Bill Text: IA HF2288 | 2023-2024 | 90th General Assembly | Introduced

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Bill Title: A bill for an act creating the Iowa our care, our options Act, and providing penalties.

Spectrum: Partisan Bill (Democrat 4-0)

Status: (Introduced - Dead) 2024-02-05 - Introduced, referred to Health and Human Services. H.J. 189. [HF2288 Detail]

Download: Iowa-2023-HF2288-Introduced.html

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House File 2288 - Introduced
HOUSE FILE 2288
BY CROKEN , ABDUL-SAMAD ,
STECKMAN , and OLSON
A BILL FOR
An Act creating the Iowa our care, our options Act, and
providing penalties.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
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Section 1. NEW SECTION . 142E.1 Findings.
1. The state of Iowa has long recognized that mentally
capable adults have a fundamental right to determine their own
medical treatment options in accordance with their own values,
beliefs, and personal preferences.
2. The state of Iowa wants to uphold both the highest
standard of medical care and the full range of options for each
individual, particularly at the end of life.
3. Terminally ill individuals may undergo unremitting
pain, agonizing discomfort, and a sudden, continuing, and
irreversible reduction in their quality of life at the end of
life.
4. The availability of medical aid in dying provides
an additional palliative care option for terminally ill
individuals who seek to retain their autonomy and some level of
control over the progression of the illness as they near the
end of life or to ease unnecessary pain and suffering.
5. Integration of medical aid in dying into standard
end-of-life care has demonstrably improved the quality of
services delivered to terminally ill individuals by enhancing
palliative care training of providers, prompting development
and enhancement of palliative care service delivery systems,
and promoting more in-depth conversations between providers
and terminally ill individuals about the full range of care
options leading to more appropriate end-of-life care planning,
including increased hospice use.
6. The state of Iowa affirms that an attending provider
who respects and honors a terminally ill patient’s values
and priorities for that terminally ill patient’s last days
of life and prescribes or dispenses medication for any such
qualified patient pursuant to this chapter is practicing lawful
patient-directed care.
Sec. 2. NEW SECTION . 142E.2 Short title.
This chapter shall be known and may be cited as the “Iowa Our
Care, Our Options Act” .
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Sec. 3. NEW SECTION . 142E.3 Definitions.
As used in this chapter, unless the context otherwise
requires:
1. “Adult” means an individual eighteen years of age or
older.
2. “Attending provider” means a health care provider
who a patient determines has primary responsibility for the
patient’s health care and treatment of the patient’s terminal
illness, and who provides medical care to a patient with a
terminal illness in the normal course of the provider’s medical
practice.
3. “Coercion or undue influence” means the willful attempt,
whether by deception, intimidation, or any other means, to
cause a terminally ill patient to request, or a qualified
patient to obtain or self-administer, medication pursuant
to this chapter with the intent to cause the death of the
terminally ill patient or qualified patient, or to prevent a
terminally ill patient from requesting, or a qualified patient
from obtaining or self-administering, medication pursuant to
this chapter against the wishes of the terminally ill patient
or qualified patient.
4. “Consulting provider” means a health care provider who
is qualified by specialty or experience to make a professional
diagnosis and prognosis regarding a patient’s terminal illness.
5. “Department” means the department of health and human
services.
6. “Health care facility” means a hospital licensed pursuant
to chapter 135B, a nursing facility licensed pursuant to
chapter 135C, an inpatient hospice program as defined in
section 135J.1, an elder group home as defined in section
231B.1, or an assisted living program as defined in section
231C.2. “Health care facility” does not include the location of
an individual health care provider.
7. “Health care provider” means a person who is licensed,
certified, or otherwise authorized or permitted by the laws
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of this state to administer health care, diagnose and treat
medical conditions, and prescribe and dispense medications,
including controlled substances. “Health care provider” does
not include a health care facility.
8. “Informed decision” means a voluntary, affirmative
decision by a terminally ill patient to request and obtain a
prescription for medication pursuant to this chapter that the
terminally ill patient may self-administer to bring about a
peaceful death, after being fully informed by the attending
provider of all of the following:
a. The patient’s medical diagnosis.
b. The patient’s prognosis.
c. The feasible end-of-life care and treatment options for
the patient’s terminal illness, including but not limited to
comfort care, palliative care, hospice care, and pain control,
and the risks and benefits of each option.
d. The patient’s right to withdraw consent at any time,
and that the patient is not under any obligation to continue a
previously chosen option for end-of-life care or treatment.
9. “Licensed mental health provider” means a psychiatrist
licensed pursuant to chapter 148, a psychologist licensed
pursuant to chapter 154B, or an independent social worker
licensed pursuant to chapter 154C.
10. “Medical aid in dying” means the medical practice
authorized under this chapter and established standards
of medical care to determine a terminally ill patient’s
qualifications, evaluate a terminally ill patient’s request
for medication, and provide a terminally ill patient with
a prescription for medication or dispense the prescribed
medication to bring about the terminally ill patient’s peaceful
death.
11. “Medical confirmation” means the medical opinion of the
attending provider has been confirmed by a consulting provider
who has examined the patient and the patient’s relevant medical
records.
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12. “Mentally capable” means that in the opinion of the
attending provider, a consulting provider, and a licensed
mental health care provider, as applicable, the patient
requesting medical aid in dying has the ability to make and
communicate an informed decision.
13. “Patient” means an adult who is under the care of a
health care provider.
14. “Patient-directed care” means patient-centered care that
is not only respectful of and responsive to individual patient
preferences, needs, and values, but also ensures that patient
values guide all clinical decisions and that patients are fully
informed of and able to access all legal end-of-life care and
treatment options.
15. “Prognosis of six months or less” with reference to
a terminal illness means the terminal illness will, within
reasonable medical judgment, result in a patient’s death within
six months.
16. “Qualified patient” means a mentally capable, terminally
ill patient, who is a resident of Iowa and has satisfied
the requirements of this chapter in order to obtain and
self-administer a prescription for medication to bring about
the terminally ill patient’s peaceful death.
17. “Self-administer” or “self-administration” means a
qualified patient’s affirmative, conscious, voluntary act to
ingest medication prescribed pursuant to this chapter to bring
about the patient’s own peaceful death. “Self-administer”
or “self-administration” does not include administration of
medication via injection or intravenous infusion.
18. “Terminal illness” or “terminally ill” means an
incurable illness with a prognosis of six months or less.
19. “Terminally ill patient” means a patient who has been
certified by a health care provider to be terminally ill.
Sec. 4. NEW SECTION . 142E.4 Process for requesting
medication for medical aid in dying.
1. A patient who is mentally capable, is a resident of this
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state, and has been certified by a health care provider to be
terminally ill, may request medication that the patient may
self-administer to end the patient’s life as follows:
a. By making two oral requests to the terminally
ill patient’s attending provider separated by a
fifteen-calendar-day waiting period, beginning from the
day the first request is made.
b. By providing one written request to the terminally ill
patient’s attending provider.
2. A written request made under this section shall be in
substantially the form described in section 142E.5, shall be
signed and dated, or attested to, by the terminally ill patient
requesting medical aid in dying, and shall be signed and dated,
or attested to, by one witness.
3. Oral and written requests made under this section must be
made by the terminally ill patient and shall not be made by any
other individual including the terminally ill patient’s agent
under a power of attorney executed pursuant to chapter 633B, an
attorney in fact under a durable power of attorney for health
care pursuant to chapter 144B, or via a declaration relating to
use of life-sustaining procedures pursuant to chapter 144A.
4. A patient shall not qualify to make a request under this
section solely based on age or disability.
5. Notwithstanding subsection 1, if a terminally ill
patient’s attending provider attests that the terminally ill
patient will, within reasonable medical judgment, die within
fifteen days after the terminally ill patient’s initial oral
request is made under this section, the terminally ill patient
may reiterate the oral request to the attending provider at any
time after making the initial oral request and the fifteen-day
waiting period shall be waived.
Sec. 5. NEW SECTION . 142E.5 Form of written request ——
requirements.
1. A written request for medication that a terminally ill
patient may self-administer to end the terminally ill patient’s
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life as authorized by this chapter shall be in substantially
the following form:
Request for Medication
to End My Life in
a Peaceful Manner
I, ___________________________________ am an adult of sound
mind. I have been diagnosed with
_______________________________________________, and given a
prognosis of six months or less to live.
I have been fully informed of the feasible alternatives,
and the concurrent or additional care and treatment options
for my terminal illness, including but not limited to comfort
care, palliative care, hospice care, and pain control, and the
potential risks and benefits of each. I have been offered or
received resources or referrals to pursue these alternative
and concurrent or additional care and treatment options for my
terminal illness.
I have been fully informed of the nature of the medication to
be prescribed, the risks and benefits, and the probable result
of self-administering the medication, should I decide to do
so. I understand that I can rescind this request at any time,
and that I am under no obligation to fill the prescription once
provided nor to self-administer the medication if I obtain the
medication.
I request that my attending provider furnish a prescription
for medication that will end my life in a peaceful manner if
I choose to self-administer it, and I authorize my attending
provider to contact a pharmacist to dispense the prescription
at a time of my choosing.
I make this request voluntarily, free from coercion and
undue influence, and I accept full responsibility for my
actions.
________________________________________ _____________
Requestor Signature Date
________________________________________ _____________
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Witness Signature Date
2. A witness shall not be any of the following:
a. A relative of the terminally ill patient by blood,
marriage, or adoption.
b. A person who at the time the request is signed would
be entitled to any portion of the estate of the terminally
ill patient upon death under any will, trust, or other legal
instrument, or by operation of law.
Sec. 6. NEW SECTION . 142E.6 Attending provider duties.
An attending provider shall do all of the following:
1. Provide care that conforms to accepted medical
standards.
2. After confirming that a patient is terminally ill,
determine whether the patient requesting medical aid in dying
meets all of the following criteria:
a. Is mentally capable.
b. Has made the request for medication voluntarily and free
from coercion or undue influence.
c. Is a resident of the state.
3. In confirming that the terminally ill patient’s request
does not arise from coercion or undue influence by another
person, discuss with the terminally ill patient, outside the
presence of other persons with the exception of an interpreter
if necessary, whether the terminally ill patient feels coerced
or unduly influenced by another person.
4. Thoroughly educate the terminally ill patient about all
of the following:
a. The feasible alternatives and concurrent or additional
care and treatment options for the patient’s terminal illness,
including but not limited to comfort care, palliative care,
hospice care, or pain control, and the potential risks and
benefits of each.
b. The potential risks, benefits, and probable result of
self-administering the medication to be prescribed to bring
about a peaceful death.
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c. The choices available to the terminally ill patient
that reflect the terminally ill patient’s self-determination,
including that the terminally ill patient is under no
obligation to fill the prescription once provided nor to
self-administer the medication if the medication is obtained.
d. The terminally ill patient’s right to rescind the request
for medication pursuant to this chapter at any time and in any
manner.
e. The benefits of notifying family of the terminally ill
patient’s decision to request medication pursuant to this
chapter as an end-of-life care option.
f. With regard to a terminally ill patient’s
self-administration of the medication:
(1) The recommended methods for self-administering the
medication to be prescribed.
(2) The safekeeping and proper disposal of any unused
medication in accordance with federal and state law.
(3) The importance of having another individual present
when the terminally ill patient self-administers the medication
to be prescribed.
(4) The importance of not taking the medication in a public
place.
5. Provide the terminally ill patient with a referral for
comfort care, palliative care, hospice care, pain control, or
other end-of-life care and treatment options as requested or
as clinically indicated.
6. a. Refer the terminally ill patient to a consulting
provider for medical confirmation that the patient requesting
medication pursuant to this chapter is eligible.
b. The attending provider shall add the medical confirmation
provided under paragraph “a” to the terminally ill patient’s
medical record.
7. Refer the terminally ill patient to a licensed mental
health provider for evaluation in accordance with section
142E.8 if the attending provider observes signs that the
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terminally ill patient may not be mentally capable of making
an informed decision, and add the licensed mental health
provider’s written determination to the terminally ill
patient’s medical record.
8. Ensure that all appropriate steps are carried out in
accordance with this chapter before providing a prescription
for medication pursuant to this chapter to a terminally ill
patient.
9. Once the terminally ill patient is determined to be a
qualified patient, do either of the following:
a. Deliver the prescription for the requested medication
personally, by mail, or through an authorized electronic
transmission to a licensed pharmacist who will dispense
the medication, including ancillary medications intended
to minimize the qualified patient’s discomfort, to the
attending provider, to the qualified patient, or to a person
expressly designated by the qualified patient, in person or
with a signature required on delivery, by mail service, or by
messenger service.
b. Dispense the prescribed requested medication, including
ancillary medications intended to minimize the qualified
patient’s discomfort, to the qualified patient or to a person
expressly designated by the qualified patient in person,
if the attending provider has a current drug enforcement
administration number if required under chapter 124.
10. Document in the qualified patient’s medical record the
qualified patient’s diagnosis and prognosis, determination of
mental capability, the dates of the qualified patient’s oral
requests, a copy of the written request, and a notation that
all the requirements under this chapter have been completed
including a description of the medication and ancillary
medications prescribed to the qualified patient pursuant to
this chapter.
Sec. 7. NEW SECTION . 142E.7 Consulting provider duties.
1. A terminally ill patient requesting medical aid in dying
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under this chapter shall receive medical confirmation from a
consulting provider prior to being deemed a qualified patient.
2. A consulting provider shall do all of the following:
a. Evaluate the terminally ill patient and the terminally
ill patient’s relevant medical records.
b. Confirm, in writing, all of the following to the
attending provider:
(1) That the patient has a terminal illness.
(2) That the terminally ill patient has made the request
for medical aid in dying voluntarily and free from coercion or
undue influence.
(3) That the terminally ill patient is mentally capable, or
provide documentation that the consulting provider has referred
the terminally ill patient to a licensed mental health provider
for further evaluation in accordance with section 142E.8.
Sec. 8. NEW SECTION . 142E.8 Confirmation —— determination
of mental capability —— referral to licensed mental health
provider.
1. If either the attending provider or the consulting
provider is unable to confirm that the terminally ill patient
requesting medication for medical aid in dying under this
chapter is mentally capable, the attending provider or
consulting provider shall refer the terminally ill patient to a
licensed mental health provider for a determination of mental
capability.
2. A licensed mental health provider who evaluates a
terminally ill patient under this section shall communicate in
writing to the attending provider or consulting provider who
requested the evaluation the licensed mental health provider’s
conclusions about whether the terminally ill patient is
mentally capable.
3. If the licensed mental health provider determines
that the terminally ill patient is not currently mentally
capable, the licensed mental health provider shall not deem the
terminally ill patient to be mentally capable and the attending
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provider shall not determine the terminally ill patient to be a
qualified patient and prescribe medication to the terminally
ill patient under this chapter.
Sec. 9. NEW SECTION . 142E.9 Reporting requirements.
1. The department shall create and make available to all
attending providers a prescribing provider checklist form
and prescribing provider follow-up form for the purposes of
reporting the information as specified under this section to
the department.
2. Within thirty calendar days of providing a prescription
to a qualified patient for medication pursuant to this chapter,
the attending provider shall submit to the department a
completed prescribing provider checklist form with all of the
following information regarding a qualified patient:
a. The qualified patient’s name and date of birth.
b. The qualified patient’s terminal diagnosis and prognosis.
c. A notation that all the requirements under this chapter
have been completed.
d. A notation that medication has been prescribed pursuant
to this chapter.
3. Within sixty calendar days of notification of a qualified
patient’s death from self-administration of medication
prescribed pursuant to this chapter, the attending provider
shall submit to the department a completed prescribing provider
follow-up form with all of the following information:
a. The qualified patient’s name, date of birth, age at
death, education level, race, sex, type of insurance, if any,
and underlying illness.
b. The date of the qualified patient’s death.
c. A notation of whether or not the qualified patient was
enrolled in and receiving hospice services at the time of the
qualified patient’s death.
4. The department shall annually review a sample of records
maintained pursuant to this section to ensure compliance
and shall generate and make available to the public a
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statistical report of nonidentifying information collected.
The statistical report shall be limited to the following
information:
a. The number of prescriptions for medication written
pursuant to this chapter.
b. The number of attending providers who wrote prescriptions
for medication pursuant to this chapter.
c. The number of qualified patients who died following
self-administration of medication prescribed and dispensed
pursuant to this chapter.
5. Except as otherwise required by law, the information
collected by the department shall not be a public record and
shall not be made available for public inspection.
Sec. 10. NEW SECTION . 142E.10 Safe disposal of unused
medications.
A person who has custody or control of medication prescribed
and dispensed pursuant to this chapter that remains unused
after a qualified patient’s death shall dispose of the
medication by lawful means in accordance with state and federal
guidelines.
Sec. 11. NEW SECTION . 142E.11 Use of interpreters.
1. An interpreter whose services are provided to a patient
requesting information or services under this chapter shall
meet the standards promulgated by the Iowa interpreters and
translators association or the national board of certification
for medical interpreters, or other standard deemed acceptable
by the department.
2. An interpreter providing services pursuant to this
chapter shall not be related to a qualified patient by blood,
marriage, or adoption, or be entitled to a portion of the
qualified patient’s estate by will, trust, or other legal
instrument, or by operation of law upon the qualified patient’s
death.
Sec. 12. NEW SECTION . 142E.12 Effect on construction of
wills, contracts, and statutes.
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1. A provision in a contract, will, or other agreement,
whether written or oral, to the extent the provision would
affect whether a patient may make or rescind a request for
medication pursuant to this chapter, shall not be valid.
2. An obligation owing under any currently existing
contract shall not be conditioned or affected by the making or
rescinding of a request by a patient for medication pursuant to
this chapter.
Sec. 13. NEW SECTION . 142E.13 Insurance or annuity
policies.
1. The sale, procurement, or issuance of a life, health,
or accident insurance or annuity policy, or the rate charged
for any such policy shall not be conditioned upon or affected
by the making or rescinding of a request by a patient for
medication pursuant to this chapter.
2. A qualified patient’s act of self-administering
medication pursuant to this chapter shall not have an effect on
or invalidate any part of a life, health, or accident insurance
or annuity policy.
3. A terminally ill patient who is a covered beneficiary
of a health insurance policy shall not be subject to denial
or alteration of such benefits based on the availability of
medical aid in dying or the patient’s request or absence of a
request for medication pursuant to this chapter.
4. A terminally ill patient who is a recipient of Medicaid
coverage shall not be subject to denial or alteration of such
benefits based on the availability of medical aid in dying or
the patient’s request or absence of request for medication
pursuant to this chapter.
Sec. 14. NEW SECTION . 142E.14 Death certificate.
1. Unless otherwise prohibited by law, the attending
provider or the hospice medical director shall sign the
death certificate of a qualified patient who obtained and
self-administered a prescription for medication pursuant to
this chapter.
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2. When a death has occurred in accordance with this
chapter:
a. The manner of death of the qualified patient on a death
certificate shall not be listed as suicide or homicide.
b. The cause of death of a qualified patient on a death
certificate shall be listed as the qualified patient’s
underlying terminal illness.
c. The qualified patient’s act of self-administering
medication prescribed pursuant to this chapter shall not be
indicated on the death certificate.
3. A death that occurs in accordance with this chapter does
not alone constitute a person’s death that affects the public
interest as described pursuant to section 331.802.
a. If a death that occurs in accordance with this chapter
is referred to the state medical examiner or a county medical
examiner, a preliminary investigation may be conducted to
determine whether the person received a prescription for
medication under this chapter.
b. Any inquiry or investigation conducted by the state
medical examiner or a county medical examiner relating to
deaths that occur pursuant to this chapter shall not require
the state medical examiner or a county medical examiner to
sign the death certificate if the state medical examiner or a
county medical examiner identifies the attending provider that
prescribed the qualified patient medication pursuant to this
chapter.
Sec. 15. NEW SECTION . 142E.15 Construction of chapter.
1. Nothing in this chapter shall be interpreted to lessen
the applicable standard of care, including the standard of care
for the treatment of terminally ill patients and medical aid in
dying, for an attending provider, consulting provider, licensed
mental health provider, or any other health care provider
acting under this chapter.
2. Nothing in this chapter shall be construed to limit the
information or counseling a health care provider must provide
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to a patient in order to comply with informed consent laws and
requirements to meet a medical standard of care.
3. Nothing in this chapter shall be construed to authorize a
health care provider or any other person to end an individual’s
life by infusion, intravenous injection, mercy killing, or
euthanasia. Actions taken in accordance and compliance with
this chapter shall not, for any purposes, constitute suicide,
assisted suicide, euthanasia, mercy killing, homicide, or elder
abuse under the law.
4. A request by a patient for and the provision of
medication pursuant to this chapter do not solely constitute
neglect or elder abuse for any purpose of law, or provide the
sole basis for the appointment of a guardian or conservator.
Sec. 16. NEW SECTION . 142E.16 No duty to provide medical
aid in dying.
1. A health care provider shall provide sufficient
information to a terminally ill patient regarding available
options, alternatives, and the foreseeable risks and benefits
of each option or alternative, so that the patient is able
to make a fully informed, voluntary, affirmative decision
regarding the patient’s end-of-life care and treatment.
2. A health care provider may choose whether or not to
practice medical aid in dying pursuant to this chapter and
shall not be under any duty, whether by contract, statute, or
any other legal requirement, to participate in the practice of
medical aid in dying or to provide a qualified patient with
medication pursuant to this chapter.
3. If an attending provider is unable or unwilling to
determine a terminally ill patient’s qualification for medical
aid in dying, evaluate a terminally ill patient’s request for
medication, or provide a qualified patient with a prescription
for medication or dispense prescribed medication to a qualified
patient pursuant to this chapter, the attending provider shall
do all of the following:
a. Accurately document the terminally ill patient’s request
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in the terminally ill patient’s medical record.
b. Make reasonable efforts to accommodate the terminally
ill patient’s request including by transferring the care and
medical records of the terminally ill patient to another
attending provider upon the terminally ill patient’s request
so that the terminally ill patient is able to make a voluntary
affirmative decision regarding the terminally ill patient’s
end-of-life care and treatment.
4. Failure to inform a terminally ill patient who requests
information about available end-of-life options including
medical aid in dying, or failure to refer the terminally ill
patient to another attending provider who can provide the
information, is considered a failure to obtain informed consent
for subsequent medical treatments.
5. An attending provider shall not engage in false,
misleading, or deceptive practices relating to the attending
provider’s willingness to determine the qualification of a
terminally ill patient for medical aid in dying, to evaluate
a terminally ill patient’s request for medication, or to
provide a prescription for medication to a qualified patient
or dispense a prescribed medication to a qualified patient
pursuant to this chapter.
Sec. 17. NEW SECTION . 142E.17 Health care facility ——
permissible prohibitions and duties.
1. A health care facility that has adopted a policy
prohibiting health care providers in the course of performing
duties for the health care facility from determining the
qualification of a terminally ill patient for medical aid
in dying, evaluating a terminally ill patient’s request
for medication, or providing a qualified patient with a
prescription for medication or dispensing prescribed medication
to a qualified patient, shall provide advance notice in
writing to the health care facility’s patients and health care
providers that the health care facility is a nonparticipating
health care facility under this chapter.
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2. A nonparticipating health care facility that fails to
provide explicit, advance notice in writing to the health care
facility’s patients and health care providers shall not enforce
such a policy.
3. If a terminally ill patient wishes to transfer the
patient’s care from a nonparticipating health care facility to
another health care facility, the nonparticipating health care
facility shall coordinate a timely transfer, including transfer
of the terminally ill patient’s medical records that include
notation of the date the terminally ill patient first requested
medical aid in dying.
4. A nonparticipating health care facility shall not
prohibit a health care provider from providing services
consistent with the applicable standard of medical care
including all of the following:
a. Providing information to a patient about the availability
of medical aid in dying pursuant to this chapter.
b. Prescribing medication pursuant to this chapter for
a qualified patient outside the scope of the health care
provider’s employment or contract with the nonparticipating
health care facility and off the premises of the
nonparticipating health care facility.
c. Being present at the time a qualified patient
self-administers medication prescribed pursuant to this chapter
or at the time of the patient’s death, if requested by the
qualified patient or the qualified patient’s representative
outside the scope of the health care provider’s employment or
contractual duties.
5. A health care facility shall not engage in false,
misleading, or deceptive practices relating to the health care
facility’s policy regarding end-of-life care and treatment
services, including whether the health care facility has a
policy which prohibits affiliated health care providers from
determining a terminally ill patient’s qualification for
medical aid in dying, evaluating a terminally ill patient’s
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request for medication, or providing a prescription for or
dispensing medication to a qualified patient pursuant to this
chapter; or intentionally denying a terminally ill patient
access to medication pursuant to this chapter by failing to
transfer a terminally ill patient and the terminally ill
patient’s medical records to another health care facility in a
timely manner.
Sec. 18. NEW SECTION . 142E.18 Immunities for actions in
good faith —— prohibition against reprisals.
1. A health care provider or health care facility shall
not be subject to civil or criminal liability, professional
disciplinary action, or any other penalty for engaging in
the practice of medical aid in dying in accordance with
the standard of care and in good faith compliance with this
chapter.
2. A health care provider, health care facility, or
professional organization or association shall not subject
a health care provider or health care facility to censure,
discipline, the denial, suspension, or revocation of licensure,
loss of privileges, loss of membership, or any other penalty
for providing medical aid in dying in accordance with the
standard of care and in good faith compliance with this
chapter or for providing scientific and accurate information
about medical aid in dying to a terminally ill patient when
discussing end-of-life care and treatment options.
3. A health care provider shall not be subject to civil
or criminal liability or professional discipline if, with the
consent of the qualified patient or the qualified patient’s
representative, the health care provider is present outside the
scope of the health care provider’s professional duties when
the qualified patient self-administers medication prescribed
pursuant to this chapter or at the time of the qualified
patient’s death.
4. This section shall not be interpreted to limit civil or
criminal liability of a health care provider who intentionally
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or knowingly fails or refuses to timely submit records required
pursuant to section 142E.9.
5. This section shall not be interpreted to limit civil or
criminal liability for intentional violations of this chapter.
Sec. 19. NEW SECTION . 142E.19 Liabilities and penalties.
1. A person who without authorization of a patient
intentionally or knowingly alters or forges a request for
medication pursuant to this chapter with the intent or effect
of causing the patient’s death, or conceals or destroys a
patient’s rescission of a request for medication pursuant to
this chapter, is guilty of a class “A” felony.
2. A person who coerces or exerts undue influence over
a patient to request or utilize medication pursuant to this
chapter, with the intent or effect of causing the patient’s
death, is guilty of a class “A” felony.
3. A person who intentionally or knowingly coerces or
exerts undue influence over a terminally ill patient to forgo a
request for or to obtain medication pursuant to this chapter,
or who intentionally or knowingly denies a qualified patient
access to medication under this chapter as an end-of-life care
and treatment option is guilty of a serious misdemeanor.
4. Nothing in this section shall be interpreted to limit
liability for civil damages resulting from negligent conduct or
intentional misconduct applicable under other law for conduct
which is inconsistent with the provisions of this chapter.
5. The penalties specified in this chapter shall not
preclude application of criminal penalties applicable under
other law for conduct which is inconsistent with this chapter.
Sec. 20. NEW SECTION . 142E.20 Claims by governmental entity
for costs incurred.
A governmental entity that incurs costs resulting from a
qualified patient self-administering medication prescribed
pursuant to this chapter in a public place shall have a claim
against the estate of the qualified patient to recover such
costs and reasonable attorney fees related to enforcing the
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claim.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
This bill creates the Iowa our care, our options Act.
The bill includes findings relating to end-of-life care and
treatment options and provides definitions of terms used in the
bill.
The bill provides a process for an adult patient who is
mentally capable, is a resident of the state, and has been
determined by the patient’s attending provider and consulting
provider to be terminally ill, to request medication that the
patient may self-administer to end the patient’s life. Such
patient must make two oral requests to the patient’s attending
provider, followed by one written request to the patient’s
attending provider to request the medication.
The bill provides the form in which the written request
must be substantially made, and requires that oral and written
requests must be made by the terminally ill patient. Under
the bill, a patient shall not qualify to make a request solely
based on age or disability. The bill also provides that
notwithstanding other provisions of the bill, if a terminally
ill patient’s attending provider attests that the terminally
ill patient will, within reasonable medical judgment, die
within 15 days after making the initial oral request, the
terminally ill patient may reiterate the oral request to the
attending provider at any time after making the initial oral
request and the 15-day waiting period shall be waived.
The bill specifies the duties of the attending provider and
the consulting provider, and provides for the referral of a
terminally ill patient by either an attending provider or a
consulting provider to a licensed mental health provider to
confirm that the terminally ill patient requesting medication
for medical aid in dying is mentally capable.
The bill requires the department of health and human
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services (HHS) to create and make available to all attending
providers a prescribing provider checklist form and prescribing
provider follow-up form for the purposes of reporting the
information specified under the bill to HHS. The department
of health and human services is required to annually review
a sample of records to ensure compliance and shall generate
and make available to the public a statistical report of
nonidentifying information collected.
The bill provides for the safe disposal of unused
medications and the use of interpreters by patients.
The bill provides for the effect of a request for medication
to end a patient’s life on the construction of wills,
contracts, and statutes, as well as on insurance and annuity
policies.
The bill provides that unless otherwise prohibited by
law, the attending provider or the hospice medical director
shall sign the death certificate of a qualified patient who
obtained and self-administered a prescription for medication;
and provides specific requirements relative to a qualified
patient’s death certificate and the role of medical examiner
investigations and actions.
The bill specifies how the bill is to be interpreted
relative to applicable standards of care and informed consent
requirements; and provides that the bill is not to be construed
to authorize a health care provider or any other person to
end an individual’s life by infusion, intravenous injection,
mercy killing, or euthanasia, and that actions taken in
accordance and compliance with the bill shall not, for any
purposes, constitute suicide, assisted suicide, euthanasia,
mercy killing, homicide, or elder abuse under the law. The
bill provides that a request by a patient for and the provision
of medication pursuant to the bill does not solely constitute
neglect or elder abuse for any purpose of law, or provide the
sole basis for the appointment of a guardian or conservator.
The bill provides that a health care provider shall provide
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sufficient information to a terminally ill patient regarding
available options, the alternatives, and the foreseeable
risks and benefits of each option or alternative, so that
the terminally ill patient is able to make a fully informed,
voluntary, affirmative decision regarding the patient’s
end-of-life care and treatment; provides that a health care
provider may choose whether or not to practice medical aid in
dying and shall not be under any duty, whether by contract,
statute, or any other legal requirement, to participate in the
practice of medical aid in dying or to provide a qualified
patient with medication pursuant to the bill. The bill
requires an attending provider who is unable or unwilling to
determine a terminally ill patient’s qualification for medical
aid in dying to evaluate a terminally ill patient’s request
for medication, or to prescribe or dispense medication to a
qualified patient under the bill to otherwise accommodate the
terminally ill or qualified patient.
Failure to inform a terminally ill patient who requests
information about available end-of-life treatments including
medical aid in dying, or failure to refer a terminally ill
patient to another attending provider who can provide the
information, is considered a failure to obtain informed consent
for subsequent medical treatments. The bill prohibits an
attending provider from engaging in false, misleading, or
deceptive practices relating to the health care provider’s
willingness to determine the qualification of a terminally ill
patient for medical aid in dying, to evaluate a terminally ill
patient’s request for medication, or to provide a prescription
for or dispense medication to a qualified patient under the
bill.
The bill specifies permissible prohibitions and duties of
a health care facility that has adopted a policy prohibiting
health care providers from determining the qualification of a
patient for medical aid in dying, evaluating a terminally ill
patient’s request for medication, or prescribing or dispensing
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prescribed medication pursuant to the bill in the course of
the health care provider performing duties for the health care
facility.
The bill provides immunities for actions taken in good
faith by a health care provider or health care facility;
prohibits a health care provider, health care facility, or
professional organization or association from subjecting a
health care provider or health care facility to censure,
discipline, denial, suspension or revocation of licensure, loss
of privileges, loss of membership, or any other penalty for
providing medical aid in dying in accordance with the standard
of care and in good faith compliance with the bill, or for
providing scientific and accurate information about medical
aid in dying to a terminally ill patient when discussing
end-of-life care and treatment options; and prohibits a
health care provider from being subject to civil or criminal
liability or professional discipline if, with the consent of
the qualified patient or the qualified patient’s agent, the
health care provider is present outside the scope of their
professional duties when the qualified patient self-administers
medication prescribed pursuant to the bill or at the time of
the qualified patient’s death. Civil and criminal liability
is not limited for a health care provider who intentionally or
knowingly fails or refuses to timely submit records required to
be submitted to HHS or for intentional violations of the bill.
The bill provides for liability and criminal penalties
imposed on persons who violate the bill. A person who without
authorization of a patient intentionally or knowingly alters
or forges a request for medication with the intent or effect
of causing the patient’s death, or conceals or destroys a
patient’s rescission of a request for medication is guilty
of a class “A” felony. A person who coerces or exerts undue
influence over a patient to request or utilize medication under
the bill, with the intent or effect of causing the patient’s
death, is guilty of a class “A” felony. A class “A” felony
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is punishable by confinement for life without possibility of
parole.
A person who intentionally or knowingly coerces or exerts
undue influence over a terminally ill patient to forgo a
request for or to obtain medication pursuant to the bill, or
intentionally or knowingly denies a qualified patient access
to medication under the bill as an end-of-life care option,
is guilty of a serious misdemeanor. A serious misdemeanor is
punishable by confinement for no more than one year and a fine
of at least $430 but not more than $2,560.
The liability and penalty provisions under the bill are
not to be interpreted to limit liability for civil damages
resulting from negligent conduct or intentional misconduct
applicable under other law for conduct which is inconsistent
with the provisions of this chapter, and penalties specified in
the bill shall not preclude application of criminal penalties
applicable under other law for conduct which is inconsistent
with the bill.
The bill also provides that a governmental entity
that incurs costs resulting from a qualified patient
self-administering medication prescribed under the bill in
a public place shall have a claim against the estate of the
patient to recover such costs and reasonable attorney fees
related to the enforcement of the claim.
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