Senate File 175 - IntroducedA Bill ForAn Act 1creating the Iowa end-of-life options Act and providing
2penalties.
3BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1   Section 1.  NEW SECTION.  142E.1  Short title.
   2This chapter shall be known and may be cited as the “Iowa
3End-of-Life Options Act”
.
4   Sec. 2.  NEW SECTION.  142E.2  Definitions.
   5As used in this chapter, unless the context otherwise
6requires:
   71.  “Adult” means an individual who is eighteen years of age
8or older.
   92.  “Attending physician” means the physician who has primary
10responsibility for the care of the patient and treatment of the
11patient’s terminal disease.
   123.  “Competent” means that in the opinion of a court or in
13the opinion of the patient’s attending physician or consulting
14physician, psychiatrist, or psychologist, a patient has the
15ability to make and communicate health care decisions to
16health care providers, including communication through persons
17familiar with the patient’s manner of communicating if those
18persons are available.
   194.  “Consulting physician” means a physician who is qualified
20by specialty or experience to make a professional diagnosis and
21prognosis regarding the patient’s disease.
   225.  “Counseling” means one or more consultations as necessary
23between a licensed psychiatrist or psychologist and a patient
24for the purpose of determining that the patient is competent
25and not suffering from a psychiatric or psychological disorder
26or depression causing impaired judgment.
   276.  “Department” means the department of public health.
   287.  “Health care facility” means a health care facility as
29defined in section 135C.1.
   308.  “Health care provider” means a person licensed,
31certified, or otherwise authorized or permitted by the law of
32this state to administer health care or dispense medication in
33the ordinary course of business or practice of a profession,
34and includes a health care facility.
   359.  “Informed decision” means a decision by a qualified
-1-1patient to request and obtain a prescription to end the
2patient’s life that is based on an appreciation of the relevant
3facts and after being fully informed by the attending physician
4of all of the following:
   5a.  The patient’s medical diagnosis.
   6b.  The patient’s prognosis.
   7c.  The potential risks associated with taking the medication
8to be prescribed.
   9d.  The probable result of taking the medication to be
10prescribed.
   11e.  The feasible alternatives, including but not limited to
12comfort care, hospice care, and pain control.
   1310.  “Long-term care facility” means a long-term care unit
14of a hospital, a health care facility, an elder group home as
15defined in section 231B.1, or an assisted living program as
16defined in section 231C.2.
   1711.  “Medically confirmed” means the medical opinion of
18the attending physician has been confirmed by a consulting
19physician who has examined the patient and the patient’s
20relevant medical records.
   2112.  “Patient” means a person who is under the care of a
22physician.
   2313.  “Physician” means a person licensed to practice medicine
24and surgery or osteopathic medicine and surgery under chapter
25148.
   2614.  “Qualified patient” means a competent adult who is a
27resident of Iowa and has satisfied the requirements of this
28chapter to obtain a prescription for medication to end the
29individual’s life.
   3015.  “Self-administer” means a qualified patient’s act of
31ingesting medication to end the patient’s life.
   3216.  “Terminal disease” means an incurable and irreversible
33disease that has been medically confirmed and that will, within
34reasonable medical judgment, produce death within six months.
35   Sec. 3.  NEW SECTION.  142E.3  Request for medication.
-2-
   11.  An adult patient who is competent, is a resident of
2this state, has been determined by the patient’s attending
3physician and consulting physician to be suffering from a
4terminal disease, and has voluntarily expressed a wish to die,
5may make a written request for medication that the patient may
6self-administer to end the patient’s life in accordance with
7this chapter.
   82.  A person shall not qualify to make a written request
9under this section solely because of age or disability.
10   Sec. 4.  NEW SECTION.  142E.4  Oral and written requests —
11right to rescind.
   121.  To receive a prescription for medication that a qualified
13patient may self-administer to end the qualified patient’s life
14pursuant to this chapter, the qualified patient shall make an
15initial oral request, followed by a subsequent oral request
16at least fifteen days after the initial oral request, and a
17written request to the qualified patient’s attending physician.
   182.  At least fifteen days shall elapse between a qualified
19patient’s initial oral request and the writing of a
20prescription under this chapter.
   213.  At least forty-eight hours shall elapse between the
22submission of a qualified patient’s written request and the
23writing of a prescription under this chapter.
   244.  a.  At the time the qualified patient makes the second
25oral request, the attending physician shall offer the qualified
26patient an opportunity to rescind the request.
   27b.  A patient may rescind a request for a prescription for
28medication under this chapter at any time and in any manner
29without regard to the patient’s mental state. A prescription
30for medication under this chapter shall not be written prior
31to the attending physician offering the qualified patient an
32opportunity to rescind the request.
33   Sec. 5.  NEW SECTION.  142E.5  Procedure for request —
34witnesses.
   351.  A qualified patient who is unable to orally communicate
-3-1may make a valid oral request under this chapter by reducing
2the oral request to writing for submission to the qualified
3patient’s attending physician. Such writing is not subject
4to the requirements otherwise applicable to a written request
5under this chapter.
   62.  a.  A valid written request for medication under this
7chapter shall be in substantially the form described in section
8142E.17, shall be signed and dated by the patient, and shall
9be witnessed by at least two individuals who, in the presence
10of the patient, attest that to the best of their knowledge and
11belief the patient is competent, acting voluntarily, and is not
12being coerced to sign the request.
   13b.  One of the witnesses shall be a person who is not any of
14the following:
   15(1)  A relative of the patient by blood, marriage, or
16adoption.
   17(2)  A person who at the time the request is signed would be
18entitled to any portion of the estate of the patient upon death
19under any will or by operation of law.
   20(3)  An owner, operator, or employee of a long-term care
21facility where the patient is receiving medical treatment or
22is a resident.
   23c.  The patient’s attending physician at the time the request
24is signed shall not be a witness.
   25d.  If the patient is a patient in a long-term care facility
26at the time the written request is made, one of the witnesses
27shall be an individual designated by the facility and having
28the qualifications specified by the department by rule.
29   Sec. 6.  NEW SECTION.  142E.6  Attending physician
30responsibilities.
   311.  The attending physician shall do all of the following:
   32a.  Make the initial determination of whether a patient has
33a terminal disease, is competent, and has made the request for
34medication under this chapter voluntarily.
   35b.  Request that the patient demonstrate residency in the
-4-1state. Factors demonstrating residency in this state include
2but are not limited to:
   3(1)  Possession of an Iowa driver’s license or a
4nonoperator’s identification card.
   5(2)  Registration to vote in Iowa.
   6(3)  Evidence that the person owns or leases property in
7Iowa.
   8(4)  Filing of an Iowa tax return for the most recent tax
9year.
   10c.  Verify immediately prior to writing the prescription for
11medication, that the patient is making an informed decision.
   12d.  Refer the patient to a consulting physician for medical
13confirmation of the diagnosis, and for a determination that the
14patient is competent and acting voluntarily.
   15e.  Refer the patient for counseling if appropriate under
16section 142E.8.
   17f.  Recommend that the patient notify next of kin. However,
18a qualified patient’s request for medication shall not
19be denied based on the qualified patient’s declination or
20inability to notify next of kin.
   21g.  Counsel the patient about the importance of having
22another person present when the patient takes the medication
23prescribed and of not taking the medication in a public place.
   24h.  Inform the patient that the patient has an opportunity
25to rescind the request at any time and in any manner, and offer
26the patient an opportunity to rescind the request at the end of
27the fifteen-day waiting period under section 142E.4.
   28i.  Fulfill the medical record documentation requirements
29under section 142E.9.
   30j.  Ensure that all appropriate steps are carried out in
31accordance with this chapter prior to writing a prescription
32for medication to enable a qualified patient to end the
33patient’s life.
   34k.  Do either of the following:
   35(1)  Dispense medications directly, including ancillary
-5-1medications intended to facilitate the desired effect to
2minimize the patient’s discomfort, if the attending physician
3is authorized under law and rule to dispense such medication
4and has a current valid drug enforcement administration number,
5if required under chapter 124.
   6(2)  With the patient’s written consent:
   7(a)  Contact a pharmacist and inform the pharmacist of the
8prescription.
   9(b)  Deliver the written prescription personally, by
10mail, or by facsimile to the pharmacist who will dispense the
11medications to either the patient, the attending physician, or
12an expressly identified agent of the patient.
   132.  Notwithstanding any other provision of law to the
14contrary, the attending physician may sign the patient’s death
15certificate.
16   Sec. 7.  NEW SECTION.  142E.7  Consulting physician
17confirmation.
   18A consulting physician shall do all of the following in
19confirming that a patient is a qualified patient under this
20chapter:
   211.  Examine the patient and the patient’s relevant medical
22records and confirm, in writing, the attending physician’s
23diagnosis that the patient is suffering from a terminal
24disease.
   252.  Verify that the patient is competent, acting
26voluntarily, and has made an informed decision.
27   Sec. 8.  NEW SECTION.  142E.8  Counseling referral.
   281.  If, in the opinion of the attending physician or the
29consulting physician, a patient may be suffering from a
30psychiatric or psychological disorder or depression causing
31impaired judgment, either physician shall refer the patient for
32counseling.
   332.  An attending physician shall not prescribe medication to
34end a patient’s life pursuant to this chapter until the person
35performing the counseling determines and verifies that the
-6-1patient is not suffering from a psychiatric or psychological
2disorder or depression causing impaired judgment.
3   Sec. 9.  NEW SECTION.  142E.9  Medical record documentation
4requirements.
   5All of the following shall be documented or filed in a
6patient’s medical record in regard to a request for medication
7under this chapter:
   81.  All oral requests by a patient for medication to end the
9patient’s life pursuant to this chapter.
   102.  All written requests by a patient for medication to end
11the patient’s life pursuant to this chapter.
   123.  The attending physician’s diagnosis and prognosis
13and determinations that the patient is competent, is acting
14voluntarily, and has made an informed decision.
   154.  The consulting physician’s diagnosis and prognosis
16and verification that the patient is competent, is acting
17voluntarily, and has made an informed decision.
   185.  A report of the outcome and determinations made during
19counseling, if performed.
   206.  The attending physician’s offer to the patient to rescind
21the patient’s request at the time of the patient’s second oral
22request pursuant to section 142E.4.
   237.  A note by the attending physician indicating that all
24requirements under this chapter have been met and indicating
25the steps taken to carry out the request, including a notation
26of the medication prescribed.
27   Sec. 10.  NEW SECTION.  142E.10  Reporting requirements.
   281.  a.  The department shall require any health care
29provider, upon dispensing medication pursuant to this chapter,
30to file a copy of the dispensing record with the department.
   31b.  The department shall annually review a sample of records
32maintained under this chapter.
   332.  The department shall adopt rules to facilitate the
34collection of information regarding compliance with this
35chapter. Except as otherwise required by law, the information
-7-1collected shall not be a public record and shall not be made
2available for inspection by the public.
   33.  The department shall generate and make available to the
4public an annual statistical report of information collected
5under subsection 2.
6   Sec. 11.  NEW SECTION.  142E.11  Effect on construction of
7wills, contracts, and other agreements.
   81.  A provision in a contract, will, or other agreement,
9whether written or oral, to the extent the provision would
10affect whether a person may make or rescind a request for
11medication to end the person’s life pursuant to this chapter,
12shall not be valid.
   132.  An obligation owing under any contract shall not be
14conditioned or affected by the making or rescinding of a
15request by a person for medication to end the person’s life
16pursuant to this chapter.
17   Sec. 12.  NEW SECTION.  142E.12  Insurance or annuity
18policies.
   19The sale, procurement, or issuance of any life, health,
20or accident insurance or annuity policy or the rate charged
21for any such policy shall not be conditioned upon or affected
22by the making or rescinding of a request by a person for
23medication that may be self-administered to end the person’s
24life pursuant to this chapter. A qualified patient’s act of
25self-administering medication to end the qualified patient’s
26life pursuant to this chapter shall not have an effect upon a
27life, health, or accident insurance or annuity policy.
28   Sec. 13.  NEW SECTION.  142E.13  Construction of chapter.
   291.  Nothing in this chapter shall be construed to authorize
30a physician or any other person to end a patient’s life by
31lethal injection, mercy killing, or active euthanasia. An
32action taken in accordance with this chapter shall not, for any
33purpose, constitute suicide, assisted suicide, mercy killing,
34or homicide under the law.
   352.  Nothing in this chapter shall be interpreted to lessen
-8-1the applicable standard of care for an attending physician,
2consulting physician, psychiatrist, psychologist, or other
3health care provider acting under this chapter.
4   Sec. 14.  NEW SECTION.  142E.14  Immunities — basis
5for prohibiting health care provider from participation —
6notification — permissible sanctions.
   7Except as otherwise provided in this chapter:
   81.  A person shall not be subject to civil or criminal
9liability or professional disciplinary action for acting
10in good-faith compliance with this chapter, including
11being present when a qualified patient self-administers the
12prescribed medication to end the qualified patient’s life
13pursuant to this chapter.
   142.  A professional organization or association, or
15health care provider, shall not subject a person to censure,
16discipline, suspension, loss of license, loss of privileges,
17loss of membership, or other penalty for acting or refusing to
18act in good-faith compliance with this chapter.
   193.  A request by a patient for or provision by an attending
20physician of medication in good-faith compliance with this
21chapter shall not constitute neglect under the law or provide
22the sole basis for the appointment of a guardian or conservator
23for the patient.
   244.  A health care provider shall not be under any duty,
25whether by contract, statute, or any other legal requirement,
26to participate in the provision to a qualified patient of
27medication to end the patient’s life pursuant to this chapter.
28If a health care provider is unable or unwilling to carry out a
29patient’s request under this chapter and the patient transfers
30the patient’s care to a new health care provider, the prior
31health care provider shall transfer, upon request, a copy of
32the patient’s relevant medical records to the new health care
33provider.
   345.  a.  Notwithstanding any other provision of law to the
35contrary, a health care provider may prohibit another health
-9-1care provider from acting under this chapter on the premises
2of the prohibiting provider if the prohibiting provider has
3notified the health care provider of the prohibiting provider’s
4policy regarding actions under this chapter. Nothing in this
5paragraph shall prevent a health care provider from providing
6health care services to a patient that do not constitute action
7under this chapter.
   8b.  Notwithstanding the provisions of this section to the
9contrary, a health care provider may subject another health
10care provider to the following sanctions if the sanctioning
11health care provider has notified the sanctioned provider prior
12to action under this chapter that the health care provider
13prohibits actions under this chapter:
   14(1)  Loss of privileges, loss of membership, or other
15sanction provided pursuant to the medical staff bylaws,
16policies, or procedures of the sanctioning health care provider
17if the sanctioned provider is a member of the sanctioning
18provider’s medical staff and acts under this chapter while on
19the health care facility premises of the sanctioning health
20care provider, but not including the private medical office of
21a physician or other provider.
   22(2)  Termination of a lease or other property contract or
23other nonmonetary remedies provided by a lease or contract,
24not including loss or restriction of medical staff privileges
25or exclusion from a provider panel, if the sanctioned
26provider acts under this chapter while on the premises of the
27sanctioning health care provider or on property that is owned
28by or under the direct control of the sanctioning health care
29provider.
   30(3)  Termination of a contract or other nonmonetary remedies
31provided by a contract if the sanctioned provider acts under
32this chapter while acting in the course and scope of the
33sanctioned provider’s capacity as an employee or independent
34contractor of the sanctioning health care provider. Nothing
35in this subparagraph shall be construed to prevent any of the
-10-1following:
   2(a)  A health care provider from acting under this chapter
3while acting outside the course and scope of the provider’s
4capacity as an employee or independent contractor.
   5(b)  A patient from contracting with the patient’s attending
6physician and consulting physician to act outside the course
7and scope of the provider’s capacity as an employee or
8independent contractor of the sanctioning health care provider.
   9c.  A health care provider that imposes sanctions pursuant to
10paragraph “b” shall follow all due process and other procedures
11the sanctioning health care provider uses for the imposition of
12sanctions on other health care providers under the authority of
13the sanctioning health care provider.
   14d.  For the purposes of this subsection:
   15(1)  “Action under this chapter” means to perform the
16duties of an attending physician, the consulting physician
17function, or the counseling function as specified under this
18chapter. “Action under this chapter” does not include any of
19the following:
   20(a)  Making an initial determination that a patient has
21a terminal disease and informing the patient of the medical
22prognosis.
   23(b)  Providing information about this chapter to a patient
24upon the request of the patient.
   25(c)  Providing a patient, upon the request of the patient,
26with a referral to another physician.
   27(d)  A patient contracting with the patient’s attending
28physician and consulting physician to act outside of the
29course and scope of the provider’s capacity as an employee or
30independent contractor of the sanctioning health care provider.
   31(2)  “Notify” means a separate statement in writing to the
32health care provider specifically informing the health care
33provider prior to the provider’s action under this chapter of
34the sanctioning health care provider’s policy about actions
35under this chapter.
-11-
1   Sec. 15.  NEW SECTION.  142E.15  Liabilities — penalties.
   21.  A person who without authorization of the patient
3willfully alters or forges a request for medication under this
4chapter or conceals or destroys a rescission of a request for
5medication under this chapter with the intent or effect of
6causing the patient’s death is guilty of a class “A” felony.
   72.  A person who coerces or exerts undue influence on a
8patient to request medication for the purpose of ending the
9patient’s life pursuant to this chapter, or to destroy a
10rescission of such a request, is guilty of a class “A” felony.
   113.  Nothing in this chapter shall be construed to limit
12a person’s liability for civil damages resulting from the
13person’s negligent conduct or intentional misconduct applicable
14under other law for conduct which is inconsistent with the
15provisions of this chapter.
   164.  The penalties specified in this section shall not
17preclude criminal penalties applicable under other law for
18conduct which is inconsistent with the provisions of this
19chapter.
20   Sec. 16.  NEW SECTION.  142E.16  Claims by governmental entity
21for costs incurred.
   22A governmental entity that incurs costs resulting from a
23person terminating the person’s life pursuant to this chapter
24in a public place shall have a claim against the estate of
25the person to recover such costs and reasonable attorney fees
26related to enforcing the claim.
27   Sec. 17.  NEW SECTION.  142E.17  Form of written request.
   28A written request for medication as authorized by this
29chapter shall be in substantially the following form:
30REQUEST FOR MEDICATION
31TO END MY LIFE IN A HUMANE
32AND DIGNIFIED MANNER
33I, ______________________, am an adult of sound mind.
34I am suffering from _________, which my attending physician has
35determined is a terminal disease and which has been medically
-12-1confirmed by a consulting physician.
2I have been fully informed of my diagnosis, prognosis, the
3nature of medication to be prescribed and potential associated
4risks, the expected result, and the feasible alternatives,
5including comfort care, hospice care, and pain control.
6I request that my attending physician prescribe medication that
7will end my life in a humane and dignified manner.
8INITIAL ONE OF THE FOLLOWING:
9______ I have informed my family of my decision and taken their
10opinions into consideration.
11______ I have decided not to inform my family of my decision.
12______ I have no family to inform of my decision.
13I understand that I have the right to rescind this request at
14any time.
15I understand the full import of this request and I expect to
16die when I take the medication to be prescribed. I further
17understand that although most deaths occur within three hours,
18my death may take longer and my physician has counseled me
19about this possibility.
20I make this request voluntarily and without reservation, and I
21accept full moral responsibility for my actions.
22Signed: _______________
23Dated: _______________
24DECLARATION OF WITNESSES
25By initialing and signing below on or after the date the person
26named above signs, we declare that the person making and
27signing the above request:
28(a) Is personally known to us or has provided proof of
29identity.
30(b) Signed this request in our presence on the date of the
31person’s signature.
32(c) Appears to be of sound mind and not under duress, fraud, or
33undue influence.
34(d) Is not a patient for whom either of us is the attending
35physician.
-13-1Printed name of Witness 1 ____________________
2Signed name of Witness 1/Date ________________________
3Printed name of Witness 2 ____________________
4Signed name of Witness 2/Date ________________________
5NOTE: One witness shall not be a relative by blood, marriage,
6or adoption of the person signing this request, shall not be
7entitled to any portion of the person’s estate upon death,
8and shall not own, operate, or be employed at a health care
9facility where the person is a patient or resident. If the
10patient is an inpatient at a health care facility, one of the
11witnesses shall be an individual designated by the facility.
12EXPLANATION
13The inclusion of this explanation does not constitute agreement with
14the explanation’s substance by the members of the general assembly.
   15This bill creates the “Iowa End-of-Life Options Act”. The
16bill provides for a competent adult patient, who is a resident
17of the state of Iowa, who is terminally ill with less than six
18months to live as verified by two physicians, to voluntarily
19request medication that will end the person’s life. The
20bill provides that the patient must make an oral request, a
21subsequent oral request no less than 15 days after the initial
22request, and a written request for the medication. There is
23also a 48-hour waiting period between the submission of the
24written request and the writing of the prescription. The bill
25specifies the responsibilities of the attending physician and
26the consulting physician. The bill includes a provision for
27counseling if the attending physician deems it appropriate, the
28notification of next of kin, the right to rescind a request at
29any time, and documentation requirements. The bill provides
30for the effect of a request for medication to end the person’s
31life on the construction of wills, contracts, and statutes as
32well as on insurance and annuity policies.
   33The bill provides that the provisions of the bill are not
34to be construed to authorize a physician or any other person
35to end a patient’s life by lethal injection, mercy killing,
-14-1or active euthanasia, and that actions taken in accordance
2with the bill shall not, for any purpose, constitute suicide,
3assisted suicide, mercy killing, or homicide under the
4law. Additionally, the provisions of the bill are not to be
5interpreted to lessen the applicable standard of care for the
6attending physician, consulting physician, psychiatrist, or
7psychologist, or other health care provider acting under the
8bill.
   9The bill provides immunities for a person who acts in
10good-faith compliance with the bill, including being present
11when a patient takes the prescribed medication to end the
12patient’s life.
   13The bill provides that a professional organization or
14association, or health care provider, shall not subject a
15person to censure, discipline, suspension, loss of license,
16loss of privileges, loss of membership, or other penalty for
17acting or refusing to act in good-faith compliance with the
18bill, but does provide for prohibitions by a health care
19provider on the premises of the health care provider relative
20to the bill. The bill provides that a request by a patient
21for or provision by an attending physician of medication in
22good-faith compliance with the bill does not constitute neglect
23under the law or provide the sole basis for the appointment
24of a guardian or conservator for the patient. Under the
25bill, a health care provider is not under any duty, whether
26by contract, statute, or any other legal requirement, to
27participate in the provision to a patient of medication to
28end the patient’s life. If a health care provider is unable
29or unwilling to carry out a patient’s request under the bill,
30however, and the patient transfers the patient’s care to a
31new health care provider, the prior health care provider is
32required to transfer, upon request, a copy of the patient’s
33relevant medical records to the new health care provider.
   34The bill provides that a person who, without authorization
35of the patient, willfully alters or forges a request for
-15-1medication under the bill or conceals or destroys a rescission
2of such a request with the intent or effect of causing the
3patient’s death is guilty of a class “A” felony. Additionally,
4a person who coerces or exerts undue influence on a patient
5to request medication for the purpose of ending the patient’s
6life under the bill, or to destroy a rescission of such a
7request, is guilty of a class “A” felony. A class “A” felony
8is punishable by confinement for life without possibility of
9parole.
   10The bill provides that the provisions of the bill are
11not to be construed to limit a person’s liability for civil
12damages resulting from other negligent conduct or intentional
13misconduct by the person and that the penalties specified in
14the bill shall not preclude criminal penalties applicable under
15other law for conduct which is inconsistent with the provisions
16of the bill.
   17The bill provides that if a governmental entity incurs costs
18resulting from a person terminating the person’s life under the
19bill in a public place, the governmental entity has a claim
20against the estate of the person to recover such costs and
21reasonable attorney fees related to enforcing the claim.
   22The bill also provides the form for the request for
23medication to end a person’s life.
-16-
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