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 1 providing penalties. 2 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 3 TLSB 5681YH (2) 90 pf/ko

H.F. 2288 Section 1. NEW SECTION . 142E.1 Findings. 1 1. The state of Iowa has long recognized that mentally 2 capable adults have a fundamental right to determine their own 3 medical treatment options in accordance with their own values, 4 beliefs, and personal preferences. 5 2. The state of Iowa wants to uphold both the highest 6 standard of medical care and the full range of options for each 7 individual, particularly at the end of life. 8 3. Terminally ill individuals may undergo unremitting 9 pain, agonizing discomfort, and a sudden, continuing, and 10 irreversible reduction in their quality of life at the end of 11 life. 12 4. The availability of medical aid in dying provides 13 an additional palliative care option for terminally ill 14 individuals who seek to retain their autonomy and some level of 15 control over the progression of the illness as they near the 16 end of life or to ease unnecessary pain and suffering. 17 5. Integration of medical aid in dying into standard 18 end-of-life care has demonstrably improved the quality of 19 services delivered to terminally ill individuals by enhancing 20 palliative care training of providers, prompting development 21 and enhancement of palliative care service delivery systems, 22 and promoting more in-depth conversations between providers 23 and terminally ill individuals about the full range of care 24 options leading to more appropriate end-of-life care planning, 25 including increased hospice use. 26 6. The state of Iowa affirms that an attending provider 27 who respects and honors a terminally ill patient’s values 28 and priorities for that terminally ill patient’s last days 29 of life and prescribes or dispenses medication for any such 30 qualified patient pursuant to this chapter is practicing lawful 31 patient-directed care. 32 Sec. 2. NEW SECTION . 142E.2 Short title. 33 This chapter shall be known and may be cited as the “Iowa Our 34 Care, Our Options Act” . 35 -1- LSB 5681YH (2) 90 pf/ko 1/ 24

H.F. 2288 Sec. 3. NEW SECTION . 142E.3 Definitions. 1 As used in this chapter, unless the context otherwise 2 requires: 3 1. “Adult” means an individual eighteen years of age or 4 older. 5 2. “Attending provider” means a health care provider 6 who a patient determines has primary responsibility for the 7 patient’s health care and treatment of the patient’s terminal 8 illness, and who provides medical care to a patient with a 9 terminal illness in the normal course of the provider’s medical 10 practice. 11 3. “Coercion or undue influence” means the willful attempt, 12 whether by deception, intimidation, or any other means, to 13 cause a terminally ill patient to request, or a qualified 14 patient to obtain or self-administer, medication pursuant 15 to this chapter with the intent to cause the death of the 16 terminally ill patient or qualified patient, or to prevent a 17 terminally ill patient from requesting, or a qualified patient 18 from obtaining or self-administering, medication pursuant to 19 this chapter against the wishes of the terminally ill patient 20 or qualified patient. 21 4. “Consulting provider” means a health care provider who 22 is qualified by specialty or experience to make a professional 23 diagnosis and prognosis regarding a patient’s terminal illness. 24 5. “Department” means the department of health and human 25 services. 26 6. “Health care facility” means a hospital licensed pursuant 27 to chapter 135B, a nursing facility licensed pursuant to 28 chapter 135C, an inpatient hospice program as defined in 29 section 135J.1, an elder group home as defined in section 30 231B.1, or an assisted living program as defined in section 31 231C.2. “Health care facility” does not include the location of 32 an individual health care provider. 33 7. “Health care provider” means a person who is licensed, 34 certified, or otherwise authorized or permitted by the laws 35 -2- LSB 5681YH (2) 90 pf/ko 2/ 24

H.F. 2288 of this state to administer health care, diagnose and treat 1 medical conditions, and prescribe and dispense medications, 2 including controlled substances. “Health care provider” does 3 not include a health care facility. 4 8. “Informed decision” means a voluntary, affirmative 5 decision by a terminally ill patient to request and obtain a 6 prescription for medication pursuant to this chapter that the 7 terminally ill patient may self-administer to bring about a 8 peaceful death, after being fully informed by the attending 9 provider of all of the following: 10 a. The patient’s medical diagnosis. 11 b. The patient’s prognosis. 12 c. The feasible end-of-life care and treatment options for 13 the patient’s terminal illness, including but not limited to 14 comfort care, palliative care, hospice care, and pain control, 15 and the risks and benefits of each option. 16 d. The patient’s right to withdraw consent at any time, 17 and that the patient is not under any obligation to continue a 18 previously chosen option for end-of-life care or treatment. 19 9. “Licensed mental health provider” means a psychiatrist 20 licensed pursuant to chapter 148, a psychologist licensed 21 pursuant to chapter 154B, or an independent social worker 22 licensed pursuant to chapter 154C. 23 10. “Medical aid in dying” means the medical practice 24 authorized under this chapter and established standards 25 of medical care to determine a terminally ill patient’s 26 qualifications, evaluate a terminally ill patient’s request 27 for medication, and provide a terminally ill patient with 28 a prescription for medication or dispense the prescribed 29 medication to bring about the terminally ill patient’s peaceful 30 death. 31 11. “Medical confirmation” means the medical opinion of the 32 attending provider has been confirmed by a consulting provider 33 who has examined the patient and the patient’s relevant medical 34 records. 35 -3- LSB 5681YH (2) 90 pf/ko 3/ 24

H.F. 2288 12. “Mentally capable” means that in the opinion of the 1 attending provider, a consulting provider, and a licensed 2 mental health care provider, as applicable, the patient 3 requesting medical aid in dying has the ability to make and 4 communicate an informed decision. 5 13. “Patient” means an adult who is under the care of a 6 health care provider. 7 14. “Patient-directed care” means patient-centered care that 8 is not only respectful of and responsive to individual patient 9 preferences, needs, and values, but also ensures that patient 10 values guide all clinical decisions and that patients are fully 11 informed of and able to access all legal end-of-life care and 12 treatment options. 13 15. “Prognosis of six months or less” with reference to 14 a terminal illness means the terminal illness will, within 15 reasonable medical judgment, result in a patient’s death within 16 six months. 17 16. “Qualified patient” means a mentally capable, terminally 18 ill patient, who is a resident of Iowa and has satisfied 19 the requirements of this chapter in order to obtain and 20 self-administer a prescription for medication to bring about 21 the terminally ill patient’s peaceful death. 22 17. “Self-administer” or “self-administration” means a 23 qualified patient’s affirmative, conscious, voluntary act to 24 ingest medication prescribed pursuant to this chapter to bring 25 about the patient’s own peaceful death. “Self-administer” 26 or “self-administration” does not include administration of 27 medication via injection or intravenous infusion. 28 18. “Terminal illness” or “terminally ill” means an 29 incurable illness with a prognosis of six months or less. 30 19. “Terminally ill patient” means a patient who has been 31 certified by a health care provider to be terminally ill. 32 Sec. 4. NEW SECTION . 142E.4 Process for requesting 33 medication for medical aid in dying. 34 1. A patient who is mentally capable, is a resident of this 35 -4- LSB 5681YH (2) 90 pf/ko 4/ 24

H.F. 2288 state, and has been certified by a health care provider to be 1 terminally ill, may request medication that the patient may 2 self-administer to end the patient’s life as follows: 3 a. By making two oral requests to the terminally 4 ill patient’s attending provider separated by a 5 fifteen-calendar-day waiting period, beginning from the 6 day the first request is made. 7 b. By providing one written request to the terminally ill 8 patient’s attending provider. 9 2. A written request made under this section shall be in 10 substantially the form described in section 142E.5, shall be 11 signed and dated, or attested to, by the terminally ill patient 12 requesting medical aid in dying, and shall be signed and dated, 13 or attested to, by one witness. 14 3. Oral and written requests made under this section must be 15 made by the terminally ill patient and shall not be made by any 16 other individual including the terminally ill patient’s agent 17 under a power of attorney executed pursuant to chapter 633B, an 18 attorney in fact under a durable power of attorney for health 19 care pursuant to chapter 144B, or via a declaration relating to 20 use of life-sustaining procedures pursuant to chapter 144A. 21 4. A patient shall not qualify to make a request under this 22 section solely based on age or disability. 23 5. Notwithstanding subsection 1, if a terminally ill 24 patient’s attending provider attests that the terminally ill 25 patient will, within reasonable medical judgment, die within 26 fifteen days after the terminally ill patient’s initial oral 27 request is made under this section, the terminally ill patient 28 may reiterate the oral request to the attending provider at any 29 time after making the initial oral request and the fifteen-day 30 waiting period shall be waived. 31 Sec. 5. NEW SECTION . 142E.5 Form of written request —— 32 requirements. 33 1. A written request for medication that a terminally ill 34 patient may self-administer to end the terminally ill patient’s 35 -5- LSB 5681YH (2) 90 pf/ko 5/ 24

H.F. 2288 life as authorized by this chapter shall be in substantially 1 the following form: 2 Request for Medication 3 to End My Life in 4 a Peaceful Manner 5 I, ___________________________________ am an adult of sound 6 mind. I have been diagnosed with 7 _______________________________________________, and given a 8 prognosis of six months or less to live. 9 I have been fully informed of the feasible alternatives, 10 and the concurrent or additional care and treatment options 11 for my terminal illness, including but not limited to comfort 12 care, palliative care, hospice care, and pain control, and the 13 potential risks and benefits of each. I have been offered or 14 received resources or referrals to pursue these alternative 15 and concurrent or additional care and treatment options for my 16 terminal illness. 17 I have been fully informed of the nature of the medication to 18 be prescribed, the risks and benefits, and the probable result 19 of self-administering the medication, should I decide to do 20 so. I understand that I can rescind this request at any time, 21 and that I am under no obligation to fill the prescription once 22 provided nor to self-administer the medication if I obtain the 23 medication. 24 I request that my attending provider furnish a prescription 25 for medication that will end my life in a peaceful manner if 26 I choose to self-administer it, and I authorize my attending 27 provider to contact a pharmacist to dispense the prescription 28 at a time of my choosing. 29 I make this request voluntarily, free from coercion and 30 undue influence, and I accept full responsibility for my 31 actions. 32 ________________________________________ _____________ 33 Requestor Signature Date 34 ________________________________________ _____________ 35 -6- LSB 5681YH (2) 90 pf/ko 6/ 24

H.F. 2288 Witness Signature Date 1 2. A witness shall not be any of the following: 2 a. A relative of the terminally ill patient by blood, 3 marriage, or adoption. 4 b. A person who at the time the request is signed would 5 be entitled to any portion of the estate of the terminally 6 ill patient upon death under any will, trust, or other legal 7 instrument, or by operation of law. 8 Sec. 6. NEW SECTION . 142E.6 Attending provider duties. 9 An attending provider shall do all of the following: 10 1. Provide care that conforms to accepted medical 11 standards. 12 2. After confirming that a patient is terminally ill, 13 determine whether the patient requesting medical aid in dying 14 meets all of the following criteria: 15 a. Is mentally capable. 16 b. Has made the request for medication voluntarily and free 17 from coercion or undue influence. 18 c. Is a resident of the state. 19 3. In confirming that the terminally ill patient’s request 20 does not arise from coercion or undue influence by another 21 person, discuss with the terminally ill patient, outside the 22 presence of other persons with the exception of an interpreter 23 if necessary, whether the terminally ill patient feels coerced 24 or unduly influenced by another person. 25 4. Thoroughly educate the terminally ill patient about all 26 of the following: 27 a. The feasible alternatives and concurrent or additional 28 care and treatment options for the patient’s terminal illness, 29 including but not limited to comfort care, palliative care, 30 hospice care, or pain control, and the potential risks and 31 benefits of each. 32 b. The potential risks, benefits, and probable result of 33 self-administering the medication to be prescribed to bring 34 about a peaceful death. 35 -7- LSB 5681YH (2) 90 pf/ko 7/ 24

H.F. 2288 c. The choices available to the terminally ill patient 1 that reflect the terminally ill patient’s self-determination, 2 including that the terminally ill patient is under no 3 obligation to fill the prescription once provided nor to 4 self-administer the medication if the medication is obtained. 5 d. The terminally ill patient’s right to rescind the request 6 for medication pursuant to this chapter at any time and in any 7 manner. 8 e. The benefits of notifying family of the terminally ill 9 patient’s decision to request medication pursuant to this 10 chapter as an end-of-life care option. 11 f. With regard to a terminally ill patient’s 12 self-administration of the medication: 13 (1) The recommended methods for self-administering the 14 medication to be prescribed. 15 (2) The safekeeping and proper disposal of any unused 16 medication in accordance with federal and state law. 17 (3) The importance of having another individual present 18 when the terminally ill patient self-administers the medication 19 to be prescribed. 20 (4) The importance of not taking the medication in a public 21 place. 22 5. Provide the terminally ill patient with a referral for 23 comfort care, palliative care, hospice care, pain control, or 24 other end-of-life care and treatment options as requested or 25 as clinically indicated. 26 6. a. Refer the terminally ill patient to a consulting 27 provider for medical confirmation that the patient requesting 28 medication pursuant to this chapter is eligible. 29 b. The attending provider shall add the medical confirmation 30 provided under paragraph “a” to the terminally ill patient’s 31 medical record. 32 7. Refer the terminally ill patient to a licensed mental 33 health provider for evaluation in accordance with section 34 142E.8 if the attending provider observes signs that the 35 -8- LSB 5681YH (2) 90 pf/ko 8/ 24

H.F. 2288 terminally ill patient may not be mentally capable of making 1 an informed decision, and add the licensed mental health 2 provider’s written determination to the terminally ill 3 patient’s medical record. 4 8. Ensure that all appropriate steps are carried out in 5 accordance with this chapter before providing a prescription 6 for medication pursuant to this chapter to a terminally ill 7 patient. 8 9. Once the terminally ill patient is determined to be a 9 qualified patient, do either of the following: 10 a. Deliver the prescription for the requested medication 11 personally, by mail, or through an authorized electronic 12 transmission to a licensed pharmacist who will dispense 13 the medication, including ancillary medications intended 14 to minimize the qualified patient’s discomfort, to the 15 attending provider, to the qualified patient, or to a person 16 expressly designated by the qualified patient, in person or 17 with a signature required on delivery, by mail service, or by 18 messenger service. 19 b. Dispense the prescribed requested medication, including 20 ancillary medications intended to minimize the qualified 21 patient’s discomfort, to the qualified patient or to a person 22 expressly designated by the qualified patient in person, 23 if the attending provider has a current drug enforcement 24 administration number if required under chapter 124. 25 10. Document in the qualified patient’s medical record the 26 qualified patient’s diagnosis and prognosis, determination of 27 mental capability, the dates of the qualified patient’s oral 28 requests, a copy of the written request, and a notation that 29 all the requirements under this chapter have been completed 30 including a description of the medication and ancillary 31 medications prescribed to the qualified patient pursuant to 32 this chapter. 33 Sec. 7. NEW SECTION . 142E.7 Consulting provider duties. 34 1. A terminally ill patient requesting medical aid in dying 35 -9- LSB 5681YH (2) 90 pf/ko 9/ 24

H.F. 2288 under this chapter shall receive medical confirmation from a 1 consulting provider prior to being deemed a qualified patient. 2 2. A consulting provider shall do all of the following: 3 a. Evaluate the terminally ill patient and the terminally 4 ill patient’s relevant medical records. 5 b. Confirm, in writing, all of the following to the 6 attending provider: 7 (1) That the patient has a terminal illness. 8 (2) That the terminally ill patient has made the request 9 for medical aid in dying voluntarily and free from coercion or 10 undue influence. 11 (3) That the terminally ill patient is mentally capable, or 12 provide documentation that the consulting provider has referred 13 the terminally ill patient to a licensed mental health provider 14 for further evaluation in accordance with section 142E.8. 15 Sec. 8. NEW SECTION . 142E.8 Confirmation —— determination 16 of mental capability —— referral to licensed mental health 17 provider. 18 1. If either the attending provider or the consulting 19 provider is unable to confirm that the terminally ill patient 20 requesting medication for medical aid in dying under this 21 chapter is mentally capable, the attending provider or 22 consulting provider shall refer the terminally ill patient to a 23 licensed mental health provider for a determination of mental 24 capability. 25 2. A licensed mental health provider who evaluates a 26 terminally ill patient under this section shall communicate in 27 writing to the attending provider or consulting provider who 28 requested the evaluation the licensed mental health provider’s 29 conclusions about whether the terminally ill patient is 30 mentally capable. 31 3. If the licensed mental health provider determines 32 that the terminally ill patient is not currently mentally 33 capable, the licensed mental health provider shall not deem the 34 terminally ill patient to be mentally capable and the attending 35 -10- LSB 5681YH (2) 90 pf/ko 10/ 24

H.F. 2288 provider shall not determine the terminally ill patient to be a 1 qualified patient and prescribe medication to the terminally 2 ill patient under this chapter. 3 Sec. 9. NEW SECTION . 142E.9 Reporting requirements. 4 1. The department shall create and make available to all 5 attending providers a prescribing provider checklist form 6 and prescribing provider follow-up form for the purposes of 7 reporting the information as specified under this section to 8 the department. 9 2. Within thirty calendar days of providing a prescription 10 to a qualified patient for medication pursuant to this chapter, 11 the attending provider shall submit to the department a 12 completed prescribing provider checklist form with all of the 13 following information regarding a qualified patient: 14 a. The qualified patient’s name and date of birth. 15 b. The qualified patient’s terminal diagnosis and prognosis. 16 c. A notation that all the requirements under this chapter 17 have been completed. 18 d. A notation that medication has been prescribed pursuant 19 to this chapter. 20 3. Within sixty calendar days of notification of a qualified 21 patient’s death from self-administration of medication 22 prescribed pursuant to this chapter, the attending provider 23 shall submit to the department a completed prescribing provider 24 follow-up form with all of the following information: 25 a. The qualified patient’s name, date of birth, age at 26 death, education level, race, sex, type of insurance, if any, 27 and underlying illness. 28 b. The date of the qualified patient’s death. 29 c. A notation of whether or not the qualified patient was 30 enrolled in and receiving hospice services at the time of the 31 qualified patient’s death. 32 4. The department shall annually review a sample of records 33 maintained pursuant to this section to ensure compliance 34 and shall generate and make available to the public a 35 -11- LSB 5681YH (2) 90 pf/ko 11/ 24

H.F. 2288 statistical report of nonidentifying information collected. 1 The statistical report shall be limited to the following 2 information: 3 a. The number of prescriptions for medication written 4 pursuant to this chapter. 5 b. The number of attending providers who wrote prescriptions 6 for medication pursuant to this chapter. 7 c. The number of qualified patients who died following 8 self-administration of medication prescribed and dispensed 9 pursuant to this chapter. 10 5. Except as otherwise required by law, the information 11 collected by the department shall not be a public record and 12 shall not be made available for public inspection. 13 Sec. 10. NEW SECTION . 142E.10 Safe disposal of unused 14 medications. 15 A person who has custody or control of medication prescribed 16 and dispensed pursuant to this chapter that remains unused 17 after a qualified patient’s death shall dispose of the 18 medication by lawful means in accordance with state and federal 19 guidelines. 20 Sec. 11. NEW SECTION . 142E.11 Use of interpreters. 21 1. An interpreter whose services are provided to a patient 22 requesting information or services under this chapter shall 23 meet the standards promulgated by the Iowa interpreters and 24 translators association or the national board of certification 25 for medical interpreters, or other standard deemed acceptable 26 by the department. 27 2. An interpreter providing services pursuant to this 28 chapter shall not be related to a qualified patient by blood, 29 marriage, or adoption, or be entitled to a portion of the 30 qualified patient’s estate by will, trust, or other legal 31 instrument, or by operation of law upon the qualified patient’s 32 death. 33 Sec. 12. NEW SECTION . 142E.12 Effect on construction of 34 wills, contracts, and statutes. 35 -12- LSB 5681YH (2) 90 pf/ko 12/ 24

H.F. 2288 1. A provision in a contract, will, or other agreement, 1 whether written or oral, to the extent the provision would 2 affect whether a patient may make or rescind a request for 3 medication pursuant to this chapter, shall not be valid. 4 2. An obligation owing under any currently existing 5 contract shall not be conditioned or affected by the making or 6 rescinding of a request by a patient for medication pursuant to 7 this chapter. 8 Sec. 13. NEW SECTION . 142E.13 Insurance or annuity 9 policies. 10 1. The sale, procurement, or issuance of a life, health, 11 or accident insurance or annuity policy, or the rate charged 12 for any such policy shall not be conditioned upon or affected 13 by the making or rescinding of a request by a patient for 14 medication pursuant to this chapter. 15 2. A qualified patient’s act of self-administering 16 medication pursuant to this chapter shall not have an effect on 17 or invalidate any part of a life, health, or accident insurance 18 or annuity policy. 19 3. A terminally ill patient who is a covered beneficiary 20 of a health insurance policy shall not be subject to denial 21 or alteration of such benefits based on the availability of 22 medical aid in dying or the patient’s request or absence of a 23 request for medication pursuant to this chapter. 24 4. A terminally ill patient who is a recipient of Medicaid 25 coverage shall not be subject to denial or alteration of such 26 benefits based on the availability of medical aid in dying or 27 the patient’s request or absence of request for medication 28 pursuant to this chapter. 29 Sec. 14. NEW SECTION . 142E.14 Death certificate. 30 1. Unless otherwise prohibited by law, the attending 31 provider or the hospice medical director shall sign the 32 death certificate of a qualified patient who obtained and 33 self-administered a prescription for medication pursuant to 34 this chapter. 35 -13- LSB 5681YH (2) 90 pf/ko 13/ 24

H.F. 2288 2. When a death has occurred in accordance with this 1 chapter: 2 a. The manner of death of the qualified patient on a death 3 certificate shall not be listed as suicide or homicide. 4 b. The cause of death of a qualified patient on a death 5 certificate shall be listed as the qualified patient’s 6 underlying terminal illness. 7 c. The qualified patient’s act of self-administering 8 medication prescribed pursuant to this chapter shall not be 9 indicated on the death certificate. 10 3. A death that occurs in accordance with this chapter does 11 not alone constitute a person’s death that affects the public 12 interest as described pursuant to section 331.802. 13 a. If a death that occurs in accordance with this chapter 14 is referred to the state medical examiner or a county medical 15 examiner, a preliminary investigation may be conducted to 16 determine whether the person received a prescription for 17 medication under this chapter. 18 b. Any inquiry or investigation conducted by the state 19 medical examiner or a county medical examiner relating to 20 deaths that occur pursuant to this chapter shall not require 21 the state medical examiner or a county medical examiner to 22 sign the death certificate if the state medical examiner or a 23 county medical examiner identifies the attending provider that 24 prescribed the qualified patient medication pursuant to this 25 chapter. 26 Sec. 15. NEW SECTION . 142E.15 Construction of chapter. 27 1. Nothing in this chapter shall be interpreted to lessen 28 the applicable standard of care, including the standard of care 29 for the treatment of terminally ill patients and medical aid in 30 dying, for an attending provider, consulting provider, licensed 31 mental health provider, or any other health care provider 32 acting under this chapter. 33 2. Nothing in this chapter shall be construed to limit the 34 information or counseling a health care provider must provide 35 -14- LSB 5681YH (2) 90 pf/ko 14/ 24

H.F. 2288 to a patient in order to comply with informed consent laws and 1 requirements to meet a medical standard of care. 2 3. Nothing in this chapter shall be construed to authorize a 3 health care provider or any other person to end an individual’s 4 life by infusion, intravenous injection, mercy killing, or 5 euthanasia. Actions taken in accordance and compliance with 6 this chapter shall not, for any purposes, constitute suicide, 7 assisted suicide, euthanasia, mercy killing, homicide, or elder 8 abuse under the law. 9 4. A request by a patient for and the provision of 10 medication pursuant to this chapter do not solely constitute 11 neglect or elder abuse for any purpose of law, or provide the 12 sole basis for the appointment of a guardian or conservator. 13 Sec. 16. NEW SECTION . 142E.16 No duty to provide medical 14 aid in dying. 15 1. A health care provider shall provide sufficient 16 information to a terminally ill patient regarding available 17 options, alternatives, and the foreseeable risks and benefits 18 of each option or alternative, so that the patient is able 19 to make a fully informed, voluntary, affirmative decision 20 regarding the patient’s end-of-life care and treatment. 21 2. A health care provider may choose whether or not to 22 practice medical aid in dying pursuant to this chapter and 23 shall not be under any duty, whether by contract, statute, or 24 any other legal requirement, to participate in the practice of 25 medical aid in dying or to provide a qualified patient with 26 medication pursuant to this chapter. 27 3. If an attending provider is unable or unwilling to 28 determine a terminally ill patient’s qualification for medical 29 aid in dying, evaluate a terminally ill patient’s request for 30 medication, or provide a qualified patient with a prescription 31 for medication or dispense prescribed medication to a qualified 32 patient pursuant to this chapter, the attending provider shall 33 do all of the following: 34 a. Accurately document the terminally ill patient’s request 35 -15- LSB 5681YH (2) 90 pf/ko 15/ 24

H.F. 2288 in the terminally ill patient’s medical record. 1 b. Make reasonable efforts to accommodate the terminally 2 ill patient’s request including by transferring the care and 3 medical records of the terminally ill patient to another 4 attending provider upon the terminally ill patient’s request 5 so that the terminally ill patient is able to make a voluntary 6 affirmative decision regarding the terminally ill patient’s 7 end-of-life care and treatment. 8 4. Failure to inform a terminally ill patient who requests 9 information about available end-of-life options including 10 medical aid in dying, or failure to refer the terminally ill 11 patient to another attending provider who can provide the 12 information, is considered a failure to obtain informed consent 13 for subsequent medical treatments. 14 5. An attending provider shall not engage in false, 15 misleading, or deceptive practices relating to the attending 16 provider’s willingness to determine the qualification of a 17 terminally ill patient for medical aid in dying, to evaluate 18 a terminally ill patient’s request for medication, or to 19 provide a prescription for medication to a qualified patient 20 or dispense a prescribed medication to a qualified patient 21 pursuant to this chapter. 22 Sec. 17. NEW SECTION . 142E.17 Health care facility —— 23 permissible prohibitions and duties. 24 1. A health care facility that has adopted a policy 25 prohibiting health care providers in the course of performing 26 duties for the health care facility from determining the 27 qualification of a terminally ill patient for medical aid 28 in dying, evaluating a terminally ill patient’s request 29 for medication, or providing a qualified patient with a 30 prescription for medication or dispensing prescribed medication 31 to a qualified patient, shall provide advance notice in 32 writing to the health care facility’s patients and health care 33 providers that the health care facility is a nonparticipating 34 health care facility under this chapter. 35 -16- LSB 5681YH (2) 90 pf/ko 16/ 24

H.F. 2288 2. A nonparticipating health care facility that fails to 1 provide explicit, advance notice in writing to the health care 2 facility’s patients and health care providers shall not enforce 3 such a policy. 4 3. If a terminally ill patient wishes to transfer the 5 patient’s care from a nonparticipating health care facility to 6 another health care facility, the nonparticipating health care 7 facility shall coordinate a timely transfer, including transfer 8 of the terminally ill patient’s medical records that include 9 notation of the date the terminally ill patient first requested 10 medical aid in dying. 11 4. A nonparticipating health care facility shall not 12 prohibit a health care provider from providing services 13 consistent with the applicable standard of medical care 14 including all of the following: 15 a. Providing information to a patient about the availability 16 of medical aid in dying pursuant to this chapter. 17 b. Prescribing medication pursuant to this chapter for 18 a qualified patient outside the scope of the health care 19 provider’s employment or contract with the nonparticipating 20 health care facility and off the premises of the 21 nonparticipating health care facility. 22 c. Being present at the time a qualified patient 23 self-administers medication prescribed pursuant to this chapter 24 or at the time of the patient’s death, if requested by the 25 qualified patient or the qualified patient’s representative 26 outside the scope of the health care provider’s employment or 27 contractual duties. 28 5. A health care facility shall not engage in false, 29 misleading, or deceptive practices relating to the health care 30 facility’s policy regarding end-of-life care and treatment 31 services, including whether the health care facility has a 32 policy which prohibits affiliated health care providers from 33 determining a terminally ill patient’s qualification for 34 medical aid in dying, evaluating a terminally ill patient’s 35 -17- LSB 5681YH (2) 90 pf/ko 17/ 24

H.F. 2288 request for medication, or providing a prescription for or 1 dispensing medication to a qualified patient pursuant to this 2 chapter; or intentionally denying a terminally ill patient 3 access to medication pursuant to this chapter by failing to 4 transfer a terminally ill patient and the terminally ill 5 patient’s medical records to another health care facility in a 6 timely manner. 7 Sec. 18. NEW SECTION . 142E.18 Immunities for actions in 8 good faith —— prohibition against reprisals. 9 1. A health care provider or health care facility shall 10 not be subject to civil or criminal liability, professional 11 disciplinary action, or any other penalty for engaging in 12 the practice of medical aid in dying in accordance with 13 the standard of care and in good faith compliance with this 14 chapter. 15 2. A health care provider, health care facility, or 16 professional organization or association shall not subject 17 a health care provider or health care facility to censure, 18 discipline, the denial, suspension, or revocation of licensure, 19 loss of privileges, loss of membership, or any other penalty 20 for providing medical aid in dying in accordance with the 21 standard of care and in good faith compliance with this 22 chapter or for providing scientific and accurate information 23 about medical aid in dying to a terminally ill patient when 24 discussing end-of-life care and treatment options. 25 3. A health care provider shall not be subject to civil 26 or criminal liability or professional discipline if, with the 27 consent of the qualified patient or the qualified patient’s 28 representative, the health care provider is present outside the 29 scope of the health care provider’s professional duties when 30 the qualified patient self-administers medication prescribed 31 pursuant to this chapter or at the time of the qualified 32 patient’s death. 33 4. This section shall not be interpreted to limit civil or 34 criminal liability of a health care provider who intentionally 35 -18- LSB 5681YH (2) 90 pf/ko 18/ 24

H.F. 2288 or knowingly fails or refuses to timely submit records required 1 pursuant to section 142E.9. 2 5. This section shall not be interpreted to limit civil or 3 criminal liability for intentional violations of this chapter. 4 Sec. 19. NEW SECTION . 142E.19 Liabilities and penalties. 5 1. A person who without authorization of a patient 6 intentionally or knowingly alters or forges a request for 7 medication pursuant to this chapter with the intent or effect 8 of causing the patient’s death, or conceals or destroys a 9 patient’s rescission of a request for medication pursuant to 10 this chapter, is guilty of a class “A” felony. 11 2. A person who coerces or exerts undue influence over 12 a patient to request or utilize medication pursuant to this 13 chapter, with the intent or effect of causing the patient’s 14 death, is guilty of a class “A” felony. 15 3. A person who intentionally or knowingly coerces or 16 exerts undue influence over a terminally ill patient to forgo a 17 request for or to obtain medication pursuant to this chapter, 18 or who intentionally or knowingly denies a qualified patient 19 access to medication under this chapter as an end-of-life care 20 and treatment option is guilty of a serious misdemeanor. 21 4. Nothing in this section shall be interpreted to limit 22 liability for civil damages resulting from negligent conduct or 23 intentional misconduct applicable under other law for conduct 24 which is inconsistent with the provisions of this chapter. 25 5. The penalties specified in this chapter shall not 26 preclude application of criminal penalties applicable under 27 other law for conduct which is inconsistent with this chapter. 28 Sec. 20. NEW SECTION . 142E.20 Claims by governmental entity 29 for costs incurred. 30 A governmental entity that incurs costs resulting from a 31 qualified patient self-administering medication prescribed 32 pursuant to this chapter in a public place shall have a claim 33 against the estate of the qualified patient to recover such 34 costs and reasonable attorney fees related to enforcing the 35 -19- LSB 5681YH (2) 90 pf/ko 19/ 24

H.F. 2288 claim. 1 EXPLANATION 2 The inclusion of this explanation does not constitute agreement with 3 the explanation’s substance by the members of the general assembly. 4 This bill creates the Iowa our care, our options Act. 5 The bill includes findings relating to end-of-life care and 6 treatment options and provides definitions of terms used in the 7 bill. 8 The bill provides a process for an adult patient who is 9 mentally capable, is a resident of the state, and has been 10 determined by the patient’s attending provider and consulting 11 provider to be terminally ill, to request medication that the 12 patient may self-administer to end the patient’s life. Such 13 patient must make two oral requests to the patient’s attending 14 provider, followed by one written request to the patient’s 15 attending provider to request the medication. 16 The bill provides the form in which the written request 17 must be substantially made, and requires that oral and written 18 requests must be made by the terminally ill patient. Under 19 the bill, a patient shall not qualify to make a request solely 20 based on age or disability. The bill also provides that 21 notwithstanding other provisions of the bill, if a terminally 22 ill patient’s attending provider attests that the terminally 23 ill patient will, within reasonable medical judgment, die 24 within 15 days after making the initial oral request, the 25 terminally ill patient may reiterate the oral request to the 26 attending provider at any time after making the initial oral 27 request and the 15-day waiting period shall be waived. 28 The bill specifies the duties of the attending provider and 29 the consulting provider, and provides for the referral of a 30 terminally ill patient by either an attending provider or a 31 consulting provider to a licensed mental health provider to 32 confirm that the terminally ill patient requesting medication 33 for medical aid in dying is mentally capable. 34 The bill requires the department of health and human 35 -20- LSB 5681YH (2) 90 pf/ko 20/ 24