SB27,1,5 1An Act to amend 979.01 (1) (intro.); to repeal and recreate chapter 154 (title);
2and to create 16.009 (2) (p), 146.82 (2) (a) 8m., chapter 156 and 979.01 (1g) of
3the statutes; relating to: permitting certain individuals to make written
4requests for medication for the purpose of ending their lives, and providing
5penalties.
Analysis by the Legislative Reference Bureau
This bill permits a person who is of sound mind and not incapacitated, is at least
18 years of age, is a resident of Wisconsin and has a terminal disease to voluntarily
make a written request to his or her attending physician for medication for the
purpose of ending his or her life in a humane and dignified manner. Further, the bill
sets forth a statutory form of a request for medication and requires that the
department of health and family services (DHFS) prepare and provide copies of the
request form for distribution to certain facilities, associations and persons.
The bill establishes the following requirements that must be met before an
individual's attending physician may write a prescription in response to the
individual's request for medication:
1. First, the requester must make the request orally. Then, not fewer than 15
days later, the requester must again request by use of a valid request form that is
substantially in the form specified in the bill, is in writing, is signed in the presence
of 3 qualified witnesses and dated by the requester, is made voluntarily and is filed
in the requester's patient health care record. After the request is filed, the requester
must make a 2nd oral request of his or her attending physician for the medication.

2. The requester's attending physician must determine that the requester
meets the statutory requirements for making the request; must inform the requester
of his or her diagnosis and prognosis, the probable results of taking the prescribed
medication and the alternatives to doing so; must refer the requester to a consulting
physician for review and must, if the requester may be suffering from a psychiatric
or psychological disorder, refer the requester to a psychiatrist or psychologist for
review; must, in the requester's patient health care record, document certain
information and certify that the statutory requirements have been met regarding the
request; must ask the requester to inform his or her next of kin about the request;
must inform the requester that the request is revocable and offer him or her the
opportunity to revoke it; and must report information about the request to DHFS on
a form prescribed by DHFS.
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 statutory 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 that causes impaired judgment or from
depression that causes impaired judgment.
The bill specifies that, if the requester is a patient in a health care facility, at
least one of the witnesses to the written request for medication must be a patients'
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 living
will 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 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.
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:
SB27, s. 1 1Section 1. 16.009 (2) (p) of the statutes is created to read:
SB27,2,22 16.009 (2) (p) Designate patients' advocates under s. 156.19.
SB27, s. 2
1Section 2. 146.82 (2) (a) 8m. of the statutes is created to read:
SB27,3,42 146.82 (2) (a) 8m. To the department under s. 156.07 (8) (g). The release of a
3patient health care record under this subdivision shall be limited to the information
4requested by the department under s. 156.25.
SB27, s. 3 5Section 3. Chapter 154 (title) of the statutes is repealed and recreated to read:
SB27,3,76 Chapter 154
7 Living wills
SB27, s. 4 8Section 4. Chapter 156 of the statutes is created to read:
SB27,3,109 Chapter 156
10 Death with dignity
SB27,3,11 11156.01 Definitions. In this chapter:
SB27,3,13 12(1) "Attending physician" means a physician who has primary responsibility
13for the care of the requester and treatment of the requester's terminal disease.
SB27,3,15 14(2) "Comfort care" means palliative care, as defined in s. 50.90 (3), or supportive
15care, as defined in s. 50.90 (4).
SB27,3,18 16(3) "Consulting physician" means a physician who is qualified by specialty or
17experience to make a professional diagnosis and prognosis with respect to the
18requester's disease.
SB27,3,19 19(4) "Department" means the department of health and family services.
SB27,3,20 20(5) "Health care facility" has the meaning given in s. 155.01 (6).
SB27,3,21 21(6) "Health care provider" has the meaning given in s. 155.01 (7).
SB27,3,24 22(7) "Incapacity" means the inability to receive and evaluate information
23effectively or to communicate decisions to such an extent that the individual lacks
24the capacity to manage his or her health care decisions.
SB27,4,4
1(8) "Informed decision" means a decision by an individual, to request and
2obtain a prescription to end his or her life in a humane and dignified manner, that
3is based on an appreciation of the relevant facts and is made after having been fully
4informed by the attending physician of all of the following:
SB27,4,55 (a) The individual's medical diagnosis.
SB27,4,66 (b) The individual's prognosis.
SB27,4,77 (c) The potential risks associated with taking the medication to be prescribed.
SB27,4,88 (d) The probable result of taking the medication to be prescribed.
SB27,4,99 (e) The feasible alternatives, including comfort care and care of a hospice.
SB27,4,10 10(9) "Multipurpose senior center" has the meaning given in s. 155.01 (9).
SB27,4,11 11(10) "Patient health care records" has the meaning given in s. 146.81 (4).
SB27,4,12 12(11) "Physician" has the meaning given in s. 448.01 (5).
SB27,4,14 13(12) "Request for medication" means a document made under the requirements
14of s. 156.05.
SB27,4,17 15(13) "Requester" means an individual who requests medication under the
16requirements of this chapter for the purpose of ending his or her life in a humane and
17dignified manner.
SB27,4,18 18(14) "Residence" has the meaning given in s. 46.27 (1) (d).
SB27,4,22 19(15) "Responsible person" means the attending physician, a health care
20professional working with the requester, an inpatient health care facility in which
21the requester is located or the requester's spouse, child, parent, brother, sister,
22grandparent or grandchild.
SB27,4,25 23(16) "Social worker" means a person certified as a social worker, advanced
24practice social worker, independent social worker or independent clinical social
25worker under s. 457.08.
SB27,5,3
1(17) "Terminal disease" means an incurable and irreversible disease that has
2been diagnosed by an individual's attending physician and medically confirmed and
3that will, within reasonable medical judgment, cause death within 6 months.
SB27,5,9 4156.03 Authorization to make request. An individual who is of sound mind,
5has attained age 18, has residence in this state, does not have incapacity and has a
6terminal disease may voluntarily make a request for medication for the purpose of
7ending his or her life in a humane and dignified manner. An individual for whom an
8adjudication of incompetence and appointment of a guardian of the person is in effect
9under ch. 880 is presumed not to be of sound mind for purposes of this section.
SB27,5,11 10156.05 Valid request for medication; requirements. (1) A valid request
11for medication shall be, for the purposes of s. 156.03, all of the following:
SB27,5,1212 (a) In writing.
SB27,5,1413 (b) Dated and signed by the requester or, at the express direction and in the
14presence of the requester, by an individual who has attained age 18.
SB27,5,1515 (c) Signed in the presence of 3 witnesses who meet the requirements of sub. (2).
SB27,5,1616 (d) Made voluntarily.
SB27,5,1717 (e) Substantially in the form specified in s. 156.15.
SB27,5,2118 (f) Filed in the requester's patient health care record in the custody of the
19requester's attending physician and, if the requester is an inpatient of a health care
20facility, in the requester's patient health care record in the custody of the health care
21facility.
SB27,5,24 22(2) (a) A witness to the making of a valid request for medication shall be an
23individual who has attained age 18. No witness to the making of a valid request for
24medication may, at the time of the witnessing, be any of the following:
SB27,5,2525 1. Related to the requester by blood, marriage or adoption.
SB27,6,2
12. An individual who has knowledge that he or she is entitled to or has a claim
2on any portion of the requester's estate.
SB27,6,33 3. Directly financially responsible for the requester's health care.
SB27,6,74 4. An individual who is a health care provider who is serving the requester at
5the time of the witnessing; an employe, other than a chaplain or a social worker, of
6the health care provider; or an employe, other than a chaplain or a social worker, of
7a health care facility in which the requester is a patient.
SB27,6,108 (b) If a requester is a patient or resident of a nursing home or community-based
9residential facility, at least one of the witnesses to the request shall be a patients'
10advocate designated under s. 156.19.
SB27,6,12 11156.07 Attending physician; responsibilities and limitations. The
12attending physician shall do all of the following:
SB27,6,14 13(1) Determine whether the requester has a terminal disease, does not have
14incapacity and is making a request under s. 156.03 voluntarily.
SB27,6,15 15(2) Inform the requester of all of the following:
SB27,6,1616 (a) The requester's medical diagnosis.
SB27,6,1717 (b) The requester's prognosis.
SB27,6,1818 (c) The potential risks associated with taking the medication to be prescribed.
SB27,6,1919 (d) The probable result of taking the medication to be prescribed.
SB27,6,2120 (e) The feasible alternatives to taking the medication to be prescribed,
21including comfort care and care of a hospice.
SB27,6,23 22(3) Refer the requester to a consulting physician to meet the requirements of
23s. 156.09.
SB27,6,25 24(4) Refer the requester for review and counseling if this is determined to be
25appropriate under s. 156.11.
SB27,7,1
1(5) Ask the requester to notify his or her next of kin with respect to the request.
SB27,7,5 2(6) Inform the requester that he or she may revoke the request at any time;
3explain the methods of revocation that are specified under s. 156.17 (1); and offer the
4requester an opportunity to revoke the request at the time, if any, that the requester
5makes a 2nd oral request under s. 156.13 (3) (c).
SB27,7,7 6(7) Before writing a prescription in response to a request for medication, verify
7that all of the following have occurred:
SB27,7,88 (a) The requester has fulfilled the requirements of s. 156.13 (3).
SB27,7,109 (b) No fewer than 48 hours have elapsed since the requester made a written
10request for medication.
SB27,7,1111 (c) The requester has made an informed decision.
SB27,7,13 12(8) Document or file all of the following in the requester's patient health care
13record:
SB27,7,1414 (a) All oral and written requests for medication that are made by the requester.
SB27,7,1715 (b) The attending physician's diagnosis of and prognosis for the requester and
16determination as to whether the requester is incapacitated, is acting voluntarily and
17has made an informed decision.
SB27,7,2018 (c) The consulting 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.
SB27,7,2221 (d) A certification of the outcome and determinations made during any review
22and counseling for which the requester was referred under s. 156.11.
SB27,7,2423 (e) The attending physician's offer of an opportunity to revoke the request for
24medication, as required under sub. (6).
SB27,7,2525 (f) Evidence of a revocation, if made, as specified in s. 156.17 (2).
SB27,8,11
1(g) A certification as to whether the requirements of this chapter are met and
2indicating the steps taken to fulfill the request for medication, including a notation
3of any medication that is prescribed. The attending physician shall report the
4information under this paragraph to the department on a form prescribed by the
5department. Any information reported to the department under this paragraph that
6could identify the requester, the attending physician, the consulting physician or the
7psychiatrist or psychologist to whom referral was made under s. 156.11, if any, is
8confidential and may not be disclosed by the department except under an
9investigation of an alleged violation of this chapter. The report of information under
10this paragraph is not a violation of any person's responsibility for maintaining the
11confidentiality of patient health care records under s. 146.82.
SB27,8,18 12(9) If the attending physician refuses to act as the attending physician in
13complying with the requester's request for medication under this chapter, the
14attending physician shall make a good-faith attempt to transfer the requester's care
15and treatment to another physician who will act as the attending physician under
16this chapter and will comply with the requester's request for medication. If a
17transfer is made, the attending physician to whom the requester's care and
18treatment is transferred shall comply with the requirements of this section.
SB27,8,24 19156.09 Consulting physician. Before an attending physician may fulfill a
20request for medication under this chapter, a consulting physician shall examine the
21requester and his or her relevant patient health care records and shall medically
22confirm the attending physician's determinations that the requester suffers from a
23terminal disease, does not have incapacity, is making a request for medication
24voluntarily and has made an informed decision.
SB27,9,11
1156.11 Referral for review and counseling. If in the opinion of the
2attending physician or the consulting physician a requester may be suffering from
3a psychiatric or psychological disorder, including depression, that causes impaired
4judgment, the attending physician or consulting physician shall refer the requester
5for review and counseling to a physician specializing in psychiatry or a licensed
6psychologist, as defined in s. 455.01 (4). No request for medication may be fulfilled
7under this chapter unless the physician specializing in psychiatry or psychologist to
8whom referral was made determines and certifies in writing that the requester is not
9suffering from a psychiatric or psychological disorder, including depression, that
10causes impaired judgment. The certification, if any, shall be filed in the requester's
11patient health care record under s. 156.07 (8).
SB27,9,14 12156.13 Requester rights, responsibilities and limitations. (1) No
13requester may receive a prescription for medication that fulfills a request for
14medication under this chapter unless he or she has made an informed decision.
SB27,9,17 15(2) No requester may be required to notify his or her next of kin regarding his
16or her request for medication, and no request for medication may be denied because
17the requester has failed to notify his or her next of kin.
SB27,9,19 18(3) In order to receive a prescription under a request for medication, a
19requester shall do all of the following:
SB27,9,2120 (a) Orally make a request of his or her attending physician for medication for
21the purpose of ending his or her life.
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