Iowa's Our Care, Our Options Act

In recent years there has been a dramatic increase in the number of states considering death with dignity laws. Sometimes called "assisted suicide," "right to die," or "medical aid-in-dying" initiatives, these laws make it possible for terminally ill patients to use prescribed medication to end their lives peacefully rather than suffering a difficult death.

The catalyst for greater national attention to this issue was 29-year-old Brittany Maynard, a woman diagnosed with terminal brain cancer who moved from California to Oregon to end her life in 2014. Maynard chose Oregon because California had not yet passed its aid-in-dying law, and Oregon was one of just a few states that allow terminally ill patients to legally end their lives.

Iowa's 2023 Our Care, Our Options Act

Spurred by Maynard's decision and the resulting publicity, the Iowa legislature began introducing death with dignity bills in 2015. None of them passed. Now, in the 2023 legislative session, Iowa lawmakers are considering a bill called the Our Care, Our Options Act (numbered HF533 and HF612), that would allow terminally ill patients who meet certain requirements to request life-ending medication.

This article first clarifies some confusing language related to death with dignity laws and then sets out the basics of Iowa's proposed law.

Death With Dignity, Assisted Suicide, Right to Die: What's in a Name?

"Death with dignity" and "medical aid in dying" are two of the most commonly accepted phrases describing the process by which a terminally ill person ingests prescribed medication to hasten death. Many people still think of this process as "assisted suicide" or "physician assisted suicide." However, proponents of death with dignity argue that the term "suicide" doesn't apply to terminally ill people who would prefer to live but, facing certain death within months, choose a more gentle way of dying. In fact, Iowa's proposed law states that terminating one's life under the law is not suicide. (See HF533, Section 11 and HF612, Section 11.)

Increasingly, health organizations are turning away from the term "suicide" to describe a terminally ill patient's choice to reduce the suffering of an inevitable death. The phrase "aid in dying" is becoming a more accepted way to refer to this process.

You may also see the phrase "right to die" used in place of "death with dignity." However, "right to die" is more accurately used in the context of directing one's own medical care—that is, refusing life-sustaining treatment such as a respirator or feeding tubes when permanently unconscious or close to death. You can provide your own health care directions by completing an Iowa health care proxy and a living will. (See the end of this article for more information.)

An Overview of Iowa's Our Care, Our Options Act

Iowa's Our Care, Our Options Act is modeled closely on Oregon's Death With Dignity Act, which took effect in 1997. If Iowa's law passes, a patient requesting aid-in-dying medication will have to be:

• at least 18 years old
• an Iowa resident
• mentally capable of making and communicating health care decisions, and
• diagnosed with a terminal disease that will result in death within six months.

A patient who meets the requirements above will be prescribed aid-in-dying medication only if:

• The patient makes two verbal requests to their health care provider, at least 48 hours apart. (The 48-hour waiting period may be waived if the provider has confirmed that the patient is fewer than 48 hours from death when making the initial verbal request.)
• The patient gives a written request to the provider, signed in front of one qualified, adult witness. (The law sets out the specific form that the patient must use.)
• The prescribing health care provider and one other health care provider confirm the patient's diagnosis and prognosis.
• The prescribing provider and one other provider determine that the patient is capable of making medical decisions.
• The patient has a psychological examination, if either health care provider feels the patient's judgment is impaired.
• The prescribing provider confirms that the patient is not being coerced or unduly influenced by others when making the request.
• The prescribing provider informs the patient of any feasible alternatives to the medication, including care to relieve pain and keep the patient comfortable.
• The prescribing provider asks the patient to notify their next of kin of the prescription request.
• The prescribing provider offers the patient the opportunity to withdraw the request for aid-in-dying medication before granting the prescription.

To use the medication, the patient must be able to ingest it on their own. A doctor or other person who administers the lethal medication may face criminal charges.

In addition, no other person—such as a health care agent or attorney-in-fact—may make a request for aid-in-dying medication on behalf of the patient. And the patient may not use a health care declaration to request aid-in-dying medication.

You can read the full text of Iowa's Our Care, Our Options Act on the Iowa legislature's website.

Learn More

To find out more about the history and current status of death with dignity laws in the United States, visit the website of the Death With Dignity National Center.

For information about appointing a health care agent and making known your own wishes for medical care at the end of life, see the Living Wills & Medical Powers of Attorney section of Nolo.com.

Updated March 17, 2023