H.F. 2305 Section 1. Section 135J.1, Code 2026, is amended to read as 1 follows: 2 135J.1 Definitions. 3 For the purposes of this chapter unless otherwise defined: 4 1. “Attending physician provider ” means a physician licensed 5 pursuant to chapter 148 or a physician assistant licensed 6 pursuant to chapter 148C , physician assistant, or an advanced 7 registered nurse practitioner who is licensed in this state . 8 2. “Attorney in fact” means an individual who is designated 9 by a durable power of attorney for health care as an agent 10 to make health care decisions on behalf of a patient and has 11 consented to act in that capacity. 12 3. “Close adult friend” means a friend of a patient to whom 13 all of the following apply: 14 a. The individual is at least eighteen years of age. 15 b. The individual has shown special care and concern for the 16 patient. 17 c. The individual maintains regular contact with the patient 18 and is familiar with the patient’s health, activities, and 19 beliefs. 20 d. The individual has provided an affidavit to the patient’s 21 attending provider that states that the individual is willing 22 and able to be involved in the patient’s care. 23 2. 4. “Core services” means physician services, nursing 24 services, medical social services, counseling services, 25 and volunteer services. These core services, as well as 26 others deemed necessary by the hospice in delivering safe 27 and appropriate care to its case load the hospice’s hospice 28 patients , can be provided through either direct or indirect 29 arrangement by the hospice. 30 3. 5. “Department” means the department of inspections, 31 appeals, and licensing. 32 6. “Durable power of attorney for health care” means a 33 document authorizing an attorney in fact to make health care 34 decisions for a patient if the patient is unable, in the 35 -1- LSB 1139HV (3) 91 lh/ko 1/ 18

H.F. 2305 judgment of the patient’s attending provider, to make health 1 care decisions. 2 4. 7. “Hospice patient” or “patient” means a diagnosed 3 terminally ill person an individual with an anticipated life 4 expectancy of six months or less, as certified by the attending 5 physician provider , who, alone or in conjunction with a unit of 6 care as defined in subsection 9 , has voluntarily requested and 7 received admission into the a hospice program. If the patient 8 is unable to request admission, a family member may voluntarily 9 request and receive admission on the patient’s behalf. 10 5. 8. “Hospice patient’s family” means the immediate kin of 11 the a hospice patient, including a spouse, parent, stepparent, 12 brother, sister, stepbrother, stepsister, child, or stepchild. 13 Additional relatives or individuals with significant personal 14 ties to the hospice patient may be included in the hospice 15 patient’s family. 16 6. 9. “Hospice program” means a centrally coordinated 17 program of home and inpatient care provided directly or through 18 an agreement under the direction of an identifiable hospice 19 administration providing palliative care directed at symptom 20 management and supportive medical and other health services 21 to terminally ill hospice patients and their families. A 22 licensed hospice program shall utilize a medically directed 23 interdisciplinary team and provide care to meet the physical, 24 emotional, social, spiritual, and other special needs which 25 are experienced during the final stages of illness, dying, and 26 bereavement. Hospice care shall be available twenty-four hours 27 a day, seven days a week. 28 7. 10. “Interdisciplinary team” means the hospice patient 29 and the hospice patient’s family, the attending physician 30 provider , and all of the following individuals trained to serve 31 with a licensed hospice program: 32 a. A licensed physician pursuant to chapter 148 . 33 b. A licensed registered nurse pursuant to chapter 152 . 34 c. An individual with at least a baccalaureate degree in the 35 -2- LSB 1139HV (3) 91 lh/ko 2/ 18

H.F. 2305 field of social work providing medical-social services. 1 d. Trained hospice volunteers Volunteer services . 2 e. As deemed appropriate by the hospice, physician 3 assistants, providers of special services including but not 4 limited to a spiritual counselor, a pharmacist pharmacists , or 5 professionals in the fields of mental health may be included 6 on the interdisciplinary team. 7 8. 11. “Palliative care” means specialized medical care 8 directed at managing symptoms experienced by the hospice 9 provided to a patient , as well as addressing related needs 10 of the patient and family as they experience the stress of 11 the dying process who has been diagnosed by the patient’s 12 attending provider with a serious illness. Palliative care is 13 stress and symptom management care, based on the needs of the 14 patient rather than the patient’s diagnosis, provided by an 15 interdisciplinary team . The intent of palliative care is to 16 enhance the quality of life for the hospice patient and family 17 unit , and is not treatment directed at cure of the terminal 18 illness . Palliative care may be provided at any stage of a 19 patient’s serious illness, regardless of the patient’s age, and 20 may be provided in conjunction with curative treatment for the 21 serious illness. 22 12. “Serious illness” means a health condition that carries 23 a high risk of mortality and either negatively impacts a 24 person’s daily functioning or quality of life, or excessively 25 strains the person’s caregivers. 26 13. “Terminal condition” means the same as defined in 27 section 144A.2. 28 9. 14. “Unit of care” means the a hospice patient and the 29 hospice patient’s family within a hospice program. 30 10. 15. “Volunteer services” means the services provided by 31 individuals who have successfully completed a training program 32 developed by a licensed hospice program. 33 Sec. 2. Section 135J.3, Code 2026, is amended to read as 34 follows: 35 -3- LSB 1139HV (3) 91 lh/ko 3/ 18

H.F. 2305 135J.3 Basic requirements. 1 A licensed hospice program shall include: 2 1. A planned program of hospice care, the medical components 3 of which shall be under the direction of an attending physician 4 provider . 5 2. Centrally administered, coordinated hospice core 6 services provided in home, outpatient, or institutional 7 settings. 8 3. A mechanism that assures the rights of the patient and 9 family a unit of care . 10 4. Palliative care Symptom management provided to a hospice 11 patient and family unit of care under the direction of an 12 attending physician provider . 13 5. An interdisciplinary team which develops, implements, 14 and evaluates the hospice plan of care for the patient and 15 family a unit of care . 16 6. Bereavement services. 17 7. Accessible hospice care twenty-four hours a day, seven 18 days a week in all settings. 19 8. An ongoing system of quality assurance and utilization 20 review. 21 Sec. 3. NEW SECTION . 135J.3A Patient incapable of making a 22 treatment decision. 23 A patient who has a terminal condition, and who is comatose, 24 incompetent, or otherwise physically or mentally incapable 25 of communication, and who has not expressed their desire 26 for palliative care or a hospice program, may be placed in 27 a hospice program by any of the following individuals, who 28 shall be guided by the express or implied intentions of the 29 patient, in the following order of priority if no individual 30 in the previous priority is reasonably available, willing, and 31 competent to make the decision. 32 1. The patient’s attorney in fact. 33 2. The guardian of the patient appointed pursuant to chapter 34 633. If the patient has appointed more than one guardian with 35 -4- LSB 1139HV (3) 91 lh/ko 4/ 18

H.F. 2305 equal responsibilities, the decision agreed to by a majority 1 of the guardians. If no majority consensus is achieved by the 2 guardians, a court order shall be required. 3 3. The patient’s spouse. 4 4. An adult child of the patient or, if the patient 5 has more than one adult child, the decision agreed to by a 6 majority of the adult children who are reasonably available for 7 consultation with the patient’s attending provider. 8 5. A parent of the patient, or if the patient has more than 9 one parent, the decision agreed to by both parents if both 10 are reasonably available for consultation with the patient’s 11 attending provider. 12 6. An adult sibling of the patient, or if the patient has 13 more than one sibling, the decision agreed to by a majority 14 of the adult siblings who are reasonably available for 15 consultation with the patient’s attending provider. 16 7. The decision agreed to by a majority of the patient’s 17 relatives, including but not limited to grandchildren, 18 grandparents, aunts, uncles, nieces, nephews, stepchildren, 19 stepparents, and stepsiblings who are at least eighteen years 20 of age and reasonably available for consultation with the 21 patient’s attending provider. 22 8. A close adult friend. 23 Sec. 4. Section 144A.2, Code 2026, is amended to read as 24 follows: 25 144A.2 Definitions. 26 Except as otherwise provided, as used in this chapter : 27 1. “Adult” means an individual eighteen years of age or 28 older. 29 2. “Advanced registered nurse practitioner” means the same as 30 defined in section 152.1. 31 2. 3. “Attending physician provider ” means the physician 32 selected by, or assigned to, the patient who has primary 33 responsibility for the treatment and care of the patient same 34 as defined in section 135J.1 . 35 -5- LSB 1139HV (3) 91 lh/ko 5/ 18

H.F. 2305 3. 4. “Attending physician assistant” means the physician 1 assistant selected by, or assigned to, the patient who has 2 primary responsibility for the treatment and care of the 3 patient “Attorney in fact” means the same as defined in section 4 135J.1 . 5 5. “Close adult friend” means the same as defined in section 6 135J.1. 7 4. 6. “Declaration” means a document executed in accordance 8 with the requirements of section 144A.3 . 9 5. 7. “Department” means the department of health and human 10 services. 11 8. “Durable power of attorney for health care” means the same 12 as defined in section 135J.1. 13 6. 9. “Emergency medical care provider” means emergency 14 medical care provider as defined in section 147A.1 . 15 7. 10. “Health care provider” means a person, including an 16 emergency medical care provider, who is licensed, certified, or 17 otherwise authorized or permitted by the law of this state to 18 administer health care in the ordinary course of business or in 19 the practice of a profession. 20 8. 11. “Hospital” means hospital as defined in section 21 135B.1 . 22 9. 12. a. “Life-sustaining procedure” means any medical 23 procedure, treatment, or intervention, including resuscitation, 24 which meets both of the following requirements: 25 (1) Utilizes mechanical or artificial means to sustain, 26 restore, or supplant a spontaneous vital function. 27 (2) When applied to a patient in a terminal condition, would 28 serve only to prolong the dying process. 29 b. “Life-sustaining procedure” does not include the 30 provision of nutrition or hydration except when required 31 to be provided parenterally or through intubation, or the 32 administration of medication or performance of any medical 33 procedure deemed necessary to provide comfort care or to 34 alleviate pain. 35 -6- LSB 1139HV (3) 91 lh/ko 6/ 18

H.F. 2305 10. 13. “Out-of-hospital do-not-resuscitate order” means 1 a written order signed by a physician an attending provider , 2 executed in accordance with the requirements of section 3 144A.7A and issued consistent with this chapter , that directs 4 the withholding or withdrawal of resuscitation when an adult 5 patient in a terminal condition is outside the hospital. 6 11. 14. “Physician” means a person licensed to practice 7 medicine and surgery or osteopathic medicine and surgery in 8 this state. 9 12. 15. “Physician assistant” means a person licensed to 10 practice as a physician assistant in this state. 11 13. 16. “Qualified patient” means a patient who has 12 executed a declaration or an out-of-hospital do-not-resuscitate 13 order in accordance with this chapter and who has been 14 determined by the attending physician to be in a terminal 15 condition. 16 14. 17. “Resuscitation” means any medical intervention that 17 utilizes mechanical or artificial means to sustain, restore, 18 or supplant a spontaneous vital function, including but not 19 limited to chest compression, defibrillation, intubation, and 20 emergency drugs intended to alter cardiac function or otherwise 21 to sustain life. 22 15. 18. “Terminal condition” means an incurable or 23 irreversible condition that, without the administration 24 of life-sustaining procedures, will, in the opinion of the 25 attending physician, result in death within a relatively short 26 period of time or a state of permanent unconsciousness from 27 which, to a reasonable degree of medical certainty, there can 28 be no recovery. 29 Sec. 5. Section 144A.3, subsections 3 and 5, Code 2026, are 30 amended to read as follows: 31 3. It is the responsibility of the declarant to provide 32 the declarant’s attending physician or health care provider 33 with the declaration. An attending physician or health care 34 provider may presume, in the absence of actual notice to the 35 -7- LSB 1139HV (3) 91 lh/ko 7/ 18

H.F. 2305 contrary, that the declaration complies with this chapter and 1 is valid. 2 5. A declaration executed pursuant to this chapter may, but 3 need not, be in the following form: 4 DECLARATION 5 If I should have an incurable or irreversible condition that 6 will result either in death within a relatively short period 7 of time or a state of permanent unconsciousness from which, 8 to a reasonable degree of medical certainty, there can be no 9 recovery, it is my desire that my life not be prolonged by 10 the administration of life-sustaining procedures. If I am 11 unable to participate in my health care decisions, I direct 12 my attending physician provider to withhold or withdraw 13 life-sustaining procedures that merely prolong the dying 14 process and are not necessary to my comfort or freedom from 15 pain. 16 Sec. 6. Section 144A.4, Code 2026, is amended to read as 17 follows: 18 144A.4 Revocation of declaration. 19 1. A declaration may be revoked at any time and in any 20 manner by which the declarant is able to communicate the 21 declarant’s intent to revoke, without regard to mental or 22 physical condition. A revocation is only effective as to the 23 attending physician or attending physician assistant provider 24 upon communication to such physician or physician assistant 25 attending provider by the declarant or by another to whom the 26 revocation was communicated. 27 2. The attending physician or attending physician assistant 28 provider shall make the revocation a part of the declarant’s 29 medical record. 30 Sec. 7. Section 144A.5, Code 2026, is amended to read as 31 follows: 32 144A.5 Determination of terminal condition. 33 When an attending physician provider who has been provided 34 with a declaration determines that the declarant is in a 35 -8- LSB 1139HV (3) 91 lh/ko 8/ 18

H.F. 2305 terminal condition, this decision must be confirmed by another 1 physician. The attending physician provider must record that 2 determination in the declarant’s medical record. 3 Sec. 8. Section 144A.6, subsection 2, Code 2026, is amended 4 to read as follows: 5 2. The declaration of a qualified patient known to the 6 attending physician provider to be pregnant shall not be in 7 effect as long as the fetus could develop to the point of live 8 birth with continued application of life-sustaining procedures. 9 However, the provisions of this subsection do not impair any 10 existing rights or responsibilities that any person may have 11 in regard to the withholding or withdrawal of life-sustaining 12 procedures. 13 Sec. 9. Section 144A.7, subsections 1 and 2, Code 2026, are 14 amended to read as follows: 15 1. Life-sustaining procedures may be withheld or withdrawn 16 from a patient who is in a terminal condition and who is 17 comatose, incompetent, or otherwise physically or mentally 18 incapable of communication , and who has not made a declaration 19 in accordance with this chapter section 144A.3 if there is 20 consultation and written agreement for the withholding or the 21 withdrawal of life-sustaining procedures between the attending 22 physician provider, another physician, physician assistant, 23 or advanced registered nurse practitioner, and any of the 24 following individuals, who shall be guided by the express or 25 implied intentions of the patient, in the following order 26 of priority if no individual in a prior class the previous 27 priority is reasonably available, willing, and competent to act 28 make a decision : 29 a. The attorney in fact designated to make treatment 30 decisions for the patient should such person be diagnosed as 31 suffering from a terminal condition, if the designation is in 32 writing and complies with chapter 144B . 33 b. The guardian of the person of the patient if one has been 34 appointed , provided pursuant to chapter 633, or the guardian 35 -9- LSB 1139HV (3) 91 lh/ko 9/ 18

H.F. 2305 of the patient who has obtained court approval is obtained in 1 accordance with section 232D.401, subsection 4 , paragraph “a” , 2 or section 633.635, subsection 3 , paragraph “b” , subparagraph 3 (1) . This paragraph does not require the appointment of a 4 guardian in order for a treatment decision to be made under 5 this section . 6 c. The patient’s spouse. 7 d. An adult child of the patient or, if the patient 8 has more than one adult child, the decision agreed to by a 9 majority of the adult children who are reasonably available for 10 consultation with the patient’s attending provider . 11 e. A parent of the patient, or parents if both the patient 12 has more than one parent, the decision agreed to by both 13 parents if both are reasonably available for consultation with 14 the patient’s attending provider . 15 f. An adult sibling of the patient or, if the patient 16 has more than one adult sibling, the decision agreed to by a 17 majority of the adult siblings who are reasonably available for 18 consultation with the patient’s attending provider . 19 g. The decision agreed to by a majority of the patient’s 20 relatives, including but not limited to grandchildren, 21 grandparents, aunts, uncles, nieces, nephews, stepchildren, 22 stepparents, and stepsiblings who are reasonably available for 23 consultation with the patient’s attending provider. 24 h. A close adult friend. 25 2. When a decision is made pursuant to this section to 26 withhold or withdraw life-sustaining procedures, there shall 27 be a witness present at the time of the consultation with the 28 patient’s attending provider when that the decision is made. 29 The witness shall be an adult who is not related to the patient 30 by blood, marriage, or adoption within the third degree of 31 consanguinity and who is not a health care provider or an 32 employee of a health care provider involved in the patient’s 33 care. 34 Sec. 10. Section 144A.7A, subsections 1 and 3, Code 2026, 35 -10- LSB 1139HV (3) 91 lh/ko 10/ 18

H.F. 2305 are amended to read as follows: 1 1. If an attending physician or attending physician 2 assistant provider issues an out-of-hospital do-not-resuscitate 3 order for an adult patient under this section , the physician 4 attending provider shall use the form prescribed pursuant to 5 subsection 2 , include a copy of the order in the patient’s 6 medical record, and provide a copy to the patient or an 7 individual authorized to act on the patient’s behalf. 8 3. The out-of-hospital do-not-resuscitate order form shall 9 include all of the following: 10 a. The patient’s name. 11 b. The patient’s date of birth. 12 c. The name of the individual authorized to act on the 13 patient’s behalf, if applicable. 14 d. A statement that the patient is in a terminal condition. 15 e. The physician’s or physician assistant’s attending 16 provider’s signature. 17 f. The date the form is signed. 18 g. A concise statement of the nature and scope of the order. 19 h. Any other information necessary to provide clear and 20 reliable instructions to a health care provider. 21 Sec. 11. NEW SECTION . 144A.7B Procedure in absence of 22 out-of-hospital do-not-resuscitate order. 23 1. Resuscitation may be withheld or withdrawn from a patient 24 who has a terminal illness, and who is comatose, incompetent, 25 or otherwise physically or mentally incapable of communication, 26 and who has not executed an out-of-hospital do-not-resuscitate 27 order, if there is consultation and written agreement for the 28 withholding or the withdrawal of resuscitation between the 29 attending provider physician and another physician, physician 30 assistant, or advanced registered nurse practitioner and any 31 of the following individuals, who shall be guided by the 32 express or implied intentions of the patient, in the following 33 order of priority if no individual in the previous priority 34 is reasonably available, willing, and competent to make a 35 -11- LSB 1139HV (3) 91 lh/ko 11/ 18

H.F. 2305 decision. 1 a. The patient’s attorney in fact. 2 b. The guardian of the patient appointed pursuant to chapter 3 633. If the patient is appointed more than one guardian with 4 equal responsibilities, the decision agreed to by a majority of 5 the guardians. If no consensus is achieved by the guardians, a 6 court order shall be required. 7 c. The patient’s spouse. 8 d. An adult child of the patient or, if the patient 9 has more than one adult child, the decision agreed to by a 10 majority of the adult children who are reasonably available for 11 consultation with the patient’s attending provider. 12 e. A parent of the patient or, if the patient has more 13 than one parent, the decision agreed to by both of the parents 14 if both are reasonably available for consultation with the 15 patient’s attending provider. 16 f. An adult sibling of the patient or, if the patient 17 has more than one adult sibling, the decision agreed to by a 18 majority of the adult siblings who are reasonably available for 19 consultation with the patient’s attending provider. 20 g. The decision agreed to by a majority of the patient’s 21 relatives, including but not limited to grandchildren, 22 grandparents, aunts, uncles, nieces, nephews, stepchildren, 23 stepparents, and stepsiblings who are reasonably available for 24 consultation with the patient’s attending provider. 25 h. A close adult friend. 26 2. When a decision is made pursuant to this section to 27 withhold or withdraw resuscitation, a witness shall be present 28 at the time of the consultation with the patient’s attending 29 provider when the decision is made. 30 Sec. 12. Section 144A.8, subsection 1, Code 2026, is amended 31 to read as follows: 32 1. An attending physician provider who is unwilling to 33 comply with the requirements of section 144A.5 , or who is 34 unwilling to comply with the declaration of a qualified 35 -12- LSB 1139HV (3) 91 lh/ko 12/ 18

H.F. 2305 patient in accordance with section 144A.6 or an out-of-hospital 1 do-not-resuscitate order pursuant to section 144A.7A , or who is 2 unwilling to comply with the provisions of section 144A.7 or 3 144A.7A shall take all reasonable steps to effect the transfer 4 of the patient to another physician provider . 5 Sec. 13. Section 144B.1, Code 2026, is amended to read as 6 follows: 7 144B.1 Definitions. 8 For purposes of this chapter , unless the context otherwise 9 requires: 10 1. “Attending provider” means the same as defined in section 11 135J.1. 12 1. 2. “Attorney in fact” means an individual who is 13 designated by a durable power of attorney for health care as an 14 agent to make health care decisions on behalf of a principal 15 and has consented to act in that capacity. 16 2. 3. “Designee” means a person named in a declaration 17 under chapter 144C . 18 3. 4. “Durable power of attorney for health care” means a 19 document authorizing an attorney in fact to make health care 20 decisions for the principal if the principal is unable, in the 21 judgment of the attending physician or attending physician 22 assistant provider , to make health care decisions. 23 4. 5. “Health care” means any care, treatment, service, 24 or procedure to maintain, diagnose, or treat an individual’s 25 physical or mental condition. “Health care” does not include 26 the provision of nutrition or hydration except when they are 27 required to be provided parenterally or through intubation. 28 5. 6. “Health care decision” means the consent, refusal of 29 consent, or withdrawal of consent to health care. 30 6. 7. “Health care provider” means a person who is 31 licensed, certified, or otherwise authorized or permitted by 32 the law laws of this state to administer health care in the 33 ordinary course of business or in the practice of a profession. 34 7. 8. “Principal” means a person age eighteen or older who 35 -13- LSB 1139HV (3) 91 lh/ko 13/ 18

H.F. 2305 has executed a durable power of attorney for health care. 1 Sec. 14. Section 144B.5, subsection 1, Code 2026, is amended 2 to read as follows: 3 1. A durable power of attorney for health care executed 4 pursuant to this chapter may, but need not, be in the following 5 form: 6 I hereby designate ........ as my attorney in fact (my 7 agent) and give to my agent the power to make health care 8 decisions for me. This power exists only when I am unable, in 9 the judgment of my attending physician or attending physician 10 assistant provider , to make those health care decisions. The 11 attorney in fact must act consistently with my desires as 12 stated in this document or otherwise made known. 13 Except as otherwise specified in this document, this document 14 gives my agent the power, where otherwise consistent with the 15 law laws of this state, to consent to my physician or physician 16 assistant attending provider not giving health care or stopping 17 health care which is necessary to keep me alive. 18 This document gives my agent power to make health care 19 decisions on my behalf, including to consent, to refuse to 20 consent, or to withdraw consent to the provision of any care, 21 treatment, service, or procedure to maintain, diagnose, or 22 treat a physical or mental condition. This power is subject 23 to any statement of my desires and any limitations included in 24 this document. 25 My agent has the right to examine my medical records and to 26 consent to disclosure of such records. 27 Sec. 15. Section 144B.6, subsection 1, Code 2026, is amended 28 to read as follows: 29 1. Unless the district court sitting in equity specifically 30 finds that the attorney in fact is acting in a manner contrary 31 to the wishes of the principal or the durable power of attorney 32 for health care provides otherwise, an attorney in fact who 33 is known to the health care provider to be available and 34 willing to make health care decisions has priority over any 35 -14- LSB 1139HV (3) 91 lh/ko 14/ 18

H.F. 2305 other person, including a guardian appointed pursuant to 1 chapter 633 , to act for the principal in all matters of health 2 care decisions. The attorney in fact has authority to make 3 a particular health care decision only if the principal is 4 unable, in the judgment of the attending physician or attending 5 physician assistant provider , to make the health care decision. 6 If the principal objects to a decision to withhold or withdraw 7 health care, the principal shall be presumed to be able to make 8 a decision. 9 Sec. 16. Section 144C.2, subsection 16, Code 2026, is 10 amended to read as follows: 11 16. “Licensed hospice program” means a licensed hospice 12 program as defined described in section 135J.1 . 13 Sec. 17. Section 633.635, Code 2026, is amended by adding 14 the following new subsection: 15 NEW SUBSECTION . 6. Notwithstanding subsection 2 or 3, a 16 guardian may make a decision for a protected person pursuant to 17 sections 135J.3A, 144A.7, and 144A.7B without court approval. 18 EXPLANATION 19 The inclusion of this explanation does not constitute agreement with 20 the explanation’s substance by the members of the general assembly. 21 This bill relates to health care decisions related to 22 palliative care, hospice programs, life-sustaining procedures, 23 and out-of-hospital do-not-resuscitate orders. 24 Current law requires a hospice program to provide palliative 25 care in order to be eligible for a license. The bill removes 26 this requirement and requires a hospice program to provide 27 care directed at symptom management to be eligible to receive 28 a license. 29 Under the bill, if a patient who has a terminal condition, 30 is comatose, incompetent, or incapable of communication, and 31 has not expressed their desire regarding palliative care or a 32 hospice program, certain individuals in order of priority have 33 the authority to make the decision to place the patient in a 34 hospice program. The individuals who have the authority to 35 -15- LSB 1139HV (3) 91 lh/ko 15/ 18

H.F. 2305 make such a decision include the patient’s attorney in fact, 1 guardian, spouse, adult child, parent, adult sibling, and close 2 adult friend. The bill defines “close adult friend”. An 3 individual making a decision for such a patient shall be guided 4 by the express or implied intention of the patient. 5 Current law provides that certain individuals in order of 6 priority, including a patient’s attorney in fact, guardian, 7 spouse, adult child, parent, and adult sibling, have the 8 authority to withhold or withdraw life-sustaining procedures 9 from a patient who has a terminal condition, is comatose, 10 incompetent, or incapable of communication, and who has not 11 made a declaration for life-sustaining procedures. The bill 12 broadens these categories to include relatives of the patient 13 and a close adult friend of the patient. The bill provides 14 restrictions on who may act as a witness to the consultation 15 when the decision is made with the patient’s attending 16 provider, rather than with the patient’s attending physician 17 as is required under current law. The bill defines “attending 18 provider” as a physician, physician assistant, or an advanced 19 registered nurse practitioner. 20 Current law requires a patient’s attending physician 21 to receive and record in the patient’s medical record a 22 declaration for life-sustaining procedures on behalf of a 23 patient. If a patient wants to revoke this declaration, a 24 revocation is only effective as to the patient’s attending 25 physician when it is communicated to the patient’s attending 26 physician. Once the patient’s attending physician receives 27 a declaration, the attending physician must determine if the 28 patient has a terminal condition. Under the bill, a patient’s 29 attending provider is required to receive and record in the 30 patient’s medical record any declaration for life-sustaining 31 procedures on behalf of a patient. A revocation is only 32 effective as to the patient’s attending provider when it is 33 communicated to the patient’s attending provider. Once the 34 patient’s attending provider receives a declaration, the 35 -16- LSB 1139HV (3) 91 lh/ko 16/ 18

H.F. 2305 attending provider must determine if the patient has a terminal 1 condition. 2 Under current law, an out-of-hospital do-not-resuscitate 3 order for a patient is required to be issued and signed 4 by a patient’s attending physician. Under the bill, an 5 out-of-hospital do-not-resuscitate order is required to be 6 issued and signed by a patient’s attending provider. 7 The bill provides that resuscitation may be withheld or 8 withdrawn from a patient who has a terminal condition, who is 9 comatose, incompetent, or incapable of communication, and who 10 has not executed an out-of-hospital do-not-resuscitate order if 11 there is consultation and written agreement to do so between 12 the patient’s attending provider and the patient’s attorney in 13 fact, guardian, spouse, adult child, parent, adult sibling, 14 relative, or close adult friend. An individual making a health 15 care decision for such a patient shall be guided by the express 16 or implied intention of the patient in making the decision. A 17 witness, as specified in the bill, shall be present at the time 18 of consultation with the patient’s attending provider when a 19 decision is made to withdraw or withhold resuscitation. 20 Under current law, the authority provided to an agent under 21 a durable power of attorney for health care (POA) executed by 22 a patient exists only when the patient’s attending physician 23 determines that the patient is unable to make health care 24 decisions. The agent can consent to a patient’s attending 25 physician withholding life-sustaining care to the patient. The 26 bill provides that the authority provided to an agent under 27 a POA executed by a patient exists only when the patient’s 28 attending provider determines that the patient is unable to 29 make health care decisions. 30 Current law requires a guardian to obtain court approval 31 before the guardian may consent to the withholding or 32 withdrawal of life-sustaining procedures for a protected 33 person. The bill makes an exception to this requirement and 34 allows a guardian to make a decision for the protected person 35 -17- LSB 1139HV (3) 91 lh/ko 17/ 18