Bill Text: IA HF612 | 2023-2024 | 90th General Assembly | Introduced

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Bill Title: A bill for an act relating to care and choices at the end of life, providing penalties, and including effective date provisions.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2023-03-03 - Introduced, referred to Judiciary. H.J. 493. [HF612 Detail]

Download: Iowa-2023-HF612-Introduced.html

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