HF 708 (LSB 1139YH (8) 91)

HOUSE FILE 708

BY  BERGAN

A BILL FOR

An Act relating to health care decisions related to palliative care, hospice programs, life-sustaining procedures, and out-of-hospital do-not-resuscitate orders.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  Section 135J.1, Code 2025, is amended by adding the following new subsections:
   NEW SUBSECTION.  1A.  “Attorney in fact” means an individual who is designated by a durable power of attorney for health care as an agent to make health care decisions on behalf of a patient and has consented to act in that capacity.
   NEW SUBSECTION.  1B.  “Close adult friend” means a friend of the patient to whom all of the following apply:
   a.  The individual is at least eighteen years of age.
   b.  The individual has shown special care and concern for the patient.
   c.  The individual maintains regular contact with the patient and is familiar with the patient’s health, activities, and beliefs.
   d.  The individual has signed an affidavit with the patient’s attending physician that states that the close adult friend is willing and able to be involved in the patient’s care.
   NEW SUBSECTION.  3A.  “Durable power of attorney for health care” means a document authorizing an attorney in fact to make health care decisions for the patient if the patient is unable, in the judgment of the patient’s attending physician or attending physician assistant, to make health care decisions.
   NEW SUBSECTION.  8A.  “Serious illness” means a health condition that carries a high risk of mortality and either negatively impacts a person’s daily functioning or quality of life, or excessively strains the person’s caregivers.
   NEW SUBSECTION.  8B.  “Terminal condition” means the same as defined in section 144A.2.
    Sec. 2.  Section 135J.1, subsections 4, 6, 8, and 9, Code 2025, are amended to read as follows:
   4.  “Hospice patient” or “patient” means a person diagnosed terminally ill person with a terminal illness by an attending physician, with an anticipated life expectancy of six months or less, as certified by the attending physician, who, alone or in conjunction with a unit of care as defined in subsection 9, has voluntarily requested and received admission into the a hospice program. If the patient is unable to request admission, a family member may voluntarily request and receive admission on the patient’s behalf.
   6.  “Hospice program” means a centrally coordinated program of home and inpatient care provided directly or through an agreement under the direction of an identifiable hospice administration providing palliative care directed at symptom management and supportive medical and other health services to terminally ill hospice patients and their families. A licensed hospice program shall utilize a medically directed interdisciplinary team and provide care to meet the physical, emotional, social, spiritual, and other special needs which are experienced during the final stages of illness, dying, and bereavement. Hospice care shall be available twenty-four hours a day, seven days a week.
   8.  “Palliative care” means specialized medical care directed at managing symptoms experienced by the hospice patient, as well as addressing related needs of the patient and family as they experience the stress of the dying process a patient diagnosed by an attending physician with a serious illness.  Palliative care is provided by a trained team of health care providers who work together with a patient’s health care providers to provide support through stress and symptom management based on the needs of the patient, not the patient’s prognosis. The intent of palliative care is to enhance the quality of life for the hospice patient and family unit, and is not treatment directed at cure of the terminal illness.  Palliative care is appropriate for a patient at any age and at any stage of a serious illness and can be utilized with curative treatment for the serious illness.
   9.  “Unit of care” means the a hospice patient and the hospice patient’s family within a hospice program.
    Sec. 3.  Section 135J.3, subsections 3, 4, and 5, Code 2025, are amended to read as follows:
   3.  A mechanism that assures the rights of the patient and family unit of care.
   4.  Palliative Symptom management care provided to a hospice patient and family unit of care under the direction of an attending physician.
   5.  An interdisciplinary team which develops, implements, and evaluates the hospice plan of care for the patient and family unit of care.
    Sec. 4.  NEW SECTION.  135J.3A  Patient incapable of making a treatment decision.
   A patient who has a terminal condition, and who is comatose, incompetent, or otherwise physically or mentally incapable of communication, and who has not expressed their desire for palliative care or a hospice program, may be placed in a hospice program by any of the following individuals, who shall be guided by the express or implied intentions of the patient, in the following order of priority if no individual in the previous priority is reasonably available, willing, and competent to make the decision.
   1.  The attorney in fact of a durable power of attorney for health care executed by the patient pursuant to chapter 144B.
   2.  The guardian of the patient appointed pursuant to chapter 633.
   3.  The patient’s spouse.
   4.  An adult child or stepchild of the patient or, if the patient has more than one adult child or stepchild, the decision agreed to by a majority of the adult children and stepchildren who are reasonably available for consultation with the patient’s attending physician.
   5.  A parent or stepparent of the patient, or if the patient has more than one parent or stepparent, the decision agreed to by a majority of the parents and stepparents who are reasonably available for consultation with the patient’s attending physician.
   6.  An adult sibling or stepsibling of the patient, or if the patient has more than one sibling or stepsibling, the decision agreed to by a majority of the adult siblings and stepsiblings who are reasonably available for consultation with the patient’s attending physician.
   7.  The decision agreed to by a majority of the patient’s relatives, including but not limited to grandchildren, grandparents, aunts, uncles, nieces, and nephews, who are reasonably available for consultation with the patient’s attending physician.
   8.  A close adult friend.
    Sec. 5.  Section 144A.2, Code 2025, is amended by adding the following new subsections:
   NEW SUBSECTION.  3A.  “Attorney in fact” means an individual who is designated by a durable power of attorney for health care as an agent to make health care decisions on behalf of a patient and has consented to act in that capacity.
   NEW SUBSECTION.  3B.  “Close adult friend” means a friend of the patient to whom all of the following apply:
   a.  The individual is at least eighteen years of age.
   b.  The individual has shown special care and concern for the patient.
   c.  The individual maintains regular contact with the patient and is familiar with the patient’s health, activities, and beliefs.
   d.  The individual has signed an affidavit with the patient’s attending physician that states that the close adult friend is willing and able to be involved in the patient’s care.
   NEW SUBSECTION.  5A.  “Durable power of attorney for health care” means a document authorizing an attorney in fact to make health care decisions for the patient if the patient is unable, in the judgment of the patient’s attending physician or attending physician assistant, to make health care decisions.
    Sec. 6.  Section 144A.7, subsections 1 and 2, Code 2025, are amended to read as follows:
   1.  Life-sustaining procedures may be withheld or withdrawn from a patient who is in a terminal condition, and who is comatose, incompetent, or otherwise physically or mentally incapable of communication, and who has not made a declaration in accordance with this chapter section 144A.3 if there is consultation and written agreement for the withholding or the withdrawal of life-sustaining procedures between the attending physician and any of the following individuals, who shall be guided by the express or implied intentions of the patient, in the following order of priority if no individual in a prior class the previous priority is reasonably available, willing, and competent to act: make a decision.
   a.  The attorney in fact designated to make treatment decisions for the patient should such person be diagnosed as suffering from a terminal condition, if the designation is in writing and complies with chapter 144B.
   b.  The guardian of the person of the patient if one has been appointed, provided pursuant to chapter 633, or the guardian of the patient who has obtained court approval is obtained in accordance with section 232D.401, subsection 4, paragraph “a”, or section 633.635, subsection 3, paragraph “b”, subparagraph (1). This paragraph does not require the appointment of a guardian in order for a treatment decision to be made under this section.
   c.  The patient’s spouse.
   d.  An adult child or stepchild of the patient or, if the patient has more than one adult child or stepchild, the decision agreed to by a majority of the adult children and stepchildren who are reasonably available for consultation with the patient’s attending physician.
   e.  A parent or stepparent of the patient, or parents if both the patient has more than one parent or stepparent, the decision agreed to by a majority of the parents and stepparents who are reasonably available for consultation with the patient’s attending physician.
   f.  An adult sibling or stepsibling of the patient or, if the patient has more than one adult sibling or stepsibling, the decision agreed to by a majority of the adult siblings and stepsiblings who are reasonably available for consultation with the patient’s attending physician.
   g.  The decision agreed to by a majority of the patient’s relatives, including but not limited to grandchildren, grandparents, aunts, uncles, nieces, and nephews, who are reasonably available for consultation with the patient’s attending physician.
   h.  A close adult friend.
   2.  When a decision is made pursuant to this section to withhold or withdraw life-sustaining procedures, there shall be a witness present at the time of the consultation with the patient’s attending physician when that the decision is made.  The witness shall be an adult who is not related to the patient by blood, marriage, or adoption within the third degree of consanguinity and who is not an attending physician or an employee of an attending physician involved in the patient’s care.
    Sec. 7.  NEW SECTION.  144A.7B  Procedure in absence of out-of-hospital do-not-resuscitate order.
   1.  Resuscitation may be withheld or withdrawn from a patient who has a terminal illness, and who is comatose, incompetent, or otherwise physically or mentally incapable of communication, and who has not executed an out-of-hospital do-not-resuscitate order, if there is consultation and written agreement for the withholding or the withdrawal of resuscitation between the attending physician and any of the following individuals, who shall be guided by the express or implied intentions of the patient, in the following order of priority if no individual in the previous priority is reasonably available, willing, and competent to make a decision.
   a.  The attorney in fact of a durable power of attorney for health care executed by the patient pursuant to chapter 144B.
   b.  The guardian of the patient appointed pursuant to chapter 633.
   c.  The patient’s spouse.
   d.  An adult child or stepchild of the patient or, if the patient has more than one adult child or stepchild, the decision agreed to by a majority of the adult children and stepchildren who are reasonably available for consultation with the patient’s attending physician.
   e.  A parent or stepparent of the patient, or if the patient has more than one parent or stepparent, the decision agreed to by a majority of the parents and stepparents who are reasonably available for consultation with the patient’s attending physician.
   f.  An adult sibling or stepsibling of the patient, or if the patient has more than one adult sibling or stepsibling, the decision agreed to by a majority of the adult siblings and stepsiblings who are reasonably available for consultation with the patient’s attending physician.
   g.  The decision agreed to by a majority of the relatives, including but not limited to grandchildren, grandparents, aunts, uncles, nieces, and nephews, who are reasonably available for consultation with the patient’s attending physician.
   h.  A close adult friend.
   2.  When a decision is made pursuant to this section to withhold or withdraw resuscitation, a witness shall be present at the time of the consultation with the patient’s attending physician when the decision is made. The witness shall be an adult who is not related to the patient by blood, marriage, or adoption within the third degree of consanguinity and who is not the attending physician or an employee of the attending physician involved in the patient’s care.
    Sec. 8.  Section 144C.2, subsection 16, Code 2025, is amended to read as follows:
   16.  “Licensed hospice program” means a licensed hospice program as defined described in section 135J.1.
    Sec. 9.  Section 633.635, Code 2025, is amended by adding the following new subsection:
   NEW SUBSECTION.  6.  Notwithstanding subsection 2 or 3, a guardian may make a decision for a protected person pursuant to sections 135J.3A, 144A.7, and 144A.7B without court approval.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill relates to health care decisions related to palliative care, hospice programs, life-sustaining procedures, and out-of-hospital do-not-resuscitate orders.
   Current law requires a hospice program to provide palliative care in order to be eligible for a license. The bill removes this requirement and requires a hospice program to provide care directed at symptom management to be eligible to receive a license.
   Under the bill, if a patient who has a terminal condition, and is comatose, incompetent, or incapable of communication, and has not expressed their desire regarding palliative care or a hospice program, certain individuals in order of priority have the authority to make the decision to place the patient in a hospice program. The individuals who have the authority to make such a decision include an attorney in fact, a guardian, the patient’s spouse, an adult child or stepchild, a parent or stepparent, adult sibling or adult stepsibling, a relative of the patient, and a close adult friend. The bill defines close adult friend. An individual making a decision for such a patient shall be guided by the express or implied intention of the patient in making the decision.
   Current law provides that certain individuals in order of priority, including an attorney in fact, a guardian, the patient’s spouse, an adult child, a parent, and an adult sibling, have the authority to withhold or withdraw life-sustaining procedures from a patient who has a terminal condition, and who is comatose, incompetent, or incapable of communication, and who has not made a declaration for life-sustaining procedures. The bill broadens these categories to include stepchildren, stepparents, and stepsiblings, relatives of the patient, and a close adult friend of the patient. The bill provides restrictions on who may act as a witness to the consultation when the decision is made with the patient’s attending physician.
   The bill provides that resuscitation may be withheld or withdrawn from a patient who has a terminal condition, and who is comatose, incompetent, or incapable of communication, and who has not executed an out-of-hospital do-not-resuscitate order if there is consultation and written agreement between the patient’s attending physician and certain individuals, in order of priority, making the decision. The individuals who are authorized to make such a decision include an attorney in fact, a guardian, the patient’s spouse, an adult child or stepchild, a parent or stepparent, adult sibling or adult stepsibling, a relative of the patient, and a close adult friend. An individual making a health care decision for such a patient shall be guided by the express or implied intention of the patient in making the decision. A witness, as specified in the bill, shall be present at the time of consultation with the patient’s attending physician when a decision is made to withdraw or withhold resuscitation.
   Current law requires a guardian to obtain court approval before the guardian may consent to the withholding or withdrawal of life-sustaining procedures for a protected person. The bill makes an exception to this requirement and allows a guardian to make a decision for the protected person relating to hospice care, life-sustaining procedures, and resuscitation without court approval in circumstances detailed in the bill.