Bill > SF2101

Introduced Session

This bill creates the Iowa our care, our options Act. The bill includes findings relating to end-of-life care and treatment options and provides definitions of terms used in the bill. The bill provides a process for an adult patient who is mentally capable, is a resident of the state, and has been determined by the patient’s attending provider and consulting provider to be terminally ill, to request medication that the patient may self-administer to end the patient’s life. Such patient must make two oral requests to the patient’s attending provider, followed by one written request to the patient’s attending provider to request the medication. The bill provides the form in which the written request must be substantially made, and requires that oral and written requests must be made by the terminally ill patient. Under the bill, a patient shall not qualify to make a request solely based on age or disability. The bill also provides that notwithstanding other provisions of the bill, if a terminally ill patient’s attending provider attests that the terminally ill patient will, within a reasonable degree of medical certainty, die within 15 days after making the initial oral request, the terminally ill patient may reiterate the oral request to the attending provider at any time after making the initial oral request and the 15-day waiting period shall be waived. The bill specifies the duties of the attending provider and the consulting provider, and provides for the referral of a terminally ill patient by either an attending provider or a consulting provider to a licensed mental health provider to confirm that the terminally ill patient requesting medication for medical aid in dying is mentally capable. The bill requires the department of health and human services (HHS) to create and make available to all attending providers a prescribing provider checklist form and prescribing provider follow-up form for the purposes of reporting the information specified under the bill to HHS. The department of health and human services is required to annually review a sample of records to ensure compliance and shall generate and make available to the public a statistical report of nonidentifying information collected. The bill provides for the safe disposal of unused medications and the use of interpreters by patients. The bill provides for the effect of a request for medication to end a patient’s life on the construction of wills, contracts, and statutes, as well as on insurance and annuity policies. The bill provides that unless otherwise prohibited by law, the attending provider or the hospice medical director shall sign the death certificate of a qualified patient who obtained and self-administered a prescription for medication; and provides specific requirements relative to a qualified patient’s death certificate and the role of medical examiner investigations and actions. The bill specifies how the bill is to be interpreted relative to applicable standards of care and informed consent requirements; and provides that the bill is not to be construed to authorize a health care provider or any other person to end an individual’s life by infusion, intravenous injection, mercy killing, or euthanasia, and that actions taken in accordance and compliance with the bill shall not, for any purposes, constitute suicide, assisted suicide, euthanasia, mercy killing, homicide, or elder abuse under the law. The bill provides that a request by a patient for and the provision of medication pursuant to the bill does not solely constitute neglect or elder abuse for any purpose of law, or provide the sole basis for the appointment of a guardian or conservator. The bill provides that a health care provider shall provide sufficient information to a terminally ill patient regarding available options, the alternatives, and the foreseeable risks and benefits of each option or alternative, so that the terminally ill patient is able to make a fully informed, voluntary, affirmative decision regarding the patient’s end-of-life care and treatment; provides that a health care provider may choose whether or not to practice medical aid in dying and shall not be under any duty, whether by contract, statute, or any other legal requirement, to participate in the practice of medical aid in dying or to provide a qualified patient with medication pursuant to the bill. The bill requires an attending provider who is unable or unwilling to determine a terminally ill patient’s qualification for medical aid in dying to evaluate a terminally ill patient’s request for medication, or to prescribe or dispense medication to a qualified patient under the bill to otherwise accommodate the terminally ill or qualified patient. Failure to inform a terminally ill patient who requests information about available end-of-life treatments including medical aid in dying, or failure to refer a terminally ill patient to another attending provider who can provide the information, is considered a failure to obtain informed consent for subsequent medical treatments. The bill prohibits an attending provider from engaging in false, misleading, or deceptive practices relating to the health care provider’s willingness to determine the qualification of a terminally ill patient for medical aid in dying, to evaluate a terminally ill patient’s request for medication, or to provide a prescription for or dispense medication to a qualified patient under the bill. The bill specifies permissible prohibitions and duties of a health care facility that has adopted a policy prohibiting health care providers from determining the qualification of a patient for medical aid in dying, evaluating a terminally ill patient’s request for medication, or prescribing or dispensing prescribed medication pursuant to the bill in the course of the health care provider performing duties for the health care facility. The bill provides immunities for actions taken in good faith by a health care provider or health care facility; prohibits a health care provider, health care facility, or professional organization or association from subjecting a health care provider or health care facility to censure, discipline, denial, suspension or revocation of licensure, loss of privileges, loss of membership, or any other penalty for providing medical aid in dying in accordance with the standard of care and in good faith compliance with the bill, or for providing scientific and accurate information about medical aid in dying to a terminally ill patient when discussing end-of-life care and treatment options; and prohibits a health care provider from being subject to civil or criminal liability or professional discipline if, with the consent of the qualified patient or the qualified patient’s agent, the health care provider is present outside the scope of their professional duties when the qualified patient self-administers medication prescribed pursuant to the bill or at the time of the qualified patient’s death. Civil and criminal liability is not limited for a health care provider who intentionally or knowingly fails or refuses to timely submit records required to be submitted to HHS or for intentional violations of the bill. The bill provides for liability and criminal penalties imposed on persons who violate the bill. A person who without authorization of a patient intentionally or knowingly alters or forges a request for medication with the intent or effect of causing the patient’s death, or conceals or destroys a patient’s rescission of a request for medication is guilty of a class “A” felony. A person who coerces or exerts undue influence over a patient to request or utilize medication under the bill, with the intent or effect of causing the patient’s death, is guilty of a class “A” felony. A class “A” felony is punishable by confinement for life without possibility of parole. A person who intentionally or knowingly coerces or exerts undue influence over a terminally ill patient to forgo a request for or to obtain medication pursuant to the bill, or intentionally or knowingly denies a qualified patient access to medication under the bill as an end-of-life care option, is guilty of a serious misdemeanor. A serious misdemeanor is punishable by confinement for no more than one year and a fine of at least $430 but not more than $2,560. The liability and penalty provisions under the bill are not to be interpreted to limit liability for civil damages resulting from negligent conduct or intentional misconduct applicable under other law for conduct which is inconsistent with the provisions of this chapter, and penalties specified in the bill shall not preclude application of criminal penalties applicable under other law for conduct which is inconsistent with the bill. The bill also provides that a governmental entity that incurs costs resulting from a qualified patient self-administering medication prescribed under the bill in a public place shall have a claim against the estate of the patient to recover such costs and reasonable attorney fees related to the enforcement of the claim.

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Nate Boulton (D)*, 

Subcommittee: Edler, Costello, and Trone Garriott. S.J. 152. (on 01/25/2024)

Official Document