SB169,11,1716
I understand the full import of this request, and I expect to die when I take the
17medication to be prescribed.
SB169,11,1918
I make this request voluntarily and without reservation, and I accept full moral
19responsibility for my actions.
SB169,11,2020
Signed: ....
SB169,11,2121
Dated: ....
SB169,11,22
22Statement and signatures
SB169,11,23
23of witnesses
SB169,12,824
I know the requester personally or I have received proof of his or her identity
25and I believe him or her to be of sound mind and at least 18 years of age. I believe
1that the requester makes this request voluntarily. I am at least 18 years of age, am
2not related to the requester by blood, marriage, or adoption, and am not directly
3financially responsible for the requester's health care. I am not a health care
4provider who is an individual and is serving the requester at this time, an employee
5of a health care provider who is serving the requester at this time, other than a
6chaplain or a social worker, or an employee, other than a chaplain or a social worker,
7of a health care facility in which the requester is a patient. To the best of my
8knowledge, I am not entitled to and do not have a claim on the requester's estate.
SB169,12,99
Witness No. 1:
SB169,12,1010
(print) Name: ....
SB169,12,1111
Address: ....
SB169,12,1212
Signature: ....
SB169,12,1313
Witness No. 2:
SB169,12,1414
(print) Name: ....
SB169,12,1515
Address: ....
SB169,12,1616
Signature: ....
SB169,12,1717
Witness No. 3:
SB169,12,1818
(print) Name: ....
SB169,12,1919
Address: ....
SB169,12,2020
Signature: ....
SB169,12,2421
If the requester is a patient in a health care facility, at least one of the above
22witnesses must be a patients' advocate designated by the board on aging and
23long-term care. A patients' advocate who is a witness should print "patients'
24advocate" after the printing of his or her name above.
SB169,13,2
1156.17 Revocation of request for medication.
(1) A requester may revoke
2his or her request for medication at any time by doing any of the following:
SB169,13,53
(a) Canceling, defacing, obliterating, burning, tearing, or otherwise destroying
4the request for medication or directing another in the presence of the requester to
5destroy, in the same manner, the request for medication.
SB169,13,76
(b) Executing a statement, in writing, that is signed and dated by the requester,
7expressing the requester's intent to revoke the request for medication.
SB169,13,98
(c) Orally expressing the requester's intent to revoke the request for
9medication, in the presence of 2 witnesses.
SB169,13,1010
(d) Making a subsequent request for medication.
SB169,13,14
11(2) The requester's health care provider shall, upon notification of revocation
12of the requester's request for medication, record in the requester's medical record the
13time, date, and place of the revocation and the time, date, and place, if different, of
14the notification to the health care provider of the revocation.
SB169,13,21
15156.19 Designation of patients' advocates. The board on aging and
16long-term care shall designate staff of the long-term care ombudsman program as
17patients' advocates. A person so designated shall serve as a witness to a request for
18medication of a requester who is a patient or resident of a nursing home or
19community-based residential facility, as required under s. 156.05 (2) (b), and shall
20speak on behalf of the requester to ensure that his or her needs or wants are
21communicated to and addressed by his or her attending physician.
SB169,13,25
22156.21 Duties and immunities. (1) No health care provider that is not an
23individual and no health care facility may be held civilly liable and no health care
24provider who is an individual may be charged with a crime, held civilly liable, or
25charged with unprofessional conduct for any of the following:
SB169,14,5
1(a) Failing to fulfill a request for medication, except that failure of an attending
2physician to fulfill a request for medication constitutes unprofessional conduct if the
3attending physician refuses or fails to make a good faith attempt to transfer the
4requester's care and treatment to another physician who will act as attending
5physician under this chapter and fulfill the request for medication.
SB169,14,76
(b) In the absence of actual knowledge of a revocation, fulfilling a request for
7medication that is in compliance with this chapter.
SB169,14,108
(c) Acting contrary to or failing to act on a revocation of a request for medication,
9unless the health care facility or health care provider has actual knowledge of the
10revocation.
SB169,14,14
11(2) In the absence of actual notice to the contrary, a health care facility or health
12care provider may presume that a requester was authorized to make his or her
13request for medication under the requirements of this chapter and that the request
14for medication is valid.
SB169,14,17
15(3) (a) No person who acts in good faith as a witness to a request for medication
16under this chapter may be held civilly or criminally liable for a death that results
17from taking medication under a fulfilled request for medication under this chapter.
SB169,14,1918
(b) Paragraph (a) does not apply to a person who acts as a witness in violation
19of s. 156.05 (2) (a).
SB169,14,23
20156.23 General provisions. (1) (a) The making of a request for medication
21under this chapter does not, for any purpose, constitute attempted suicide. Taking
22medication under a fulfilled request for medication under this chapter does not, for
23any purpose, constitute suicide.
SB169,15,3
1(b) Paragraph (a) does not prohibit an insurer from making a determination
2that a requester has attempted suicide or committed suicide if the requester has so
3acted, apart from the request for medication.
SB169,15,6
4(2) The making of a request for medication under this chapter does not revoke
5or otherwise modify a power of attorney for health care or living will that the
6requester may have executed.
SB169,15,10
7(3) No individual may be required to make a request for medication as a
8condition for receipt of health care or admission to a health care facility. The making
9of a request for medication is not a bar to the receipt of health care or the admission
10to a health care facility.
SB169,15,12
11(4) A request for medication that is in its original form or is a legible photocopy
12or electronic facsimile copy is presumed to be valid.
SB169,15,16
13(5) Nothing in this chapter may be construed to condone, authorize, approve,
14or permit any affirmative or deliberate act to end life other than through taking
15medication that is prescribed under a request for medication as provided in this
16chapter.
SB169,15,20
17156.25 Record review. The department shall annually examine a sampling
18of patient health care records of requesters for whom medication was prescribed as
19requested under a request for medication and about whom the department has
20received information under s. 156.07 (8) (g).
SB169,15,24
21156.27 Penalties. (1) Any person who willfully conceals, cancels, defaces,
22obliterates, or damages the request for medication of another without the requester's
23consent may be fined not more than $500 or imprisoned for not more than 30 days
24or both.
SB169,16,5
1(2) Any person who, with the intent to cause a requester to take medication that
2is prescribed under a request for medication contrary to the wishes of the requester,
3illegally falsifies or forges the request for medication of another, or conceals a
4revocation under s. 156.17 (1) (a) or (b) shall be fined not more than $10,000 or
5imprisoned for not more than 10 years or both.
SB169,16,9
6(3) Any responsible person who, with the intent to cause a requester to take
7medication that is prescribed under a request for medication contrary to the wishes
8of the requester, conceals personal knowledge of a revocation under s. 156.17 shall
9be fined not more than $10,000 or imprisoned for not more than 10 years or both.
SB169, s. 4
10Section
4. 979.01 (1) (intro.) of the statutes is amended to read:
SB169,16,1611
979.01
(1) (intro.)
All Except as provided in sub. (1t), all physicians, authorities
12of hospitals, sanatoriums, public and private institutions, convalescent homes,
13authorities of any institution of a like nature, and other persons having knowledge
14of the death of any person who has died under any of the following circumstances,
15shall immediately report the death to the sheriff, police chief, medical examiner
, or
16coroner of the county where the death took place:
SB169, s. 5
17Section
5. 979.01 (1t) of the statutes is created to read:
SB169,16,2018
979.01
(1t) 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.
SB169,17,222
(1)
Requests
for medication; penalties. The treatment of section 156.27 of the
23statutes first applies to requests for medication made under the requirements of
1chapter 156 of the statutes, as created by this act, on the effective date of this
2subsection.