Bill Text: IA HF374 | 2019-2020 | 88th General Assembly | Introduced

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Bill Title: A bill for an act creating the Iowa end-of-life options Act and providing penalties.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2019-04-24 - Sponsors added, Cohoon, Kurth, Thede, Winckler, Hunter, Anderson, Gaines, Lensing, Brown-Powers, Wolfe, B. Meyer, Wessel-Kroeschell, Olson, Bennett, Steckman, Kacena, Nielsen and Konfrst. H.J. 1011. [HF374 Detail]

Download: Iowa-2019-HF374-Introduced.html

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House File 374 - Introduced
HOUSE FILE 374
BY MASCHER
A BILL FOR
An Act creating the Iowa end-of-life 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 Short title.
This chapter shall be known and may be cited as the “Iowa
End-of-Life Options Act” .
Sec. 2. NEW SECTION . 142E.2 Definitions.
As used in this chapter, unless the context otherwise
requires:
1. “Adult” means an individual who is eighteen years of age
or older.
2. “Attending physician” means the physician who has primary
responsibility for the care of the patient and treatment of the
patient’s terminal disease.
3. “Competent” means that in the opinion of a court or in
the opinion of the patient’s attending physician or consulting
physician, psychiatrist, or psychologist, a patient has the
ability to make and communicate health care decisions to
health care providers, including communication through persons
familiar with the patient’s manner of communicating if those
persons are available.
4. “Consulting physician” means a physician who is qualified
by specialty or experience to make a professional diagnosis and
prognosis regarding the patient’s disease.
5. “Counseling” means one or more consultations as necessary
between a licensed psychiatrist or psychologist and a patient
for the purpose of determining that the patient is competent
and not suffering from a psychiatric or psychological disorder
or depression causing impaired judgment.
6. “Department” means the department of public health.
7. “Health care facility” means a health care facility as
defined in section 135C.1.
8. “Health care provider” means a person licensed,
certified, or otherwise authorized or permitted by the law of
this state to administer health care or dispense medication in
the ordinary course of business or practice of a profession,
and includes a health care facility.
9. “Informed decision” means a decision by a qualified
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patient to request and obtain a prescription to end the
patient’s life that is based on an appreciation of the relevant
facts and after being fully informed by the attending physician
of all of the following:
a. The patient’s medical diagnosis.
b. The patient’s prognosis.
c. The potential risks associated with taking the medication
to be prescribed.
d. The probable result of taking the medication to be
prescribed.
e. The feasible alternatives, including but not limited to
comfort care, hospice care, and pain control.
10. “Long-term care facility” means a long-term care unit
of a hospital, a health care facility, an elder group home as
defined in section 231B.1, or an assisted living program as
defined in section 231C.2.
11. “Medically confirmed” means the medical opinion of
the attending physician has been confirmed by a consulting
physician who has examined the patient and the patient’s
relevant medical records.
12. “Patient” means a person who is under the care of a
physician.
13. “Physician” means a person licensed to practice medicine
and surgery or osteopathic medicine and surgery under chapter
148.
14. “Qualified patient” means a competent adult who is a
resident of Iowa and has satisfied the requirements of this
chapter to obtain a prescription for medication to end the
individual’s life.
15. “Self-administer” means a qualified patient’s act of
ingesting medication to end the patient’s life.
16. “Terminal disease” means an incurable and irreversible
disease that has been medically confirmed and that will, within
reasonable medical judgment, produce death within six months.
Sec. 3. NEW SECTION . 142E.3 Request for medication.
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1. An adult patient who is competent, is a resident of
this state, has been determined by the patient’s attending
physician and consulting physician to be suffering from a
terminal disease, and has voluntarily expressed a wish to die,
may make a written request for medication that the patient may
self-administer to end the patient’s life in accordance with
this chapter.
2. A person shall not qualify to make a written request
under this section solely because of age or disability.
Sec. 4. NEW SECTION . 142E.4 Oral and written requests ——
right to rescind.
1. To receive a prescription for medication that a qualified
patient may self-administer to end the qualified patient’s life
pursuant to this chapter, the qualified patient shall make an
initial oral request, followed by a subsequent oral request
at least fifteen days after the initial oral request, and a
written request to the qualified patient’s attending physician.
2. At least fifteen days shall elapse between a qualified
patient’s initial oral request and the writing of a
prescription under this chapter.
3. At least forty-eight hours shall elapse between the
submission of a qualified patient’s written request and the
writing of a prescription under this chapter.
4. a. At the time the qualified patient makes the second
oral request, the attending physician shall offer the qualified
patient an opportunity to rescind the request.
b. A patient may rescind a request for a prescription for
medication under this chapter at any time and in any manner
without regard to the patient’s mental state. A prescription
for medication under this chapter shall not be written prior
to the attending physician offering the qualified patient an
opportunity to rescind the request.
Sec. 5. NEW SECTION . 142E.5 Procedure for request ——
witnesses.
1. A qualified patient who is unable to orally communicate
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may make a valid oral request under this chapter by reducing
the oral request to writing for submission to the qualified
patient’s attending physician. Such writing is not subject
to the requirements otherwise applicable to a written request
under this chapter.
2. a. A valid written request for medication under this
chapter shall be in substantially the form described in section
142E.17, shall be signed and dated by the patient, and shall
be witnessed by at least two individuals who, in the presence
of the patient, attest that to the best of their knowledge and
belief the patient is competent, acting voluntarily, and is not
being coerced to sign the request.
b. One of the witnesses shall be a person who is not any of
the following:
(1) A relative of the patient by blood, marriage, or
adoption.
(2) A person who at the time the request is signed would be
entitled to any portion of the estate of the patient upon death
under any will or by operation of law.
(3) An owner, operator, or employee of a long-term care
facility where the patient is receiving medical treatment or
is a resident.
c. The patient’s attending physician at the time the request
is signed shall not be a witness.
d. If the patient is a patient in a long-term care facility
at the time the written request is made, one of the witnesses
shall be an individual designated by the facility and having
the qualifications specified by the department by rule.
Sec. 6. NEW SECTION . 142E.6 Attending physician
responsibilities.
1. The attending physician shall do all of the following:
a. Make the initial determination of whether a patient has
a terminal disease, is competent, and has made the request for
medication under this chapter voluntarily.
b. Request that the patient demonstrate residency in the
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state. Factors demonstrating residency in this state include
but are not limited to:
(1) Possession of an Iowa driver’s license or a
nonoperator’s identification card.
(2) Registration to vote in Iowa.
(3) Evidence that the person owns or leases property in
Iowa.
(4) Filing of an Iowa tax return for the most recent tax
year.
c. Verify immediately prior to writing the prescription for
medication, that the patient is making an informed decision.
d. Refer the patient to a consulting physician for medical
confirmation of the diagnosis, and for a determination that the
patient is competent and acting voluntarily.
e. Refer the patient for counseling if appropriate under
section 142E.8.
f. Recommend that the patient notify next of kin. However,
a qualified patient’s request for medication shall not
be denied based on the qualified patient’s declination or
inability to notify next of kin.
g. Counsel the patient about the importance of having
another person present when the patient takes the medication
prescribed and of not taking the medication in a public place.
h. Inform the patient that the patient has an opportunity
to rescind the request at any time and in any manner, and offer
the patient an opportunity to rescind the request at the end of
the fifteen-day waiting period under section 142E.4.
i. Fulfill the medical record documentation requirements
under section 142E.9.
j. Ensure that all appropriate steps are carried out in
accordance with this chapter prior to writing a prescription
for medication to enable a qualified patient to end the
patient’s life.
k. Do either of the following:
(1) Dispense medications directly, including ancillary
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medications intended to facilitate the desired effect to
minimize the patient’s discomfort, if the attending physician
is authorized under law and rule to dispense such medication
and has a current valid drug enforcement administration number,
if required under chapter 124.
(2) With the patient’s written consent:
(a) Contact a pharmacist and inform the pharmacist of the
prescription.
(b) Deliver the written prescription personally, by
mail, or by facsimile to the pharmacist who will dispense the
medications to either the patient, the attending physician, or
an expressly identified agent of the patient.
2. Notwithstanding any other provision of law to the
contrary, the attending physician may sign the patient’s death
certificate.
Sec. 7. NEW SECTION . 142E.7 Consulting physician
confirmation.
A consulting physician shall do all of the following in
confirming that a patient is a qualified patient under this
chapter:
1. Examine the patient and the patient’s relevant medical
records and confirm, in writing, the attending physician’s
diagnosis that the patient is suffering from a terminal
disease.
2. Verify that the patient is competent, acting
voluntarily, and has made an informed decision.
Sec. 8. NEW SECTION . 142E.8 Counseling referral.
1. If, in the opinion of the attending physician or the
consulting physician, a patient may be suffering from a
psychiatric or psychological disorder or depression causing
impaired judgment, either physician shall refer the patient for
counseling.
2. An attending physician shall not prescribe medication to
end a patient’s life pursuant to this chapter until the person
performing the counseling determines and verifies that the
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patient is not suffering from a psychiatric or psychological
disorder or depression causing impaired judgment.
Sec. 9. NEW SECTION . 142E.9 Medical record documentation
requirements.
All of the following shall be documented or filed in a
patient’s medical record in regard to a request for medication
under this chapter:
1. All oral requests by a patient for medication to end the
patient’s life pursuant to this chapter.
2. All written requests by a patient for medication to end
the patient’s life pursuant to this chapter.
3. The attending physician’s diagnosis and prognosis
and determinations that the patient is competent, is acting
voluntarily, and has made an informed decision.
4. The consulting physician’s diagnosis and prognosis
and verification that the patient is competent, is acting
voluntarily, and has made an informed decision.
5. A report of the outcome and determinations made during
counseling, if performed.
6. The attending physician’s offer to the patient to rescind
the patient’s request at the time of the patient’s second oral
request pursuant to section 142E.4.
7. A note by the attending physician indicating that all
requirements under this chapter have been met and indicating
the steps taken to carry out the request, including a notation
of the medication prescribed.
Sec. 10. NEW SECTION . 142E.10 Reporting requirements.
1. a. The department shall require any health care
provider, upon dispensing medication pursuant to this chapter,
to file a copy of the dispensing record with the department.
b. The department shall annually review a sample of records
maintained under this chapter.
2. The department shall adopt rules to facilitate the
collection of information regarding compliance with this
chapter. Except as otherwise required by law, the information
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collected shall not be a public record and shall not be made
available for inspection by the public.
3. The department shall generate and make available to the
public an annual statistical report of information collected
under subsection 2.
Sec. 11. NEW SECTION . 142E.11 Effect on construction of
wills, contracts, and other agreements.
1. A provision in a contract, will, or other agreement,
whether written or oral, to the extent the provision would
affect whether a person may make or rescind a request for
medication to end the person’s life pursuant to this chapter,
shall not be valid.
2. An obligation owing under any contract shall not be
conditioned or affected by the making or rescinding of a
request by a person for medication to end the person’s life
pursuant to this chapter.
Sec. 12. NEW SECTION . 142E.12 Insurance or annuity
policies.
The sale, procurement, or issuance of any 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 person for
medication that may be self-administered to end the person’s
life pursuant to this chapter. A qualified patient’s act of
self-administering medication to end the qualified patient’s
life pursuant to this chapter shall not have an effect upon a
life, health, or accident insurance or annuity policy.
Sec. 13. NEW SECTION . 142E.13 Construction of chapter.
1. Nothing in this chapter shall be construed to authorize
a physician or any other person to end a patient’s life by
lethal injection, mercy killing, or active euthanasia. An
action taken in accordance with this chapter shall not, for any
purpose, constitute suicide, assisted suicide, mercy killing,
or homicide under the law.
2. Nothing in this chapter shall be interpreted to lessen
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the applicable standard of care for an attending physician,
consulting physician, psychiatrist, psychologist, or other
health care provider acting under this chapter.
Sec. 14. NEW SECTION . 142E.14 Immunities —— basis
for prohibiting health care provider from participation ——
notification —— permissible sanctions.
Except as otherwise provided in this chapter:
1. A person shall not be subject to civil or criminal
liability or professional disciplinary action for acting
in good-faith compliance with this chapter, including
being present when a qualified patient self-administers the
prescribed medication to end the qualified patient’s life
pursuant to this chapter.
2. A professional organization or association, or
health care provider, shall not subject a person to censure,
discipline, suspension, loss of license, loss of privileges,
loss of membership, or other penalty for acting or refusing to
act in good-faith compliance with this chapter.
3. A request by a patient for or provision by an attending
physician of medication in good-faith compliance with this
chapter shall not constitute neglect under the law or provide
the sole basis for the appointment of a guardian or conservator
for the patient.
4. A health care provider shall not be under any duty,
whether by contract, statute, or any other legal requirement,
to participate in the provision to a qualified patient of
medication to end the patient’s life pursuant to this chapter.
If a health care provider is unable or unwilling to carry out a
patient’s request under this chapter and the patient transfers
the patient’s care to a new health care provider, the prior
health care provider shall transfer, upon request, a copy of
the patient’s relevant medical records to the new health care
provider.
5. a. Notwithstanding any other provision of law to the
contrary, a health care provider may prohibit another health
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care provider from acting under this chapter on the premises
of the prohibiting provider if the prohibiting provider has
notified the health care provider of the prohibiting provider’s
policy regarding actions under this chapter. Nothing in this
paragraph shall prevent a health care provider from providing
health care services to a patient that do not constitute action
under this chapter.
b. Notwithstanding the provisions of this section to the
contrary, a health care provider may subject another health
care provider to the following sanctions if the sanctioning
health care provider has notified the sanctioned provider prior
to action under this chapter that the health care provider
prohibits actions under this chapter:
(1) Loss of privileges, loss of membership, or other
sanction provided pursuant to the medical staff bylaws,
policies, or procedures of the sanctioning health care provider
if the sanctioned provider is a member of the sanctioning
provider’s medical staff and acts under this chapter while on
the health care facility premises of the sanctioning health
care provider, but not including the private medical office of
a physician or other provider.
(2) Termination of a lease or other property contract or
other nonmonetary remedies provided by a lease or contract,
not including loss or restriction of medical staff privileges
or exclusion from a provider panel, if the sanctioned
provider acts under this chapter while on the premises of the
sanctioning health care provider or on property that is owned
by or under the direct control of the sanctioning health care
provider.
(3) Termination of a contract or other nonmonetary remedies
provided by a contract if the sanctioned provider acts under
this chapter while acting in the course and scope of the
sanctioned provider’s capacity as an employee or independent
contractor of the sanctioning health care provider. Nothing
in this subparagraph shall be construed to prevent any of the
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following:
(a) A health care provider from acting under this chapter
while acting outside the course and scope of the provider’s
capacity as an employee or independent contractor.
(b) A patient from contracting with the patient’s attending
physician and consulting physician to act outside the course
and scope of the provider’s capacity as an employee or
independent contractor of the sanctioning health care provider.
c. A health care provider that imposes sanctions pursuant to
paragraph “b” shall follow all due process and other procedures
the sanctioning health care provider uses for the imposition of
sanctions on other health care providers under the authority of
the sanctioning health care provider.
d. For the purposes of this subsection:
(1) “Action under this chapter” means to perform the
duties of an attending physician, the consulting physician
function, or the counseling function as specified under this
chapter. “Action under this chapter” does not include any of
the following:
(a) Making an initial determination that a patient has
a terminal disease and informing the patient of the medical
prognosis.
(b) Providing information about this chapter to a patient
upon the request of the patient.
(c) Providing a patient, upon the request of the patient,
with a referral to another physician.
(d) A patient contracting with the patient’s attending
physician and consulting physician to act outside of the
course and scope of the provider’s capacity as an employee or
independent contractor of the sanctioning health care provider.
(2) “Notify” means a separate statement in writing to the
health care provider specifically informing the health care
provider prior to the provider’s action under this chapter of
the sanctioning health care provider’s policy about actions
under this chapter.
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Sec. 15. NEW SECTION . 142E.15 Liabilities —— penalties.
1. A person who without authorization of the patient
willfully alters or forges a request for medication under this
chapter or conceals or destroys a rescission of a request for
medication under this chapter with the intent or effect of
causing the patient’s death is guilty of a class “A” felony.
2. A person who coerces or exerts undue influence on a
patient to request medication for the purpose of ending the
patient’s life pursuant to this chapter, or to destroy a
rescission of such a request, is guilty of a class “A” felony.
3. Nothing in this chapter shall be construed to limit
a person’s liability for civil damages resulting from the
person’s negligent conduct or intentional misconduct applicable
under other law for conduct which is inconsistent with the
provisions of this chapter.
4. The penalties specified in this section shall not
preclude criminal penalties applicable under other law for
conduct which is inconsistent with the provisions of this
chapter.
Sec. 16. NEW SECTION . 142E.16 Claims by governmental entity
for costs incurred.
A governmental entity that incurs costs resulting from a
person terminating the person’s life pursuant to this chapter
in a public place shall have a claim against the estate of
the person to recover such costs and reasonable attorney fees
related to enforcing the claim.
Sec. 17. NEW SECTION . 142E.17 Form of written request.
A written request for medication as authorized by this
chapter shall be in substantially the following form:
REQUEST FOR MEDICATION
TO END MY LIFE IN A HUMANE
AND DIGNIFIED MANNER
I, ______________________, am an adult of sound mind.
I am suffering from _________, which my attending physician has
determined is a terminal disease and which has been medically
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confirmed by a consulting physician.
I have been fully informed of my diagnosis, prognosis, the
nature of medication to be prescribed and potential associated
risks, the expected result, and the feasible alternatives,
including comfort care, hospice care, and pain control.
I request that my attending physician prescribe medication that
will end my life in a humane and dignified manner.
INITIAL ONE OF THE FOLLOWING:
______ I have informed my family of my decision and taken their
opinions into consideration.
______ I have decided not to inform my family of my decision.
______ I have no family to inform of my decision.
I understand that I have the right to rescind this request at
any time.
I understand the full import of this request and I expect to
die when I take the medication to be prescribed. I further
understand that although most deaths occur within three hours,
my death may take longer and my physician has counseled me
about this possibility.
I make this request voluntarily and without reservation, and I
accept full moral responsibility for my actions.
Signed: _______________
Dated: _______________
DECLARATION OF WITNESSES
By initialing and signing below on or after the date the person
named above signs, we declare that the person making and
signing the above request:
(a) Is personally known to us or has provided proof of
identity.
(b) Signed this request in our presence on the date of the
person’s signature.
(c) Appears to be of sound mind and not under duress, fraud, or
undue influence.
(d) Is not a patient for whom either of us is the attending
physician.
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Printed name of Witness 1 ____________________
Signed name of Witness 1/Date ________________________
Printed name of Witness 2 ____________________
Signed name of Witness 2/Date ________________________
NOTE: One witness shall not be a relative by blood, marriage,
or adoption of the person signing this request, shall not be
entitled to any portion of the person’s estate upon death,
and shall not own, operate, or be employed at a health care
facility where the person is a patient or resident. If the
patient is an inpatient at a health care facility, one of the
witnesses shall be an individual designated by the facility.
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 End-of-Life Options Act”. The
bill provides for a competent adult patient, who is a resident
of the state of Iowa, who is terminally ill with less than six
months to live as verified by two physicians, to voluntarily
request medication that will end the person’s life. The
bill provides that the patient must make an oral request, a
subsequent oral request no less than 15 days after the initial
request, and a written request for the medication. There is
also a 48-hour waiting period between the submission of the
written request and the writing of the prescription. The bill
specifies the responsibilities of the attending physician and
the consulting physician. The bill includes a provision for
counseling if the attending physician deems it appropriate, the
notification of next of kin, the right to rescind a request at
any time, and documentation requirements. The bill provides
for the effect of a request for medication to end the person’s
life on the construction of wills, contracts, and statutes as
well as on insurance and annuity policies.
The bill provides that the provisions of the bill are not
to be construed to authorize a physician or any other person
to end a patient’s life by lethal injection, mercy killing,
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or active euthanasia, and that actions taken in accordance
with the bill shall not, for any purpose, constitute suicide,
assisted suicide, mercy killing, or homicide under the
law. Additionally, the provisions of the bill are not to be
interpreted to lessen the applicable standard of care for the
attending physician, consulting physician, psychiatrist, or
psychologist, or other health care provider acting under the
bill.
The bill provides immunities for a person who acts in
good-faith compliance with the bill, including being present
when a patient takes the prescribed medication to end the
patient’s life.
The bill provides that a professional organization or
association, or health care provider, shall not subject a
person to censure, discipline, suspension, loss of license,
loss of privileges, loss of membership, or other penalty for
acting or refusing to act in good-faith compliance with the
bill, but does provide for prohibitions by a health care
provider on the premises of the health care provider relative
to the bill. The bill provides that a request by a patient
for or provision by an attending physician of medication in
good-faith compliance with the bill does not constitute neglect
under the law or provide the sole basis for the appointment
of a guardian or conservator for the patient. Under the
bill, a health care provider is not under any duty, whether
by contract, statute, or any other legal requirement, to
participate in the provision to a patient of medication to
end the patient’s life. If a health care provider is unable
or unwilling to carry out a patient’s request under the bill,
however, and the patient transfers the patient’s care to a
new health care provider, the prior health care provider is
required to transfer, upon request, a copy of the patient’s
relevant medical records to the new health care provider.
The bill provides that a person who, without authorization
of the patient, willfully alters or forges a request for
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medication under the bill or conceals or destroys a rescission
of such a request with the intent or effect of causing the
patient’s death is guilty of a class “A” felony. Additionally,
a person who coerces or exerts undue influence on a patient
to request medication for the purpose of ending the patient’s
life under the bill, or to destroy a rescission of such a
request, is guilty of a class “A” felony. A class “A” felony
is punishable by confinement for life without possibility of
parole.
The bill provides that the provisions of the bill are
not to be construed to limit a person’s liability for civil
damages resulting from other negligent conduct or intentional
misconduct by the person and that the penalties specified in
the bill shall not preclude criminal penalties applicable under
other law for conduct which is inconsistent with the provisions
of the bill.
The bill provides that if a governmental entity incurs costs
resulting from a person terminating the person’s life under the
bill in a public place, the governmental entity has a claim
against the estate of the person to recover such costs and
reasonable attorney fees related to enforcing the claim.
The bill also provides the form for the request for
medication to end a person’s life.
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