Read the full stored bill text
House
File
708
-
Introduced
HOUSE
FILE
708
BY
BERGAN
A
BILL
FOR
An
Act
relating
to
health
care
decisions
related
to
palliative
1
care,
hospice
programs,
life-sustaining
procedures,
and
2
out-of-hospital
do-not-resuscitate
orders.
3
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
4
TLSB
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708
Section
1.
Section
135J.1,
Code
2025,
is
amended
by
adding
1
the
following
new
subsections:
2
NEW
SUBSECTION
.
1A.
“Attorney
in
fact”
means
an
individual
3
who
is
designated
by
a
durable
power
of
attorney
for
health
4
care
as
an
agent
to
make
health
care
decisions
on
behalf
of
a
5
patient
and
has
consented
to
act
in
that
capacity.
6
NEW
SUBSECTION
.
1B.
“Close
adult
friend”
means
a
friend
of
7
the
patient
to
whom
all
of
the
following
apply:
8
a.
The
individual
is
at
least
eighteen
years
of
age.
9
b.
The
individual
has
shown
special
care
and
concern
for
the
10
patient.
11
c.
The
individual
maintains
regular
contact
with
the
patient
12
and
is
familiar
with
the
patient’s
health,
activities,
and
13
beliefs.
14
d.
The
individual
has
signed
an
affidavit
with
the
patient’s
15
attending
physician
that
states
that
the
close
adult
friend
is
16
willing
and
able
to
be
involved
in
the
patient’s
care.
17
NEW
SUBSECTION
.
3A.
“Durable
power
of
attorney
for
health
18
care”
means
a
document
authorizing
an
attorney
in
fact
to
19
make
health
care
decisions
for
the
patient
if
the
patient
is
20
unable,
in
the
judgment
of
the
patient’s
attending
physician
or
21
attending
physician
assistant,
to
make
health
care
decisions.
22
NEW
SUBSECTION
.
8A.
“Serious
illness”
means
a
health
23
condition
that
carries
a
high
risk
of
mortality
and
either
24
negatively
impacts
a
person’s
daily
functioning
or
quality
of
25
life,
or
excessively
strains
the
person’s
caregivers.
26
NEW
SUBSECTION
.
8B.
“Terminal
condition”
means
the
same
as
27
defined
in
section
144A.2.
28
Sec.
2.
Section
135J.1,
subsections
4,
6,
8,
and
9,
Code
29
2025,
are
amended
to
read
as
follows:
30
4.
“Hospice
patient”
or
“patient”
means
a
person
diagnosed
31
terminally
ill
person
with
a
terminal
illness
by
an
attending
32
physician,
with
an
anticipated
life
expectancy
of
six
months
or
33
less,
as
certified
by
the
attending
physician,
who,
alone
or
in
34
conjunction
with
a
unit
of
care
as
defined
in
subsection
9
,
has
35
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voluntarily
requested
and
received
admission
into
the
a
hospice
1
program.
If
the
patient
is
unable
to
request
admission,
a
2
family
member
may
voluntarily
request
and
receive
admission
on
3
the
patient’s
behalf.
4
6.
“Hospice
program”
means
a
centrally
coordinated
program
5
of
home
and
inpatient
care
provided
directly
or
through
an
6
agreement
under
the
direction
of
an
identifiable
hospice
7
administration
providing
palliative
care
directed
at
symptom
8
management
and
supportive
medical
and
other
health
services
9
to
terminally
ill
hospice
patients
and
their
families.
A
10
licensed
hospice
program
shall
utilize
a
medically
directed
11
interdisciplinary
team
and
provide
care
to
meet
the
physical,
12
emotional,
social,
spiritual,
and
other
special
needs
which
13
are
experienced
during
the
final
stages
of
illness,
dying,
and
14
bereavement.
Hospice
care
shall
be
available
twenty-four
hours
15
a
day,
seven
days
a
week.
16
8.
“Palliative
care”
means
specialized
medical
care
directed
17
at
managing
symptoms
experienced
by
the
hospice
patient,
as
18
well
as
addressing
related
needs
of
the
patient
and
family
19
as
they
experience
the
stress
of
the
dying
process
a
patient
20
diagnosed
by
an
attending
physician
with
a
serious
illness
.
21
Palliative
care
is
provided
by
a
trained
team
of
health
22
care
providers
who
work
together
with
a
patient’s
health
23
care
providers
to
provide
support
through
stress
and
symptom
24
management
based
on
the
needs
of
the
patient,
not
the
patient’s
25
prognosis.
The
intent
of
palliative
care
is
to
enhance
the
26
quality
of
life
for
the
hospice
patient
and
family
unit
,
and
27
is
not
treatment
directed
at
cure
of
the
terminal
illness
.
28
Palliative
care
is
appropriate
for
a
patient
at
any
age
and
29
at
any
stage
of
a
serious
illness
and
can
be
utilized
with
30
curative
treatment
for
the
serious
illness.
31
9.
“Unit
of
care”
means
the
a
hospice
patient
and
the
32
hospice
patient’s
family
within
a
hospice
program.
33
Sec.
3.
Section
135J.3,
subsections
3,
4,
and
5,
Code
2025,
34
are
amended
to
read
as
follows:
35
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3.
A
mechanism
that
assures
the
rights
of
the
patient
and
1
family
unit
of
care
.
2
4.
Palliative
Symptom
management
care
provided
to
a
hospice
3
patient
and
family
unit
of
care
under
the
direction
of
an
4
attending
physician.
5
5.
An
interdisciplinary
team
which
develops,
implements,
6
and
evaluates
the
hospice
plan
of
care
for
the
patient
and
7
family
unit
of
care
.
8
Sec.
4.
NEW
SECTION
.
135J.3A
Patient
incapable
of
making
a
9
treatment
decision.
10
A
patient
who
has
a
terminal
condition,
and
who
is
comatose,
11
incompetent,
or
otherwise
physically
or
mentally
incapable
12
of
communication,
and
who
has
not
expressed
their
desire
13
for
palliative
care
or
a
hospice
program,
may
be
placed
in
14
a
hospice
program
by
any
of
the
following
individuals,
who
15
shall
be
guided
by
the
express
or
implied
intentions
of
the
16
patient,
in
the
following
order
of
priority
if
no
individual
17
in
the
previous
priority
is
reasonably
available,
willing,
and
18
competent
to
make
the
decision.
19
1.
The
attorney
in
fact
of
a
durable
power
of
attorney
for
20
health
care
executed
by
the
patient
pursuant
to
chapter
144B.
21
2.
The
guardian
of
the
patient
appointed
pursuant
to
chapter
22
633.
23
3.
The
patient’s
spouse.
24
4.
An
adult
child
or
stepchild
of
the
patient
or,
if
25
the
patient
has
more
than
one
adult
child
or
stepchild,
the
26
decision
agreed
to
by
a
majority
of
the
adult
children
and
27
stepchildren
who
are
reasonably
available
for
consultation
with
28
the
patient’s
attending
physician.
29
5.
A
parent
or
stepparent
of
the
patient,
or
if
the
patient
30
has
more
than
one
parent
or
stepparent,
the
decision
agreed
to
31
by
a
majority
of
the
parents
and
stepparents
who
are
reasonably
32
available
for
consultation
with
the
patient’s
attending
33
physician.
34
6.
An
adult
sibling
or
stepsibling
of
the
patient,
or
if
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the
patient
has
more
than
one
sibling
or
stepsibling,
the
1
decision
agreed
to
by
a
majority
of
the
adult
siblings
and
2
stepsiblings
who
are
reasonably
available
for
consultation
with
3
the
patient’s
attending
physician.
4
7.
The
decision
agreed
to
by
a
majority
of
the
patient’s
5
relatives,
including
but
not
limited
to
grandchildren,
6
grandparents,
aunts,
uncles,
nieces,
and
nephews,
who
are
7
reasonably
available
for
consultation
with
the
patient’s
8
attending
physician.
9
8.
A
close
adult
friend.
10
Sec.
5.
Section
144A.2,
Code
2025,
is
amended
by
adding
the
11
following
new
subsections:
12
NEW
SUBSECTION
.
3A.
“Attorney
in
fact”
means
an
individual
13
who
is
designated
by
a
durable
power
of
attorney
for
health
14
care
as
an
agent
to
make
health
care
decisions
on
behalf
of
a
15
patient
and
has
consented
to
act
in
that
capacity.
16
NEW
SUBSECTION
.
3B.
“Close
adult
friend”
means
a
friend
of
17
the
patient
to
whom
all
of
the
following
apply:
18
a.
The
individual
is
at
least
eighteen
years
of
age.
19
b.
The
individual
has
shown
special
care
and
concern
for
the
20
patient.
21
c.
The
individual
maintains
regular
contact
with
the
patient
22
and
is
familiar
with
the
patient’s
health,
activities,
and
23
beliefs.
24
d.
The
individual
has
signed
an
affidavit
with
the
patient’s
25
attending
physician
that
states
that
the
close
adult
friend
is
26
willing
and
able
to
be
involved
in
the
patient’s
care.
27
NEW
SUBSECTION
.
5A.
“Durable
power
of
attorney
for
health
28
care”
means
a
document
authorizing
an
attorney
in
fact
to
29
make
health
care
decisions
for
the
patient
if
the
patient
is
30
unable,
in
the
judgment
of
the
patient’s
attending
physician
or
31
attending
physician
assistant,
to
make
health
care
decisions.
32
Sec.
6.
Section
144A.7,
subsections
1
and
2,
Code
2025,
are
33
amended
to
read
as
follows:
34
1.
Life-sustaining
procedures
may
be
withheld
or
withdrawn
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from
a
patient
who
is
in
a
terminal
condition
,
and
who
is
1
comatose,
incompetent,
or
otherwise
physically
or
mentally
2
incapable
of
communication
,
and
who
has
not
made
a
declaration
3
in
accordance
with
this
chapter
section
144A.3
if
there
is
4
consultation
and
written
agreement
for
the
withholding
or
the
5
withdrawal
of
life-sustaining
procedures
between
the
attending
6
physician
and
any
of
the
following
individuals,
who
shall
be
7
guided
by
the
express
or
implied
intentions
of
the
patient,
in
8
the
following
order
of
priority
if
no
individual
in
a
prior
9
class
the
previous
priority
is
reasonably
available,
willing,
10
and
competent
to
act:
make
a
decision.
11
a.
The
attorney
in
fact
designated
to
make
treatment
12
decisions
for
the
patient
should
such
person
be
diagnosed
as
13
suffering
from
a
terminal
condition,
if
the
designation
is
in
14
writing
and
complies
with
chapter
144B
.
15
b.
The
guardian
of
the
person
of
the
patient
if
one
has
been
16
appointed
,
provided
pursuant
to
chapter
633,
or
the
guardian
17
of
the
patient
who
has
obtained
court
approval
is
obtained
in
18
accordance
with
section
232D.401,
subsection
4
,
paragraph
“a”
,
19
or
section
633.635,
subsection
3
,
paragraph
“b”
,
subparagraph
20
(1)
.
This
paragraph
does
not
require
the
appointment
of
a
21
guardian
in
order
for
a
treatment
decision
to
be
made
under
22
this
section
.
23
c.
The
patient’s
spouse.
24
d.
An
adult
child
or
stepchild
of
the
patient
or,
if
25
the
patient
has
more
than
one
adult
child
or
stepchild
,
the
26
decision
agreed
to
by
a
majority
of
the
adult
children
and
27
stepchildren
who
are
reasonably
available
for
consultation
with
28
the
patient’s
attending
physician
.
29
e.
A
parent
or
stepparent
of
the
patient,
or
parents
if
30
both
the
patient
has
more
than
one
parent
or
stepparent,
the
31
decision
agreed
to
by
a
majority
of
the
parents
and
stepparents
32
who
are
reasonably
available
for
consultation
with
the
33
patient’s
attending
physician
.
34
f.
An
adult
sibling
or
stepsibling
of
the
patient
or,
if
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the
patient
has
more
than
one
adult
sibling
or
stepsibling,
1
the
decision
agreed
to
by
a
majority
of
the
adult
siblings
and
2
stepsiblings
who
are
reasonably
available
for
consultation
with
3
the
patient’s
attending
physician
.
4
g.
The
decision
agreed
to
by
a
majority
of
the
patient’s
5
relatives,
including
but
not
limited
to
grandchildren,
6
grandparents,
aunts,
uncles,
nieces,
and
nephews,
who
are
7
reasonably
available
for
consultation
with
the
patient’s
8
attending
physician.
9
h.
A
close
adult
friend.
10
2.
When
a
decision
is
made
pursuant
to
this
section
to
11
withhold
or
withdraw
life-sustaining
procedures,
there
shall
12
be
a
witness
present
at
the
time
of
the
consultation
with
13
the
patient’s
attending
physician
when
that
the
decision
is
14
made.
The
witness
shall
be
an
adult
who
is
not
related
to
the
15
patient
by
blood,
marriage,
or
adoption
within
the
third
degree
16
of
consanguinity
and
who
is
not
an
attending
physician
or
an
17
employee
of
an
attending
physician
involved
in
the
patient’s
18
care.
19
Sec.
7.
NEW
SECTION
.
144A.7B
Procedure
in
absence
of
20
out-of-hospital
do-not-resuscitate
order.
21
1.
Resuscitation
may
be
withheld
or
withdrawn
from
a
patient
22
who
has
a
terminal
illness,
and
who
is
comatose,
incompetent,
23
or
otherwise
physically
or
mentally
incapable
of
communication,
24
and
who
has
not
executed
an
out-of-hospital
do-not-resuscitate
25
order,
if
there
is
consultation
and
written
agreement
for
the
26
withholding
or
the
withdrawal
of
resuscitation
between
the
27
attending
physician
and
any
of
the
following
individuals,
who
28
shall
be
guided
by
the
express
or
implied
intentions
of
the
29
patient,
in
the
following
order
of
priority
if
no
individual
30
in
the
previous
priority
is
reasonably
available,
willing,
and
31
competent
to
make
a
decision.
32
a.
The
attorney
in
fact
of
a
durable
power
of
attorney
for
33
health
care
executed
by
the
patient
pursuant
to
chapter
144B.
34
b.
The
guardian
of
the
patient
appointed
pursuant
to
chapter
35
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633.
1
c.
The
patient’s
spouse.
2
d.
An
adult
child
or
stepchild
of
the
patient
or,
if
3
the
patient
has
more
than
one
adult
child
or
stepchild,
the
4
decision
agreed
to
by
a
majority
of
the
adult
children
and
5
stepchildren
who
are
reasonably
available
for
consultation
with
6
the
patient’s
attending
physician.
7
e.
A
parent
or
stepparent
of
the
patient,
or
if
the
patient
8
has
more
than
one
parent
or
stepparent,
the
decision
agreed
to
9
by
a
majority
of
the
parents
and
stepparents
who
are
reasonably
10
available
for
consultation
with
the
patient’s
attending
11
physician.
12
f.
An
adult
sibling
or
stepsibling
of
the
patient,
or
if
13
the
patient
has
more
than
one
adult
sibling
or
stepsibling,
14
the
decision
agreed
to
by
a
majority
of
the
adult
siblings
and
15
stepsiblings
who
are
reasonably
available
for
consultation
with
16
the
patient’s
attending
physician.
17
g.
The
decision
agreed
to
by
a
majority
of
the
relatives,
18
including
but
not
limited
to
grandchildren,
grandparents,
19
aunts,
uncles,
nieces,
and
nephews,
who
are
reasonably
20
available
for
consultation
with
the
patient’s
attending
21
physician.
22
h.
A
close
adult
friend.
23
2.
When
a
decision
is
made
pursuant
to
this
section
to
24
withhold
or
withdraw
resuscitation,
a
witness
shall
be
present
25
at
the
time
of
the
consultation
with
the
patient’s
attending
26
physician
when
the
decision
is
made.
The
witness
shall
be
an
27
adult
who
is
not
related
to
the
patient
by
blood,
marriage,
or
28
adoption
within
the
third
degree
of
consanguinity
and
who
is
29
not
the
attending
physician
or
an
employee
of
the
attending
30
physician
involved
in
the
patient’s
care.
31
Sec.
8.
Section
144C.2,
subsection
16,
Code
2025,
is
amended
32
to
read
as
follows:
33
16.
“Licensed
hospice
program”
means
a
licensed
hospice
34
program
as
defined
described
in
section
135J.1
.
35
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Sec.
9.
Section
633.635,
Code
2025,
is
amended
by
adding
the
1
following
new
subsection:
2
NEW
SUBSECTION
.
6.
Notwithstanding
subsection
2
or
3,
a
3
guardian
may
make
a
decision
for
a
protected
person
pursuant
to
4
sections
135J.3A,
144A.7,
and
144A.7B
without
court
approval.
5
EXPLANATION
6
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
7
the
explanation’s
substance
by
the
members
of
the
general
assembly.
8
This
bill
relates
to
health
care
decisions
related
to
9
palliative
care,
hospice
programs,
life-sustaining
procedures,
10
and
out-of-hospital
do-not-resuscitate
orders.
11
Current
law
requires
a
hospice
program
to
provide
palliative
12
care
in
order
to
be
eligible
for
a
license.
The
bill
removes
13
this
requirement
and
requires
a
hospice
program
to
provide
14
care
directed
at
symptom
management
to
be
eligible
to
receive
15
a
license.
16
Under
the
bill,
if
a
patient
who
has
a
terminal
condition,
17
and
is
comatose,
incompetent,
or
incapable
of
communication,
18
and
has
not
expressed
their
desire
regarding
palliative
care
19
or
a
hospice
program,
certain
individuals
in
order
of
priority
20
have
the
authority
to
make
the
decision
to
place
the
patient
in
21
a
hospice
program.
The
individuals
who
have
the
authority
to
22
make
such
a
decision
include
an
attorney
in
fact,
a
guardian,
23
the
patient’s
spouse,
an
adult
child
or
stepchild,
a
parent
24
or
stepparent,
adult
sibling
or
adult
stepsibling,
a
relative
25
of
the
patient,
and
a
close
adult
friend.
The
bill
defines
26
close
adult
friend.
An
individual
making
a
decision
for
such
a
27
patient
shall
be
guided
by
the
express
or
implied
intention
of
28
the
patient
in
making
the
decision.
29
Current
law
provides
that
certain
individuals
in
order
30
of
priority,
including
an
attorney
in
fact,
a
guardian,
31
the
patient’s
spouse,
an
adult
child,
a
parent,
and
an
32
adult
sibling,
have
the
authority
to
withhold
or
withdraw
33
life-sustaining
procedures
from
a
patient
who
has
a
terminal
34
condition,
and
who
is
comatose,
incompetent,
or
incapable
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of
communication,
and
who
has
not
made
a
declaration
for
1
life-sustaining
procedures.
The
bill
broadens
these
categories
2
to
include
stepchildren,
stepparents,
and
stepsiblings,
3
relatives
of
the
patient,
and
a
close
adult
friend
of
the
4
patient.
The
bill
provides
restrictions
on
who
may
act
as
a
5
witness
to
the
consultation
when
the
decision
is
made
with
the
6
patient’s
attending
physician.
7
The
bill
provides
that
resuscitation
may
be
withheld
or
8
withdrawn
from
a
patient
who
has
a
terminal
condition,
and
who
9
is
comatose,
incompetent,
or
incapable
of
communication,
and
10
who
has
not
executed
an
out-of-hospital
do-not-resuscitate
11
order
if
there
is
consultation
and
written
agreement
between
12
the
patient’s
attending
physician
and
certain
individuals,
in
13
order
of
priority,
making
the
decision.
The
individuals
who
14
are
authorized
to
make
such
a
decision
include
an
attorney
15
in
fact,
a
guardian,
the
patient’s
spouse,
an
adult
child
or
16
stepchild,
a
parent
or
stepparent,
adult
sibling
or
adult
17
stepsibling,
a
relative
of
the
patient,
and
a
close
adult
18
friend.
An
individual
making
a
health
care
decision
for
such
a
19
patient
shall
be
guided
by
the
express
or
implied
intention
of
20
the
patient
in
making
the
decision.
A
witness,
as
specified
21
in
the
bill,
shall
be
present
at
the
time
of
consultation
with
22
the
patient’s
attending
physician
when
a
decision
is
made
to
23
withdraw
or
withhold
resuscitation.
24
Current
law
requires
a
guardian
to
obtain
court
approval
25
before
the
guardian
may
consent
to
the
withholding
or
26
withdrawal
of
life-sustaining
procedures
for
a
protected
27
person.
The
bill
makes
an
exception
to
this
requirement
and
28
allows
a
guardian
to
make
a
decision
for
the
protected
person
29
relating
to
hospice
care,
life-sustaining
procedures,
and
30
resuscitation
without
court
approval
in
circumstances
detailed
31
in
the
bill.
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