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Senate File 2101 - IntroducedA Bill ForAn Act 1creating the Iowa our care, our options Act, and
2providing penalties.
3BE 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 adults have a fundamental right to determine their own
4medical treatment options in accordance with their own values,
5beliefs, and personal preferences.
62. The state of Iowa wants to uphold both the highest
7standard of medical care and the full range of options for each
8individual, 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 illness as they near the
17end 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 the quality of
20services delivered to terminally ill individuals by enhancing
21palliative care training of providers, prompting development
22and enhancement of palliative care service delivery systems,
23and promoting more in-depth conversations between providers
24and terminally ill individuals about the full range of care
25options leading to more appropriate end-of-life care planning,
26including increased hospice use.
276. The state of Iowa affirms that an attending provider
28who respects and honors a terminally ill patient’s values
29and priorities for that terminally ill patient’s last days
30of life and prescribes or dispenses medication for any such
31qualified patient pursuant to this chapter is practicing lawful
32patient-directed care.
33 Sec. 2. NEW SECTION. 142E.2 Short title.
34This chapter shall be known and may be cited as the “Iowa Our
35Care, Our Options Act”.
-1-1 Sec. 3. NEW SECTION. 142E.3 Definitions.
2As used in this chapter, unless the context otherwise
3requires:
41. “Adult” means an individual eighteen years of age or
5older.
62. “Attending provider” means a health care provider
7who a patient determines has primary responsibility for the
8patient’s health care and treatment of the patient’s terminal
9illness, and who provides medical care to a patient with a
10terminal illness in the normal course of the provider’s medical
11practice.
123. “Coercion or undue influence” means the willful attempt,
13whether by deception, intimidation, or any other means, to
14cause a terminally ill patient to request, or a qualified
15patient to obtain or self-administer, medication pursuant
16to this chapter with the intent to cause the death of the
17terminally ill patient or qualified patient, or to prevent a
18terminally ill patient from requesting, or a qualified patient
19from obtaining or self-administering, medication pursuant to
20this chapter against the wishes of the terminally ill patient
21or qualified patient.
224. “Consulting provider” means a health care provider who
23is qualified by specialty or experience to make a professional
24diagnosis and prognosis regarding a patient’s terminal illness.
255. “Department” means the department of health and human
26services.
276. “Health care facility” means a hospital licensed pursuant
28to chapter 135B, a nursing facility licensed pursuant to
29chapter 135C, an inpatient hospice program as defined in
30section 135J.1, an elder group home as defined in section
31231B.1, or an assisted living program as defined in section
32231C.2. “Health care facility” does not include the location of
33an individual health care provider.
347. “Health care provider” means a person who is licensed,
35certified, or otherwise authorized or permitted by the laws
-2-1of this state to administer health care, diagnose and treat
2medical conditions, and prescribe and dispense medications,
3including controlled substances. “Health care provider” does
4not include a health care facility.
58. “Informed decision” means a voluntary, affirmative
6decision by a terminally ill patient to request and obtain a
7prescription for medication pursuant to this chapter that the
8terminally ill patient may self-administer to bring about a
9peaceful death, after being fully informed by the attending
10provider of all of the following:
11a. The patient’s medical diagnosis.
12b. The patient’s prognosis.
13c. The feasible end-of-life care and treatment options for
14the patient’s terminal illness, including but not limited to
15comfort care, palliative care, hospice care, and pain control,
16and the risks and benefits of each option.
17d. The patient’s right to withdraw consent at any time,
18and that the patient is not under any obligation to continue a
19previously chosen option for end-of-life care or treatment.
209. “Licensed mental health provider” means a psychiatrist
21licensed pursuant to chapter 148, a psychologist licensed
22pursuant to chapter 154B, or an independent social worker
23licensed pursuant to chapter 154C.
2410. “Medical aid in dying” means the medical practice
25authorized under this chapter and established standards
26of medical care to determine a terminally ill patient’s
27qualifications, evaluate a terminally ill patient’s request
28for medication, and provide a terminally ill patient with
29a prescription for medication or dispense the prescribed
30medication to bring about the terminally ill patient’s peaceful
31death.
3211. “Medical confirmation” means the medical opinion of the
33attending provider has been confirmed by a consulting provider
34who has examined the patient and the patient’s relevant medical
35records.
-3- 112. “Mentally capable” means that in the opinion of the
2attending provider, a consulting provider, and a licensed
3mental health care provider, as applicable, the patient
4requesting medical aid in dying has the ability to make and
5communicate an informed decision.
613. “Patient” means an adult who is under the care of a
7health care provider.
814. “Patient-directed care” means patient-centered care that
9is not only respectful of and responsive to individual patient
10preferences, needs, and values, but also ensures that patient
11values guide all clinical decisions and that patients are fully
12informed of and able to access all legal end-of-life care and
13treatment options.
1415. “Prognosis of six months or less” with reference to a
15terminal illness means the terminal illness will, within a
16reasonable degree of medical certainty, result in a patient’s
17death within six months.
1816. “Qualified patient” means a mentally capable, terminally
19ill patient, who is a resident of Iowa and has satisfied
20the requirements of this chapter in order to obtain and
21self-administer a prescription for medication to bring about
22the terminally ill patient’s peaceful death.
2317. “Self-administer” or “self-administration” means a
24qualified patient’s affirmative, conscious, voluntary act to
25ingest medication prescribed pursuant to this chapter to bring
26about the patient’s own peaceful death. “Self-administer”
27or “self-administration” does not include administration of
28medication via injection or intravenous infusion.
2918. “Terminal illness” or “terminally ill” means an
30incurable illness with a prognosis of six months or less.
3119. “Terminally ill patient” means a patient who has been
32certified by a health care provider to be terminally ill.
33 Sec. 4. NEW SECTION. 142E.4 Process for requesting
34medication for medical aid in dying.
351. A patient who is mentally capable, is a resident of this
-4-1state, and has been certified by a health care provider to be
2terminally ill, may request medication that the patient may
3self-administer to end the patient’s life as follows:
4a. By making two oral requests to the terminally
5ill patient’s attending provider separated by a
6fifteen-calendar-day waiting period, beginning from the
7day the first request is made.
8b. By providing one written request to the terminally ill
9patient’s attending provider.
102. A written request made under this section shall be in
11substantially the form described in section 142E.5, shall be
12signed and dated, or attested to, by the terminally ill patient
13requesting medical aid in dying, and shall be signed and dated,
14or attested to, by one witness.
153. Oral and written requests made under this section must be
16made by the terminally ill patient and shall not be made by any
17other individual including the terminally ill patient’s agent
18under a power of attorney executed pursuant to chapter 633B, an
19attorney in fact under a durable power of attorney for health
20care pursuant to chapter 144B, or via a declaration relating to
21use of life-sustaining procedures pursuant to chapter 144A.
224. A patient shall not qualify to make a request under this
23section solely based on age or disability.
245. Notwithstanding subsection 1, if a terminally ill
25patient’s attending provider attests that the terminally ill
26patient will, within a reasonable degree of medical certainty,
27die within fifteen days after the terminally ill patient’s
28initial oral request is made under this section, the terminally
29ill patient may reiterate the oral request to the attending
30provider at any time after making the initial oral request and
31the fifteen-day waiting period shall be waived.
32 Sec. 5. NEW SECTION. 142E.5 Form of written request —
33requirements.
341. A written request for medication that a terminally ill
35patient may self-administer to end the terminally ill patient’s
-5-1life as authorized by this chapter shall be in substantially
2the following form:
3Request for Medication
4to End My Life in
5a Peaceful Manner
6I, ___________________________________ am an adult of sound
7mind. I have been diagnosed with
8_______________________________________________, and given a
9prognosis of six months or less to live.
10I have been fully informed of the feasible alternatives,
11and the concurrent or additional care and treatment options
12for my terminal illness, including but not limited to comfort
13care, palliative care, hospice care, and pain control, and the
14potential risks and benefits of each. I have been offered or
15received resources or referrals to pursue these alternative
16and concurrent or additional care and treatment options for my
17terminal illness.
18I have been fully informed of the nature of the medication to
19be prescribed, the risks and benefits, and the probable result
20of self-administering the medication, should I decide to do
21so. I understand that I can rescind this request at any time,
22and that I am under no obligation to fill the prescription once
23provided nor to self-administer the medication if I obtain the
24medication.
25I request that my attending provider furnish a prescription
26for medication that will end my life in a peaceful manner if
27I choose to self-administer it, and I authorize my attending
28provider to contact a pharmacist to dispense the prescription
29at a time of my choosing.
30I make this request voluntarily, free from coercion and
31undue influence, and I accept full responsibility for my
32actions.
33________________________________________ _____________
34Requestor Signature Date
35________________________________________ _____________
-6-1Witness Signature Date
22. A witness shall not be any of the following:
3a. A relative of the terminally ill patient by blood,
4marriage, or adoption.
5b. A person who at the time the request is signed would
6be entitled to any portion of the estate of the terminally
7ill patient upon death under any will, trust, or other legal
8instrument, or by operation of law.
9 Sec. 6. NEW SECTION. 142E.6 Attending provider duties.
10An attending provider shall do all of the following:
111. Provide care that conforms to accepted medical
12standards.
132. After confirming that a patient is terminally ill,
14determine whether the patient requesting medical aid in dying
15meets all of the following criteria:
16a. Is mentally capable.
17b. Has made the request for medication voluntarily and free
18from coercion or undue influence.
19c. Is a resident of the state.
203. In confirming that the terminally ill patient’s request
21does not arise from coercion or undue influence by another
22person, discuss with the terminally ill patient, outside the
23presence of other persons with the exception of an interpreter
24if necessary, whether the terminally ill patient feels coerced
25or unduly influenced by another person.
264. Thoroughly educate the terminally ill patient about all
27of the following:
28a. The feasible alternatives and concurrent or additional
29care and treatment options for the patient’s terminal illness,
30including but not limited to comfort care, palliative care,
31hospice care, or pain control, and the potential risks and
32benefits of each.
33b. The potential risks, benefits, and probable result of
34self-administering the medication to be prescribed to bring
35about a peaceful death.
-7- 1c. The choices available to the terminally ill patient
2that reflect the terminally ill patient’s self-determination,
3including that the terminally ill patient is under no
4obligation to fill the prescription once provided nor to
5self-administer the medication if the medication is obtained.
6d. The terminally ill patient’s right to rescind the request
7for medication pursuant to this chapter at any time and in any
8manner.
9e. The benefits of notifying family of the terminally ill
10patient’s decision to request medication pursuant to this
11chapter as an end-of-life care option.
12f. With regard to a terminally ill patient’s
13self-administration of the medication:
14(1) The recommended methods for self-administering the
15medication to be prescribed.
16(2) The safekeeping and proper disposal of any unused
17medication in accordance with federal and state law.
18(3) The importance of having another individual present
19when the terminally ill patient self-administers the medication
20to be prescribed.
21(4) The importance of not taking the medication in a public
22place.
235. Provide the terminally ill patient with a referral for
24comfort care, palliative care, hospice care, pain control, or
25other end-of-life care and treatment options as requested or
26as clinically indicated.
276. a. Refer the terminally ill patient to a consulting
28provider for medical confirmation that the patient requesting
29medication pursuant to this chapter is eligible.
30b. The attending provider shall add the medical confirmation
31provided under paragraph “a” to the terminally ill patient’s
32medical record.
337. Refer the terminally ill patient to a licensed mental
34health provider for evaluation in accordance with section
35142E.8 if the attending provider observes signs that the
-8-1terminally ill patient may not be mentally capable of making
2an informed decision, and add the licensed mental health
3provider’s written determination to the terminally ill
4patient’s medical record.
58. Ensure that all appropriate steps are carried out in
6accordance with this chapter before providing a prescription
7for medication pursuant to this chapter to a terminally ill
8patient.
99. Once the terminally ill patient is determined to be a
10qualified patient, do either of the following:
11a. Deliver the prescription for the requested medication
12personally, by mail, or through an authorized electronic
13transmission to a licensed pharmacist who will dispense
14the medication, including ancillary medications intended
15to minimize the qualified patient’s discomfort, to the
16attending provider, to the qualified patient, or to a person
17expressly designated by the qualified patient, in person or
18with a signature required on delivery, by mail service, or by
19messenger service.
20b. Dispense the prescribed requested medication, including
21ancillary medications intended to minimize the qualified
22patient’s discomfort, to the qualified patient or to a person
23expressly designated by the qualified patient in person,
24if the attending provider has a current drug enforcement
25administration number if required under chapter 124.
2610. Document in the qualified patient’s medical record the
27qualified patient’s diagnosis and prognosis, determination of
28mental capability, the dates of the qualified patient’s oral
29requests, a copy of the written request, and a notation that
30all the requirements under this chapter have been completed
31including a description of the medication and ancillary
32medications prescribed to the qualified patient pursuant to
33this chapter.
34 Sec. 7. NEW SECTION. 142E.7 Consulting provider duties.
351. A terminally ill patient requesting medical aid in dying
-9-1under this chapter shall receive medical confirmation from a
2consulting provider prior to being deemed a qualified patient.
32. A consulting provider shall do all of the following:
4a. Evaluate the terminally ill patient and the terminally
5ill patient’s relevant medical records.
6b. Confirm, in writing, all of the following to the
7attending provider:
8(1) That the patient has a terminal illness.
9(2) That the terminally ill patient has made the request
10for medical aid in dying voluntarily and free from coercion or
11undue influence.
12(3) That the terminally ill patient is mentally capable, or
13provide documentation that the consulting provider has referred
14the terminally ill patient to a licensed mental health provider
15for further evaluation in accordance with section 142E.8.
16 Sec. 8. NEW SECTION. 142E.8 Confirmation — determination
17of mental capability — referral to licensed mental health
18provider.
191. If either the attending provider or the consulting
20provider is unable to confirm that the terminally ill patient
21requesting medication for medical aid in dying under this
22chapter is mentally capable, the attending provider or
23consulting provider shall refer the terminally ill patient to a
24licensed mental health provider for a determination of mental
25capability.
262. A licensed mental health provider who evaluates a
27terminally ill patient under this section shall communicate in
28writing to the attending provider or consulting provider who
29requested the evaluation the licensed mental health provider’s
30conclusions about whether the terminally ill patient is
31mentally capable.
323. If the licensed mental health provider determines
33that the terminally ill patient is not currently mentally
34capable, the licensed mental health provider shall not deem the
35terminally ill patient to be mentally capable and the attending
-10-1provider shall not determine the terminally ill patient to be a
2qualified patient and prescribe medication to the terminally
3ill patient under this chapter.
4 Sec. 9. NEW SECTION. 142E.9 Reporting requirements.
51. The department shall create and make available to all
6attending providers a prescribing provider checklist form
7and prescribing provider follow-up form for the purposes of
8reporting the information as specified under this section to
9the department.
102. Within thirty calendar days of providing a prescription
11to a qualified patient for medication pursuant to this chapter,
12the attending provider shall submit to the department a
13completed prescribing provider checklist form with all of the
14following information regarding a qualified patient:
15a. The qualified patient’s name and date of birth.
16b. The qualified patient’s terminal diagnosis and prognosis.
17c. A notation that all the requirements under this chapter
18have been completed.
19d. A notation that medication has been prescribed pursuant
20to this chapter.
213. Within sixty calendar days of notification of a qualified
22patient’s death from self-administration of medication
23prescribed pursuant to this chapter, the attending provider
24shall submit to the department a completed prescribing provider
25follow-up form with all of the following information:
26a. The qualified patient’s name, date of birth, age at
27death, education level, race, sex, type of insurance, if any,
28and underlying illness.
29b. The date of the qualified patient’s death.
30c. A notation of whether or not the qualified patient was
31enrolled in and receiving hospice services at the time of the
32qualified patient’s death.
334. The department shall annually review a sample of records
34maintained pursuant to this section to ensure compliance
35and shall generate and make available to the public a
-11-1statistical report of nonidentifying information collected.
2The statistical report shall be limited to the following
3information:
4a. The number of prescriptions for medication written
5pursuant to this chapter.
6b. The number of attending providers who wrote prescriptions
7for medication pursuant to this chapter.
8c. The number of qualified patients who died following
9self-administration of medication prescribed and dispensed
10pursuant to this chapter.
115. Except as otherwise required by law, the information
12collected by the department shall not be a public record and
13shall not be made available for public inspection.
14 Sec. 10. NEW SECTION. 142E.10 Safe disposal of unused
15medications.
16A person who has custody or control of medication prescribed
17and dispensed pursuant to this chapter that remains unused
18after a qualified patient’s death shall dispose of the
19medication by lawful means in accordance with state and federal
20guidelines.
21 Sec. 11. NEW SECTION. 142E.11 Use of interpreters.
221. An interpreter whose services are provided to a patient
23requesting information or services under this chapter shall
24meet the standards promulgated by the Iowa interpreters and
25translators association or the national board of certification
26for medical interpreters, or other standard deemed acceptable
27by the department.
282. An interpreter providing services pursuant to this
29chapter shall not be related to a qualified patient by blood,
30marriage, or adoption, or be entitled to a portion of the
31qualified patient’s estate by will, trust, or other legal
32instrument, or by operation of law upon the qualified patient’s
33death.
34 Sec. 12. NEW SECTION. 142E.12 Effect on construction of
35wills, contracts, and statutes.
-12- 11. A provision in a contract, will, or other agreement,
2whether written or oral, to the extent the provision would
3affect whether a patient may make or rescind a request for
4medication pursuant to this chapter, shall not be valid.
52. An obligation owing under any currently existing
6contract shall not be conditioned or affected by the making or
7rescinding of a request by a patient for medication pursuant to
8this chapter.
9 Sec. 13. NEW SECTION. 142E.13 Insurance or annuity
10policies.
111. The sale, procurement, or issuance of a life, health,
12or accident insurance or annuity policy, or the rate charged
13for any such policy shall not be conditioned upon or affected
14by the making or rescinding of a request by a patient for
15medication pursuant to this chapter.
162. A qualified patient’s act of self-administering
17medication pursuant to this chapter shall not have an effect on
18or invalidate any part of a life, health, or accident insurance
19or annuity policy.
203. A terminally ill patient who is a covered beneficiary
21of a health insurance policy shall not be subject to denial
22or alteration of such benefits based on the availability of
23medical aid in dying or the patient’s request or absence of a
24request for medication pursuant to this chapter.
254. A terminally ill patient who is a recipient of Medicaid
26coverage shall not be subject to denial or alteration of such
27benefits based on the availability of medical aid in dying or
28the patient’s request or absence of request for medication
29pursuant to this chapter.
30 Sec. 14. NEW SECTION. 142E.14 Death certificate.
311. Unless otherwise prohibited by law, the attending
32provider or the hospice medical director shall sign the
33death certificate of a qualified patient who obtained and
34self-administered a prescription for medication pursuant to
35this chapter.
-13- 12. When a death has occurred in accordance with this
2chapter:
3a. The manner of death of the qualified patient on a death
4certificate shall not be listed as suicide or homicide.
5b. The cause of death of a qualified patient on a death
6certificate shall be listed as the qualified patient’s
7underlying terminal illness.
8c. The qualified patient’s act of self-administering
9medication prescribed pursuant to this chapter shall not be
10indicated on the death certificate.
113. A death that occurs in accordance with this chapter does
12not alone constitute a person’s death that affects the public
13interest as described pursuant to section 331.802.
14a. If a death that occurs in accordance with this chapter
15is referred to the state medical examiner or a county medical
16examiner, a preliminary investigation may be conducted to
17determine whether the person received a prescription for
18medication under this chapter.
19b. Any inquiry or investigation conducted by the state
20medical examiner or a county medical examiner relating to
21deaths that occur pursuant to this chapter shall not require
22the state medical examiner or a county medical examiner to
23sign the death certificate if the state medical examiner or a
24county medical examiner identifies the attending provider that
25prescribed the qualified patient medication pursuant to this
26chapter.
27 Sec. 15. NEW SECTION. 142E.15 Construction of chapter.
281. Nothing in this chapter shall be interpreted to lessen
29the applicable standard of care, including the standard of care
30for the treatment of terminally ill patients and medical aid in
31dying, for an attending provider, consulting provider, licensed
32mental health provider, or any other health care provider
33acting under this chapter.
342. Nothing in this chapter shall be construed to limit the
35information or counseling a health care provider must provide
-14-1to a patient in order to comply with informed consent laws and
2requirements to meet a medical standard of care.
33. Nothing in this chapter shall be construed to authorize a
4health care provider or any other person to end an individual’s
5life by infusion, intravenous injection, mercy killing, or
6euthanasia. Actions taken in accordance and compliance with
7this chapter shall not, for any purposes, constitute suicide,
8assisted suicide, euthanasia, mercy killing, homicide, or elder
9abuse under the law.
104. A request by a patient for and the provision of
11medication pursuant to this chapter do not solely constitute
12neglect or elder abuse for any purpose of law, or provide the
13sole basis for the appointment of a guardian or conservator.
14 Sec. 16. NEW SECTION. 142E.16 No duty to provide medical
15aid in dying.
161. A health care provider shall provide sufficient
17information to a terminally ill patient regarding available
18options, alternatives, and the foreseeable risks and benefits
19of each option or alternative, so that the patient is able
20to make a fully informed, voluntary, affirmative decision
21regarding the patient’s end-of-life care and treatment.
222. A health care provider may choose whether or not to
23practice medical aid in dying pursuant to this chapter and
24shall not be under any duty, whether by contract, statute, or
25any other legal requirement, to participate in the practice of
26medical aid in dying or to provide a qualified patient with
27medication pursuant to this chapter.
283. If an attending provider is unable or unwilling to
29determine a terminally ill patient’s qualification for medical
30aid in dying, evaluate a terminally ill patient’s request for
31medication, or provide a qualified patient with a prescription
32for medication or dispense prescribed medication to a qualified
33patient pursuant to this chapter, the attending provider shall
34do all of the following:
35a. Accurately document the terminally ill patient’s request
-15-1in the terminally ill patient’s medical record.
2b. Make reasonable efforts to accommodate the terminally
3ill patient’s request including by transferring the care and
4medical records of the terminally ill patient to another
5attending provider upon the terminally ill patient’s request
6so that the terminally ill patient is able to make a voluntary
7affirmative decision regarding the terminally ill patient’s
8end-of-life care and treatment.
94. Failure to inform a terminally ill patient who requests
10information about available end-of-life options including
11medical aid in dying, or failure to refer the terminally ill
12patient to another attending provider who can provide the
13information, is considered a failure to obtain informed consent
14for subsequent medical treatments.
155. An attending provider shall not engage in false,
16misleading, or deceptive practices relating to the attending
17provider’s willingness to determine the qualification of a
18terminally ill patient for medical aid in dying, to evaluate
19a terminally ill patient’s request for medication, or to
20provide a prescription for medication to a qualified patient
21or dispense a prescribed medication to a qualified patient
22pursuant to this chapter.
23 Sec. 17. NEW SECTION. 142E.17 Health care facility —
24permissible prohibitions and duties.
251. A health care facility that has adopted a policy
26prohibiting health care providers in the course of performing
27duties for the health care facility from determining the
28qualification of a terminally ill patient for medical aid
29in dying, evaluating a terminally ill patient’s request
30for medication, or providing a qualified patient with a
31prescription for medication or dispensing prescribed medication
32to a qualified patient, shall provide advance notice in
33writing to the health care facility’s patients and health care
34providers that the health care facility is a nonparticipating
35health care facility under this chapter.
-16- 12. A nonparticipating health care facility that fails to
2provide explicit, advance notice in writing to the health care
3facility’s patients and health care providers shall not enforce
4such a policy.
53. If a terminally ill patient wishes to transfer the
6patient’s care from a nonparticipating health care facility to
7another health care facility, the nonparticipating health care
8facility shall coordinate a timely transfer, including transfer
9of the terminally ill patient’s medical records that include
10notation of the date the terminally ill patient first requested
11medical aid in dying.
124. A nonparticipating health care facility shall not
13prohibit a health care provider from providing services
14consistent with the applicable standard of medical care
15including all of the following:
16a. Providing information to a patient about the availability
17of medical aid in dying pursuant to this chapter.
18b. Prescribing medication pursuant to this chapter for
19a qualified patient outside the scope of the health care
20provider’s employment or contract with the nonparticipating
21health care facility and off the premises of the
22nonparticipating health care facility.
23c. Being present at the time a qualified patient
24self-administers medication prescribed pursuant to this chapter
25or at the time of the patient’s death, if requested by the
26qualified patient or the qualified patient’s representative
27outside the scope of the health care provider’s employment or
28contractual duties.
295. A health care facility shall not engage in false,
30misleading, or deceptive practices relating to the health care
31facility’s policy regarding end-of-life care and treatment
32services, including whether the health care facility has a
33policy which prohibits affiliated health care providers from
34determining a terminally ill patient’s qualification for
35medical aid in dying, evaluating a terminally ill patient’s
-17-1request for medication, or providing a prescription for or
2dispensing medication to a qualified patient pursuant to this
3chapter; or intentionally denying a terminally ill patient
4access to medication pursuant to this chapter by failing to
5transfer a terminally ill patient and the terminally ill
6patient’s medical records to another health care facility in a
7timely manner.
8 Sec. 18. NEW SECTION. 142E.18 Immunities for actions in
9good faith — prohibition against reprisals.
101. A health care provider or health care facility shall
11not be subject to civil or criminal liability, professional
12disciplinary action, or any other penalty for engaging in
13the practice of medical aid in dying in accordance with
14the standard of care and in good faith compliance with this
15chapter.
162. A health care provider, health care facility, or
17professional organization or association shall not subject
18a health care provider or health care facility to censure,
19discipline, the denial, suspension, or revocation of licensure,
20loss of privileges, loss of membership, or any other penalty
21for providing medical aid in dying in accordance with the
22standard of care and in good faith compliance with this
23chapter or for providing scientific and accurate information
24about medical aid in dying to a terminally ill patient when
25discussing end-of-life care and treatment options.
263. A health care provider shall not be subject to civil
27or criminal liability or professional discipline if, with the
28consent of the qualified patient or the qualified patient’s
29representative, the health care provider is present outside the
30scope of the health care provider’s professional duties when
31the qualified patient self-administers medication prescribed
32pursuant to this chapter or at the time of the qualified
33patient’s death.
344. This section shall not be interpreted to limit civil or
35criminal liability of a health care provider who intentionally
-18-1or knowingly fails or refuses to timely submit records required
2pursuant to section 142E.9.
35. This section shall not be interpreted to limit civil or
4criminal liability for intentional violations of this chapter.
5 Sec. 19. NEW SECTION. 142E.19 Liabilities and penalties.
61. A person who without authorization of a patient
7intentionally or knowingly alters or forges a request for
8medication pursuant to this chapter with the intent or effect
9of causing the patient’s death, or conceals or destroys a
10patient’s rescission of a request for medication pursuant to
11this chapter, is guilty of a class “A” felony.
122. A person who coerces or exerts undue influence over
13a patient to request or utilize medication pursuant to this
14chapter, with the intent or effect of causing the patient’s
15death, is guilty of a class “A” felony.
163. A person who intentionally or knowingly coerces or
17exerts undue influence over a terminally ill patient to forgo a
18request for or to obtain medication pursuant to this chapter,
19or who intentionally or knowingly denies a qualified patient
20access to medication under this chapter as an end-of-life care
21and treatment option is guilty of a serious misdemeanor.
224. Nothing in this section shall be interpreted to limit
23liability for civil damages resulting from negligent conduct or
24intentional misconduct applicable under other law for conduct
25which is inconsistent with the provisions of this chapter.
265. The penalties specified in this chapter shall not
27preclude application of criminal penalties applicable under
28other law for conduct which is inconsistent with this chapter.
29 Sec. 20. NEW SECTION. 142E.20 Claims by governmental entity
30for costs incurred.
31A governmental entity that incurs costs resulting from a
32qualified patient self-administering medication prescribed
33pursuant to this chapter in a public place shall have a claim
34against the estate of the qualified patient to recover such
35costs and reasonable attorney fees related to enforcing the
-19-1claim.
2EXPLANATION
3The inclusion of this explanation does not constitute agreement with
4the explanation’s substance by the members of the general assembly.
5This bill creates the Iowa our care, our options Act.
6The bill includes findings relating to end-of-life care and
7treatment options and provides definitions of terms used in the
8bill.
9The bill provides a process for an adult patient who is
10mentally capable, is a resident of the state, and has been
11determined by the patient’s attending provider and consulting
12provider to be terminally ill, to request medication that the
13patient may self-administer to end the patient’s life. Such
14patient must make two oral requests to the patient’s attending
15provider, followed by one written request to the patient’s
16attending provider to request the medication.
17The bill provides the form in which the written request
18must be substantially made, and requires that oral and written
19requests must be made by the terminally ill patient. Under
20the bill, a patient shall not qualify to make a request solely
21based on age or disability. The bill also provides that
22notwithstanding other provisions of the bill, if a terminally
23ill patient’s attending provider attests that the terminally
24ill patient will, within a reasonable degree of medical
25certainty, die within 15 days after making the initial oral
26request, the terminally ill patient may reiterate the oral
27request to the attending provider at any time after making the
28initial oral request and the 15-day waiting period shall be
29waived.
30The bill specifies the duties of the attending provider and
31the consulting provider, and provides for the referral of a
32terminally ill patient by either an attending provider or a
33consulting provider to a licensed mental health provider to
34confirm that the terminally ill patient requesting medication
35for medical aid in dying is mentally capable.
-20- 1The bill requires the department of health and human
2services (HHS) to create and make available to all attending
3providers a prescribing provider checklist form and prescribing
4provider follow-up form for the purposes of reporting the
5information specified under the bill to HHS. The department
6of health and human services is required to annually review
7a sample of records to ensure compliance and shall generate
8and make available to the public a statistical report of
9nonidentifying information collected.
10The bill provides for the safe disposal of unused
11medications and the use of interpreters by patients.
12The bill provides for the effect of a request for medication
13to end a patient’s life on the construction of wills,
14contracts, and statutes, as well as on insurance and annuity
15policies.
16The bill provides that unless otherwise prohibited by
17law, the attending provider or the hospice medical director
18shall sign the death certificate of a qualified patient who
19obtained and self-administered a prescription for medication;
20and provides specific requirements relative to a qualified
21patient’s death certificate and the role of medical examiner
22investigations and actions.
23The bill specifies how the bill is to be interpreted
24relative to applicable standards of care and informed consent
25requirements; and provides that the bill is not to be construed
26to authorize a health care provider or any other person to
27end an individual’s life by infusion, intravenous injection,
28mercy killing, or euthanasia, and that actions taken in
29accordance and compliance with the bill shall not, for any
30purposes, constitute suicide, assisted suicide, euthanasia,
31mercy killing, homicide, or elder abuse under the law. The
32bill provides that a request by a patient for and the provision
33of medication pursuant to the bill does not solely constitute
34neglect or elder abuse for any purpose of law, or provide the
35sole basis for the appointment of a guardian or conservator.
-21- 1The bill provides that a health care provider shall provide
2sufficient information to a terminally ill patient regarding
3available options, the alternatives, and the foreseeable
4risks and benefits of each option or alternative, so that
5the terminally ill patient is able to make a fully informed,
6voluntary, affirmative decision regarding the patient’s
7end-of-life care and treatment; provides that a health care
8provider may choose whether or not to practice medical aid in
9dying and shall not be under any duty, whether by contract,
10statute, or any other legal requirement, to participate in the
11practice of medical aid in dying or to provide a qualified
12patient with medication pursuant to the bill. The bill
13requires an attending provider who is unable or unwilling to
14determine a terminally ill patient’s qualification for medical
15aid in dying to evaluate a terminally ill patient’s request
16for medication, or to prescribe or dispense medication to a
17qualified patient under the bill to otherwise accommodate the
18terminally ill or qualified patient.
19Failure to inform a terminally ill patient who requests
20information about available end-of-life treatments including
21medical aid in dying, or failure to refer a terminally ill
22patient to another attending provider who can provide the
23information, is considered a failure to obtain informed consent
24for subsequent medical treatments. The bill prohibits an
25attending provider from engaging in false, misleading, or
26deceptive practices relating to the health care provider’s
27willingness to determine the qualification of a terminally ill
28patient for medical aid in dying, to evaluate a terminally ill
29patient’s request for medication, or to provide a prescription
30for or dispense medication to a qualified patient under the
31bill.
32The bill specifies permissible prohibitions and duties of
33a health care facility that has adopted a policy prohibiting
34health care providers from determining the qualification of a
35patient for medical aid in dying, evaluating a terminally ill
-22-1patient’s request for medication, or prescribing or dispensing
2prescribed medication pursuant to the bill in the course of
3the health care provider performing duties for the health care
4facility.
5The bill provides immunities for actions taken in good
6faith by a health care provider or health care facility;
7prohibits a health care provider, health care facility, or
8professional organization or association from subjecting a
9health care provider or health care facility to censure,
10discipline, denial, suspension or revocation of licensure, loss
11of privileges, loss of membership, or any other penalty for
12providing medical aid in dying in accordance with the standard
13of care and in good faith compliance with the bill, or for
14providing scientific and accurate information about medical
15aid in dying to a terminally ill patient when discussing
16end-of-life care and treatment options; and prohibits a
17health care provider from being subject to civil or criminal
18liability or professional discipline if, with the consent of
19the qualified patient or the qualified patient’s agent, the
20health care provider is present outside the scope of their
21professional duties when the qualified patient self-administers
22medication prescribed pursuant to the bill or at the time of
23the qualified patient’s death. Civil and criminal liability
24is not limited for a health care provider who intentionally or
25knowingly fails or refuses to timely submit records required to
26be submitted to HHS or for intentional violations of the bill.
27The bill provides for liability and criminal penalties
28imposed on persons who violate the bill. A person who without
29authorization of a patient intentionally or knowingly alters
30or forges a request for medication with the intent or effect
31of causing the patient’s death, or conceals or destroys a
32patient’s rescission of a request for medication is guilty
33of a class “A” felony. A person who coerces or exerts undue
34influence over a patient to request or utilize medication under
35the bill, with the intent or effect of causing the patient’s
-23-1death, is guilty of a class “A” felony. A class “A” felony
2is punishable by confinement for life without possibility of
3parole.
4A person who intentionally or knowingly coerces or exerts
5undue influence over a terminally ill patient to forgo a
6request for or to obtain medication pursuant to the bill, or
7intentionally or knowingly denies a qualified patient access
8to medication under the bill as an end-of-life care option,
9is guilty of a serious misdemeanor. A serious misdemeanor is
10punishable by confinement for no more than one year and a fine
11of at least $430 but not more than $2,560.
12The liability and penalty provisions under the bill are
13not to be interpreted to limit liability for civil damages
14resulting from negligent conduct or intentional misconduct
15applicable under other law for conduct which is inconsistent
16with the provisions of this chapter, and penalties specified in
17the bill shall not preclude application of criminal penalties
18applicable under other law for conduct which is inconsistent
19with the bill.
20The bill also provides that a governmental entity
21that incurs costs resulting from a qualified patient
22self-administering medication prescribed under the bill in
23a public place shall have a claim against the estate of the
24patient to recover such costs and reasonable attorney fees
25related to the enforcement of the claim.
-24-pf/ko
2providing penalties.
3BE 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 adults have a fundamental right to determine their own
4medical treatment options in accordance with their own values,
5beliefs, and personal preferences.
62. The state of Iowa wants to uphold both the highest
7standard of medical care and the full range of options for each
8individual, 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 illness as they near the
17end 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 the quality of
20services delivered to terminally ill individuals by enhancing
21palliative care training of providers, prompting development
22and enhancement of palliative care service delivery systems,
23and promoting more in-depth conversations between providers
24and terminally ill individuals about the full range of care
25options leading to more appropriate end-of-life care planning,
26including increased hospice use.
276. The state of Iowa affirms that an attending provider
28who respects and honors a terminally ill patient’s values
29and priorities for that terminally ill patient’s last days
30of life and prescribes or dispenses medication for any such
31qualified patient pursuant to this chapter is practicing lawful
32patient-directed care.
33 Sec. 2. NEW SECTION. 142E.2 Short title.
34This chapter shall be known and may be cited as the “Iowa Our
35Care, Our Options Act”.
-1-1 Sec. 3. NEW SECTION. 142E.3 Definitions.
2As used in this chapter, unless the context otherwise
3requires:
41. “Adult” means an individual eighteen years of age or
5older.
62. “Attending provider” means a health care provider
7who a patient determines has primary responsibility for the
8patient’s health care and treatment of the patient’s terminal
9illness, and who provides medical care to a patient with a
10terminal illness in the normal course of the provider’s medical
11practice.
123. “Coercion or undue influence” means the willful attempt,
13whether by deception, intimidation, or any other means, to
14cause a terminally ill patient to request, or a qualified
15patient to obtain or self-administer, medication pursuant
16to this chapter with the intent to cause the death of the
17terminally ill patient or qualified patient, or to prevent a
18terminally ill patient from requesting, or a qualified patient
19from obtaining or self-administering, medication pursuant to
20this chapter against the wishes of the terminally ill patient
21or qualified patient.
224. “Consulting provider” means a health care provider who
23is qualified by specialty or experience to make a professional
24diagnosis and prognosis regarding a patient’s terminal illness.
255. “Department” means the department of health and human
26services.
276. “Health care facility” means a hospital licensed pursuant
28to chapter 135B, a nursing facility licensed pursuant to
29chapter 135C, an inpatient hospice program as defined in
30section 135J.1, an elder group home as defined in section
31231B.1, or an assisted living program as defined in section
32231C.2. “Health care facility” does not include the location of
33an individual health care provider.
347. “Health care provider” means a person who is licensed,
35certified, or otherwise authorized or permitted by the laws
-2-1of this state to administer health care, diagnose and treat
2medical conditions, and prescribe and dispense medications,
3including controlled substances. “Health care provider” does
4not include a health care facility.
58. “Informed decision” means a voluntary, affirmative
6decision by a terminally ill patient to request and obtain a
7prescription for medication pursuant to this chapter that the
8terminally ill patient may self-administer to bring about a
9peaceful death, after being fully informed by the attending
10provider of all of the following:
11a. The patient’s medical diagnosis.
12b. The patient’s prognosis.
13c. The feasible end-of-life care and treatment options for
14the patient’s terminal illness, including but not limited to
15comfort care, palliative care, hospice care, and pain control,
16and the risks and benefits of each option.
17d. The patient’s right to withdraw consent at any time,
18and that the patient is not under any obligation to continue a
19previously chosen option for end-of-life care or treatment.
209. “Licensed mental health provider” means a psychiatrist
21licensed pursuant to chapter 148, a psychologist licensed
22pursuant to chapter 154B, or an independent social worker
23licensed pursuant to chapter 154C.
2410. “Medical aid in dying” means the medical practice
25authorized under this chapter and established standards
26of medical care to determine a terminally ill patient’s
27qualifications, evaluate a terminally ill patient’s request
28for medication, and provide a terminally ill patient with
29a prescription for medication or dispense the prescribed
30medication to bring about the terminally ill patient’s peaceful
31death.
3211. “Medical confirmation” means the medical opinion of the
33attending provider has been confirmed by a consulting provider
34who has examined the patient and the patient’s relevant medical
35records.
-3- 112. “Mentally capable” means that in the opinion of the
2attending provider, a consulting provider, and a licensed
3mental health care provider, as applicable, the patient
4requesting medical aid in dying has the ability to make and
5communicate an informed decision.
613. “Patient” means an adult who is under the care of a
7health care provider.
814. “Patient-directed care” means patient-centered care that
9is not only respectful of and responsive to individual patient
10preferences, needs, and values, but also ensures that patient
11values guide all clinical decisions and that patients are fully
12informed of and able to access all legal end-of-life care and
13treatment options.
1415. “Prognosis of six months or less” with reference to a
15terminal illness means the terminal illness will, within a
16reasonable degree of medical certainty, result in a patient’s
17death within six months.
1816. “Qualified patient” means a mentally capable, terminally
19ill patient, who is a resident of Iowa and has satisfied
20the requirements of this chapter in order to obtain and
21self-administer a prescription for medication to bring about
22the terminally ill patient’s peaceful death.
2317. “Self-administer” or “self-administration” means a
24qualified patient’s affirmative, conscious, voluntary act to
25ingest medication prescribed pursuant to this chapter to bring
26about the patient’s own peaceful death. “Self-administer”
27or “self-administration” does not include administration of
28medication via injection or intravenous infusion.
2918. “Terminal illness” or “terminally ill” means an
30incurable illness with a prognosis of six months or less.
3119. “Terminally ill patient” means a patient who has been
32certified by a health care provider to be terminally ill.
33 Sec. 4. NEW SECTION. 142E.4 Process for requesting
34medication for medical aid in dying.
351. A patient who is mentally capable, is a resident of this
-4-1state, and has been certified by a health care provider to be
2terminally ill, may request medication that the patient may
3self-administer to end the patient’s life as follows:
4a. By making two oral requests to the terminally
5ill patient’s attending provider separated by a
6fifteen-calendar-day waiting period, beginning from the
7day the first request is made.
8b. By providing one written request to the terminally ill
9patient’s attending provider.
102. A written request made under this section shall be in
11substantially the form described in section 142E.5, shall be
12signed and dated, or attested to, by the terminally ill patient
13requesting medical aid in dying, and shall be signed and dated,
14or attested to, by one witness.
153. Oral and written requests made under this section must be
16made by the terminally ill patient and shall not be made by any
17other individual including the terminally ill patient’s agent
18under a power of attorney executed pursuant to chapter 633B, an
19attorney in fact under a durable power of attorney for health
20care pursuant to chapter 144B, or via a declaration relating to
21use of life-sustaining procedures pursuant to chapter 144A.
224. A patient shall not qualify to make a request under this
23section solely based on age or disability.
245. Notwithstanding subsection 1, if a terminally ill
25patient’s attending provider attests that the terminally ill
26patient will, within a reasonable degree of medical certainty,
27die within fifteen days after the terminally ill patient’s
28initial oral request is made under this section, the terminally
29ill patient may reiterate the oral request to the attending
30provider at any time after making the initial oral request and
31the fifteen-day waiting period shall be waived.
32 Sec. 5. NEW SECTION. 142E.5 Form of written request —
33requirements.
341. A written request for medication that a terminally ill
35patient may self-administer to end the terminally ill patient’s
-5-1life as authorized by this chapter shall be in substantially
2the following form:
3Request for Medication
4to End My Life in
5a Peaceful Manner
6I, ___________________________________ am an adult of sound
7mind. I have been diagnosed with
8_______________________________________________, and given a
9prognosis of six months or less to live.
10I have been fully informed of the feasible alternatives,
11and the concurrent or additional care and treatment options
12for my terminal illness, including but not limited to comfort
13care, palliative care, hospice care, and pain control, and the
14potential risks and benefits of each. I have been offered or
15received resources or referrals to pursue these alternative
16and concurrent or additional care and treatment options for my
17terminal illness.
18I have been fully informed of the nature of the medication to
19be prescribed, the risks and benefits, and the probable result
20of self-administering the medication, should I decide to do
21so. I understand that I can rescind this request at any time,
22and that I am under no obligation to fill the prescription once
23provided nor to self-administer the medication if I obtain the
24medication.
25I request that my attending provider furnish a prescription
26for medication that will end my life in a peaceful manner if
27I choose to self-administer it, and I authorize my attending
28provider to contact a pharmacist to dispense the prescription
29at a time of my choosing.
30I make this request voluntarily, free from coercion and
31undue influence, and I accept full responsibility for my
32actions.
33________________________________________ _____________
34Requestor Signature Date
35________________________________________ _____________
-6-1Witness Signature Date
22. A witness shall not be any of the following:
3a. A relative of the terminally ill patient by blood,
4marriage, or adoption.
5b. A person who at the time the request is signed would
6be entitled to any portion of the estate of the terminally
7ill patient upon death under any will, trust, or other legal
8instrument, or by operation of law.
9 Sec. 6. NEW SECTION. 142E.6 Attending provider duties.
10An attending provider shall do all of the following:
111. Provide care that conforms to accepted medical
12standards.
132. After confirming that a patient is terminally ill,
14determine whether the patient requesting medical aid in dying
15meets all of the following criteria:
16a. Is mentally capable.
17b. Has made the request for medication voluntarily and free
18from coercion or undue influence.
19c. Is a resident of the state.
203. In confirming that the terminally ill patient’s request
21does not arise from coercion or undue influence by another
22person, discuss with the terminally ill patient, outside the
23presence of other persons with the exception of an interpreter
24if necessary, whether the terminally ill patient feels coerced
25or unduly influenced by another person.
264. Thoroughly educate the terminally ill patient about all
27of the following:
28a. The feasible alternatives and concurrent or additional
29care and treatment options for the patient’s terminal illness,
30including but not limited to comfort care, palliative care,
31hospice care, or pain control, and the potential risks and
32benefits of each.
33b. The potential risks, benefits, and probable result of
34self-administering the medication to be prescribed to bring
35about a peaceful death.
-7- 1c. The choices available to the terminally ill patient
2that reflect the terminally ill patient’s self-determination,
3including that the terminally ill patient is under no
4obligation to fill the prescription once provided nor to
5self-administer the medication if the medication is obtained.
6d. The terminally ill patient’s right to rescind the request
7for medication pursuant to this chapter at any time and in any
8manner.
9e. The benefits of notifying family of the terminally ill
10patient’s decision to request medication pursuant to this
11chapter as an end-of-life care option.
12f. With regard to a terminally ill patient’s
13self-administration of the medication:
14(1) The recommended methods for self-administering the
15medication to be prescribed.
16(2) The safekeeping and proper disposal of any unused
17medication in accordance with federal and state law.
18(3) The importance of having another individual present
19when the terminally ill patient self-administers the medication
20to be prescribed.
21(4) The importance of not taking the medication in a public
22place.
235. Provide the terminally ill patient with a referral for
24comfort care, palliative care, hospice care, pain control, or
25other end-of-life care and treatment options as requested or
26as clinically indicated.
276. a. Refer the terminally ill patient to a consulting
28provider for medical confirmation that the patient requesting
29medication pursuant to this chapter is eligible.
30b. The attending provider shall add the medical confirmation
31provided under paragraph “a” to the terminally ill patient’s
32medical record.
337. Refer the terminally ill patient to a licensed mental
34health provider for evaluation in accordance with section
35142E.8 if the attending provider observes signs that the
-8-1terminally ill patient may not be mentally capable of making
2an informed decision, and add the licensed mental health
3provider’s written determination to the terminally ill
4patient’s medical record.
58. Ensure that all appropriate steps are carried out in
6accordance with this chapter before providing a prescription
7for medication pursuant to this chapter to a terminally ill
8patient.
99. Once the terminally ill patient is determined to be a
10qualified patient, do either of the following:
11a. Deliver the prescription for the requested medication
12personally, by mail, or through an authorized electronic
13transmission to a licensed pharmacist who will dispense
14the medication, including ancillary medications intended
15to minimize the qualified patient’s discomfort, to the
16attending provider, to the qualified patient, or to a person
17expressly designated by the qualified patient, in person or
18with a signature required on delivery, by mail service, or by
19messenger service.
20b. Dispense the prescribed requested medication, including
21ancillary medications intended to minimize the qualified
22patient’s discomfort, to the qualified patient or to a person
23expressly designated by the qualified patient in person,
24if the attending provider has a current drug enforcement
25administration number if required under chapter 124.
2610. Document in the qualified patient’s medical record the
27qualified patient’s diagnosis and prognosis, determination of
28mental capability, the dates of the qualified patient’s oral
29requests, a copy of the written request, and a notation that
30all the requirements under this chapter have been completed
31including a description of the medication and ancillary
32medications prescribed to the qualified patient pursuant to
33this chapter.
34 Sec. 7. NEW SECTION. 142E.7 Consulting provider duties.
351. A terminally ill patient requesting medical aid in dying
-9-1under this chapter shall receive medical confirmation from a
2consulting provider prior to being deemed a qualified patient.
32. A consulting provider shall do all of the following:
4a. Evaluate the terminally ill patient and the terminally
5ill patient’s relevant medical records.
6b. Confirm, in writing, all of the following to the
7attending provider:
8(1) That the patient has a terminal illness.
9(2) That the terminally ill patient has made the request
10for medical aid in dying voluntarily and free from coercion or
11undue influence.
12(3) That the terminally ill patient is mentally capable, or
13provide documentation that the consulting provider has referred
14the terminally ill patient to a licensed mental health provider
15for further evaluation in accordance with section 142E.8.
16 Sec. 8. NEW SECTION. 142E.8 Confirmation — determination
17of mental capability — referral to licensed mental health
18provider.
191. If either the attending provider or the consulting
20provider is unable to confirm that the terminally ill patient
21requesting medication for medical aid in dying under this
22chapter is mentally capable, the attending provider or
23consulting provider shall refer the terminally ill patient to a
24licensed mental health provider for a determination of mental
25capability.
262. A licensed mental health provider who evaluates a
27terminally ill patient under this section shall communicate in
28writing to the attending provider or consulting provider who
29requested the evaluation the licensed mental health provider’s
30conclusions about whether the terminally ill patient is
31mentally capable.
323. If the licensed mental health provider determines
33that the terminally ill patient is not currently mentally
34capable, the licensed mental health provider shall not deem the
35terminally ill patient to be mentally capable and the attending
-10-1provider shall not determine the terminally ill patient to be a
2qualified patient and prescribe medication to the terminally
3ill patient under this chapter.
4 Sec. 9. NEW SECTION. 142E.9 Reporting requirements.
51. The department shall create and make available to all
6attending providers a prescribing provider checklist form
7and prescribing provider follow-up form for the purposes of
8reporting the information as specified under this section to
9the department.
102. Within thirty calendar days of providing a prescription
11to a qualified patient for medication pursuant to this chapter,
12the attending provider shall submit to the department a
13completed prescribing provider checklist form with all of the
14following information regarding a qualified patient:
15a. The qualified patient’s name and date of birth.
16b. The qualified patient’s terminal diagnosis and prognosis.
17c. A notation that all the requirements under this chapter
18have been completed.
19d. A notation that medication has been prescribed pursuant
20to this chapter.
213. Within sixty calendar days of notification of a qualified
22patient’s death from self-administration of medication
23prescribed pursuant to this chapter, the attending provider
24shall submit to the department a completed prescribing provider
25follow-up form with all of the following information:
26a. The qualified patient’s name, date of birth, age at
27death, education level, race, sex, type of insurance, if any,
28and underlying illness.
29b. The date of the qualified patient’s death.
30c. A notation of whether or not the qualified patient was
31enrolled in and receiving hospice services at the time of the
32qualified patient’s death.
334. The department shall annually review a sample of records
34maintained pursuant to this section to ensure compliance
35and shall generate and make available to the public a
-11-1statistical report of nonidentifying information collected.
2The statistical report shall be limited to the following
3information:
4a. The number of prescriptions for medication written
5pursuant to this chapter.
6b. The number of attending providers who wrote prescriptions
7for medication pursuant to this chapter.
8c. The number of qualified patients who died following
9self-administration of medication prescribed and dispensed
10pursuant to this chapter.
115. Except as otherwise required by law, the information
12collected by the department shall not be a public record and
13shall not be made available for public inspection.
14 Sec. 10. NEW SECTION. 142E.10 Safe disposal of unused
15medications.
16A person who has custody or control of medication prescribed
17and dispensed pursuant to this chapter that remains unused
18after a qualified patient’s death shall dispose of the
19medication by lawful means in accordance with state and federal
20guidelines.
21 Sec. 11. NEW SECTION. 142E.11 Use of interpreters.
221. An interpreter whose services are provided to a patient
23requesting information or services under this chapter shall
24meet the standards promulgated by the Iowa interpreters and
25translators association or the national board of certification
26for medical interpreters, or other standard deemed acceptable
27by the department.
282. An interpreter providing services pursuant to this
29chapter shall not be related to a qualified patient by blood,
30marriage, or adoption, or be entitled to a portion of the
31qualified patient’s estate by will, trust, or other legal
32instrument, or by operation of law upon the qualified patient’s
33death.
34 Sec. 12. NEW SECTION. 142E.12 Effect on construction of
35wills, contracts, and statutes.
-12- 11. A provision in a contract, will, or other agreement,
2whether written or oral, to the extent the provision would
3affect whether a patient may make or rescind a request for
4medication pursuant to this chapter, shall not be valid.
52. An obligation owing under any currently existing
6contract shall not be conditioned or affected by the making or
7rescinding of a request by a patient for medication pursuant to
8this chapter.
9 Sec. 13. NEW SECTION. 142E.13 Insurance or annuity
10policies.
111. The sale, procurement, or issuance of a life, health,
12or accident insurance or annuity policy, or the rate charged
13for any such policy shall not be conditioned upon or affected
14by the making or rescinding of a request by a patient for
15medication pursuant to this chapter.
162. A qualified patient’s act of self-administering
17medication pursuant to this chapter shall not have an effect on
18or invalidate any part of a life, health, or accident insurance
19or annuity policy.
203. A terminally ill patient who is a covered beneficiary
21of a health insurance policy shall not be subject to denial
22or alteration of such benefits based on the availability of
23medical aid in dying or the patient’s request or absence of a
24request for medication pursuant to this chapter.
254. A terminally ill patient who is a recipient of Medicaid
26coverage shall not be subject to denial or alteration of such
27benefits based on the availability of medical aid in dying or
28the patient’s request or absence of request for medication
29pursuant to this chapter.
30 Sec. 14. NEW SECTION. 142E.14 Death certificate.
311. Unless otherwise prohibited by law, the attending
32provider or the hospice medical director shall sign the
33death certificate of a qualified patient who obtained and
34self-administered a prescription for medication pursuant to
35this chapter.
-13- 12. When a death has occurred in accordance with this
2chapter:
3a. The manner of death of the qualified patient on a death
4certificate shall not be listed as suicide or homicide.
5b. The cause of death of a qualified patient on a death
6certificate shall be listed as the qualified patient’s
7underlying terminal illness.
8c. The qualified patient’s act of self-administering
9medication prescribed pursuant to this chapter shall not be
10indicated on the death certificate.
113. A death that occurs in accordance with this chapter does
12not alone constitute a person’s death that affects the public
13interest as described pursuant to section 331.802.
14a. If a death that occurs in accordance with this chapter
15is referred to the state medical examiner or a county medical
16examiner, a preliminary investigation may be conducted to
17determine whether the person received a prescription for
18medication under this chapter.
19b. Any inquiry or investigation conducted by the state
20medical examiner or a county medical examiner relating to
21deaths that occur pursuant to this chapter shall not require
22the state medical examiner or a county medical examiner to
23sign the death certificate if the state medical examiner or a
24county medical examiner identifies the attending provider that
25prescribed the qualified patient medication pursuant to this
26chapter.
27 Sec. 15. NEW SECTION. 142E.15 Construction of chapter.
281. Nothing in this chapter shall be interpreted to lessen
29the applicable standard of care, including the standard of care
30for the treatment of terminally ill patients and medical aid in
31dying, for an attending provider, consulting provider, licensed
32mental health provider, or any other health care provider
33acting under this chapter.
342. Nothing in this chapter shall be construed to limit the
35information or counseling a health care provider must provide
-14-1to a patient in order to comply with informed consent laws and
2requirements to meet a medical standard of care.
33. Nothing in this chapter shall be construed to authorize a
4health care provider or any other person to end an individual’s
5life by infusion, intravenous injection, mercy killing, or
6euthanasia. Actions taken in accordance and compliance with
7this chapter shall not, for any purposes, constitute suicide,
8assisted suicide, euthanasia, mercy killing, homicide, or elder
9abuse under the law.
104. A request by a patient for and the provision of
11medication pursuant to this chapter do not solely constitute
12neglect or elder abuse for any purpose of law, or provide the
13sole basis for the appointment of a guardian or conservator.
14 Sec. 16. NEW SECTION. 142E.16 No duty to provide medical
15aid in dying.
161. A health care provider shall provide sufficient
17information to a terminally ill patient regarding available
18options, alternatives, and the foreseeable risks and benefits
19of each option or alternative, so that the patient is able
20to make a fully informed, voluntary, affirmative decision
21regarding the patient’s end-of-life care and treatment.
222. A health care provider may choose whether or not to
23practice medical aid in dying pursuant to this chapter and
24shall not be under any duty, whether by contract, statute, or
25any other legal requirement, to participate in the practice of
26medical aid in dying or to provide a qualified patient with
27medication pursuant to this chapter.
283. If an attending provider is unable or unwilling to
29determine a terminally ill patient’s qualification for medical
30aid in dying, evaluate a terminally ill patient’s request for
31medication, or provide a qualified patient with a prescription
32for medication or dispense prescribed medication to a qualified
33patient pursuant to this chapter, the attending provider shall
34do all of the following:
35a. Accurately document the terminally ill patient’s request
-15-1in the terminally ill patient’s medical record.
2b. Make reasonable efforts to accommodate the terminally
3ill patient’s request including by transferring the care and
4medical records of the terminally ill patient to another
5attending provider upon the terminally ill patient’s request
6so that the terminally ill patient is able to make a voluntary
7affirmative decision regarding the terminally ill patient’s
8end-of-life care and treatment.
94. Failure to inform a terminally ill patient who requests
10information about available end-of-life options including
11medical aid in dying, or failure to refer the terminally ill
12patient to another attending provider who can provide the
13information, is considered a failure to obtain informed consent
14for subsequent medical treatments.
155. An attending provider shall not engage in false,
16misleading, or deceptive practices relating to the attending
17provider’s willingness to determine the qualification of a
18terminally ill patient for medical aid in dying, to evaluate
19a terminally ill patient’s request for medication, or to
20provide a prescription for medication to a qualified patient
21or dispense a prescribed medication to a qualified patient
22pursuant to this chapter.
23 Sec. 17. NEW SECTION. 142E.17 Health care facility —
24permissible prohibitions and duties.
251. A health care facility that has adopted a policy
26prohibiting health care providers in the course of performing
27duties for the health care facility from determining the
28qualification of a terminally ill patient for medical aid
29in dying, evaluating a terminally ill patient’s request
30for medication, or providing a qualified patient with a
31prescription for medication or dispensing prescribed medication
32to a qualified patient, shall provide advance notice in
33writing to the health care facility’s patients and health care
34providers that the health care facility is a nonparticipating
35health care facility under this chapter.
-16- 12. A nonparticipating health care facility that fails to
2provide explicit, advance notice in writing to the health care
3facility’s patients and health care providers shall not enforce
4such a policy.
53. If a terminally ill patient wishes to transfer the
6patient’s care from a nonparticipating health care facility to
7another health care facility, the nonparticipating health care
8facility shall coordinate a timely transfer, including transfer
9of the terminally ill patient’s medical records that include
10notation of the date the terminally ill patient first requested
11medical aid in dying.
124. A nonparticipating health care facility shall not
13prohibit a health care provider from providing services
14consistent with the applicable standard of medical care
15including all of the following:
16a. Providing information to a patient about the availability
17of medical aid in dying pursuant to this chapter.
18b. Prescribing medication pursuant to this chapter for
19a qualified patient outside the scope of the health care
20provider’s employment or contract with the nonparticipating
21health care facility and off the premises of the
22nonparticipating health care facility.
23c. Being present at the time a qualified patient
24self-administers medication prescribed pursuant to this chapter
25or at the time of the patient’s death, if requested by the
26qualified patient or the qualified patient’s representative
27outside the scope of the health care provider’s employment or
28contractual duties.
295. A health care facility shall not engage in false,
30misleading, or deceptive practices relating to the health care
31facility’s policy regarding end-of-life care and treatment
32services, including whether the health care facility has a
33policy which prohibits affiliated health care providers from
34determining a terminally ill patient’s qualification for
35medical aid in dying, evaluating a terminally ill patient’s
-17-1request for medication, or providing a prescription for or
2dispensing medication to a qualified patient pursuant to this
3chapter; or intentionally denying a terminally ill patient
4access to medication pursuant to this chapter by failing to
5transfer a terminally ill patient and the terminally ill
6patient’s medical records to another health care facility in a
7timely manner.
8 Sec. 18. NEW SECTION. 142E.18 Immunities for actions in
9good faith — prohibition against reprisals.
101. A health care provider or health care facility shall
11not be subject to civil or criminal liability, professional
12disciplinary action, or any other penalty for engaging in
13the practice of medical aid in dying in accordance with
14the standard of care and in good faith compliance with this
15chapter.
162. A health care provider, health care facility, or
17professional organization or association shall not subject
18a health care provider or health care facility to censure,
19discipline, the denial, suspension, or revocation of licensure,
20loss of privileges, loss of membership, or any other penalty
21for providing medical aid in dying in accordance with the
22standard of care and in good faith compliance with this
23chapter or for providing scientific and accurate information
24about medical aid in dying to a terminally ill patient when
25discussing end-of-life care and treatment options.
263. A health care provider shall not be subject to civil
27or criminal liability or professional discipline if, with the
28consent of the qualified patient or the qualified patient’s
29representative, the health care provider is present outside the
30scope of the health care provider’s professional duties when
31the qualified patient self-administers medication prescribed
32pursuant to this chapter or at the time of the qualified
33patient’s death.
344. This section shall not be interpreted to limit civil or
35criminal liability of a health care provider who intentionally
-18-1or knowingly fails or refuses to timely submit records required
2pursuant to section 142E.9.
35. This section shall not be interpreted to limit civil or
4criminal liability for intentional violations of this chapter.
5 Sec. 19. NEW SECTION. 142E.19 Liabilities and penalties.
61. A person who without authorization of a patient
7intentionally or knowingly alters or forges a request for
8medication pursuant to this chapter with the intent or effect
9of causing the patient’s death, or conceals or destroys a
10patient’s rescission of a request for medication pursuant to
11this chapter, is guilty of a class “A” felony.
122. A person who coerces or exerts undue influence over
13a patient to request or utilize medication pursuant to this
14chapter, with the intent or effect of causing the patient’s
15death, is guilty of a class “A” felony.
163. A person who intentionally or knowingly coerces or
17exerts undue influence over a terminally ill patient to forgo a
18request for or to obtain medication pursuant to this chapter,
19or who intentionally or knowingly denies a qualified patient
20access to medication under this chapter as an end-of-life care
21and treatment option is guilty of a serious misdemeanor.
224. Nothing in this section shall be interpreted to limit
23liability for civil damages resulting from negligent conduct or
24intentional misconduct applicable under other law for conduct
25which is inconsistent with the provisions of this chapter.
265. The penalties specified in this chapter shall not
27preclude application of criminal penalties applicable under
28other law for conduct which is inconsistent with this chapter.
29 Sec. 20. NEW SECTION. 142E.20 Claims by governmental entity
30for costs incurred.
31A governmental entity that incurs costs resulting from a
32qualified patient self-administering medication prescribed
33pursuant to this chapter in a public place shall have a claim
34against the estate of the qualified patient to recover such
35costs and reasonable attorney fees related to enforcing the
-19-1claim.
2EXPLANATION
3The inclusion of this explanation does not constitute agreement with
4the explanation’s substance by the members of the general assembly.
5This bill creates the Iowa our care, our options Act.
6The bill includes findings relating to end-of-life care and
7treatment options and provides definitions of terms used in the
8bill.
9The bill provides a process for an adult patient who is
10mentally capable, is a resident of the state, and has been
11determined by the patient’s attending provider and consulting
12provider to be terminally ill, to request medication that the
13patient may self-administer to end the patient’s life. Such
14patient must make two oral requests to the patient’s attending
15provider, followed by one written request to the patient’s
16attending provider to request the medication.
17The bill provides the form in which the written request
18must be substantially made, and requires that oral and written
19requests must be made by the terminally ill patient. Under
20the bill, a patient shall not qualify to make a request solely
21based on age or disability. The bill also provides that
22notwithstanding other provisions of the bill, if a terminally
23ill patient’s attending provider attests that the terminally
24ill patient will, within a reasonable degree of medical
25certainty, die within 15 days after making the initial oral
26request, the terminally ill patient may reiterate the oral
27request to the attending provider at any time after making the
28initial oral request and the 15-day waiting period shall be
29waived.
30The bill specifies the duties of the attending provider and
31the consulting provider, and provides for the referral of a
32terminally ill patient by either an attending provider or a
33consulting provider to a licensed mental health provider to
34confirm that the terminally ill patient requesting medication
35for medical aid in dying is mentally capable.
-20- 1The bill requires the department of health and human
2services (HHS) to create and make available to all attending
3providers a prescribing provider checklist form and prescribing
4provider follow-up form for the purposes of reporting the
5information specified under the bill to HHS. The department
6of health and human services is required to annually review
7a sample of records to ensure compliance and shall generate
8and make available to the public a statistical report of
9nonidentifying information collected.
10The bill provides for the safe disposal of unused
11medications and the use of interpreters by patients.
12The bill provides for the effect of a request for medication
13to end a patient’s life on the construction of wills,
14contracts, and statutes, as well as on insurance and annuity
15policies.
16The bill provides that unless otherwise prohibited by
17law, the attending provider or the hospice medical director
18shall sign the death certificate of a qualified patient who
19obtained and self-administered a prescription for medication;
20and provides specific requirements relative to a qualified
21patient’s death certificate and the role of medical examiner
22investigations and actions.
23The bill specifies how the bill is to be interpreted
24relative to applicable standards of care and informed consent
25requirements; and provides that the bill is not to be construed
26to authorize a health care provider or any other person to
27end an individual’s life by infusion, intravenous injection,
28mercy killing, or euthanasia, and that actions taken in
29accordance and compliance with the bill shall not, for any
30purposes, constitute suicide, assisted suicide, euthanasia,
31mercy killing, homicide, or elder abuse under the law. The
32bill provides that a request by a patient for and the provision
33of medication pursuant to the bill does not solely constitute
34neglect or elder abuse for any purpose of law, or provide the
35sole basis for the appointment of a guardian or conservator.
-21- 1The bill provides that a health care provider shall provide
2sufficient information to a terminally ill patient regarding
3available options, the alternatives, and the foreseeable
4risks and benefits of each option or alternative, so that
5the terminally ill patient is able to make a fully informed,
6voluntary, affirmative decision regarding the patient’s
7end-of-life care and treatment; provides that a health care
8provider may choose whether or not to practice medical aid in
9dying and shall not be under any duty, whether by contract,
10statute, or any other legal requirement, to participate in the
11practice of medical aid in dying or to provide a qualified
12patient with medication pursuant to the bill. The bill
13requires an attending provider who is unable or unwilling to
14determine a terminally ill patient’s qualification for medical
15aid in dying to evaluate a terminally ill patient’s request
16for medication, or to prescribe or dispense medication to a
17qualified patient under the bill to otherwise accommodate the
18terminally ill or qualified patient.
19Failure to inform a terminally ill patient who requests
20information about available end-of-life treatments including
21medical aid in dying, or failure to refer a terminally ill
22patient to another attending provider who can provide the
23information, is considered a failure to obtain informed consent
24for subsequent medical treatments. The bill prohibits an
25attending provider from engaging in false, misleading, or
26deceptive practices relating to the health care provider’s
27willingness to determine the qualification of a terminally ill
28patient for medical aid in dying, to evaluate a terminally ill
29patient’s request for medication, or to provide a prescription
30for or dispense medication to a qualified patient under the
31bill.
32The bill specifies permissible prohibitions and duties of
33a health care facility that has adopted a policy prohibiting
34health care providers from determining the qualification of a
35patient for medical aid in dying, evaluating a terminally ill
-22-1patient’s request for medication, or prescribing or dispensing
2prescribed medication pursuant to the bill in the course of
3the health care provider performing duties for the health care
4facility.
5The bill provides immunities for actions taken in good
6faith by a health care provider or health care facility;
7prohibits a health care provider, health care facility, or
8professional organization or association from subjecting a
9health care provider or health care facility to censure,
10discipline, denial, suspension or revocation of licensure, loss
11of privileges, loss of membership, or any other penalty for
12providing medical aid in dying in accordance with the standard
13of care and in good faith compliance with the bill, or for
14providing scientific and accurate information about medical
15aid in dying to a terminally ill patient when discussing
16end-of-life care and treatment options; and prohibits a
17health care provider from being subject to civil or criminal
18liability or professional discipline if, with the consent of
19the qualified patient or the qualified patient’s agent, the
20health care provider is present outside the scope of their
21professional duties when the qualified patient self-administers
22medication prescribed pursuant to the bill or at the time of
23the qualified patient’s death. Civil and criminal liability
24is not limited for a health care provider who intentionally or
25knowingly fails or refuses to timely submit records required to
26be submitted to HHS or for intentional violations of the bill.
27The bill provides for liability and criminal penalties
28imposed on persons who violate the bill. A person who without
29authorization of a patient intentionally or knowingly alters
30or forges a request for medication with the intent or effect
31of causing the patient’s death, or conceals or destroys a
32patient’s rescission of a request for medication is guilty
33of a class “A” felony. A person who coerces or exerts undue
34influence over a patient to request or utilize medication under
35the bill, with the intent or effect of causing the patient’s
-23-1death, is guilty of a class “A” felony. A class “A” felony
2is punishable by confinement for life without possibility of
3parole.
4A person who intentionally or knowingly coerces or exerts
5undue influence over a terminally ill patient to forgo a
6request for or to obtain medication pursuant to the bill, or
7intentionally or knowingly denies a qualified patient access
8to medication under the bill as an end-of-life care option,
9is guilty of a serious misdemeanor. A serious misdemeanor is
10punishable by confinement for no more than one year and a fine
11of at least $430 but not more than $2,560.
12The liability and penalty provisions under the bill are
13not to be interpreted to limit liability for civil damages
14resulting from negligent conduct or intentional misconduct
15applicable under other law for conduct which is inconsistent
16with the provisions of this chapter, and penalties specified in
17the bill shall not preclude application of criminal penalties
18applicable under other law for conduct which is inconsistent
19with the bill.
20The bill also provides that a governmental entity
21that incurs costs resulting from a qualified patient
22self-administering medication prescribed under the bill in
23a public place shall have a claim against the estate of the
24patient to recover such costs and reasonable attorney fees
25related to the enforcement of the claim.
-24-pf/ko