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AB1078,4,4 3(2) “Attending provider” means the provider who has primary responsibility
4for the care of an individual and treatment of that individual's terminal disease.
AB1078,4,6 5(3) “Coercion or undue influence” means the willful attempt, whether by
6deception, intimidation, or any other means, to do any of the following:
AB1078,4,87 (a) Cause an individual to request, obtain, or self-administer medication under
8this chapter with intent to cause the death of the individual.
AB1078,4,109 (b) Prevent a qualified individual from obtaining or self-administering
10medication under this chapter.
AB1078,4,13 11(4) “Consulting provider” means a provider who is qualified by specialty or
12experience to make a professional diagnosis and prognosis regarding an individual's
13disease.
AB1078,4,14 14(5) “Department” means the department of health services.
AB1078,4,17 15(6) “Health care facility” means a general hospital, medical clinic, nursing
16home, or in-patient hospice facility or any other entity regulated under ch. 50. A
17health care facility does not include individual providers.
AB1078,4,21 18(7) “Informed decision” means a decision by a qualified individual to request
19and obtain a prescription for medication under this chapter that the qualified
20individual may self-administer to bring about his or her peaceful death, after being
21fully informed by the individual's attending provider of all of the following:
AB1078,4,2222 (a) The individual's diagnosis and prognosis.
AB1078,4,2323 (b) The potential risks associated with taking the medication to be prescribed.
AB1078,4,2424 (c) The probable result of taking the medication to be prescribed.
AB1078,5,3
1(d) The feasible end-of-life care and treatment options for the individual's
2terminal disease, including comfort care, palliative care, hospice care and pain
3control, and the risks and benefits of each.
AB1078,5,54 (e) The individual's right to withdraw a request under this chapter or consent
5for any other treatment at any time.
AB1078,5,9 6(8) Notwithstanding sub. (13), “licensed mental health care provider” means
7a psychiatrist, psychologist, clinical social worker, psychiatric nurse practitioner,
8clinical mental health counselor, or clinical professional counselor licensed, certified,
9or otherwise credentialed in this state.
AB1078,5,12 10(9) “Medical aid in dying” means the practice of evaluating a request,
11determining qualification, and providing a prescription to a qualified individual
12under this chapter.
AB1078,5,15 13(10) “Medically confirmed” means that a consulting provider, after performing
14a medical evaluation, has confirmed an attending provider's medical opinion that an
15individual is eligible to receive medication under this chapter.
AB1078,5,19 16(11) “Mentally capable” means that in the opinion of an attending provider or
17consulting provider, or a licensed mental health care provider if a determination is
18requested under s. 156.17, an individual requesting medication under this chapter
19has the ability to make and communicate an informed decision.
AB1078,5,22 20(12) “Prognosis of six months or less” means an individual's terminal disease
21will, within reasonable medical judgment, result in the death of that individual
22within six months.
AB1078,6,2 23(13) “Provider” means a person licensed, certified, or otherwise authorized or
24permitted by this state to diagnose and treat medical conditions and prescribe and

1dispense medication, including controlled substances, but does not include a health
2care facility. Provider includes any of the following:
AB1078,6,33 (a) A physician licensed under ch. 448.
AB1078,6,44 (b) An advanced practice registered nurse, as defined in s. 154.01 (1g).
AB1078,6,55 (c) A physician assistant licensed under subch. VIII of ch. 448.
AB1078,6,9 6(14) “Qualified individual” means a mentally capable adult who has satisfied
7the requirements of this chapter in order to obtain a prescription for medication to
8bring about a peaceful death. No person will be considered a “qualified individual”
9under this chapter solely because of advanced age or disability.
AB1078,6,13 10(15) “Self-administer” means a qualified individual performs an affirmative,
11conscious, and voluntary act to ingest medication prescribed under this chapter to
12bring about the individual's peaceful death. Self-administration does not include
13administration by intravenous or other parenteral injection or infusion.
AB1078,6,16 14(16) “Terminal disease” means an incurable and irreversible disease that has
15been medically confirmed and will, within reasonable medical judgment, produce
16death within six months.
AB1078,6,20 17156.05 Informed consent. (1) Nothing in this chapter may be construed to
18limit the information a provider must provide to an individual in order to comply
19with the medical standard of care and with informed consent requirements under
20state law.
AB1078,6,22 21(2) If a provider is unable or unwilling to fulfill a request for medication under
22this chapter, the provider shall proceed as required under s. 156.21 (2).
AB1078,7,2 23(3) Failure by a provider to provide information about medical aid in dying to
24an individual who requests it, or failure to refer the individual to another provider

1who can provide the information upon request, shall constitute a failure to obtain
2informed consent for subsequent medical treatments.
AB1078,7,4 3156.07 Standard of care. (1) Care that complies with the requirements of
4this chapter meets the medical standard of care.
AB1078,7,7 5(2) Nothing in this chapter exempts a provider or other medical personnel from
6meeting the medical standard of care for the treatment of individuals with a terminal
7disease.
AB1078,7,12 8156.09 Qualification. (1) A mentally capable adult with a terminal disease
9and a prognosis of six months or less may request a prescription for medication under
10this chapter. A qualified individual shall have made an oral request and a written
11request, and reiterated the oral request to the individual's attending provider no less
12than 15 days after making the initial oral request.
AB1078,7,15 13(2) The attending provider and consulting provider of a qualified individual
14shall have met each of their respective requirements as set forth in ss. 156.13 and
15156.15.
AB1078,7,21 16(3) Notwithstanding sub. (1), if an individual's attending provider has
17medically determined that the individual will, within reasonable medical judgment,
18die within 15 days after making an initial oral request under sub. (1), the 15-day
19waiting period set forth in sub. (1) is waived and the individual may reiterate the oral
20request to the attending provider as required under sub. (1) at any time after making
21the initial oral request.
AB1078,7,23 22(4) At the time an individual makes the second oral request, the individual's
23attending provider shall offer the individual an opportunity to rescind the request.
AB1078,8,2 24(5) Oral and written requests for medical aid in dying may be made only by the
25requesting individual and may not be made by the individual's surrogate

1decision-maker, health care proxy, attorney-in-fact for health care, or through an
2advance health care directive.
AB1078,8,6 3(6) If an individual decides to transfer care to another provider, the former
4provider shall transfer all relevant medical records, including written
5documentation of the date of the individual's request or requests concerning medical
6aid in dying.
AB1078,8,12 7156.11 Form of written request. (1) A valid written request for medication
8under this chapter shall be signed and dated by the requesting individual, and
9witnessed by at least one person who, in the presence of the requesting individual,
10attests that, to the best of the witness's knowledge and belief, the individual is
11capable, acting voluntarily, and is not being coerced nor unduly influenced to sign the
12request.
AB1078,8,14 13(2) The witness required under this section must be a person who is not any
14of the following:
AB1078,8,1515 (a) A relative of the requesting individual by blood, marriage, or adoption.
AB1078,8,1816 (b) A person who at the time the request is signed would be entitled to any
17portion of the estate of the requesting individual upon death under any will or by
18operation of law.
AB1078,8,2019 (c) An owner, operator, or employee of a health care facility where the
20requesting individual is receiving medical treatment or is a resident.
AB1078,8,22 21(3) The requesting individual's attending provider at the time the request is
22signed may not be a witness.
AB1078,8,23 23(4) The requesting individual's interpreter may not be a witness.
AB1078,8,25 24(5) The written request for medication shall be in substantially the following
25form:
AB1078,9,1
1REQUEST FOR MEDICATION
AB1078,9,22 TO END MY LIFE IN A
AB1078,9,33 PEACEFUL MANNER
AB1078,9,64 I, .... (insert name), am an adult of sound mind. I have been diagnosed with ....
5(insert description of terminal disease), and given a prognosis of six months or less
6to live.
AB1078,9,117 I have been fully informed of the feasible alternatives, concurrent or additional
8treatment opportunities for my terminal disease, including comfort care, palliative
9care, hospice care, or pain control and the potential risks and benefits of each. I have
10been offered or received resources or referrals to pursue these alternative,
11concurrent or additional treatment opportunities for my terminal disease.
AB1078,9,1612 I have been fully informed of the nature of the medication to be prescribed and
13the risks and benefits, including that the likely outcome of self-administering the
14medication is death. I understand that I can rescind this request at any time, that
15I am under no obligation to fill the prescription once written nor to self-administer
16the medication if I obtain it.
AB1078,9,2017 I request that my attending provider furnish a prescription for medication that
18will end my life in a peaceful manner if I choose to self-administer it, and I authorize
19my attending provider to contact a pharmacist to dispense the prescription at a time
20of my choosing.
AB1078,9,2121 I make this request voluntarily, free from coercion or undue influence.
AB1078,9,2222 Signed: ....
AB1078,9,2323 Dated: ....
AB1078,9,2424 Witness Signature: ....
AB1078,9,2525 Dated: ....
AB1078,10,3
1156.13 Attending provider responsibilities. (1) The attending provider
2for an individual shall do all of the following with regard to requests for medication
3under this chapter:
AB1078,10,54 (a) Determine whether the individual has a terminal disease with a prognosis
5of six months or less and is mentally capable.
AB1078,10,96 (b) Confirm that the individual's request for medication under this chapter does
7not arise from coercion or undue influence by asking the individual about coercion
8and influence, outside the presence of other persons and except for an interpreter as
9necessary.
AB1078,10,1010 (c) Inform the individual of all of the following:
AB1078,10,1111 1. The individual's diagnosis.
AB1078,10,1212 2. The individual's prognosis.
AB1078,10,1413 3. The potential risks, benefits, and probable result of self-administering the
14prescribed medication to bring about a peaceful death.
AB1078,10,1715 4. The potential benefits and risks of feasible alternatives, including
16concurrent or additional treatment options for the individual's terminal disease,
17palliative care, comfort care, hospice care, and pain control.
AB1078,10,1918 5. The individual's right to rescind the request for medication under this
19chapter at any time and in any manner.
AB1078,10,2120 (d) Inform the individual that there is no obligation to fill the prescription nor
21an obligation to self-administer the medication, if it is obtained.
AB1078,10,2422 (e) Provide the individual with a referral for comfort care, palliative care,
23hospice care, pain control, or any other end-of-life treatment option as requested or
24as clinically indicated.
AB1078,11,3
1(f) Refer the individual to a consulting provider for medical confirmation that
2the individual requesting medication under this chapter both has a terminal disease
3with a prognosis of six months or less and is mentally capable.
AB1078,11,54 (g) Include the consulting provider's written determination, as provided under
5s. 156.15, in the individual's medical record.
AB1078,11,86 (h) Refer the individual to a licensed mental health care provider if the
7attending provider observes signs that the individual may not be capable of making
8an informed decision.
AB1078,11,119 (i) Include the licensed mental health care provider's written determination,
10as provided under s. 156.17, in the individual's medical record, if such determination
11was requested.
AB1078,11,1312 (j) Inform the individual of the benefits of notifying the next of kin of the
13individual's decision to request medication under this chapter.
AB1078,11,1414 (k) Fulfill all medical record documentation requirements.
AB1078,11,1715 (L) Ensure that all procedures required in order to fulfill a request for
16medication under this chapter are followed before providing a prescription to a
17qualified individual for medication under this chapter, including all of the following:
AB1078,11,1918 1. Confirm that the individual has made an informed decision to obtain a
19prescription for medication under this chapter.
AB1078,11,2120 2. Offer the individual an opportunity to rescind the request for medication
21under this chapter.
AB1078,12,222 3. Educate the individual on the recommended procedure for
23self-administering the medication to be prescribed; the safe-keeping and proper
24disposal of unused medication in accordance with state and federal law; the

1importance of having another person present when the individual self-administers
2the medication to be prescribed; and not taking the medication in a public place.
AB1078,12,113 (m) Deliver the prescription personally, by mail, or through an authorized
4electronic transmission to a licensed pharmacist who will dispense the medication,
5including any ancillary medications, to the attending provider, to the qualified
6individual, or to an individual expressly designated by the qualified individual in
7person or with a signature required on delivery, by mail service or by messenger
8service, or if authorized by the federal drug enforcement agency, dispense the
9prescribed medication, including any ancillary medications, to the qualified
10individual or an individual expressly designated by the qualified individual in
11person.
AB1078,12,1612 (n) Document in the qualified individual's medical record the individual's
13diagnosis and prognosis, determination of mental capability, the date of the oral
14request or requests, a copy of the written request, a notation that the requirements
15under this chapter have been completed, and identification of the medication and
16ancillary medications prescribed to the qualified individual under this chapter.
AB1078,12,18 17(2) Notwithstanding any other provision of law, the attending provider may
18sign the individual's death certificate.
AB1078,12,21 19156.15 Consulting provider responsibilities. A consulting provider for an
20individual shall do all of the following with regard to requests for medication under
21this chapter:
AB1078,12,22 22(1) Evaluate the individual and the individual's relevant medical records.
AB1078,12,24 23(2) Confirm, in writing, to the individual's attending provider that all of the
24following are true:
AB1078,12,2525 (a) The individual has a terminal disease with prognosis of six months or less.
AB1078,13,4
1(b) The individual is mentally capable. If the consulting provider is unable to
2confirm that the individual is mentally capable, the consulting provider shall provide
3documentation that the consulting provider has referred the individual for further
4evaluation in accordance with s. 157.17.
AB1078,13,55 (c) The individual is acting voluntarily, free from coercion or undue influence.
AB1078,13,11 6156.17 Referral for confirmation that the requesting individual is
7mentally capable. (1)
If either an attending provider or a consulting provider is
8unable to confirm that an individual making a request for medication under this
9chapter is capable of making an informed decision, the attending provider or the
10consulting provider shall refer the individual to a licensed mental health care
11provider for determination regarding mental capability.
AB1078,13,14 12(2) The licensed mental health care provider who evaluates the individual
13under this section shall submit to the requesting attending provider or consulting
14provider a written determination of whether the individual is mentally capable.
AB1078,13,18 15(3) If the licensed mental health care provider determines that the individual
16is not mentally capable, the individual may not be deemed a qualified individual and
17the attending provider may not prescribe medication to the individual under this
18chapter.
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