3. A consulting physician to whom the requester is referred must medically
confirm the attending physician's diagnosis and determination that the requester
meets the requirements for making the request. Any psychologist or psychiatrist to
whom the requester is referred by the attending or consulting physician must
determine and certify in writing that the requester is not suffering from a psychiatric
or psychological disorder, including depression, that causes impaired judgment.
The bill specifies that, if the requester is a resident of a nursing home or
community-based residential facility, at least one of the witnesses to the written
request for medication must be a residents' advocate designated by the Board on
Aging and Long-Term Care. The bill also specifies procedures by which a requester
may revoke a request for medication and provides that making a request for
medication does not revoke or otherwise modify a declaration to physicians or health
care power of attorney that a requester may have. The bill provides that making a
request for medication does not constitute attempted suicide and that taking
medication under a fulfilled request does not constitute suicide. The bill establishes
penalties for certain actions with regard to the request for medication, but prohibits
a health care facility or health care provider from being charged with a crime, being
held civilly liable, or being charged with unprofessional conduct for failing to fulfill
a request (except that an attending physician who refuses to fulfill a valid request
and fails to make a good faith attempt to transfer the requester to another physician
who will fulfill the request may be charged with unprofessional conduct), for
fulfilling a valid request, or for acting contrary to or failing to act on a revocation of
a request unless the health care facility or health care provider has actual knowledge
of the revocation.
This bill also provides that, when a patient dies as a result of a request for
medication under the bill, a physician or other person having knowledge of the death
need not report the death to the sheriff, medical examiner, or coroner of the county
or the police chief of the community where the death took place, as is required for
certain deaths, including suicides, under current law.
Because this bill creates a new crime or revises a penalty for an existing crime,
the Joint Review Committee on Criminal Penalties may be requested to prepare a
report.
For further information see the state and local fiscal estimate, which will be
printed as an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB552,1
1Section 1
. 16.009 (2) (q) of the statutes is created to read:
AB552,3,22
16.009
(2) (q) Designate residents' advocates under s. 156.19.
AB552,2
3Section 2
. 146.82 (2) (a) 8m. of the statutes is created to read:
AB552,3,44
146.82
(2) (a) 8m. To the department under s. 156.09 (8) (g).
AB552,3
5Section 3
. Chapter 156 of the statutes is created to read:
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Chapter 156
7
compassionate choices
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8156.01 Definitions. In this chapter:
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9(1) “Attending physician" means a physician who has primary responsibility
10for the care of the requester and treatment of the requester's terminal disease.
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11(2) “Comfort care" means palliative care, as defined in s. 50.90 (3), or supportive
12care, as defined in s. 50.90 (4).
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13(3) “Consulting physician" means a physician who is qualified by specialty or
14experience to make a professional diagnosis and prognosis with respect to the
15requester's disease.
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16(4) “Department" means the department of health services.
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17(5) “Health care facility" has the meaning given in s. 155.01 (6).
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18(6) “Health care provider" has the meaning given in s. 155.01 (7).
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19(7) “Incapacity" has the meaning given in s. 155.01 (8).
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1(8) “Multipurpose senior center" has the meaning given in s. 155.01 (9).
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2(9) “Patient health care records" has the meaning given in s. 146.81 (4).
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3(10) “Request for medication" means a request for medication under the
4requirements of this chapter for the purpose of ending the requester's life in a
5humane and dignified manner.
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6(11) “Requester" means an individual who makes a request for medication.
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7(12) “Residence" has the meaning given in s. 46.27 (1) (d).
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8(13) “Responsible person" means the attending physician, a health care
9provider serving the requester, an inpatient health care facility in which the
10requester is located, or the requester's spouse, child, parent, brother, sister,
11grandparent, or grandchild.
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12(14) “Social worker" means a person certified under s. 457.08 as a social worker,
13advanced practice social worker, independent social worker, or clinical social worker.
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14(15) “Terminal disease" means an incurable and irreversible disease that has
15been diagnosed by an individual's attending physician and medically confirmed and
16that will, within reasonable medical judgment, cause death within 6 months.
AB552,4,22
17156.03 Authorization to make request. An individual who is of sound mind,
18has attained age 18, has residence in this state, does not have incapacity, and has a
19terminal disease may voluntarily make a request for medication for the purpose of
20ending his or her life in a humane and dignified manner. An individual for whom an
21adjudication of incompetence and appointment of a guardian of the person is in effect
22under ch. 54 is presumed not to be of sound mind for purposes of this section.
AB552,5,4
23156.05 Requester rights, responsibilities, and limitations. (1) No
24requester may receive a prescription that fulfills a request for medication unless he
25or she has made an informed decision. An informed decision under this chapter
1means a decision by an individual to request and obtain a prescription for medication
2so as to end his or her life in a humane and dignified manner that is based on an
3appreciation of the relevant facts and is made after having been fully informed by
4the attending physician of all of the following:
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(a) The individual's medical diagnosis.
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(b) The individual's prognosis.
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(c) The potential risks associated with taking the medication to be prescribed
8under this chapter.
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(d) The probable result of taking the medication to be prescribed under this
10chapter.
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(e) The feasible alternatives, including comfort care, hospice care, and pain
12control.
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13(2) In order to receive a prescription for medication to end his or her life, a
14requester shall do all of the following:
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(a) Make an oral request for medication for the purpose of ending his or her life
16to his or her attending physician.
AB552,5,2017
(b) No fewer than 15 days after making the oral request for medication under
18par. (a), complete a valid written request for medication under s. 156.07. The written
19request under this paragraph may not be completed until a consulting physician
20completes the examination and report required under s. 156.11.
AB552,5,2321
(c) After completing a written request for medication under par. (b), make a 2nd
22oral request for medication for the purpose of ending his or her life to his or her
23attending physician.
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1(3) No requester may be required to notify his or her next of kin regarding his
2or her request for medication, and no request for medication may be denied because
3the requester has failed to notify his or her next of kin.
AB552,6,6
4156.07 Valid written request for medication; requirements. (1) A
5written request for medication under s. 156.05 (2) (b) is valid only if it is all of the
6following:
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(a) In writing.
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(b) Dated and signed by the requester or, at the express direction and in the
9presence of the requester, by an individual who has attained age 18.
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(c) Signed in the presence of 3 witnesses who meet the requirements of sub. (2).
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(d) Made voluntarily.
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(e) Substantially in the form specified in s. 156.15.
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(f) Filed in the requester's patient health care record in the custody of the
14requester's attending physician and, if the requester is an inpatient of a health care
15facility, in the requester's patient health care record in the custody of the health care
16facility.
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17(2) (a) A witness to the making of a valid written request for medication under
18this section shall be an individual who has attained age 18. No witness to the making
19of a valid written request for medication may, at the time of the witnessing, be any
20of the following:
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1. Related to the requester by blood, marriage, or adoption.
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2. An individual who has knowledge that he or she is entitled to or has a claim
23on any portion of the requester's estate.
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3. Directly financially responsible for the requester's health care.
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14. An individual who is a health care provider who is serving the requester at
2the time of the witnessing; an employee, other than a chaplain or a social worker, of
3the health care provider; or an employee, other than a chaplain or a social worker,
4of a health care facility in which the requester is a patient.
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(b) If a requester is a resident of a nursing home or community-based
6residential facility, at least one of the witnesses to the request shall be a residents'
7advocate designated under s. 156.19.
AB552,7,9
8156.09 Attending physician; responsibilities, and limitations. The
9attending physician shall do all of the following:
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10(1) Determine whether the requester has a terminal disease, does not have
11incapacity, and is making a request under this chapter voluntarily.
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12(2) Inform the requester of all of the following:
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(a) The requester's medical diagnosis.
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(b) The requester's prognosis.
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(c) The potential risks associated with taking the medication to be prescribed
16under this chapter.
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(d) The probable result of taking the medication to be prescribed under this
18chapter.
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(e) The feasible alternatives to taking the medication to be prescribed under
20this chapter, including comfort care, hospice care, and pain control.
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21(3) Refer the requester to a consulting physician under the requirements of s.
22156.11.
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23(4) Refer the requester for review and counseling if the referral is determined
24to be appropriate under s. 156.13.
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1(5) Ask the requester to notify his or her next of kin with respect to the request
2for medication.
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3(6) Inform the requester that he or she may revoke the request for medication
4at any time; explain the methods of revocation that are specified under s. 156.17 (1);
5and offer the requester an opportunity to revoke the request at the time, if any, that
6the requester orally asks for medication under s. 156.05 (2) (c).
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7(7) Before writing a prescription that fulfills a request for medication, verify
8that all of the following have occurred:
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(a) The requester has fulfilled the requirements of s. 156.05 (2).
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(b) No fewer than 48 hours have elapsed since the requester made a 2nd oral
11request for medication under s. 156.05 (2) (c).
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(c) The requester has made an informed decision under s. 156.05 (1).
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13(8) Document or file all of the following in the requester's patient health care
14record:
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(a) All occasions that the requester orally asks for medication under s. 156.05
16(2) (a) or (c) as well as all written requests for medication under s. 156.05 (2) (b) that
17are made by the requester.
AB552,8,2018
(b) The attending physician's diagnosis of and prognosis for the requester and
19determination as to whether the requester is incapacitated, is acting voluntarily, and
20has made an informed decision under s. 156.05 (1).
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(c) The consulting physician's diagnosis of and prognosis for the requester and
22determination as to whether the requester is incapacitated, is acting voluntarily, and
23has made an informed decision under s. 156.05 (1).
AB552,8,2524
(d) A certification of the outcome and determinations made during any review
25and counseling for which the requester was referred under s. 156.13.
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1(e) A certification as to whether the attending physician offered the requester
2an opportunity to revoke the request for medication, as required under sub. (6).
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(f) Evidence of a revocation, if made, as specified in s. 156.17 (2).
AB552,9,144
(g) A certification as to whether the requirements of this chapter are met and
5indicating the steps taken to fulfill the request for medication, including a notation
6of any medication that is prescribed. The attending physician shall report the
7information under this paragraph to the department on a form prescribed by the
8department. Information reported to the department under this paragraph that
9could identify the requester, the attending physician, the consulting physician, or the
10psychiatrist or psychologist to whom referral was made under s. 156.13, if any, is
11confidential and may not be disclosed by the department except under an
12investigation of an alleged violation of this chapter. The report of information under
13this paragraph is not a violation of any person's responsibility for maintaining the
14confidentiality of patient health care records under s. 146.82.
AB552,9,21
15(9) If the attending physician refuses to fulfill the requester's request for
16medication that meets the requirements of this chapter, the attending physician
17shall make a good faith attempt to transfer the requester's care and treatment to
18another physician who will act as the attending physician under this chapter and will
19fulfill the requester's request for medication. If a transfer is made, the attending
20physician to whom the requester's care and treatment is transferred shall comply
21with the requirements of this section.
AB552,9,25
22156.11 Consulting physician confirmation. Before an attending physician
23may fulfill a request for medication under this chapter, a consulting physician shall
24examine the requester and his or her relevant patient health care records and shall
25medically confirm the attending physician's determinations that the requester
1suffers from a terminal disease, does not have incapacity, is making a request for
2medication voluntarily, and has made an informed decision. The consulting
3physician shall complete a written report regarding his or her findings and provide
4it to the attending physician for filing in the requester's patient health care record
5in compliance with the certification requirement of s. 156.09 (8) (g).
AB552,10,17
6156.13 Referral for review and counseling. If in the opinion of the
7attending physician or the consulting physician a requester may be suffering from
8a psychiatric or psychological disorder, including depression, that causes impaired
9judgment, the attending physician or consulting physician shall refer the requester
10for review and counseling to a physician specializing in psychiatry or a licensed
11psychologist, as defined in s. 455.01 (4). If a referral is made by the attending or
12consulting physician, no request for medication may be fulfilled under this chapter
13unless the physician specializing in psychiatry, or the psychologist, to whom referral
14was made, determines and certifies in writing that the requester is not suffering from
15a psychiatric or psychological disorder, including depression, that causes impaired
16judgment. The attending physician shall file the certification in the requester's
17patient health care record under s. 156.09 (8) (d).
AB552,11,4
18156.15 Written request for medication; form. The department shall
19prepare and provide copies of a request for medication authorization form and
20accompanying information for distribution in quantities to health care providers,
21hospitals, nursing homes, multipurpose senior centers, county clerks, and local bar
22associations and individually to private persons. The department shall include, in
23information accompanying the copy of the request for medication authorization
24form, at least the statutory definitions of terms used in the request for medication
25authorization form, statutory restrictions on who may be witnesses to a valid request
1for medication under s. 156.07, and a statement explaining that valid witnesses
2acting in good faith are statutorily immune from civil or criminal liability. The
3request for medication authorization form distributed by the department shall be in
4the following form:
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REQUEST FOR MEDICATION
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AUTHORIZATION TO END MY LIFE IN A
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HUMANE AND DIGNIFIED MANNER
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I, .... (insert name), am an adult of sound mind, do not have incapacity, and am
9a resident of Wisconsin.
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I am suffering from .... (insert description of terminal disease), which my
11attending physician has determined is a terminal disease and which has been
12medically confirmed by a consulting physician.
AB552,11,1513
I have been fully informed of my diagnosis, prognosis, the nature of medication
14to be prescribed and potential associated risks, the expected result, and the feasible
15alternatives, including comfort care, hospice care, and pain control.
AB552,11,1716
I request that my attending physician prescribe medication that will end my life
17in a humane and dignified manner.