SB224,9,23 22(3) In order to receive a prescription under a request for medication, a
23requester shall do all of the following:
SB224,9,2524 (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.
SB224,10,53 (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.
SB224,10,16 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:
SB224,10,2120 I, ...., am an adult of sound mind, do not have incapacity, and am a resident of
SB224,10,2322 I am suffering from ...., which my attending physician has determined is a
23terminal disease and which has been medically confirmed by a consulting physician.
1I have been fully informed of my diagnosis, prognosis, the nature of medication
2to be prescribed and potential associated risks, the expected result, and the feasible
3alternatives, including comfort care, hospice care, and pain control.
SB224,11,54 I request that my attending physician prescribe medication that will end my life
5in a humane and dignified manner.
SB224,11,87 .... I have informed my family members of my decision and taken their opinions
8into consideration.
SB224,11,99 .... I have decided not to inform my family of my decision.
SB224,11,1010 .... I have no family to inform of my decision.
SB224,11,1111 I understand that I have the right to revoke this request at any time.
SB224,11,1312 I understand the full import of this request and I expect to die when I take the
13medication to be prescribed.
SB224,11,1514 I make this request voluntarily and without reservation, and I accept full moral
15responsibility for my actions.
SB224,11,1616 Signed: ....
SB224,11,1717 Dated: ....
SB224,11,18 18Statement and signatures
SB224,11,19 19of witnesses
SB224,12,420 I know the requester personally or I have received proof of his or her identity
21and I believe him or her to be of sound mind and at least 18 years of age. I believe
22that the requester makes this request voluntarily. I am at least 18 years of age, am
23not related to the requester by blood, marriage, or adoption, and am not directly
24financially responsible for the requester's health care. I am not a health care
25provider who is serving the requester at this time; an employee of the health care

1provider, other than a chaplain or a social worker; or an employee, other than a
2chaplain or a social worker, of a health care facility in which the requester is a
3patient. To the best of my knowledge, I am not entitled to and do not have a claim
4on the requester's estate.
SB224,12,55 Witness No. 1:
SB224,12,66 (print) Name: ....
SB224,12,77 Address: ....
SB224,12,88 Signature: ....
SB224,12,99 Witness No. 2:
SB224,12,1010 (print) Name: ....
SB224,12,1111 Address: ....
SB224,12,1212 Signature: ....
SB224,12,1313 Witness No. 3:
SB224,12,1414 (print) Name: ....
SB224,12,1515 Address: ....
SB224,12,1616 Signature: ....
SB224,12,2017 If the requester is a patient in a health care facility, at least one of the above
18witnesses must be a patients' advocate designated by the board on aging and
19long-term care. A patients' advocate who is a witness should print "patients'
20advocate" after the printing of his or her name above.
SB224,12,22 21156.17 Revocation of request for medication. (1) A requester may revoke
22his or her request for medication at any time by doing any of the following:
SB224,12,2523 (a) Canceling, defacing, obliterating, burning, tearing, or otherwise destroying
24the request for medication or directing another in the presence of the requester to
25destroy, in the same manner, the request for medication.
1(b) Executing a statement, in writing, that is signed and dated by the requester,
2expressing the requester's intent to revoke the request for medication.
SB224,13,43 (c) Orally expressing the requester's intent to revoke the request for
4medication, in the presence of 2 witnesses.
SB224,13,55 (d) Making a subsequent request for medication.
SB224,13,9 6(2) The requester's health care provider shall, upon notification of revocation
7of the requester's request for medication, record in the requester's medical record the
8time, date, and place of the revocation and the time, date, and place, if different, of
9the notification to the health care provider of the revocation.
SB224,13,16 10156.19 Designation of patients' advocates. The board on aging and
11long-term care shall designate staff of the long-term care ombudsman program as
12patients' advocates. A person so designated shall serve as a witness to a request for
13medication of a requester who is a patient or resident of a nursing home or
14community-based residential facility, as required under s. 156.05 (2) (b), and shall
15speak on behalf of the requester to ensure that his or her needs or wants are
16communicated to and addressed by his or her attending physician.
SB224,13,19 17156.21 Duties and immunities. (1) No health care facility or health care
18provider may be charged with a crime, held civilly liable, or charged with
19unprofessional conduct for any of the following:
SB224,13,2420 (a) Failing to fulfill a request for medication, except that failure of an attending
21physician to fulfill a request for medication constitutes unprofessional conduct if the
22attending physician refuses or fails to make a good faith attempt to transfer the
23requester's care and treatment to another physician who will act as attending
24physician under this chapter and fulfill the request for medication.
1(b) In the absence of actual knowledge of a revocation, fulfilling a request for
2medication that is in compliance with this chapter.
SB224,14,53 (c) Acting contrary to or failing to act on a revocation of a request for medication,
4unless the health care facility or health care provider has actual knowledge of the
SB224,14,9 6(2) In the absence of actual notice to the contrary, a health care facility or health
7care provider may presume that a requester was authorized to make his or her
8request for medication under the requirements of this chapter and that the request
9for medication is valid.
SB224,14,12 10(3) (a) No person who acts in good faith as a witness to a request for medication
11under this chapter may be held civilly or criminally liable for a death that results
12from taking medication under a fulfilled request for medication under this chapter.
SB224,14,1413 (b) Paragraph (a) does not apply to a person who acts as a witness in violation
14of s. 156.05 (2) (a).
SB224,14,18 15156.23 General provisions. (1) (a) The making of a request for medication
16under this chapter does not, for any purpose, constitute attempted suicide. Taking
17medication under a fulfilled request for medication under this chapter does not, for
18any purpose, constitute suicide.
SB224,14,2119 (b) Paragraph (a) does not prohibit an insurer from making a determination
20that a requester has attempted suicide or committed suicide if the requester has so
21acted, apart from the request for medication.
SB224,14,24 22(2) The making of a request for medication under this chapter does not revoke
23or otherwise modify a power of attorney for health care or living will that the
24requester may have executed.
1(3) No individual may be required to make a request for medication as a
2condition for receipt of health care or admission to a health care facility. The making
3of a request for medication is not a bar to the receipt of health care or the admission
4to a health care facility.
SB224,15,6 5(4) A request for medication that is in its original form or is a legible photocopy
6or electronic facsimile copy is presumed to be valid.
SB224,15,10 7(5) Nothing in this chapter may be construed to condone, authorize, approve,
8or permit any affirmative or deliberate act to end life other than through taking
9medication that is prescribed under a request for medication as provided in this
SB224,15,14 11156.25 Record review. The department shall annually examine a sampling
12of patient health care records of requesters for whom medication was prescribed as
13requested under a request for medication and about whom the department has
14received information under s. 156.07 (8) (g).
SB224,15,18 15156.27 Penalties. (1) Any person who willfully conceals, cancels, defaces,
16obliterates, or damages the request for medication of another without the requester's
17consent may be fined not more than $500 or imprisoned for not more than 30 days
18or both.
SB224,15,23 19(2) Any person who, with the intent to cause a requester to take medication that
20is prescribed under a request for medication contrary to the wishes of the requester,
21illegally falsifies or forges the request for medication of another or conceals a
22revocation under s. 156.17 (1) (a) or (b) shall be fined not more than $10,000 or
23imprisoned for not more than 10 years or both.
SB224,16,3 24(3) Any responsible person who, with the intent to cause a requester to take
25medication that is prescribed under a request for medication contrary to the wishes

1of the requester, conceals personal knowledge of a revocation under s. 156.17 shall
2be fined not more than $10,000 or, except for a health care facility, imprisoned for not
3more than 10 years or both.
SB224, s. 4 4Section 4. 979.01 (1) (intro.) of the statutes is amended to read:
SB224,16,115 979.01 (1) (intro.) All Except as provided in sub. (1j), all physicians, authorities
6of hospitals, sanatoriums, public and private institutions, convalescent homes,
7authorities of any institution of a like nature, and other persons having knowledge
8of the death of any person who has died under any of the following circumstances,
9shall immediately report the death to the sheriff, police chief, or and medical
10examiner or coroner of the county and to the police chief of any community where the
11death took place:
SB224, s. 5 12Section 5. 979.01 (1g) of the statutes is amended to read:
SB224,16,1713 979.01 (1g) A sheriff or police chief shall, immediately upon notification of a
14death under sub. (1), notify the coroner or the medical examiner, and the coroner or
15medical examiner of the county where death took place
, if the crime, injury, or event
16occurred in another county, shall immediately report the death to the coroner or
17medical examiner of that county.
SB224, s. 6 18Section 6. 979.01 (1j) of the statutes is created to read:
SB224,16,2119 979.01 (1j) Subsection (1) does not apply to a death that results from taking
20medication under a fulfilled request for medication that is in accordance with the
21requirements of ch. 156.
SB224, s. 7 22Section 7. 979.01 (1r) of the statutes is repealed.
SB224,16,2323 (End)