Bill > HF533

Introduced Session

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. 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 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. 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. 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 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.

AI Summary

Committee Categories

Sue Cahill (D)*,  Elinor Levin (D)*,  Beth Wessel-Kroeschell (D)*, 

Introduced, referred to Health and Human Services. H.J. 453. (on 03/01/2023)

Official Document