Wisconsin 2023-2024 Regular Session

Wisconsin Assembly Bill AB781 Compare Versions

Only one version of the bill is available at this time.

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3	3	2023 - 2024 LEGISLATURE
4	4	2023 ASSEMBLY BILL 781
5	5	December 8, 2023 - Introduced by Representatives OHNSTAD, JOERS, PALMERI,
6	6	SNODGRASS, EMERSON, JACOBSON, CONLEY, STUBBS, SINICKI, SUBECK and CLANCY,
7	7	cosponsored by Senators HESSELBEIN, AGARD, CARPENTER, TAYLOR, ROYS and
8	8	SPREITZER. Referred to Committee on Health, Aging and Long-Term Care.
9	9	*AUTHORS SUBJECT TO CHANGE*
10	10	AN ACT to create chapter 156 and 979.01 (1j) of the statutes; relating to:
11	11	permitting certain qualified individuals to make a request for medication for
12	12	the purpose of ending their lives and providing a penalty.
13	13	Analysis by the Legislative Reference Bureau
14	14	This bill permits an individual who is at least 18 years of age, mentally capable,
15	15	and has a terminal disease with a prognosis of less than six months to live to
16	16	voluntarily request a prescription for medication for the purpose of ending his or her
17	17	life. Under the bill, “terminal disease” means an incurable and irreversible disease
18	18	that has been medically confirmed and will, within reasonable medical judgment,
19	19	produce death within six months. The bill authorizes the individual's attending
20	20	provider to issue a prescription for the medication if specified requirements are met.
21	21	Under the bill, an attending or consulting provider must be a licensed physician, an
22	22	advanced practice registered nurse, or a physician assistant. Death following
23	23	self-administering medication in accordance with the requirements of the bill does
24	24	not alone constitute grounds for post-mortem inquiry and such a death may not be
25	25	designated as suicide or homicide.
26	26	The bill requires that the Department of Health Services develop and distribute
27	27	certain standard forms to be used for reporting by attending providers in the context
28	28	of requests for medication under the provisions of the bill.
29	29	The bill establishes certain requirements that must be met before an attending
30	30	provider may issue a prescription in response to an individual's request for a
31	31	prescription for medication to end his or her life. With certain exceptions for an
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37	37	individual who is determined to be within 15 days of death, a qualified individual
38	38	must make an oral request and a written request and reiterate the oral request to
39	39	his or her attending provider no less than 15 days after making the initial oral
40	40	request. The oral and written requests for medical aid in dying may only be made
41	41	by the requesting individual and not by any surrogate decision-maker, health care
42	42	proxy, attorney-in-fact for health care, or through an advance health care directive.
43	43	The written request must be substantially in the form provided in the bill. It must
44	44	be signed and dated by the individual and witnessed by at least one individual who
45	45	meets certain qualifications and attests that the individual is capable, acting
46	46	voluntarily, and is not being coerced or unduly influenced to sign the request.
47	47	The bill requires an attending provider to comply with certain requirements
48	48	with respect to requests for medication under the bill, including 1) determining
49	49	whether an individual has a terminal disease with a prognosis of six months or less
50	50	to live and is mentally capable; 2) confirming that the individual's request does not
51	51	arise from coercion or undue influence; 3) informing the individual of certain
52	52	information specified in the bill, including the potential risks, benefits, and probable
53	53	result of self-administering the prescribed medication; 4) informing the individual
54	54	that there is no obligation to fill the prescription nor an obligation to self-administer
55	55	the medication, even if obtained; 6) providing a referral for comfort care, palliative
56	56	care, hospice care, pain control, or other end-of-life treatment options as requested
57	57	or as medically indicated; 7) referring the individual to a consulting provider for
58	58	medical confirmation that the individual requesting medication under the bill both
59	59	has a terminal disease with a prognosis of six months or less to live and is mentally
60	60	capable; and 8) before providing a prescription, confirming that the individual has
61	61	made an informed decision to obtain medication under the bill, offering the
62	62	individual an opportunity to rescind the request, and educating the individual on the
63	63	recommended procedure for self-administration of the medication, the safe-keeping
64	64	and proper disposal of unused medication, the importance of having another person
65	65	present when the person self-administers the medication, and not taking the
66	66	medication in a public place. Under the bill, a consulting provider must evaluate an
67	67	individual making a request for medication under the provisions of the bill and
68	68	confirm, in writing, to the attending provider that the individual has a terminal
69	69	disease with a prognosis of six months or less to live; that the individual is mentally
70	70	capable or that the consulting provider has referred the individual to a licensed
71	71	mental health provider for further evaluation; and that the individual is acting
72	72	voluntarily, free from coercion or undue influence. The bill requires that if either the
73	73	attending provider or the consulting provider is unable to confirm that the individual
74	74	is capable of making an informed decision, the attending provider or the consulting
75	75	provider must refer the individual to a licensed mental health provider for
76	76	determination regarding mental capability.
77	77	The bill specifies that a provider may choose whether or not to practice medical
78	78	aid in dying under the provisions of the bill, but if a provider is unable or unwilling
79	79	to fulfill an individual's request for medication under the bill, the provider must still
80	80	document the date of the individual's request in the patient's medical record and, if
81	81	requested, transfer the individual's medical records to a new provider. The bill also - 3 -2023 - 2024 Legislature
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85	85	specifies that a health care facility may prohibit providers from qualifying,
86	86	prescribing, or dispensing medication under the provisions of the bill while
87	87	performing duties for the facility, but if it does so, it must provide advance notice to
88	88	providers and staff in writing, and then on a yearly basis. If an individual wishes
89	89	to transfer to another facility, the facility must coordinate a timely transfer. Finally,
90	90	no health care facility may prohibit a provider from fulfilling the requirements of
91	91	informed consent and meeting the medical standard of care, including by allowing
92	92	a provider to prescribe medication under the provisions of the bill outside of the scope
93	93	of the provider's employment or contract with the prohibiting facility and off the
94	94	premises of the the prohibiting facility.
95	95	The bill includes immunity for actions taken in good faith, but also includes
96	96	penalties for intentionally or knowingly 1) altering or forging an individual's request
97	97	for medication under the bill; 2) concealing or destroying a rescission of a request for
98	98	medication under the bill; or 3) coercing or exerting undue influence on an individual
99	99	with a terminal disease to request or use medication under the bill. The bill expressly
100	100	does not not limit civil liability or damages arising from negligent conduct or
101	101	intentional misconduct.
102	102	Under the bill, insurance, including insurance rates, may not be conditioned on
103	103	or affected by an individual's act of making or rescinding a request for medication
104	104	under the provisions of the bill. Further, a qualified individual's act of
105	105	self-administering medication consistent with the provisions of the bill does not
106	106	invalidate any part of a life, health, or accident insurance policy, or an annuity policy.
107	107	Finally, no insurance plan may deny or alter benefits to an individual with a terminal
108	108	disease who is a covered beneficiary based on the availability of medical aid in dying,
109	109	the individual's request for medication under the provisions of the bill, or the absence
110	110	of such a request.
111	111	Because this bill creates a new crime or revises a penalty for an existing crime,
112	112	the Joint Review Committee on Criminal Penalties may be requested to prepare a
113	113	report.
114	114	For further information see the state fiscal estimate, which will be printed as
115	115	an appendix to this bill.
116	116	The people of the state of Wisconsin, represented in senate and assembly, do
117	117	enact as follows:
118	118	SECTION 1. Chapter 156 of the statutes is created to read:
119	119	CHAPTER 156
120	120	MEDICAL AID IN DYING
121	121	156.01 Short title. This chapter shall be known and may be cited as the “Our
122	122	Care, Our Options Act."
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130	130	156.03 Definitions. In this chapter:
131	131	(1) “Adult” means an individual who is 18 years of age or older.
132	132	(2) “Attending provider” means the provider who has primary responsibility
133	133	for the care of an individual and treatment of that individual's terminal disease.
134	134	(3) “Coercion or undue influence” means the willful attempt, whether by
135	135	deception, intimidation, or any other means, to do any of the following:
136	136	(a) Cause an individual to request, obtain, or self-administer medication under
137	137	this chapter with intent to cause the death of the individual.
138	138	(b) Prevent a qualified individual from obtaining or self-administering
139	139	medication under this chapter.
140	140	(4) “Consulting provider” means a provider who is qualified by specialty or
141	141	experience to make a professional diagnosis and prognosis regarding an individual's
142	142	disease.
143	143	(5) “Department” means the department of health services.
144	144	(6) “Health care facility” means a general hospital, medical clinic, nursing
145	145	home, or in-patient hospice facility or any other entity regulated under ch. 50. A
146	146	health care facility does not include individual providers.
147	147	(7) “Informed decision” means a decision by a qualified individual to request
148	148	and obtain a prescription for medication under this chapter that the qualified
149	149	individual may self-administer to bring about his or her peaceful death, after being
150	150	fully informed by the individual's attending provider of all of the following:
151	151	(a) The individual's diagnosis and prognosis.
152	152	(b) The potential risks associated with taking the medication to be prescribed.
153	153	(c) The probable result of taking the medication to be prescribed.
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182	182	(d) The feasible end-of-life care and treatment options for the individual's
183	183	terminal disease, including comfort care, palliative care, hospice care, and pain
184	184	control, and the risks and benefits of each.
185	185	(e) The individual's right to withdraw a request under this chapter or consent
186	186	for any other treatment at any time.
187	187	(8) Notwithstanding sub. (13), “licensed mental health care provider” means
188	188	a psychiatrist, psychologist, clinical social worker, psychiatric nurse practitioner,
189	189	clinical mental health counselor, or clinical professional counselor licensed, certified,
190	190	or otherwise credentialed in this state.
191	191	(9) “Medical aid in dying” means the practice of evaluating a request,
192	192	determining qualification, and providing a prescription to a qualified individual
193	193	under this chapter.
194	194	(10) “Medically confirmed” means that a consulting provider, after performing
195	195	a medical evaluation, has confirmed an attending provider's medical opinion that an
196	196	individual is eligible to receive medication under this chapter.
197	197	(11) “Mentally capable” means that in the opinion of an attending provider or
198	198	consulting provider, or a licensed mental health care provider if a determination is
199	199	requested under s. 156.17, an individual requesting medication under this chapter
200	200	has the ability to make and communicate an informed decision.
201	201	(12) “Prognosis of 6 months or less” means an individual's terminal disease
202	202	will, within reasonable medical judgment, result in the death of that individual
203	203	within 6 months.
204	204	(13) “Provider” means a person licensed, certified, or otherwise authorized or
205	205	permitted by this state to diagnose and treat medical conditions and prescribe and
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232	232	dispense medication, including controlled substances, but does not include a health
233	233	care facility. Provider includes any of the following:
234	234	(a) A physician licensed under ch. 448.
235	235	(b) An advanced practice registered nurse, as defined in s. 154.01 (1g).
236	236	(c) A physician assistant licensed under subch. IX of ch. 448.
237	237	(14) “Qualified individual” means a mentally capable adult who has satisfied
238	238	the requirements of this chapter in order to obtain a prescription for medication to
239	239	bring about a peaceful death. No person will be considered a “qualified individual”
240	240	under this chapter solely because of advanced age or disability.
241	241	(15) “Self-administer” means a qualified individual performs an affirmative,
242	242	conscious, and voluntary act to ingest medication prescribed under this chapter to
243	243	bring about the individual's peaceful death. Self-administration does not include
244	244	administration by intravenous or other parenteral injection or infusion.
245	245	(16) “Terminal disease” means an incurable and irreversible disease that has
246	246	been medically confirmed and will, within reasonable medical judgment, produce
247	247	death within 6 months.
248	248	156.05 Informed consent. (1) Nothing in this chapter may be construed to
249	249	limit the information a provider must provide to an individual in order to comply
250	250	with the medical standard of care and with informed consent requirements under
251	251	state law.
252	252	(2) If a provider is unable or unwilling to fulfill a request for medication under
253	253	this chapter, the provider shall proceed as required under s. 156.21 (2).
254	254	(3) Failure by a provider to provide information about medical aid in dying to
255	255	an individual who requests it, or failure to refer the individual to another provider
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284	284	who can provide the information upon request, shall constitute a failure to obtain
285	285	informed consent for subsequent medical treatments.
286	286	156.07 Standard of care. (1) Care that complies with the requirements of
287	287	this chapter meets the medical standard of care.
288	288	(2) Nothing in this chapter exempts a provider or other medical personnel from
289	289	meeting the medical standard of care for the treatment of individuals with a terminal
290	290	disease.
291	291	156.09 Qualification. (1) A mentally capable adult with a terminal disease
292	292	and a prognosis of 6 months or less may request a prescription for medication under
293	293	this chapter. A qualified individual shall have made an oral request and a written
294	294	request, and reiterated the oral request to the individual's attending provider no less
295	295	than 15 days after making the initial oral request.
296	296	(2) The attending provider and consulting provider of a qualified individual
297	297	shall have met each of their respective requirements as set forth in ss. 156.13 and
298	298	156.15.
299	299	(3) Notwithstanding sub. (1), if an individual's attending provider has
300	300	medically determined that the individual will, within reasonable medical judgment,
301	301	die within 15 days after making an initial oral request under sub. (1), the 15-day
302	302	waiting period set forth in sub. (1) is waived and the individual may reiterate the oral
303	303	request to the attending provider as required under sub. (1) at any time after making
304	304	the initial oral request.
305	305	(4) At the time an individual makes the second oral request under sub. (1), the
306	306	individual's attending provider shall offer the individual an opportunity to rescind
307	307	the request.
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334	334	(5) Oral and written requests under sub. (1) for medical aid in dying may be
335	335	made only by the requesting individual and may not be made by the individual's
336	336	surrogate decision-maker, health care proxy, attorney-in-fact for health care, or
337	337	through an advance health care directive.
338	338	(6) If an individual decides to transfer care to another provider, the former
339	339	provider shall transfer all relevant medical records, including written
340	340	documentation of the date of the individual's request or requests concerning medical
341	341	aid in dying.
342	342	156.11 Form of written request. (1) A valid written request for medication
343	343	under this chapter shall be signed and dated by the requesting individual and
344	344	witnessed by at least one person who, in the presence of the requesting individual,
345	345	attests that, to the best of the witness's knowledge and belief, the individual is
346	346	capable, acting voluntarily, and is not being coerced nor unduly influenced to sign the
347	347	request.
348	348	(2) The witness required under this section must be a person who is not any
349	349	of the following:
350	350	(a) A relative of the requesting individual by blood, marriage, or adoption.
351	351	(b) A person who, at the time the request is signed, would be entitled to any
352	352	portion of the estate of the requesting individual upon death under any will or by
353	353	operation of law.
354	354	(c) An owner, operator, or employee of a health care facility where the
355	355	requesting individual is receiving medical treatment or is a resident.
356	356	(3) The requesting individual's attending provider at the time the request is
357	357	signed may not be a witness.
358	358	(4) The requesting individual's interpreter may not be a witness.
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388	388	(5) The written request for medication shall be in substantially the following
389	389	form:
390	390	REQUEST FOR MEDICATION
391	391	TO END MY LIFE IN A
392	392	PEACEFUL MANNER
393	393	I, .... (insert name), am an adult of sound mind. I have been diagnosed with ....
394	394	(insert description of terminal disease), and given a prognosis of 6 months or less to
395	395	live.
396	396	I have been fully informed of the feasible alternative, concurrent, or additional
397	397	treatment opportunities for my terminal disease, including comfort care, palliative
398	398	care, hospice care, or pain control, and the potential risks and benefits of each. I have
399	399	been offered or received resources or referrals to pursue these alternative,
400	400	concurrent, or additional treatment opportunities for my terminal disease.
401	401	I have been fully informed of the nature of the medication to be prescribed and
402	402	the risks and benefits, including that the likely outcome of self-administering the
403	403	medication is death. I understand that I can rescind this request at any time and that
404	404	I am under no obligation to fill the prescription once written nor to self-administer
405	405	the medication if I obtain it.
406	406	I request that my attending provider furnish a prescription for medication that
407	407	will end my life in a peaceful manner if I choose to self-administer it, and I authorize
408	408	my attending provider to contact a pharmacist to dispense the prescription at a time
409	409	of my choosing.
410	410	I make this request voluntarily, free from coercion or undue influence.
411	411	Signed: ....
412	412	Dated: ....
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440	440	Witness Signature: ....
441	441	Dated: ....
442	442	156.13 Attending provider responsibilities. (1) The attending provider
443	443	for an individual shall do all of the following with regard to requests for medication
444	444	under this chapter:
445	445	(a) Determine whether the individual has a terminal disease with a prognosis
446	446	of 6 months or less and is mentally capable.
447	447	(b) Confirm that the individual's request for medication under this chapter does
448	448	not arise from coercion or undue influence by asking the individual about coercion
449	449	and influence outside the presence of other persons, except for an interpreter if
450	450	necessary.
451	451	(c) Inform the individual of all of the following:
452	452	1. The individual's diagnosis.
453	453	2. The individual's prognosis.
454	454	3. The potential risks, benefits, and probable result of self-administering the
455	455	prescribed medication to bring about a peaceful death.
456	456	4. The potential benefits and risks of feasible alternatives, including
457	457	concurrent or additional treatment options for the individual's terminal disease,
458	458	palliative care, comfort care, hospice care, and pain control.
459	459	5. The individual's right to rescind the request for medication under this
460	460	chapter at any time and in any manner.
461	461	(d) Inform the individual that there is no obligation to fill the prescription nor
462	462	an obligation to self-administer the medication if it is obtained.
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490	490	(e) Provide the individual with a referral for comfort care, palliative care,
491	491	hospice care, pain control, or any other end-of-life treatment option as requested or
492	492	as clinically indicated.
493	493	(f) Refer the individual to a consulting provider for medical confirmation that
494	494	the individual requesting medication under this chapter both has a terminal disease
495	495	with a prognosis of 6 months or less and is mentally capable.
496	496	(g) Include the consulting provider's written determination, as provided under
497	497	s. 156.15, in the individual's medical record.
498	498	(h) Refer the individual to a licensed mental health care provider if the
499	499	attending provider observes signs that the individual may not be capable of making
500	500	an informed decision.
501	501	(i) Include the licensed mental health care provider's written determination,
502	502	as provided under s. 156.17, in the individual's medical record if such determination
503	503	was requested.
504	504	(j) Inform the individual of the benefits of notifying next of kin of the
505	505	individual's decision to request medication under this chapter.
506	506	(k) Fulfill all medical record documentation requirements.
507	507	(L) Ensure that all procedures required in order to fulfill a request for
508	508	medication under this chapter are followed before providing a prescription to a
509	509	qualified individual for medication under this chapter, including all of the following:
510	510	1. Confirm that the individual has made an informed decision to obtain a
511	511	prescription for medication under this chapter.
512	512	2. Offer the individual an opportunity to rescind the request for medication
513	513	under this chapter.
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540	540	3. Educate the individual on the recommended procedure for
541	541	self-administering the medication to be prescribed; the safekeeping and proper
542	542	disposal of unused medication in accordance with state and federal law; the
543	543	importance of having another person present when the individual self-administers
544	544	the medication to be prescribed; and not taking the medication in a public place.
545	545	(m) Deliver the prescription personally, by mail, or through an authorized
546	546	electronic transmission to a licensed pharmacist who will dispense the medication,
547	547	including any ancillary medications, to the attending provider, to the qualified
548	548	individual, or to an individual expressly designated by the qualified individual in
549	549	person or with a signature required on delivery, by mail service or by messenger
550	550	service, or, if authorized by the federal drug enforcement agency, dispense the
551	551	prescribed medication, including any ancillary medications, to the qualified
552	552	individual or an individual expressly designated by the qualified individual in
553	553	person.
554	554	(n) Document in the qualified individual's medical record the individual's
555	555	diagnosis and prognosis, determination of mental capability, the date of the oral
556	556	request or requests, a copy of the written request, a notation that the requirements
557	557	under this chapter have been completed, and identification of the medication and
558	558	ancillary medications prescribed to the qualified individual under this chapter.
559	559	(2) Notwithstanding any other provision of law, the attending provider may
560	560	sign the individual's death certificate.
561	561	156.15 Consulting provider responsibilities. A consulting provider for an
562	562	individual shall do all of the following with regard to requests for medication under
563	563	this chapter:
564	564	(1) Evaluate the individual and the individual's relevant medical records.
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592	592	SECTION 1
593	593	ASSEMBLY BILL 781
594	594	(2) Confirm, in writing, to the individual's attending provider that all of the
595	595	following are true:
596	596	(a) The individual has a terminal disease with prognosis of 6 months or less.
597	597	(b) The individual is mentally capable. If the consulting provider is unable to
598	598	confirm that the individual is mentally capable, the consulting provider shall provide
599	599	documentation that the consulting provider has referred the individual for further
600	600	evaluation in accordance with s. 156.17.
601	601	(c) The individual is acting voluntarily, free from coercion or undue influence.
602	602	156.17 Referral for confirmation that the requesting individual is
603	603	mentally capable. (1) If either an attending provider or a consulting provider is
604	604	unable to confirm that an individual making a request for medication under this
605	605	chapter is capable of making an informed decision, the attending provider or the
606	606	consulting provider shall refer the individual to a licensed mental health care
607	607	provider for determination regarding mental capability.
608	608	(2) The licensed mental health care provider who evaluates the individual
609	609	under this section shall submit to the requesting attending provider or consulting
610	610	provider a written determination of whether the individual is mentally capable.
611	611	(3) If the licensed mental health care provider determines that the individual
612	612	is not mentally capable, the individual may not be deemed a qualified individual and
613	613	the attending provider may not prescribe medication to the individual under this
614	614	chapter.
615	615	156.19 Safe disposal of unused medications. A person who has custody or
616	616	control of medication prescribed under this chapter after a qualified individual's
617	617	death shall dispose of the medication by lawful means in accordance with state and
618	618	federal guidelines.
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645	645	SECTION 1 ASSEMBLY BILL 781
646	646	156.21 No duty to provide medical aid in dying. (1) A provider shall
647	647	provide sufficient information to an individual with a terminal disease regarding
648	648	available options, the alternatives, and the foreseeable risks and benefits of each
649	649	option so that the individual is able to make informed decisions regarding his or her
650	650	end-of-life health care, but a provider may choose whether or not to practice medical
651	651	aid in dying under this chapter.
652	652	(2) If a provider is unable or unwilling to fulfill an individual's request for
653	653	medication under this chapter, the provider shall do all of the following:
654	654	(a) Document the date of the individual's request in the individual's medical
655	655	record.
656	656	(b) Upon the individual's request, transfer the individual's medical records to
657	657	the new provider, consistent with federal and state law.
658	658	(3) A provider may not engage in false, misleading, or deceptive practices
659	659	relating to the provider's willingness to qualify an individual or provide a
660	660	prescription to a qualified individual under this chapter. Intentionally misleading
661	661	an individual constitutes coercion or undue influence.
662	662	156.23 Health care facility permissible prohibitions and duties. (1) A
663	663	health care facility may prohibit providers from qualifying, prescribing, or
664	664	dispensing medication under this chapter while performing duties for the facility.
665	665	A prohibiting facility must provide express advance notice in writing at the time of
666	666	hiring, contracting with, or privileging providers and staff, and on a yearly basis
667	667	thereafter. A health care facility that fails to provide advance notice in writing
668	668	waives the right to enforce any prohibition.
669	669	(2) If an individual who is a patient at a prohibiting health care facility, as
670	670	described under sub. (1), and who has made a request concerning medical aid in
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698	698	SECTION 1
699	699	ASSEMBLY BILL 781
700	700	dying wishes to transfer care to another health care facility, the prohibiting facility
701	701	shall coordinate a timely transfer, including transfer of the individual's medical
702	702	records that include notation of the date the individual first made a request
703	703	concerning medical aid in dying.
704	704	(3) No health care facility may prohibit a provider from doing any of the
705	705	following in fulfilling the requirements of informed consent and meeting the medical
706	706	of standard of care:
707	707	(a) Providing information to an individual regarding the individual's health
708	708	status, including diagnosis, prognosis, recommended treatment, treatment
709	709	alternatives, and any potential risks to the individual's health.
710	710	(b) Providing information about available services, including health care
711	711	services available under this chapter, information about relevant community
712	712	resources, and information about how to access those resources to obtain the care of
713	713	the individual's choice.
714	714	(c) Prescribing medication under this chapter for a qualified individual outside
715	715	the scope of the provider's employment or contract with the prohibiting facility and
716	716	off the premises of the prohibiting facility.
717	717	(d) Being present when a qualified individual self-administers medication
718	718	prescribed under this chapter or at the time of death, if requested by the qualified
719	719	individual or his or her representative and if outside the scope of the provider's
720	720	employment or contractual duties with the prohibiting facility.
721	721	(4) A health care facility may not engage in false, misleading, or deceptive
722	722	practices relating to its policy regarding end-of-life care services, including whether
723	723	it has a policy that prohibits affiliated providers from determining an individual's
724	724	qualification for medical aid in dying or writing a prescription for a qualified
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751	751	SECTION 1 ASSEMBLY BILL 781
752	752	individual under this chapter. A health care facility may not intentionally deny an
753	753	individual access to medication under this chapter by failing to transfer an
754	754	individual and the individual's medical records to another provider in a timely
755	755	manner. Intentionally misleading an individual or deploying misinformation to
756	756	obstruct access to services under this chapter constitutes coercion or undue
757	757	influence.
758	758	(5) If any part of this chapter is found to be in conflict with federal requirements
759	759	that are a prescribed condition for the receipt of federal funds, the conflicting part
760	760	of this chapter is inoperative solely to the extent of the conflict with respect to the
761	761	facility directly affected, and such finding or determination does not affect the
762	762	operation of the remainder of the chapter.
763	763	156.25 Immunities for actions in good faith; prohibition against
764	764	reprisals. (1) No person or health care facility shall be subject to civil or criminal
765	765	liability or professional disciplinary action, including censure, suspension, loss of
766	766	license, loss of privileges, loss of membership, or any other penalty, for engaging in
767	767	good faith compliance with this chapter.
768	768	(2) No provider, health care facility, professional organization, or association
769	769	shall subject a provider to discharge, demotion, censure, discipline, suspension, loss
770	770	of license, loss of privileges, loss of membership, discrimination, or any other penalty
771	771	for providing medical aid in dying in accordance with the medical standard of care
772	772	and in good faith under this chapter, except if a provider acts in violation of a health
773	773	care facility's valid prohibition or prohibitions under s. 156.23.
774	774	(3) No provider, health care facility, professional organization, or association
775	775	shall subject a provider to discharge, demotion, censure, discipline, suspension, loss
776	776	of license, loss of privileges, loss of membership, discrimination, or any other penalty
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804	804	SECTION 1
805	805	ASSEMBLY BILL 781
806	806	for providing medical aid in dying in accordance with the medical standard of care
807	807	and in good faith under this chapter while engaged in the outside practice of medicine
808	808	and off the facility premises or for providing scientific and accurate information
809	809	about medical aid in dying to an individual when discussing end-of-life care options.
810	810	(4) An individual is not subject to civil or criminal liability or professional
811	811	discipline if, at the request of a qualified individual, the individual is present outside
812	812	the scope of the individual's employment contract and off the facility premises when
813	813	the qualified individual self-administers medication under this chapter or at the
814	814	time of death. An individual who is present may, without civil or criminal liability,
815	815	assist the qualified individual by preparing the medication prescribed under this
816	816	chapter.
817	817	(5) A request by an individual for and the provision of medication under this
818	818	chapter alone does not constitute neglect or elder abuse for any purpose of law, nor
819	819	shall it be the sole basis for appointment of a guardian or conservator.
820	820	(6) This chapter does not limit civil liability for intentional or negligent
821	821	misconduct.
822	822	156.27 Reporting requirements. (1) The department shall create a
823	823	checklist form and a follow-up form for attending providers to facilitate collection of
824	824	the information described in this chapter and post these forms to the department's
825	825	Internet site.
826	826	(2) Within 30 calendar days of providing a prescription for medication under
827	827	this chapter, an attending provider shall submit to the department a completed
828	828	checklist form, as provided under sub. (1), with all of the following information:
829	829	(a) The qualified individual's name and date of birth.
830	830	(b) The qualified individual's terminal diagnosis and prognosis.
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857	857	SECTION 1 ASSEMBLY BILL 781
858	858	(c) Notice that the requirements under this chapter have been completed.
859	859	(d) Notice that medication has been prescribed under this chapter.
860	860	(3) Within 60 calendar days of notification of a qualified individual's death from
861	861	self-administration of medication prescribed under this chapter, the attending
862	862	provider shall submit to the department a follow up form, as provided under sub. (1),
863	863	with all of the following information:
864	864	(a) The qualified individual's name and date of birth.
865	865	(b) The date of the qualified individual's death.
866	866	(c) A notation of whether or not the qualified individual was enrolled in hospice
867	867	services at the time of the qualified individual's death.
868	868	(4) The department shall annually review a sample of records related to
869	869	requests under this chapter to ensure compliance and issue a public statistical
870	870	report. The report shall not include any identifying information and shall be limited
871	871	to the following statistical information:
872	872	(a) The number of prescriptions for medication written under this chapter.
873	873	(b) The number of providers who wrote prescriptions for medication under this
874	874	chapter.
875	875	(c) The number of qualified individuals who died following self-administration
876	876	of medication prescribed and dispensed under this chapter.
877	877	(5) Except as otherwise required by law, the information collected by the
878	878	department that is related to requests under this chapter is not a public record and
879	879	is not available for public inspection under s. 19.35.
880	880	(6) Willful failure or refusal to timely submit records required under this
881	881	chapter nullifies protections under s. 156.25.
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908	908	SECTION 1
909	909	ASSEMBLY BILL 781
910	910	156.29 Effect on construction of will, contracts, and statutes. (1) No
911	911	provision in a contract, will, or other agreement, whether written or oral, that would
912	912	determine whether an individual may make or rescind a request under this chapter
913	913	is valid.
914	914	(2) No obligation owing under any existing contract may be conditioned or
915	915	affected by an individual's act of making or rescinding a request under this chapter.
916	916	(3) It is unlawful for an insurer to deny or alter health care benefits otherwise
917	917	available to an individual with a terminal disease based on the availability of
918	918	medical aid in dying or to otherwise attempt to coerce an individual with a terminal
919	919	disease to make a request for medical aid-in-dying medication.
920	920	156.31 Insurance or annuity policies. (1) Neither the sale, procurement,
921	921	or issuance of a life, health, or accident insurance policy or an annuity policy nor the
922	922	rate charged for such a policy may be conditioned upon or affected by an individual's
923	923	act of making or rescinding a request for medication under this chapter.
924	924	(2) A qualified individual's act of self-administering medication under this
925	925	chapter does not invalidate any part of a life, health, or accident insurance policy or
926	926	an annuity policy.
927	927	(3) An insurance plan, including the Medical Assistance program under subch.
928	928	IV of ch. 49, may not deny or alter benefits to an individual with a terminal disease
929	929	who is a covered beneficiary of an insurance plan based on the availability of medical
930	930	aid in dying, the individual's request for medication under this chapter, or the
931	931	absence of a request for medication under this chapter. Failure to meet this
932	932	requirement shall constitute a violation of the insurance code of this state.
933	933	156.33 Death certificate. (1) Unless otherwise prohibited by law, an
934	934	attending provider or a hospice medical director may sign the death certificate of a
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961	961	SECTION 1 ASSEMBLY BILL 781
962	962	qualified individual who obtained and self-administered a prescription for
963	963	medication under this chapter.
964	964	(2) When a death has occurred in accordance with this chapter, the death shall
965	965	be attributed to the underlying terminal disease.
966	966	(3) A death following self-administering medication under this chapter does
967	967	not alone constitute grounds for post-mortem inquiry.
968	968	(4) A death in accordance with this chapter may not be designated as suicide
969	969	or homicide.
970	970	(5) A qualified individual's act of self-administering medication prescribed
971	971	under this chapter may not be indicated on the individual's death certificate.
972	972	(6) A coroner may conduct a preliminary investigation to determine whether
973	973	an individual received a prescription for medication under this chapter.
974	974	156.35 Liabilities and penalties. (1) Intentionally or knowingly altering
975	975	or forging an individual's request for medication under this chapter or concealing or
976	976	destroying a rescission of a request for medication under this chapter is a Class F
977	977	felony.
978	978	(2) Intentionally or knowingly exercising coercion or undue influence on an
979	979	individual with a terminal disease to request or use medication under this chapter
980	980	is a Class F felony.
981	981	(3) Nothing in this chapter limits civil liability nor damages arising from
982	982	negligent conduct or intentional misconduct, including failure to obtain informed
983	983	consent by any person, provider, or health care facility.
984	984	(4) The penalties specified in this chapter do not preclude criminal penalties
985	985	applicable under other laws for conduct inconsistent with this chapter.
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1012	1012	SECTION 1
1013	1013	ASSEMBLY BILL 781
1014	1014	(5) For purposes of this chapter, “intentionally” has the meaning given under
1015	1015	s. 939.23.
1016	1016	156.37 Claims by governmental entity for costs incurred. Any
1017	1017	governmental entity that incurs costs resulting from self-administration of
1018	1018	medication prescribed under this chapter in a public place has a claim against the
1019	1019	estate of the qualified individual to recover those costs and, notwithstanding s.
1020	1020	814.04 (1), reasonable attorney fees and costs incurred in enforcing the claim.
1021	1021	156.39 Construction. (1) Nothing in this chapter authorizes a provider or
1022	1022	any other person, including a qualified individual, to end the qualified individual's
1023	1023	life by intravenous or other parenteral injection or infusion, mercy killing, homicide,
1024	1024	murder, manslaughter, euthanasia, or any other criminal act.
1025	1025	(2) Actions taken in accordance with this chapter do not, for any purposes,
1026	1026	constitute suicide, assisted suicide, euthanasia, mercy killing, homicide, murder,
1027	1027	manslaughter, elder abuse or neglect, or any other civil or criminal violation under
1028	1028	the law.
1029	1029	SECTION 2. 979.01 (1j) of the statutes is created to read:
1030	1030	979.01 (1j) Subsection (1) does not apply to a death that results from taking
1031	1031	medication under a fulfilled request for medication that meets the requirements of
1032	1032	ch. 156.
1033	1033	SECTION 3.0Nonstatutory provisions.
1034	1034	(1) No later than 45 days after the effective date of this subsection, the
1035	1035	department of health services shall create the checklist form and the follow-up form
1036	1036	required under s. 156.27 (1).
1037	1037	SECTION 4.0Effective date.
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1063	1063	SECTION 4 ASSEMBLY BILL 781
1064	1064	(1) This act takes effect on the first day of the 7th month beginning after
1065	1065	publication.
1066	1066	(END)
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