribing provider checklist form and prescribing 30 provider follow-up form for the purposes of reporting the 31 information as specified under this Act to the department of 32 health and human services. The department of health and human 33 services shall comply with this section within forty-five days 34 of the effective date of this subsection. 35 -20- LSB 2327YH (1) 90 pf/rh 20/ 26