AB348,9,15 5156.11 Referral for review and counseling. If in the opinion of the
6attending physician or the consulting physician a requester may be suffering from
7a psychiatric or psychological disorder, including depression, that causes impaired
8judgment, the attending physician or consulting physician shall refer the requester
9for review and counseling to a physician specializing in psychiatry or a licensed
10psychologist, as defined in s. 455.01 (4). No request for medication may be fulfilled
11under this chapter unless the physician specializing in psychiatry, or the
12psychologist, to whom referral was made, determines and certifies in writing that the
13requester is not suffering from a psychiatric or psychological disorder, including
14depression, that causes impaired judgment. The certification, if any, shall be filed
15in the requester's patient health care record under s. 156.07 (8).
AB348,9,18 16156.13 Requester rights, responsibilities, and limitations. (1) No
17requester may receive a prescription for medication that fulfills a request for
18medication under this chapter unless he or she has made an informed decision.
AB348,9,21 19(2) No requester may be required to notify his or her next of kin regarding his
20or her request for medication, and no request for medication may be denied because
21the requester has failed to notify his or her next of kin.
AB348,9,23 22(3) In order to receive a prescription under a request for medication, a
23requester shall do all of the following:
AB348,9,2524 (a) Orally make a request of his or her attending physician for medication for
25the purpose of ending his or her life.
1(b) No fewer than 15 days after orally making the request under par. (a), make
2a request for medication that meets the requirements of s. 156.05.
AB348,10,53 (c) After making a request for medication under par. (b), make a 2nd oral
4request of his or her attending physician for medication for the purpose of ending his
5or her life.
AB348,10,16 6156.15 Request for medication; form. The department shall prepare and
7provide copies of a request for medication and accompanying information for
8distribution in quantities to health care providers, hospitals, nursing homes,
9multipurpose senior centers, county clerks, and local bar associations and
10individually to private persons. The department shall include, in information
11accompanying the copy of the request for medication, at least the statutory
12definitions of terms used in the request for medication, statutory restrictions on who
13may be witnesses to a valid request for medication, and a statement explaining that
14valid witnesses acting in good faith are statutorily immune from civil or criminal
15liability. The request for medication distributed by the department shall be in the
16following form:
AB348,10,2020 I, ...., am an adult of sound mind and am a resident of Wisconsin.
AB348,10,2221 I am suffering from ...., which my attending physician has determined is a
22terminal disease and which has been medically confirmed by a consulting physician.
AB348,10,2523 I have been fully informed of my diagnosis, prognosis, the nature of medication
24to be prescribed and potential associated risks, the expected result, and the feasible
25alternatives, including comfort care, hospice care, and pain control.
1I request that my attending physician prescribe medication that will end my life
2in a humane and dignified manner.
AB348,11,54 .... I have informed my family members of my decision and taken their opinions
5into consideration.
AB348,11,66 .... I have decided not to inform my family of my decision.
AB348,11,77 .... I have no family to inform of my decision.
AB348,11,88 I understand that I have the right to revoke this request at any time.
AB348,11,109 I understand the full import of this request and I expect to die when I take the
10medication to be prescribed.
AB348,11,1211 I make this request voluntarily and without reservation, and I accept full moral
12responsibility for my actions.
AB348,11,1313 Signed: ....
AB348,11,1414 Dated: ....
AB348,11,15 15Statement and signatures
AB348,11,16 16of witnesses
AB348,12,217 I know the requester personally or I have received proof of his or her identity
18and I believe him or her to be of sound mind and at least 18 years of age. I believe
19that the requester makes this request voluntarily. I am at least 18 years of age, am
20not related to the requester by blood, marriage, or adoption, and am not directly
21financially responsible for the requester's health care. I am not a health care
22provider who is serving the requester at this time, an employee of the health care
23provider, other than a chaplain or a social worker, or an employee, other than a
24chaplain or a social worker, of a health care facility in which the requester is a

1patient. To the best of my knowledge, I am not entitled to and do not have a claim
2on the requester's estate.
AB348,12,33 Witness No. 1:
AB348,12,44 (print) Name: ....
AB348,12,55 Address: ....
AB348,12,66 Signature: ....
AB348,12,77 Witness No. 2:
AB348,12,88 (print) Name: ....
AB348,12,99 Address: ....
AB348,12,1010 Signature: ....
AB348,12,1111 Witness No. 3:
AB348,12,1212 (print) Name: ....
AB348,12,1313 Address: ....
AB348,12,1414 Signature: ....
AB348,12,1815 If the requester is a patient in a health care facility, at least one of the above
16witnesses must be a patients' advocate designated by the board on aging and
17long-term care. A patients' advocate who is a witness should print "patients'
18advocate" after the printing of his or her name above.
AB348,12,20 19156.17 Revocation of request for medication. (1) A requester may revoke
20his or her request for medication at any time by doing any of the following:
AB348,12,2321 (a) Canceling, defacing, obliterating, burning, tearing, or otherwise destroying
22the request for medication or directing another in the presence of the requester to
23destroy, in the same manner, the request for medication.
AB348,12,2524 (b) Executing a statement, in writing, that is signed and dated by the requester,
25expressing the requester's intent to revoke the request for medication.
1(c) Orally expressing the requester's intent to revoke the request for
2medication, in the presence of 2 witnesses.
AB348,13,33 (d) Making a subsequent request for medication.
AB348,13,7 4(2) The requester's health care provider shall, upon notification of revocation
5of the requester's request for medication, record in the requester's medical record the
6time, date, and place of the revocation and the time, date, and place, if different, of
7the notification to the health care provider of the revocation.
AB348,13,14 8156.19 Designation of patients' advocates. The board on aging and
9long-term care shall designate staff of the long-term care ombudsman program as
10patients' advocates. A person so designated shall serve as a witness to a request for
11medication of a requester who is a patient or resident of a nursing home or
12community-based residential facility, as required under s. 156.05 (2) (b), and shall
13speak on behalf of the requester to ensure that his or her needs or wants are
14communicated to and addressed by his or her attending physician.
AB348,13,17 15156.21 Duties and immunities. (1) No health care facility or health care
16provider may be charged with a crime, held civilly liable, or charged with
17unprofessional conduct for any of the following:
AB348,13,2218 (a) Failing to fulfill a request for medication, except that failure of an attending
19physician to fulfill a request for medication constitutes unprofessional conduct if the
20attending physician refuses or fails to make a good faith attempt to transfer the
21requester's care and treatment to another physician who will act as attending
22physician under this chapter and fulfill the request for medication.
AB348,13,2423 (b) In the absence of actual knowledge of a revocation, fulfilling a request for
24medication that is in compliance with this chapter.
1(c) Acting contrary to or failing to act on a revocation of a request for medication,
2unless the health care facility or health care provider has actual knowledge of the
AB348,14,7 4(2) In the absence of actual notice to the contrary, a health care facility or health
5care provider may presume that a requester was authorized to make his or her
6request for medication under the requirements of this chapter and that the request
7for medication is valid.
AB348,14,10 8(3) (a) No person who acts in good faith as a witness to a request for medication
9under this chapter may be held civilly or criminally liable for a death that results
10from taking medication under a fulfilled request for medication under this chapter.
AB348,14,1211 (b) Paragraph (a) does not apply to a person who acts as a witness in violation
12of s. 156.05 (2) (a).
AB348,14,16 13156.23 General provisions. (1) (a) The making of a request for medication
14under this chapter does not, for any purpose, constitute attempted suicide. Taking
15medication under a fulfilled request for medication under this chapter does not, for
16any purpose, constitute suicide.
AB348,14,1917 (b) Paragraph (a) does not prohibit an insurer from making a determination
18that a requester has attempted suicide or committed suicide if the requester has so
19acted, apart from the request for medication.
AB348,14,22 20(2) The making of a request for medication under this chapter does not revoke
21or otherwise modify a power of attorney for health care or living will that the
22requester may have executed.
AB348,15,2 23(3) No individual may be required to make a request for medication as a
24condition for receipt of health care or admission to a health care facility. The making

1of a request for medication is not a bar to the receipt of health care or the admission
2to a health care facility.
AB348,15,4 3(4) A request for medication that is in its original form or is a legible photocopy
4or electronic facsimile copy is presumed to be valid.
AB348,15,8 5(5) Nothing in this chapter may be construed to condone, authorize, approve,
6or permit any affirmative or deliberate act to end life other than through taking
7medication that is prescribed under a request for medication as provided in this
AB348,15,12 9156.25 Record review. The department shall annually examine a sampling
10of patient health care records of requesters for whom medication was prescribed as
11requested under a request for medication and about whom the department has
12received information under s. 156.07 (8) (g).
AB348,15,16 13156.27 Penalties. (1) Any person who willfully conceals, cancels, defaces,
14obliterates, or damages the request for medication of another without the requester's
15consent may be fined not more than $500 or imprisoned for not more than 30 days
16or both.
AB348,15,21 17(2) Any person who, with the intent to cause a requester to take medication that
18is prescribed under a request for medication contrary to the wishes of the requester,
19illegally falsifies or forges the request for medication of another or conceals a
20revocation under s. 156.17 (1) (a) or (b) shall be fined not more than $10,000 or
21imprisoned for not more than 10 years or both.
AB348,16,2 22(3) Any responsible person who, with the intent to cause a requester to take
23medication that is prescribed under a request for medication contrary to the wishes
24of the requester, conceals personal knowledge of a revocation under s. 156.17 shall

1be fined not more than $10,000 or, except for a health care facility, imprisoned for not
2more than 10 years or both.
AB348, s. 4 3Section 4. 979.01 (1) (intro.) of the statutes is amended to read:
AB348,16,104 979.01 (1) (intro.) All Except as provided in sub. (1j), all physicians, authorities
5of hospitals, sanatoriums, public and private institutions, convalescent homes,
6authorities of any institution of a like nature, and other persons having knowledge
7of the death of any person who has died under any of the following circumstances,
8shall immediately report the death to the sheriff, police chief, or and medical
9examiner or coroner of the county and to the police chief of any community where the
10death took place:
AB348, s. 5 11Section 5. 979.01 (1g) of the statutes is amended to read:
AB348,16,1612 979.01 (1g) A sheriff or police chief shall, immediately upon notification of a
13death under sub. (1), notify the coroner or the medical examiner, and the coroner or
14medical examiner of the county where death took place
, if the crime, injury, or event
15occurred in another county, shall immediately report the death to the coroner or
16medical examiner of that county.
AB348, s. 6 17Section 6. 979.01 (1j) of the statutes is created to read:
AB348,16,2018 979.01 (1j) Subsection (1) does not apply to a death that results from taking
19medication under a fulfilled request for medication that is in accordance with the
20requirements of ch. 156.
AB348, s. 7 21Section 7. 979.01 (1r) of the statutes is repealed.
AB348,16,2222 (End)