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House File 612 - IntroducedA Bill ForAn Act 1relating to care and choices at the end of life,
2providing penalties, and including effective date
3provisions.
4BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1 Section 1. NEW SECTION. 142E.1 Findings.
21. The state of Iowa has long recognized that mentally
3capable adult individuals have a fundamental right to determine
4their own medical treatment options in accordance with their
5own values, beliefs, or personal preferences.
62. It is important that the state of Iowa upholds both the
7highest standard of medical care and the full range of options
8for each individual, particularly at the end of life.
93. Terminally ill individuals may undergo unremitting
10pain, agonizing discomfort, and a sudden, continuing, and
11irreversible reduction in their quality of life at the end of
12life.
134. The availability of medical aid in dying provides
14an additional palliative care option for terminally ill
15individuals who seek to retain their autonomy and some level of
16control over the progression of the terminal disease as they
17near the end of life or to ease unnecessary pain and suffering.
185. Integration of medical aid in dying into standard
19end-of-life care has demonstrably improved end-of-life care
20by contributing to better conversations between providers
21and their patients, earlier and more appropriate enrollment
22in hospice care, and better palliative care training for
23providers.
246. The state of Iowa seeks to affirm that a provider who
25respects and honors the values and priorities of individuals
26with a terminal disease for their last days of life and
27prescribes or dispenses medication for any such qualified
28terminally ill individual who makes a request pursuant
29to this chapter is practicing lawful patient-centered and
30patient-directed care.
317. Patient-directed care differs from patient-centered
32care in that it is not only respectful of and responsive to
33individual patient decisions, preferences, needs, and values,
34but also ensures that patient values direct all clinical
35decisions and that patients are fully informed of and able to
-1-1access legal options they desire.
2 Sec. 2. NEW SECTION. 142E.2 Short title.
3This chapter shall be known and may be cited as the “Iowa Our
4Care, Our Options Act”.
5 Sec. 3. NEW SECTION. 142E.3 Definitions.
6As used in this chapter, unless the context otherwise
7requires:
81. “Adult” means an individual eighteen years of age or
9older.
102. “Attending provider” means the provider who has primary
11responsibility for the care of a patient and treatment of the
12patient’s terminal disease.
133. “Coercion or undue influence” means the willful attempt,
14whether by deception, intimidation, or any other means, to do
15any of the following:
16a. Cause a patient to request, obtain, or self-administer
17medication pursuant to this chapter with the intent to cause
18the death of the patient.
19b. Prevent a qualified patient from obtaining or
20self-administration of medication pursuant to this chapter.
214. “Consulting provider” means a provider who is qualified
22by specialty or experience to make a professional diagnosis and
23prognosis regarding a patient’s disease.
245. “Department” means the department of health and human
25services.
266. “Health care entity” means a hospital licensed under
27chapter 135B, a nursing facility licensed under chapter 135C,
28an inpatient hospice program, a clinic, or any other facility
29licensed by the state wherein medical care is provided. “Health
30care entity” does not include a provider.
317. “Informed decision” means a decision by a medically
32capable requesting patient to request and obtain a prescription
33for medication pursuant to this chapter that the qualified
34patient may self-administer to bring about a peaceful death
35after being fully informed by the attending provider and
-2-1consulting provider of all of the following:
2a. The requesting patient’s diagnosis and prognosis.
3b. The potential risk associated with taking the medication
4to be prescribed.
5c. The probable result of taking the medication to be
6prescribed.
7d. The feasible end-of-life care and treatment options for
8the requesting patient’s terminal disease, including but not
9limited to comfort care, palliative care, hospice care, and
10pain control, and the risks and benefits of each.
11e. The requesting patient’s right to withdraw a request
12pursuant to this chapter or consent for any other treatment,
13at any time.
148. “Licensed mental health provider” means the same as a
15“mental health professional” as defined in section 228.1.
169. “Medical aid in dying” means the practice of evaluating
17a patient’s request for medication, determining if a patient
18is qualified, performing the duties specified, and providing a
19prescription to a qualified patient, pursuant to this chapter.
2010. “Medical-aid-in-dying medication” or “medication” means
21the medication prescribed and dispensed under this chapter to a
22qualified patient to bring about a peaceful death.
2311. “Medically confirmed” means the attending provider’s
24medical opinion that the patient is eligible to receive
25medication pursuant to this chapter has been confirmed by the
26consulting provider after performing a medical evaluation.
2712. “Mentally capable” means that in the opinion of the
28provider or licensed mental health provider, if an opinion is
29required under this chapter, the requesting patient has the
30ability to make and communicate an informed decision.
3113. “Oral request” means an affirmative statement that
32demonstrates a contemporaneous affirmatively stated desire by
33the requesting patient seeking medical aid in dying.
3414. “Patient” means an adult who is under the care of a
35provider.
-3- 115. “Prognosis of six months or less” means the terminal
2disease of a patient will, within reasonable medical judgment,
3result in the patient’s death within six months.
416. a. “Provider” means a person licensed, certified, or
5otherwise authorized or permitted by the law of this state
6to diagnose and treat medical conditions, and prescribe
7and dispense medication, including controlled substances.
8“Provider” includes all of the following:
9(1) A physician licensed to practice medicine pursuant to
10chapter 148.
11(2) An advanced registered nurse practitioner licensed
12under chapter 152 or an advanced practice registered nurse
13under chapter 152E.
14(3) A physician assistant licensed under chapter 148C.
15b. “Provider” does not include a health care entity.
1617. “Qualified patient” means a mentally capable patient
17who has satisfied the requirements of this chapter in order
18to obtain a prescription for medication to bring about a
19peaceful death. A person shall not be considered a “qualified
20patient” under this chapter solely because of advanced age or
21disability.
2218. “Requesting patient” means a patient with a terminal
23disease.
2419. “Self-administer” or “self-administration” means a
25qualified patient’s performance of an affirmative, conscious,
26voluntary act to ingest medication prescribed pursuant to
27this chapter to bring about the qualified patient’s peaceful
28death. “Self-administration” does not include administration by
29parenteral injection or infusion.
3020. “Terminal disease” means an incurable and irreversible
31disease that has been medically confirmed and will, within
32reasonable medical judgment, produce death within six months.
33 Sec. 4. NEW SECTION. 142E.4 Informed consent.
341. This chapter shall not be construed to limit the amount
35of information provided to a patient to ensure the patient can
-4-1make an informed decision.
22. An attending provider shall provide sufficient
3information to a patient regarding all appropriate end-of-life
4care options, including hospice and palliative care, and the
5foreseeable risks and benefits of each, so that the patient
6can make a voluntary and affirmative decision regarding the
7patient’s end-of-life care.
83. An attending provider is deemed to fail to obtain
9informed consent for subsequent medical treatment if a
10requesting patient requests information about medical aid in
11dying and, within a reasonable time, the provider has failed,
12at a minimum, to do either of the following:
13a. Provide information to the requesting patient about
14medical aid in dying and other legal end-of-life options.
15b. Document the date of the requesting patient’s request
16in the patient’s medical record and upon request transfer the
17requesting patient’s medical records to an alternative provider
18consistent with federal and state law.
194. If a requesting patient requests that the requesting
20patient’s medical records be transferred to an alternative
21provider, the requesting patient’s medical records shall be
22transferred within two business days.
23 Sec. 5. NEW SECTION. 142E.5 Standard of care.
241. Care that complies with this chapter shall be deemed to
25meet the medical standard of care.
262. This chapter shall not be construed to exempt a provider
27or other medical personnel from meeting medical standards of
28care for a patient’s treatment.
29 Sec. 6. NEW SECTION. 142E.6 Request for medical aid in
30dying.
311. A mentally capable patient with a terminal disease may
32request a prescription for medication under this chapter. The
33requesting patient shall make an oral request and a written
34request and shall reiterate the oral request to the requesting
35patient’s attending provider no less than forty-eight hours
-5-1after making the initial oral request. An oral request charted
2in the requesting patient’s medical record by a provider other
3than the requesting patient’s attending provider satisfies the
4oral request requirement under this section.
52. The attending and consulting providers of a qualified
6patient shall meet all requirements of sections 142E.8 and
7142E.9.
83. Notwithstanding any provision to the contrary under
9subsection 1, if the requesting patient’s attending provider
10has determined that the requesting patient will, based on
11reasonable medical judgment, die within forty-eight hours
12after making the initial oral request under this section,
13the requesting patient may satisfy the requirements under
14this section by reiterating the oral request to the attending
15provider at any time after making the initial oral request.
164. At the time the requesting patient makes the second oral
17request, the attending provider shall offer the requesting
18patient an opportunity to rescind the request.
195. Oral and written requests for the requesting patient must
20be made only by the requesting patient and shall not be made
21by the requesting patient’s surrogate decision-maker, health
22care proxy, attorney-in-fact for health care, or via an advance
23health care directive.
246. If a requesting patient decides to transfer the
25requesting patient’s care to an alternative provider, the
26custodian of the requesting patient’s medical records shall
27transfer all relevant medical records including written
28documentation of the dates of any of the requesting patient’s
29oral or written requests concerning medical aid in dying within
30two business days.
317. The transfer of care or medical records of a requesting
32patient does not toll or restart any waiting period under this
33section.
34 Sec. 7. NEW SECTION. 142E.7 Form of written request —
35requirements.
-6- 11. A written request for medication under this chapter shall
2be in substantially the following form, signed and dated by
3the requesting patient, and witnessed by at least one person
4who, in the presence of the requesting patient, attests that to
5the best of the witness’s knowledge and belief the requesting
6patient is mentally capable, acting voluntarily, and is not
7being coerced nor unduly influenced to sign the request.
8Request for Medication
9to End My Life in
10a Peaceful Manner
11I, ___________________________________ am an adult of sound
12mind. I have been diagnosed with
13_______________________________________________, and given a
14prognosis of six months or less to live.
15I have been fully informed of the feasible alternatives,
16and the concurrent or additional treatment opportunities for
17my terminal disease, including but not limited to comfort
18care, palliative care, hospice care, or pain control, and the
19potential risks and benefits of each. I have been offered or
20received resources or referrals to pursue these alternative,
21or concurrent or additional treatment opportunities for my
22terminal disease.
23I have been fully informed of the nature of the medication to
24be prescribed, including the risks and benefits, and understand
25that the likely outcome of self-administration of medication
26is death. I understand that I can rescind this request at any
27time, that I am under no obligation to fill the prescription
28once written nor to self-administer the medication if I obtain
29the medication.
30I request that my attending provider furnish a prescription
31for medication that will end my life if I choose to
32self-administer it, and I authorize my attending provider to
33contact a pharmacist to dispense the prescription at a time of
34my choosing.
35I make this request voluntarily, free from coercion or undue
-7-1influence.
2________________________________________ _____________
3Requesting Patient Signature Date
4________________________________________ _____________
5Witness Signature Date
62. The witness required under this section shall not be any
7of the following:
8a. A relative of the requesting patient by blood, marriage,
9or adoption.
10b. A person who at the time the request is signed would be
11entitled to any portion of the estate of the requesting patient
12upon death, under any will or by operation of law.
13c. An owner, operator, or employee of a health care entity
14where the requesting patient is receiving medical treatment or
15is a resident.
16d. The requesting patient’s attending provider at the time
17the request is signed.
18e. An interpreter for the requesting patient, if the
19requesting patient uses an interpreter.
20 Sec. 8. NEW SECTION. 142E.8 Attending provider
21responsibilities.
22The attending provider shall do all of the following:
231. Determine whether a requesting patient has a terminal
24disease with a prognosis of six months or less and is mentally
25capable.
262. Confirm that the requesting patient’s request does not
27arise from coercion or undue influence.
283. Inform the requesting patient of all of the following:
29a. The requesting patient’s diagnosis and prognosis.
30b. The potential risks, benefits, and probable result of
31self-administration of the prescribed medication to bring about
32a peaceful death.
33c. The potential benefits and risks of feasible alternatives
34including but not limited to concurrent or additional treatment
35options for the requesting patient’s terminal disease,
-8-1palliative care, comfort care, hospice care, and pain control.
2d. The requesting patient’s right to rescind the request for
3medication pursuant to this chapter at any time.
4e. That there is no obligation to fill the prescription
5nor an obligation to self-administer the medication, if the
6medication is obtained.
74. Provide the requesting patient with a referral for
8comfort care, palliative care, hospice care, pain control, or
9other end-of-life treatment options as requested by the patient
10and as clinically indicated.
115. Refer the requesting patient to a consulting provider for
12medical confirmation that the requesting patient has a terminal
13disease with a prognosis of six months or less to live and is
14mentally capable.
156. Include the consulting provider’s written determination
16in the requesting patient’s medical record.
177. Refer the requesting patient to a licensed mental health
18provider if the attending provider observes signs that the
19requesting patient may not be capable of making an informed
20decision.
218. Include the licensed mental health provider’s written
22determination in the requesting patient’s medical record, if
23such determination was requested.
249. Inform the requesting patient of the benefits of
25notifying the next of kin of the requesting patient’s decision
26to request medication pursuant to this chapter.
2710. Fulfill the medical record documentation requirements
28under this chapter.
2911. Ensure that all steps are carried out in accordance with
30this chapter before providing a prescription to a requesting
31patient for medication pursuant to this chapter including all
32of the following:
33a. Confirming that the requesting patient has made an
34informed decision to obtain a prescription for medication
35pursuant to this chapter.
-9- 1b. Offering the requesting patient an opportunity to rescind
2the request for medication pursuant to this chapter.
3c. Educating the requesting patient on all of the following:
4(1) The recommended procedure for self-administration of
5the medication to be prescribed.
6(2) The safe-keeping and proper disposal of unused
7medication in accordance with state and federal law.
8(3) The importance of having another individual present
9when the requesting patient self-administers the medication to
10be prescribed.
11(4) Not taking the medication in a public place.
1212. Once the requesting patient is determined to be a
13qualified patient, in accordance with state and federal law,
14do one of the following:
15a. Deliver the prescription personally, by mail, or through
16an authorized electronic transmission to a licensed pharmacist
17who will dispense the medication including any ancillary
18medications to the attending provider, to the qualified
19patient, or to an individual expressly designated by the
20qualified patient in person or with a signature required on
21delivery, by mail service, or by messenger service.
22b. If authorized by the federal drug enforcement agency,
23dispense the prescribed medication including any ancillary
24medications to the qualified patient or an individual
25designated in person by the qualified patient.
2613. Document in the qualified patient’s medical record the
27qualified patient’s diagnosis and prognosis, determination
28of mental capability, the date of any oral request, a copy
29of the written request, a notation that the requirements
30under this chapter have been completed, and identification of
31the medication and ancillary medications prescribed to the
32qualified patient pursuant to this chapter.
33 Sec. 9. NEW SECTION. 142E.9 Consulting provider
34responsibilities.
35A consulting provider shall do all of the following:
-10- 11. Evaluate the requesting patient and the requesting
2patient’s relevant medical records.
32. Confirm all of the following to the attending provider
4regarding the requesting patient:
5a. That the requesting patient has requested a prescription
6for medical-aid-in-dying medication.
7b. That the requesting patient has a terminal disease with a
8prognosis of six months or less to live.
9c. That the requesting patient is mentally capable, or
10provide documentation that the consulting provider has referred
11the requesting patient for further evaluation in accordance
12with section 142E.10.
13d. That the requesting patient is acting voluntarily, free
14from coercion or undue influence.
15 Sec. 10. NEW SECTION. 142E.10 Referral — determination
16that requesting patient is mentally capable.
171. If either the attending provider or the consulting
18provider doubts whether the requesting patient is mentally
19capable and is unable to confirm that the requesting patient is
20capable of making an informed decision, the attending provider
21or consulting provider shall refer the patient to a licensed
22mental health provider for a determination regarding the
23requesting patient’s mental capability.
242. The licensed mental health provider who evaluates the
25requesting patient under this section shall submit to the
26attending provider or consulting provider who made the referral
27a written determination of whether the requesting patient is
28mentally capable.
293. If the licensed mental health provider determines the
30requesting patient is not mentally capable, the requesting
31patient shall not be deemed a qualified patient and the
32attending provider shall not prescribe medication to the
33requesting patient under this chapter.
34 Sec. 11. NEW SECTION. 142E.11 Death certificate.
351. Unless otherwise prohibited by law, the attending
-11-1provider may sign the death certificate of a qualified
2patient who obtained and self-administered a prescription for
3medication pursuant to this chapter.
42. When a death has occurred in accordance with this
5chapter, the death shall be attributed to the underlying
6terminal disease, and all of the following shall apply:
7a. A death following self-administration of medication under
8this chapter does not alone constitute a person’s death that
9affects the public interest as described pursuant to section
10331.802. If a death that occurs in accordance with this
11chapter is referred to the state medical examiner or a county
12medical examiner, the state medical examiner or county medical
13examiner may conduct a preliminary investigation to determine
14whether an individual received a prescription for medication
15under this chapter.
16b. A death in accordance with this chapter shall not be
17designated a suicide or homicide.
18c. A qualified patient’s act of self-administration of
19medication prescribed pursuant to this chapter shall not be
20indicated on the death certificate.
21 Sec. 12. NEW SECTION. 142E.12 Reporting requirements —
22willful failure or refusal.
231. The department shall create and make available to all
24attending providers a prescribing provider checklist form
25and prescribing provider follow-up form for the purposes of
26reporting the information as specified under this section to
27the department.
282. Within thirty calendar days of providing a prescription
29for medication pursuant to this chapter, the attending provider
30shall submit to the department an attending provider checklist
31form with all of the following information:
32a. The qualifying patient’s name and date of birth.
33b. The qualifying patient’s terminal diagnosis and
34prognosis.
35c. Notice that the requirements under this chapter were
-12-1completed.
2d. Notice that medication has been prescribed pursuant to
3this chapter.
43. Within sixty calendar days of notification of a qualified
5patient’s death from self-administration of medication
6prescribed pursuant to this chapter, the attending provider
7shall submit to the department an attending provider follow-up
8form with all of the following information:
9a. The qualified patient’s name and date of birth.
10b. The qualified patient’s date of death.
11c. A notation of whether or not the qualified patient was
12enrolled in hospice services at the time of the qualified
13patient’s death.
144. The department shall annually review a sample of records
15pursuant to this chapter to ensure compliance and issue a
16public statistical report of nonidentifying information. The
17report shall be limited to all of the following:
18a. The number of prescriptions for medication written
19pursuant to this chapter.
20b. The number of attending providers who wrote prescriptions
21for medication pursuant to this chapter.
22c. The number of qualified patients who died following
23self-administration of medication prescribed and dispensed
24pursuant to this chapter.
255. Except as otherwise required by law, the information
26collected by the department is not a public record and is not
27available for public inspection.
286. Willful failure or refusal by an attending provider to
29timely submit reports required under this section nullifies the
30protections provided under section 142E.16.
31 Sec. 13. NEW SECTION. 142E.13 Safe disposal of unused
32medications.
33A person who has custody or control of medication prescribed
34pursuant to this chapter after the qualified patient’s death
35shall dispose of the medication by lawful means in accordance
-13-1with applicable state and federal guidelines.
2 Sec. 14. NEW SECTION. 142E.14 No duty to provide medical
3aid in dying — licensee discipline.
41. A provider shall provide sufficient information to a
5patient with a terminal disease regarding available options,
6alternatives, and the foreseeable risks and benefits of each,
7so that the patient with a terminal disease is able to make
8informed decisions regarding the patient’s end-of-life health
9care.
102. A provider may choose whether or not to practice medical
11aid in dying pursuant to this chapter.
123. If an attending provider is unable or unwilling to
13fulfill a requesting patient’s request pursuant to this
14chapter, the attending provider shall do all of the following:
15a. Document in the requesting patient’s medical record the
16date of the requesting patient’s oral or written request and
17the attending provider’s notice to the requesting patient of
18the attending provider’s inability or unwillingness to provide
19medical aid in dying.
20b. Upon the requesting patient’s request, transfer the
21requesting patient’s medical records to an alternative
22provider, consistent with federal and state law.
234. An attending provider shall not engage in false,
24misleading, or deceptive practices relating to a willingness
25to qualify a requesting patient or to provide medical aid in
26dying. A provider who engages in such false, misleading, or
27deceptive practices is subject to licensee discipline by the
28applicable licensing board or entity.
29 Sec. 15. NEW SECTION. 142E.15 Health care entity —
30permissible prohibitions and duties — penalties — licensee
31discipline.
321. A health care entity may prohibit providers from
33practicing medical aid in dying in the course of performing
34duties for the entity. A health care entity that prohibits
35the practice of medical aid in dying shall provide advance
-14-1notice in writing to providers and staff at the initial time
2of hiring, contracting, or privileging a provider, and on a
3yearly basis thereafter. A health care entity that fails to
4provide explicit, advance notice in writing to providers and
5staff that the health care entity prohibits providers from
6practicing medical aid in dying waives the right to enforce the
7prohibition.
82. If a requesting patient wishes to transfer care from a
9health care entity that prohibits the practice of medical aid
10in dying to another health care entity, the prohibiting entity
11shall coordinate a timely transfer of care including transfer
12of the requesting patient’s medical records that includes a
13notation of the date the requesting patient first made an oral
14request or a written request concerning medical aid in dying
15within two business days of the request for transfer by the
16requesting patient.
173. A health care entity shall not prohibit a provider from
18fulfilling the requirements of informed consent and meeting the
19standard of medical care under this chapter by prohibiting the
20provider from doing any of the following:
21a. Providing information to a patient regarding the
22patient’s health status including but not limited to a
23diagnosis and prognosis, recommended treatment and treatment
24alternatives, and the risks and benefits of each.
25b. Providing information regarding health care services
26available pursuant to this chapter, information about relevant
27community resources, and how to access those resources to
28obtain care of the patient’s choice.
29c. Practicing medical aid in dying outside the scope of the
30provider’s employment or contract with the prohibiting entity
31and off the premises of the prohibiting entity.
32d. Being present, if outside the scope of the provider’s
33employment or contractual duties, when a qualified patient
34self-administers medication prescribed pursuant to this
35chapter or at the time of death of the qualified patient, if
-15-1requested by the qualified patient or the qualified patient’s
2representative.
34. A prohibiting health care entity shall provide notice
4to the public by posting on the health care entity’s internet
5site that the health care entity prohibits attending providers
6from qualifying patients for medical aid in dying and from
7prescribing and dispensing medication pursuant to this chapter
8while the provider is performing duties in the course of
9performing duties for the health care entity.
105. A health care entity shall not engage in false,
11misleading, or deceptive practices relating to the health care
12entity’s policy regarding end-of-life care services, including
13whether the health care entity has a policy which prohibits
14affiliated providers from practicing medical aid in dying, or
15intentionally denying a requesting patient access to medication
16pursuant to this chapter by failing to transfer a requesting
17patient and the requesting patient’s medical records to another
18provider in a timely manner. The intentional misleading of
19a patient or deploying of misinformation to obstruct access
20to services pursuant to this chapter by a health care entity
21constitutes coercion and undue influence which is an aggravated
22misdemeanor and also subjects the health care entity to
23licensee discipline.
246. If any portion of this section is found to be in conflict
25with federal requirements which are a prescribed condition to
26the receipt of federal funds, the conflicting part of this
27section is inoperative solely to the extent of the conflict
28with respect to the health care entity directly affected, and
29such finding or determination shall not affect the operation of
30the remainder of this section or this chapter.
31 Sec. 16. NEW SECTION. 142E.16 Immunities for actions in
32good faith — prohibition against reprisals.
331. A provider or health care entity shall not be subject to
34criminal liability, licensing sanctions, or other professional
35disciplinary action for actions taken in good-faith compliance
-16-1with this chapter.
22. A provider, health care entity, or professional
3organization or association shall not subject a provider or
4health care entity to censure, discipline, suspension, loss of
5license, loss of privileges, loss of membership, or any other
6penalty for engaging in good-faith compliance with this chapter
7or for refusing to participate in accordance with this chapter.
83. A provider, health care entity, or professional
9organization or association shall not subject a provider
10to discharge, demotion, censure, discipline, suspension,
11loss of license, loss of privileges, loss of membership,
12discrimination, or any other penalty for providing medical
13aid in dying in accordance with the standard of care and
14in good faith under this chapter when the provider is
15engaged in the outside practice of medicine and not on the
16objecting provider’s, health care entity’s, or professional
17organization’s or association’s premises, or when the provider
18is providing scientific and accurate information about medical
19aid in dying to a patient when discussing end-of-life care
20options.
214. A provider is not subject to civil or criminal liability
22or professional discipline if, at the request of a qualified
23patient, the provider is present outside the scope of the
24provider’s employment and not located on the health care
25entity’s premises when the qualified patient self-administers
26medication pursuant to this chapter or at the time of the
27qualified patient’s death.
285. A person who is present at the time of
29self-administration of medication pursuant to this chapter
30may, without civil or criminal liability, assist the qualified
31patient by preparing the medication prescribed pursuant to this
32chapter.
336. The request alone by a patient for medical aid in dying
34does not constitute grounds for neglect or elder abuse for any
35purpose of law, nor shall it be the sole basis for appointment
-17-1of a guardian or conservator for the requesting patient.
27. This section does not limit civil liability of a provider
3or a health care entity for an intentional or negligent
4violation of this chapter.
5 Sec. 17. NEW SECTION. 142E.17 Effect on construction of
6wills, contracts, or other agreements.
71. A provision in a contract, will, or other agreement,
8whether written or oral, that would determine whether a
9patient may make or rescind a request for medical-aid-in-dying
10medication pursuant to this chapter is not valid.
112. An obligation owing under any currently existing
12contract shall not be conditioned or affected by a patient’s
13act of making or rescinding a request for medical-aid-in-dying
14medication pursuant to this chapter.
153. It is unlawful for an insurer to deny or alter a health
16care benefit otherwise available to a patient with a terminal
17disease based on the availability of medical aid in dying or to
18otherwise attempt to coerce a patient with a terminal disease
19to make a request for medical-aid-in-dying medication.
20 Sec. 18. NEW SECTION. 142E.18 Insurance or annuity
21policies, plans, contracts, or other agreements.
221. The sale, procurement, or issuance of a life, health, or
23accident insurance policy, plan, contract, or other agreement,
24or an annuity policy, plan, contract, or other agreement,
25or the rate charged for such policy, plan, contract, or
26other agreement shall not be conditioned upon or affected
27by a patient’s act of making or rescinding a request for
28medical-aid-in-dying medication pursuant to this chapter.
292. A qualified patient’s act of self-administration of
30medical-aid-in-dying medication pursuant to this chapter
31does not invalidate any part of a life, health, or accident
32insurance policy, plan, contract, or other agreement, or an
33annuity policy, plan, contract, or other agreement.
343. A carrier as defined in section 514C.13 shall not
35deny or alter benefits to a patient with a terminal disease
-18-1who is a covered beneficiary of the health benefit plan as
2defined in section 514C.13, based on the availability of
3medical-aid-in-dying medication, the patient’s request for
4medical-aid-in-dying medication pursuant to this chapter, or
5the absence of a request by a patient for medical-aid-in-dying
6medication pursuant to this chapter. A person who violates
7this subsection is subject to regulation by the commissioner of
8insurance under Title XIII, subtitle 1.
9 Sec. 19. NEW SECTION. 142E.19 Liabilities and penalties.
101. A person who intentionally or knowingly alters or
11forges a patient’s request for medical-aid-in-dying medication
12pursuant to this chapter or who conceals or destroys a
13rescission of a patient’s request for medical-aid-in-dying
14medication pursuant to this chapter is guilty of a class “A”
15felony.
162. A person who intentionally or knowingly coerces or exerts
17undue influence on a patient with a terminal disease to request
18medical-aid-in-dying medication pursuant to this chapter or to
19request or utilize medical-aid-in-dying medication pursuant to
20this chapter is guilty of a class “A” felony.
213. Nothing in this section shall limit civil liability
22or damages arising from negligent conduct or intentional
23misconduct by a provider or health care entity.
244. The penalties specified in this chapter shall not
25preclude application of criminal penalties applicable under
26other laws for conduct inconsistent with this chapter.
27 Sec. 20. NEW SECTION. 142E.20 Claims by governmental entity
28for costs incurred.
29A governmental entity that incurs costs resulting from
30a qualified patient’s self-administration of medication
31prescribed under this chapter in a public place shall have a
32claim against the estate of the qualified patient to recover
33such costs and reasonable attorney fees related to enforcing
34the claim.
35 Sec. 21. NEW SECTION. 142E.21 Construction.
-19- 11. Nothing in this chapter authorizes a provider or any
2other person, including a qualified patient, to end the
3qualified patient’s life by lethal injection, lethal infusion,
4mercy killing, homicide, murder, manslaughter, euthanasia, or
5any other criminal act.
62. Actions taken in accordance with this chapter do not for
7any purpose constitute suicide, assisted suicide, euthanasia,
8mercy killing, homicide, murder, manslaughter, elder abuse or
9neglect, or any other civil or criminal violation under the
10law.
11 Sec. 22. NEW SECTION. 142E.22 Severability.
12If any provision of this chapter or its application to any
13person or circumstance is held invalid, the invalidity does
14not affect other provisions or applications of this chapter
15which can be given effect without the invalid provision or
16application, and to this end the provisions of this chapter are
17severable.
18 Sec. 23. FORMS. Within forty-five days of enactment of
19this Act, the department of health and human services shall
20create an attending provider checklist form and an attending
21provider follow-up form to facilitate collection of the
22information described in this Act and shall post the forms on
23the department’s internet site.
24 Sec. 24. EFFECTIVE DATE.
251. The following, being deemed of immediate importance,
26takes effect upon enactment:
27The portion of the section of this Act enacting section
28142E.12, relating to the department of health and human
29services creating and making available to all attending
30providers a prescribing provider checklist form and prescribing
31provider follow-up form for the purposes of reporting the
32information as specified under this Act to the department of
33health and human services. The department of health and human
34services shall comply with this section within forty-five days
35of the effective date of this subsection.
-20- 12. The remainder of this Act, not including the portion
2of section 142E.12 that is effective upon enactment under
3subsection 1, is effective forty-five days after the effective
4date of subsection 1.
5EXPLANATION
6The inclusion of this explanation does not constitute agreement with
7the explanation’s substance by the members of the general assembly.
8This bill creates a new Code chapter, the “Iowa Our Care, Our
9Options Act”.
10The bill provides findings and definitions used in the new
11Code chapter.
12The bill includes provisions relating to informed consent
13relative to an adult patient making a decision about
14end-of-life care and in particular medical aid in dying
15which is defined as the practice of evaluating a patient’s
16request for medication, determining if a patient is qualified,
17performing the duties specified, and providing a prescription
18to a qualified patient, pursuant to the new Code chapter.
19The bill provides that care that complies with the new
20Code chapter meets the medical standard of care and shall not
21be construed to exempt a provider or other medical personnel
22from meeting the medical standards of care for a patient’s
23treatment.
24The bill provides the process for a mentally capable
25patient with a terminal disease to request a prescription for
26medical-aid-in-dying medication. A requesting patient shall
27make an oral request and a written request and shall reiterate
28the oral request to the requesting patient’s attending provider
29no less than 48 hours after making the initial oral request.
30However, if the attending provider has determined that the
31requesting patient will, based on reasonable medical judgment,
32die within 48 hours after making the initial oral request,
33the requesting patient may reiterate the oral request to the
34attending provider at any time after making the initial oral
35request.
-21- 1The bill specifies the form of the request for
2medical-aid-in-dying medication and the requirements for
3witnesses of the form under the new Code section.
4The bill specifies the responsibilities of the attending
5provider including determining whether a requesting patient
6has a terminal disease with a prognosis of six months or
7less and is mentally capable, confirming that the requesting
8patient’s request does not arise from coercion or undue
9influence, informing the requesting patient of certain
10information, providing the requesting patient with a referral
11for alternative end-of-life treatment options, referring
12the requesting patient to a consulting provider for medical
13confirmation that the requesting patient has a terminal disease
14with a prognosis of six months or less to live and is mentally
15capable, referring the requesting patient to a licensed mental
16health provider if the attending provider observes signs that
17the requesting patient may not be capable of making an informed
18decision, informing the requesting patient of the benefits
19of notifying the next of kin of the requesting patient’s
20decision to request medication, following all other required
21steps before providing the medication including confirming
22that the requesting patient has made an informed decision, and
23educating the requesting patient on the recommended procedure
24and other details relating to administering the medication.
25Additionally, once the attending provider has determined
26that the requesting patient is a qualified patient, either
27deliver the prescription to a licensed pharmacist to dispense
28the medication to the qualified patient, or to an individual
29expressly designated by the qualified patient; or if authorized
30by the federal drug enforcement agency, dispense the prescribed
31medication to the qualified patient or an individual designated
32in person by the qualified patient.
33The bill includes responsibilities of a consulting
34provider including evaluating the requesting patient and the
35requesting patient’s relevant medical records, confirming
-22-1certain information about the requesting patient including
2that the requesting patient has a terminal disease, is acting
3voluntarily, is free from coercion or undue influence, and
4is mentally capable or if not mentally capable then provide
5documentation that the consulting provider has referred
6the requesting patient for further evaluation by a licensed
7mental health provider. The bill provides that if either
8the attending provider or the consulting provider doubts
9whether the requesting patient is mentally capable and is
10unable to confirm that the requesting patient is capable
11of making an informed decision, the attending provider or
12consulting provider shall refer the requesting patient to a
13licensed mental health provider for a determination regarding
14the requesting patient’s mental capability. If the licensed
15mental health provider determines the requesting patient is
16not mentally capable, the requesting patient shall not be
17deemed a qualified patient and the attending provider shall not
18prescribe medication to the requesting patient under the new
19Code chapter.
20The bill includes provisions relating to the death
21certificate of a qualified patient who obtained and
22self-administered a prescription for medication under the new
23Code chapter. The bill requires the department of health
24and human services (HHS) to create and make available to all
25attending providers a prescribing provider checklist form
26and prescribing provider follow-up form for the purposes of
27reporting specified information about a qualifying patient
28within specified time periods. Willful failure or refusal by
29an attending provider to timely submit the reports nullifies
30the immunity protections provided under the new Code chapter.
31The bill provides that a person who has custody or control
32of medication prescribed under the new Code chapter after the
33qualified patient’s death shall dispose of the medication by
34lawful means in accordance with applicable state and federal
35guidelines.
-23- 1The bill provides that a provider or health care entity
2may choose whether or not to provide medical aid in dying,
3but requires those that prohibit or refuse to provide medical
4aid in dying to comply with certain notifications to patients
5and providers. Under the new Code chapter, the intentional
6misleading of a patient or deploying of misinformation to
7obstruct access to medical-aid-in-dying services by a health
8care entity constitutes coercion and undue influence which is
9an aggravated misdemeanor and subjects the health care entity
10to licensee discipline. The bill provides that a provider or
11health care entity shall not be subject to criminal liability,
12licensing sanctions, or other professional disciplinary action
13for actions taken in good-faith compliance with the new Code
14chapter. Additionally, a provider, health care entity, or
15professional organization or association is prohibited from
16certain actions against a provider or health care entity for
17engaging in good-faith compliance with or for refusing to
18participate in accordance with the new Code chapter.
19A provider, health care entity, or professional
20organization or association is prohibited from subjecting
21a provider to certain penalties for providing medical aid
22in dying in accordance with the standard of care and in
23good faith under the new Code chapter when the provider is
24engaged in the outside practice of medicine and not on the
25objecting provider’s, health care entity’s, or professional
26organization’s or association’s premises, or when the provider
27is providing scientific and accurate information about medical
28aid in dying to a patient when discussing end-of-life care
29options. A provider is not subject to civil or criminal
30liability or professional discipline if at the request of a
31qualified patient the provider is present outside the scope of
32the provider’s employment and not located on the health care
33entity’s premises when the qualified patient self-administers
34medication pursuant to the new Code chapter or at the time of
35the qualified patient’s death.
-24- 1A person who is present at the time of self-administration
2of medication may, without civil or criminal liability, assist
3the qualified patient by preparing the medication prescribed
4pursuant to the new Code chapter.
5The request alone by a patient for medical aid in dying
6does not constitute grounds for neglect or elder abuse for any
7purpose of law, nor shall it be the sole basis for appointment
8of a guardian or conservator for the requesting patient.
9However, the immunity provisions do not limit civil liability
10of a provider or a health care entity for an intentional or
11negligent violation of the new Code chapter.
12The bill includes provisions relating to the effect of the
13new Code chapter on the construction of wills, contracts, or
14other agreements and on insurance and annuity policies, plans,
15contracts, and other agreements.
16The bill provides that a person who intentionally
17or knowingly alters or forges a patient’s request for
18medical-aid-in-dying medication or who conceals or destroys
19a rescission of a patient’s request for medical-aid-in-dying
20medication pursuant to the new Code chapter is guilty
21of a class “A” felony. A class “A” felony is punishable
22by confinement for life without possibility of parole.
23Additionally, a person who intentionally or knowingly coerces
24or exerts undue influence on a patient with a terminal disease
25to request medical-aid-in-dying medication or to request or
26utilize medical-aid-in-dying medication is guilty of a class
27“A” felony.
28The bill provides that a governmental entity that incurs
29costs resulting from a qualified patient self-administering
30medication prescribed under the new Code chapter in a public
31place shall have a claim against the estate of the qualified
32individual to recover such costs and reasonable attorney fees
33related to enforcing the claim.
34The construction provisions of the new Code chapter provide
35that nothing in the Code chapter authorizes a provider or
-25-1any other person, including the qualified patient, to end
2the qualified patient’s life by lethal injection, lethal
3infusion, mercy killing, homicide, murder, manslaughter,
4euthanasia, or any other criminal act. Additionally, actions
5taken in accordance with the new Code chapter do not for any
6purpose constitute suicide, assisted suicide, euthanasia,
7mercy killing, homicide, murder, manslaughter, elder abuse or
8neglect, or any other civil or criminal violation under the
9law.
10The bill includes a severability provision. The bill
11provides that the provision requiring HHS to create and make
12available the attending provider checklist form and follow-up
13form takes effect upon enactment and requires the completion of
14this requirement within 45 days of the effective date of the
15bill.
16The remainder of the bill takes effect 45 days after the
17effective date of the form requirement.
-26-pf/rh
2providing penalties, and including effective date
3provisions.
4BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1 Section 1. NEW SECTION. 142E.1 Findings.
21. The state of Iowa has long recognized that mentally
3capable adult individuals have a fundamental right to determine
4their own medical treatment options in accordance with their
5own values, beliefs, or personal preferences.
62. It is important that the state of Iowa upholds both the
7highest standard of medical care and the full range of options
8for each individual, particularly at the end of life.
93. Terminally ill individuals may undergo unremitting
10pain, agonizing discomfort, and a sudden, continuing, and
11irreversible reduction in their quality of life at the end of
12life.
134. The availability of medical aid in dying provides
14an additional palliative care option for terminally ill
15individuals who seek to retain their autonomy and some level of
16control over the progression of the terminal disease as they
17near the end of life or to ease unnecessary pain and suffering.
185. Integration of medical aid in dying into standard
19end-of-life care has demonstrably improved end-of-life care
20by contributing to better conversations between providers
21and their patients, earlier and more appropriate enrollment
22in hospice care, and better palliative care training for
23providers.
246. The state of Iowa seeks to affirm that a provider who
25respects and honors the values and priorities of individuals
26with a terminal disease for their last days of life and
27prescribes or dispenses medication for any such qualified
28terminally ill individual who makes a request pursuant
29to this chapter is practicing lawful patient-centered and
30patient-directed care.
317. Patient-directed care differs from patient-centered
32care in that it is not only respectful of and responsive to
33individual patient decisions, preferences, needs, and values,
34but also ensures that patient values direct all clinical
35decisions and that patients are fully informed of and able to
-1-1access legal options they desire.
2 Sec. 2. NEW SECTION. 142E.2 Short title.
3This chapter shall be known and may be cited as the “Iowa Our
4Care, Our Options Act”.
5 Sec. 3. NEW SECTION. 142E.3 Definitions.
6As used in this chapter, unless the context otherwise
7requires:
81. “Adult” means an individual eighteen years of age or
9older.
102. “Attending provider” means the provider who has primary
11responsibility for the care of a patient and treatment of the
12patient’s terminal disease.
133. “Coercion or undue influence” means the willful attempt,
14whether by deception, intimidation, or any other means, to do
15any of the following:
16a. Cause a patient to request, obtain, or self-administer
17medication pursuant to this chapter with the intent to cause
18the death of the patient.
19b. Prevent a qualified patient from obtaining or
20self-administration of medication pursuant to this chapter.
214. “Consulting provider” means a provider who is qualified
22by specialty or experience to make a professional diagnosis and
23prognosis regarding a patient’s disease.
245. “Department” means the department of health and human
25services.
266. “Health care entity” means a hospital licensed under
27chapter 135B, a nursing facility licensed under chapter 135C,
28an inpatient hospice program, a clinic, or any other facility
29licensed by the state wherein medical care is provided. “Health
30care entity” does not include a provider.
317. “Informed decision” means a decision by a medically
32capable requesting patient to request and obtain a prescription
33for medication pursuant to this chapter that the qualified
34patient may self-administer to bring about a peaceful death
35after being fully informed by the attending provider and
-2-1consulting provider of all of the following:
2a. The requesting patient’s diagnosis and prognosis.
3b. The potential risk associated with taking the medication
4to be prescribed.
5c. The probable result of taking the medication to be
6prescribed.
7d. The feasible end-of-life care and treatment options for
8the requesting patient’s terminal disease, including but not
9limited to comfort care, palliative care, hospice care, and
10pain control, and the risks and benefits of each.
11e. The requesting patient’s right to withdraw a request
12pursuant to this chapter or consent for any other treatment,
13at any time.
148. “Licensed mental health provider” means the same as a
15“mental health professional” as defined in section 228.1.
169. “Medical aid in dying” means the practice of evaluating
17a patient’s request for medication, determining if a patient
18is qualified, performing the duties specified, and providing a
19prescription to a qualified patient, pursuant to this chapter.
2010. “Medical-aid-in-dying medication” or “medication” means
21the medication prescribed and dispensed under this chapter to a
22qualified patient to bring about a peaceful death.
2311. “Medically confirmed” means the attending provider’s
24medical opinion that the patient is eligible to receive
25medication pursuant to this chapter has been confirmed by the
26consulting provider after performing a medical evaluation.
2712. “Mentally capable” means that in the opinion of the
28provider or licensed mental health provider, if an opinion is
29required under this chapter, the requesting patient has the
30ability to make and communicate an informed decision.
3113. “Oral request” means an affirmative statement that
32demonstrates a contemporaneous affirmatively stated desire by
33the requesting patient seeking medical aid in dying.
3414. “Patient” means an adult who is under the care of a
35provider.
-3- 115. “Prognosis of six months or less” means the terminal
2disease of a patient will, within reasonable medical judgment,
3result in the patient’s death within six months.
416. a. “Provider” means a person licensed, certified, or
5otherwise authorized or permitted by the law of this state
6to diagnose and treat medical conditions, and prescribe
7and dispense medication, including controlled substances.
8“Provider” includes all of the following:
9(1) A physician licensed to practice medicine pursuant to
10chapter 148.
11(2) An advanced registered nurse practitioner licensed
12under chapter 152 or an advanced practice registered nurse
13under chapter 152E.
14(3) A physician assistant licensed under chapter 148C.
15b. “Provider” does not include a health care entity.
1617. “Qualified patient” means a mentally capable patient
17who has satisfied the requirements of this chapter in order
18to obtain a prescription for medication to bring about a
19peaceful death. A person shall not be considered a “qualified
20patient” under this chapter solely because of advanced age or
21disability.
2218. “Requesting patient” means a patient with a terminal
23disease.
2419. “Self-administer” or “self-administration” means a
25qualified patient’s performance of an affirmative, conscious,
26voluntary act to ingest medication prescribed pursuant to
27this chapter to bring about the qualified patient’s peaceful
28death. “Self-administration” does not include administration by
29parenteral injection or infusion.
3020. “Terminal disease” means an incurable and irreversible
31disease that has been medically confirmed and will, within
32reasonable medical judgment, produce death within six months.
33 Sec. 4. NEW SECTION. 142E.4 Informed consent.
341. This chapter shall not be construed to limit the amount
35of information provided to a patient to ensure the patient can
-4-1make an informed decision.
22. An attending provider shall provide sufficient
3information to a patient regarding all appropriate end-of-life
4care options, including hospice and palliative care, and the
5foreseeable risks and benefits of each, so that the patient
6can make a voluntary and affirmative decision regarding the
7patient’s end-of-life care.
83. An attending provider is deemed to fail to obtain
9informed consent for subsequent medical treatment if a
10requesting patient requests information about medical aid in
11dying and, within a reasonable time, the provider has failed,
12at a minimum, to do either of the following:
13a. Provide information to the requesting patient about
14medical aid in dying and other legal end-of-life options.
15b. Document the date of the requesting patient’s request
16in the patient’s medical record and upon request transfer the
17requesting patient’s medical records to an alternative provider
18consistent with federal and state law.
194. If a requesting patient requests that the requesting
20patient’s medical records be transferred to an alternative
21provider, the requesting patient’s medical records shall be
22transferred within two business days.
23 Sec. 5. NEW SECTION. 142E.5 Standard of care.
241. Care that complies with this chapter shall be deemed to
25meet the medical standard of care.
262. This chapter shall not be construed to exempt a provider
27or other medical personnel from meeting medical standards of
28care for a patient’s treatment.
29 Sec. 6. NEW SECTION. 142E.6 Request for medical aid in
30dying.
311. A mentally capable patient with a terminal disease may
32request a prescription for medication under this chapter. The
33requesting patient shall make an oral request and a written
34request and shall reiterate the oral request to the requesting
35patient’s attending provider no less than forty-eight hours
-5-1after making the initial oral request. An oral request charted
2in the requesting patient’s medical record by a provider other
3than the requesting patient’s attending provider satisfies the
4oral request requirement under this section.
52. The attending and consulting providers of a qualified
6patient shall meet all requirements of sections 142E.8 and
7142E.9.
83. Notwithstanding any provision to the contrary under
9subsection 1, if the requesting patient’s attending provider
10has determined that the requesting patient will, based on
11reasonable medical judgment, die within forty-eight hours
12after making the initial oral request under this section,
13the requesting patient may satisfy the requirements under
14this section by reiterating the oral request to the attending
15provider at any time after making the initial oral request.
164. At the time the requesting patient makes the second oral
17request, the attending provider shall offer the requesting
18patient an opportunity to rescind the request.
195. Oral and written requests for the requesting patient must
20be made only by the requesting patient and shall not be made
21by the requesting patient’s surrogate decision-maker, health
22care proxy, attorney-in-fact for health care, or via an advance
23health care directive.
246. If a requesting patient decides to transfer the
25requesting patient’s care to an alternative provider, the
26custodian of the requesting patient’s medical records shall
27transfer all relevant medical records including written
28documentation of the dates of any of the requesting patient’s
29oral or written requests concerning medical aid in dying within
30two business days.
317. The transfer of care or medical records of a requesting
32patient does not toll or restart any waiting period under this
33section.
34 Sec. 7. NEW SECTION. 142E.7 Form of written request —
35requirements.
-6- 11. A written request for medication under this chapter shall
2be in substantially the following form, signed and dated by
3the requesting patient, and witnessed by at least one person
4who, in the presence of the requesting patient, attests that to
5the best of the witness’s knowledge and belief the requesting
6patient is mentally capable, acting voluntarily, and is not
7being coerced nor unduly influenced to sign the request.
8Request for Medication
9to End My Life in
10a Peaceful Manner
11I, ___________________________________ am an adult of sound
12mind. I have been diagnosed with
13_______________________________________________, and given a
14prognosis of six months or less to live.
15I have been fully informed of the feasible alternatives,
16and the concurrent or additional treatment opportunities for
17my terminal disease, including but not limited to comfort
18care, palliative care, hospice care, or pain control, and the
19potential risks and benefits of each. I have been offered or
20received resources or referrals to pursue these alternative,
21or concurrent or additional treatment opportunities for my
22terminal disease.
23I have been fully informed of the nature of the medication to
24be prescribed, including the risks and benefits, and understand
25that the likely outcome of self-administration of medication
26is death. I understand that I can rescind this request at any
27time, that I am under no obligation to fill the prescription
28once written nor to self-administer the medication if I obtain
29the medication.
30I request that my attending provider furnish a prescription
31for medication that will end my life if I choose to
32self-administer it, and I authorize my attending provider to
33contact a pharmacist to dispense the prescription at a time of
34my choosing.
35I make this request voluntarily, free from coercion or undue
-7-1influence.
2________________________________________ _____________
3Requesting Patient Signature Date
4________________________________________ _____________
5Witness Signature Date
62. The witness required under this section shall not be any
7of the following:
8a. A relative of the requesting patient by blood, marriage,
9or adoption.
10b. A person who at the time the request is signed would be
11entitled to any portion of the estate of the requesting patient
12upon death, under any will or by operation of law.
13c. An owner, operator, or employee of a health care entity
14where the requesting patient is receiving medical treatment or
15is a resident.
16d. The requesting patient’s attending provider at the time
17the request is signed.
18e. An interpreter for the requesting patient, if the
19requesting patient uses an interpreter.
20 Sec. 8. NEW SECTION. 142E.8 Attending provider
21responsibilities.
22The attending provider shall do all of the following:
231. Determine whether a requesting patient has a terminal
24disease with a prognosis of six months or less and is mentally
25capable.
262. Confirm that the requesting patient’s request does not
27arise from coercion or undue influence.
283. Inform the requesting patient of all of the following:
29a. The requesting patient’s diagnosis and prognosis.
30b. The potential risks, benefits, and probable result of
31self-administration of the prescribed medication to bring about
32a peaceful death.
33c. The potential benefits and risks of feasible alternatives
34including but not limited to concurrent or additional treatment
35options for the requesting patient’s terminal disease,
-8-1palliative care, comfort care, hospice care, and pain control.
2d. The requesting patient’s right to rescind the request for
3medication pursuant to this chapter at any time.
4e. That there is no obligation to fill the prescription
5nor an obligation to self-administer the medication, if the
6medication is obtained.
74. Provide the requesting patient with a referral for
8comfort care, palliative care, hospice care, pain control, or
9other end-of-life treatment options as requested by the patient
10and as clinically indicated.
115. Refer the requesting patient to a consulting provider for
12medical confirmation that the requesting patient has a terminal
13disease with a prognosis of six months or less to live and is
14mentally capable.
156. Include the consulting provider’s written determination
16in the requesting patient’s medical record.
177. Refer the requesting patient to a licensed mental health
18provider if the attending provider observes signs that the
19requesting patient may not be capable of making an informed
20decision.
218. Include the licensed mental health provider’s written
22determination in the requesting patient’s medical record, if
23such determination was requested.
249. Inform the requesting patient of the benefits of
25notifying the next of kin of the requesting patient’s decision
26to request medication pursuant to this chapter.
2710. Fulfill the medical record documentation requirements
28under this chapter.
2911. Ensure that all steps are carried out in accordance with
30this chapter before providing a prescription to a requesting
31patient for medication pursuant to this chapter including all
32of the following:
33a. Confirming that the requesting patient has made an
34informed decision to obtain a prescription for medication
35pursuant to this chapter.
-9- 1b. Offering the requesting patient an opportunity to rescind
2the request for medication pursuant to this chapter.
3c. Educating the requesting patient on all of the following:
4(1) The recommended procedure for self-administration of
5the medication to be prescribed.
6(2) The safe-keeping and proper disposal of unused
7medication in accordance with state and federal law.
8(3) The importance of having another individual present
9when the requesting patient self-administers the medication to
10be prescribed.
11(4) Not taking the medication in a public place.
1212. Once the requesting patient is determined to be a
13qualified patient, in accordance with state and federal law,
14do one of the following:
15a. Deliver the prescription personally, by mail, or through
16an authorized electronic transmission to a licensed pharmacist
17who will dispense the medication including any ancillary
18medications to the attending provider, to the qualified
19patient, or to an individual expressly designated by the
20qualified patient in person or with a signature required on
21delivery, by mail service, or by messenger service.
22b. If authorized by the federal drug enforcement agency,
23dispense the prescribed medication including any ancillary
24medications to the qualified patient or an individual
25designated in person by the qualified patient.
2613. Document in the qualified patient’s medical record the
27qualified patient’s diagnosis and prognosis, determination
28of mental capability, the date of any oral request, a copy
29of the written request, a notation that the requirements
30under this chapter have been completed, and identification of
31the medication and ancillary medications prescribed to the
32qualified patient pursuant to this chapter.
33 Sec. 9. NEW SECTION. 142E.9 Consulting provider
34responsibilities.
35A consulting provider shall do all of the following:
-10- 11. Evaluate the requesting patient and the requesting
2patient’s relevant medical records.
32. Confirm all of the following to the attending provider
4regarding the requesting patient:
5a. That the requesting patient has requested a prescription
6for medical-aid-in-dying medication.
7b. That the requesting patient has a terminal disease with a
8prognosis of six months or less to live.
9c. That the requesting patient is mentally capable, or
10provide documentation that the consulting provider has referred
11the requesting patient for further evaluation in accordance
12with section 142E.10.
13d. That the requesting patient is acting voluntarily, free
14from coercion or undue influence.
15 Sec. 10. NEW SECTION. 142E.10 Referral — determination
16that requesting patient is mentally capable.
171. If either the attending provider or the consulting
18provider doubts whether the requesting patient is mentally
19capable and is unable to confirm that the requesting patient is
20capable of making an informed decision, the attending provider
21or consulting provider shall refer the patient to a licensed
22mental health provider for a determination regarding the
23requesting patient’s mental capability.
242. The licensed mental health provider who evaluates the
25requesting patient under this section shall submit to the
26attending provider or consulting provider who made the referral
27a written determination of whether the requesting patient is
28mentally capable.
293. If the licensed mental health provider determines the
30requesting patient is not mentally capable, the requesting
31patient shall not be deemed a qualified patient and the
32attending provider shall not prescribe medication to the
33requesting patient under this chapter.
34 Sec. 11. NEW SECTION. 142E.11 Death certificate.
351. Unless otherwise prohibited by law, the attending
-11-1provider may sign the death certificate of a qualified
2patient who obtained and self-administered a prescription for
3medication pursuant to this chapter.
42. When a death has occurred in accordance with this
5chapter, the death shall be attributed to the underlying
6terminal disease, and all of the following shall apply:
7a. A death following self-administration of medication under
8this chapter does not alone constitute a person’s death that
9affects the public interest as described pursuant to section
10331.802. If a death that occurs in accordance with this
11chapter is referred to the state medical examiner or a county
12medical examiner, the state medical examiner or county medical
13examiner may conduct a preliminary investigation to determine
14whether an individual received a prescription for medication
15under this chapter.
16b. A death in accordance with this chapter shall not be
17designated a suicide or homicide.
18c. A qualified patient’s act of self-administration of
19medication prescribed pursuant to this chapter shall not be
20indicated on the death certificate.
21 Sec. 12. NEW SECTION. 142E.12 Reporting requirements —
22willful failure or refusal.
231. The department shall create and make available to all
24attending providers a prescribing provider checklist form
25and prescribing provider follow-up form for the purposes of
26reporting the information as specified under this section to
27the department.
282. Within thirty calendar days of providing a prescription
29for medication pursuant to this chapter, the attending provider
30shall submit to the department an attending provider checklist
31form with all of the following information:
32a. The qualifying patient’s name and date of birth.
33b. The qualifying patient’s terminal diagnosis and
34prognosis.
35c. Notice that the requirements under this chapter were
-12-1completed.
2d. Notice that medication has been prescribed pursuant to
3this chapter.
43. Within sixty calendar days of notification of a qualified
5patient’s death from self-administration of medication
6prescribed pursuant to this chapter, the attending provider
7shall submit to the department an attending provider follow-up
8form with all of the following information:
9a. The qualified patient’s name and date of birth.
10b. The qualified patient’s date of death.
11c. A notation of whether or not the qualified patient was
12enrolled in hospice services at the time of the qualified
13patient’s death.
144. The department shall annually review a sample of records
15pursuant to this chapter to ensure compliance and issue a
16public statistical report of nonidentifying information. The
17report shall be limited to all of the following:
18a. The number of prescriptions for medication written
19pursuant to this chapter.
20b. The number of attending providers who wrote prescriptions
21for medication pursuant to this chapter.
22c. The number of qualified patients who died following
23self-administration of medication prescribed and dispensed
24pursuant to this chapter.
255. Except as otherwise required by law, the information
26collected by the department is not a public record and is not
27available for public inspection.
286. Willful failure or refusal by an attending provider to
29timely submit reports required under this section nullifies the
30protections provided under section 142E.16.
31 Sec. 13. NEW SECTION. 142E.13 Safe disposal of unused
32medications.
33A person who has custody or control of medication prescribed
34pursuant to this chapter after the qualified patient’s death
35shall dispose of the medication by lawful means in accordance
-13-1with applicable state and federal guidelines.
2 Sec. 14. NEW SECTION. 142E.14 No duty to provide medical
3aid in dying — licensee discipline.
41. A provider shall provide sufficient information to a
5patient with a terminal disease regarding available options,
6alternatives, and the foreseeable risks and benefits of each,
7so that the patient with a terminal disease is able to make
8informed decisions regarding the patient’s end-of-life health
9care.
102. A provider may choose whether or not to practice medical
11aid in dying pursuant to this chapter.
123. If an attending provider is unable or unwilling to
13fulfill a requesting patient’s request pursuant to this
14chapter, the attending provider shall do all of the following:
15a. Document in the requesting patient’s medical record the
16date of the requesting patient’s oral or written request and
17the attending provider’s notice to the requesting patient of
18the attending provider’s inability or unwillingness to provide
19medical aid in dying.
20b. Upon the requesting patient’s request, transfer the
21requesting patient’s medical records to an alternative
22provider, consistent with federal and state law.
234. An attending provider shall not engage in false,
24misleading, or deceptive practices relating to a willingness
25to qualify a requesting patient or to provide medical aid in
26dying. A provider who engages in such false, misleading, or
27deceptive practices is subject to licensee discipline by the
28applicable licensing board or entity.
29 Sec. 15. NEW SECTION. 142E.15 Health care entity —
30permissible prohibitions and duties — penalties — licensee
31discipline.
321. A health care entity may prohibit providers from
33practicing medical aid in dying in the course of performing
34duties for the entity. A health care entity that prohibits
35the practice of medical aid in dying shall provide advance
-14-1notice in writing to providers and staff at the initial time
2of hiring, contracting, or privileging a provider, and on a
3yearly basis thereafter. A health care entity that fails to
4provide explicit, advance notice in writing to providers and
5staff that the health care entity prohibits providers from
6practicing medical aid in dying waives the right to enforce the
7prohibition.
82. If a requesting patient wishes to transfer care from a
9health care entity that prohibits the practice of medical aid
10in dying to another health care entity, the prohibiting entity
11shall coordinate a timely transfer of care including transfer
12of the requesting patient’s medical records that includes a
13notation of the date the requesting patient first made an oral
14request or a written request concerning medical aid in dying
15within two business days of the request for transfer by the
16requesting patient.
173. A health care entity shall not prohibit a provider from
18fulfilling the requirements of informed consent and meeting the
19standard of medical care under this chapter by prohibiting the
20provider from doing any of the following:
21a. Providing information to a patient regarding the
22patient’s health status including but not limited to a
23diagnosis and prognosis, recommended treatment and treatment
24alternatives, and the risks and benefits of each.
25b. Providing information regarding health care services
26available pursuant to this chapter, information about relevant
27community resources, and how to access those resources to
28obtain care of the patient’s choice.
29c. Practicing medical aid in dying outside the scope of the
30provider’s employment or contract with the prohibiting entity
31and off the premises of the prohibiting entity.
32d. Being present, if outside the scope of the provider’s
33employment or contractual duties, when a qualified patient
34self-administers medication prescribed pursuant to this
35chapter or at the time of death of the qualified patient, if
-15-1requested by the qualified patient or the qualified patient’s
2representative.
34. A prohibiting health care entity shall provide notice
4to the public by posting on the health care entity’s internet
5site that the health care entity prohibits attending providers
6from qualifying patients for medical aid in dying and from
7prescribing and dispensing medication pursuant to this chapter
8while the provider is performing duties in the course of
9performing duties for the health care entity.
105. A health care entity shall not engage in false,
11misleading, or deceptive practices relating to the health care
12entity’s policy regarding end-of-life care services, including
13whether the health care entity has a policy which prohibits
14affiliated providers from practicing medical aid in dying, or
15intentionally denying a requesting patient access to medication
16pursuant to this chapter by failing to transfer a requesting
17patient and the requesting patient’s medical records to another
18provider in a timely manner. The intentional misleading of
19a patient or deploying of misinformation to obstruct access
20to services pursuant to this chapter by a health care entity
21constitutes coercion and undue influence which is an aggravated
22misdemeanor and also subjects the health care entity to
23licensee discipline.
246. If any portion of this section is found to be in conflict
25with federal requirements which are a prescribed condition to
26the receipt of federal funds, the conflicting part of this
27section is inoperative solely to the extent of the conflict
28with respect to the health care entity directly affected, and
29such finding or determination shall not affect the operation of
30the remainder of this section or this chapter.
31 Sec. 16. NEW SECTION. 142E.16 Immunities for actions in
32good faith — prohibition against reprisals.
331. A provider or health care entity shall not be subject to
34criminal liability, licensing sanctions, or other professional
35disciplinary action for actions taken in good-faith compliance
-16-1with this chapter.
22. A provider, health care entity, or professional
3organization or association shall not subject a provider or
4health care entity to censure, discipline, suspension, loss of
5license, loss of privileges, loss of membership, or any other
6penalty for engaging in good-faith compliance with this chapter
7or for refusing to participate in accordance with this chapter.
83. A provider, health care entity, or professional
9organization or association shall not subject a provider
10to discharge, demotion, censure, discipline, suspension,
11loss of license, loss of privileges, loss of membership,
12discrimination, or any other penalty for providing medical
13aid in dying in accordance with the standard of care and
14in good faith under this chapter when the provider is
15engaged in the outside practice of medicine and not on the
16objecting provider’s, health care entity’s, or professional
17organization’s or association’s premises, or when the provider
18is providing scientific and accurate information about medical
19aid in dying to a patient when discussing end-of-life care
20options.
214. A provider is not subject to civil or criminal liability
22or professional discipline if, at the request of a qualified
23patient, the provider is present outside the scope of the
24provider’s employment and not located on the health care
25entity’s premises when the qualified patient self-administers
26medication pursuant to this chapter or at the time of the
27qualified patient’s death.
285. A person who is present at the time of
29self-administration of medication pursuant to this chapter
30may, without civil or criminal liability, assist the qualified
31patient by preparing the medication prescribed pursuant to this
32chapter.
336. The request alone by a patient for medical aid in dying
34does not constitute grounds for neglect or elder abuse for any
35purpose of law, nor shall it be the sole basis for appointment
-17-1of a guardian or conservator for the requesting patient.
27. This section does not limit civil liability of a provider
3or a health care entity for an intentional or negligent
4violation of this chapter.
5 Sec. 17. NEW SECTION. 142E.17 Effect on construction of
6wills, contracts, or other agreements.
71. A provision in a contract, will, or other agreement,
8whether written or oral, that would determine whether a
9patient may make or rescind a request for medical-aid-in-dying
10medication pursuant to this chapter is not valid.
112. An obligation owing under any currently existing
12contract shall not be conditioned or affected by a patient’s
13act of making or rescinding a request for medical-aid-in-dying
14medication pursuant to this chapter.
153. It is unlawful for an insurer to deny or alter a health
16care benefit otherwise available to a patient with a terminal
17disease based on the availability of medical aid in dying or to
18otherwise attempt to coerce a patient with a terminal disease
19to make a request for medical-aid-in-dying medication.
20 Sec. 18. NEW SECTION. 142E.18 Insurance or annuity
21policies, plans, contracts, or other agreements.
221. The sale, procurement, or issuance of a life, health, or
23accident insurance policy, plan, contract, or other agreement,
24or an annuity policy, plan, contract, or other agreement,
25or the rate charged for such policy, plan, contract, or
26other agreement shall not be conditioned upon or affected
27by a patient’s act of making or rescinding a request for
28medical-aid-in-dying medication pursuant to this chapter.
292. A qualified patient’s act of self-administration of
30medical-aid-in-dying medication pursuant to this chapter
31does not invalidate any part of a life, health, or accident
32insurance policy, plan, contract, or other agreement, or an
33annuity policy, plan, contract, or other agreement.
343. A carrier as defined in section 514C.13 shall not
35deny or alter benefits to a patient with a terminal disease
-18-1who is a covered beneficiary of the health benefit plan as
2defined in section 514C.13, based on the availability of
3medical-aid-in-dying medication, the patient’s request for
4medical-aid-in-dying medication pursuant to this chapter, or
5the absence of a request by a patient for medical-aid-in-dying
6medication pursuant to this chapter. A person who violates
7this subsection is subject to regulation by the commissioner of
8insurance under Title XIII, subtitle 1.
9 Sec. 19. NEW SECTION. 142E.19 Liabilities and penalties.
101. A person who intentionally or knowingly alters or
11forges a patient’s request for medical-aid-in-dying medication
12pursuant to this chapter or who conceals or destroys a
13rescission of a patient’s request for medical-aid-in-dying
14medication pursuant to this chapter is guilty of a class “A”
15felony.
162. A person who intentionally or knowingly coerces or exerts
17undue influence on a patient with a terminal disease to request
18medical-aid-in-dying medication pursuant to this chapter or to
19request or utilize medical-aid-in-dying medication pursuant to
20this chapter is guilty of a class “A” felony.
213. Nothing in this section shall limit civil liability
22or damages arising from negligent conduct or intentional
23misconduct by a provider or health care entity.
244. The penalties specified in this chapter shall not
25preclude application of criminal penalties applicable under
26other laws for conduct inconsistent with this chapter.
27 Sec. 20. NEW SECTION. 142E.20 Claims by governmental entity
28for costs incurred.
29A governmental entity that incurs costs resulting from
30a qualified patient’s self-administration of medication
31prescribed under this chapter in a public place shall have a
32claim against the estate of the qualified patient to recover
33such costs and reasonable attorney fees related to enforcing
34the claim.
35 Sec. 21. NEW SECTION. 142E.21 Construction.
-19- 11. Nothing in this chapter authorizes a provider or any
2other person, including a qualified patient, to end the
3qualified patient’s life by lethal injection, lethal infusion,
4mercy killing, homicide, murder, manslaughter, euthanasia, or
5any other criminal act.
62. Actions taken in accordance with this chapter do not for
7any purpose constitute suicide, assisted suicide, euthanasia,
8mercy killing, homicide, murder, manslaughter, elder abuse or
9neglect, or any other civil or criminal violation under the
10law.
11 Sec. 22. NEW SECTION. 142E.22 Severability.
12If any provision of this chapter or its application to any
13person or circumstance is held invalid, the invalidity does
14not affect other provisions or applications of this chapter
15which can be given effect without the invalid provision or
16application, and to this end the provisions of this chapter are
17severable.
18 Sec. 23. FORMS. Within forty-five days of enactment of
19this Act, the department of health and human services shall
20create an attending provider checklist form and an attending
21provider follow-up form to facilitate collection of the
22information described in this Act and shall post the forms on
23the department’s internet site.
24 Sec. 24. EFFECTIVE DATE.
251. The following, being deemed of immediate importance,
26takes effect upon enactment:
27The portion of the section of this Act enacting section
28142E.12, relating to the department of health and human
29services creating and making available to all attending
30providers a prescribing provider checklist form and prescribing
31provider follow-up form for the purposes of reporting the
32information as specified under this Act to the department of
33health and human services. The department of health and human
34services shall comply with this section within forty-five days
35of the effective date of this subsection.
-20- 12. The remainder of this Act, not including the portion
2of section 142E.12 that is effective upon enactment under
3subsection 1, is effective forty-five days after the effective
4date of subsection 1.
5EXPLANATION
6The inclusion of this explanation does not constitute agreement with
7the explanation’s substance by the members of the general assembly.
8This bill creates a new Code chapter, the “Iowa Our Care, Our
9Options Act”.
10The bill provides findings and definitions used in the new
11Code chapter.
12The bill includes provisions relating to informed consent
13relative to an adult patient making a decision about
14end-of-life care and in particular medical aid in dying
15which is defined as the practice of evaluating a patient’s
16request for medication, determining if a patient is qualified,
17performing the duties specified, and providing a prescription
18to a qualified patient, pursuant to the new Code chapter.
19The bill provides that care that complies with the new
20Code chapter meets the medical standard of care and shall not
21be construed to exempt a provider or other medical personnel
22from meeting the medical standards of care for a patient’s
23treatment.
24The bill provides the process for a mentally capable
25patient with a terminal disease to request a prescription for
26medical-aid-in-dying medication. A requesting patient shall
27make an oral request and a written request and shall reiterate
28the oral request to the requesting patient’s attending provider
29no less than 48 hours after making the initial oral request.
30However, if the attending provider has determined that the
31requesting patient will, based on reasonable medical judgment,
32die within 48 hours after making the initial oral request,
33the requesting patient may reiterate the oral request to the
34attending provider at any time after making the initial oral
35request.
-21- 1The bill specifies the form of the request for
2medical-aid-in-dying medication and the requirements for
3witnesses of the form under the new Code section.
4The bill specifies the responsibilities of the attending
5provider including determining whether a requesting patient
6has a terminal disease with a prognosis of six months or
7less and is mentally capable, confirming that the requesting
8patient’s request does not arise from coercion or undue
9influence, informing the requesting patient of certain
10information, providing the requesting patient with a referral
11for alternative end-of-life treatment options, referring
12the requesting patient to a consulting provider for medical
13confirmation that the requesting patient has a terminal disease
14with a prognosis of six months or less to live and is mentally
15capable, referring the requesting patient to a licensed mental
16health provider if the attending provider observes signs that
17the requesting patient may not be capable of making an informed
18decision, informing the requesting patient of the benefits
19of notifying the next of kin of the requesting patient’s
20decision to request medication, following all other required
21steps before providing the medication including confirming
22that the requesting patient has made an informed decision, and
23educating the requesting patient on the recommended procedure
24and other details relating to administering the medication.
25Additionally, once the attending provider has determined
26that the requesting patient is a qualified patient, either
27deliver the prescription to a licensed pharmacist to dispense
28the medication to the qualified patient, or to an individual
29expressly designated by the qualified patient; or if authorized
30by the federal drug enforcement agency, dispense the prescribed
31medication to the qualified patient or an individual designated
32in person by the qualified patient.
33The bill includes responsibilities of a consulting
34provider including evaluating the requesting patient and the
35requesting patient’s relevant medical records, confirming
-22-1certain information about the requesting patient including
2that the requesting patient has a terminal disease, is acting
3voluntarily, is free from coercion or undue influence, and
4is mentally capable or if not mentally capable then provide
5documentation that the consulting provider has referred
6the requesting patient for further evaluation by a licensed
7mental health provider. The bill provides that if either
8the attending provider or the consulting provider doubts
9whether the requesting patient is mentally capable and is
10unable to confirm that the requesting patient is capable
11of making an informed decision, the attending provider or
12consulting provider shall refer the requesting patient to a
13licensed mental health provider for a determination regarding
14the requesting patient’s mental capability. If the licensed
15mental health provider determines the requesting patient is
16not mentally capable, the requesting patient shall not be
17deemed a qualified patient and the attending provider shall not
18prescribe medication to the requesting patient under the new
19Code chapter.
20The bill includes provisions relating to the death
21certificate of a qualified patient who obtained and
22self-administered a prescription for medication under the new
23Code chapter. The bill requires the department of health
24and human services (HHS) to create and make available to all
25attending providers a prescribing provider checklist form
26and prescribing provider follow-up form for the purposes of
27reporting specified information about a qualifying patient
28within specified time periods. Willful failure or refusal by
29an attending provider to timely submit the reports nullifies
30the immunity protections provided under the new Code chapter.
31The bill provides that a person who has custody or control
32of medication prescribed under the new Code chapter after the
33qualified patient’s death shall dispose of the medication by
34lawful means in accordance with applicable state and federal
35guidelines.
-23- 1The bill provides that a provider or health care entity
2may choose whether or not to provide medical aid in dying,
3but requires those that prohibit or refuse to provide medical
4aid in dying to comply with certain notifications to patients
5and providers. Under the new Code chapter, the intentional
6misleading of a patient or deploying of misinformation to
7obstruct access to medical-aid-in-dying services by a health
8care entity constitutes coercion and undue influence which is
9an aggravated misdemeanor and subjects the health care entity
10to licensee discipline. The bill provides that a provider or
11health care entity shall not be subject to criminal liability,
12licensing sanctions, or other professional disciplinary action
13for actions taken in good-faith compliance with the new Code
14chapter. Additionally, a provider, health care entity, or
15professional organization or association is prohibited from
16certain actions against a provider or health care entity for
17engaging in good-faith compliance with or for refusing to
18participate in accordance with the new Code chapter.
19A provider, health care entity, or professional
20organization or association is prohibited from subjecting
21a provider to certain penalties for providing medical aid
22in dying in accordance with the standard of care and in
23good faith under the new Code chapter when the provider is
24engaged in the outside practice of medicine and not on the
25objecting provider’s, health care entity’s, or professional
26organization’s or association’s premises, or when the provider
27is providing scientific and accurate information about medical
28aid in dying to a patient when discussing end-of-life care
29options. A provider is not subject to civil or criminal
30liability or professional discipline if at the request of a
31qualified patient the provider is present outside the scope of
32the provider’s employment and not located on the health care
33entity’s premises when the qualified patient self-administers
34medication pursuant to the new Code chapter or at the time of
35the qualified patient’s death.
-24- 1A person who is present at the time of self-administration
2of medication may, without civil or criminal liability, assist
3the qualified patient by preparing the medication prescribed
4pursuant to the new Code chapter.
5The request alone by a patient for medical aid in dying
6does not constitute grounds for neglect or elder abuse for any
7purpose of law, nor shall it be the sole basis for appointment
8of a guardian or conservator for the requesting patient.
9However, the immunity provisions do not limit civil liability
10of a provider or a health care entity for an intentional or
11negligent violation of the new Code chapter.
12The bill includes provisions relating to the effect of the
13new Code chapter on the construction of wills, contracts, or
14other agreements and on insurance and annuity policies, plans,
15contracts, and other agreements.
16The bill provides that a person who intentionally
17or knowingly alters or forges a patient’s request for
18medical-aid-in-dying medication or who conceals or destroys
19a rescission of a patient’s request for medical-aid-in-dying
20medication pursuant to the new Code chapter is guilty
21of a class “A” felony. A class “A” felony is punishable
22by confinement for life without possibility of parole.
23Additionally, a person who intentionally or knowingly coerces
24or exerts undue influence on a patient with a terminal disease
25to request medical-aid-in-dying medication or to request or
26utilize medical-aid-in-dying medication is guilty of a class
27“A” felony.
28The bill provides that a governmental entity that incurs
29costs resulting from a qualified patient self-administering
30medication prescribed under the new Code chapter in a public
31place shall have a claim against the estate of the qualified
32individual to recover such costs and reasonable attorney fees
33related to enforcing the claim.
34The construction provisions of the new Code chapter provide
35that nothing in the Code chapter authorizes a provider or
-25-1any other person, including the qualified patient, to end
2the qualified patient’s life by lethal injection, lethal
3infusion, mercy killing, homicide, murder, manslaughter,
4euthanasia, or any other criminal act. Additionally, actions
5taken in accordance with the new Code chapter do not for any
6purpose constitute suicide, assisted suicide, euthanasia,
7mercy killing, homicide, murder, manslaughter, elder abuse or
8neglect, or any other civil or criminal violation under the
9law.
10The bill includes a severability provision. The bill
11provides that the provision requiring HHS to create and make
12available the attending provider checklist form and follow-up
13form takes effect upon enactment and requires the completion of
14this requirement within 45 days of the effective date of the
15bill.
16The remainder of the bill takes effect 45 days after the
17effective date of the form requirement.
-26-pf/rh