Bills › 90th General Assembly
Relating to end-of-life care under guardianships of adults
Sponsored by the House Judiciary Committee
Topics:Courts & civil lawHealth careFamilies & human services
Same legislation: HSB 660
Where it is now
- Done: IntroducedFebruary 6, 2024
- Done: SubcommitteeFebruary 6, 2024
- Done: House committeeFebruary 14, 2024
- Stopped: Passes the HouseDied when the General Assembly ended
- Next: Senate committee
- Next: Passes the Senate
- Next: To the Governor
- Next: Signed into law
Died when the session ended The 2024 session adjourned on April 19, 2024, the General Assembly’s last regular session. Bills that didn’t pass both chambers died. What’s a funnel?
What’s in it
AI summary Guardians who look after adults would gain the power to make end-of-life medical decisions, such as choosing hospice care or signing do-not-resuscitate orders. Before making these choices, the guardian must talk to the person they are helping or, if that isn't possible, talk to the person's family and doctor. Unless the person is terminally ill, the guardian must get permission from a judge before they can stop life-sustaining treatments or authorize anything that ends a person's life.1
Read the official explanation
This bill relates to end-of-life care decisions under guardianships of adults. Under current law, a court may grant a guardian the ability to make decisions regarding the care, maintenance, health, education, welfare, and safety of the protected person except as otherwise limited by the court, which the guardian may exercise thereafter without prior court approval. The bill provides that this includes end-of-life care decisions (hospice, palliative care, and life-sustaining interventions, and the power to execute, reaffirm, or revoke a do-not-resuscitate or do-not-intubate order). A guardian is only able to make an end-of-life care decision if the guardian has consulted with the protected person not more than 14 days before executing the end-of-life care decision and consulted with the protected person’s attending physician. However, if the protected person is not able to have a meaningful conversation about end-of-life care decisions, a guardian may instead consult with family members and other significant others of the protected person not more than 14 days before executing the end-of-life decision. The bill provides that except for cases in which the protected person’s diagnosis is a terminal illness with life expectancy of six months or less, a guardian may not authorize the withdrawal of life-sustaining procedures or authorize any medicine or procedure that terminates the protected person’s life without first obtaining a court order authorizing such action.
Why it matters. Guardians of adults would gain the authority to make end-of-life care decisions, such as choosing hospice or palliative care, after consulting with the protected person or their family and attending physician. Unless the person has a terminal illness with a life expectancy of six months or less, guardians must obtain a court order before withdrawing life-sustaining procedures or authorizing actions that terminate a person's life. The Department of Health and Human Services would see an estimated cost increase of approximately $129,000 per year.2
House subcommittee
Named February 6, 2024 (as HSB 660). On February 7, 2024 it recommended passage. Vote Total: 2-1.
Three legislators hear a bill first and recommend what the committee should do; it’s the best time to weigh in. How to take part
1 written public comment to its subcommittee: February 7, 2024 (1) · on the Legislature’s site
Fiscal note
Cost: up to $129,000 Compare with other bills
AI summary This bill specifies that court-ordered guardians have the authority to make end-of-life care decisions for the adults they protect. It is estimated to increase costs to the Department of Health and Human Services by approximately $129,000 per year.4
Read the fiscal note
Description
House File 2577 relates to end-of-life care under guardianships of adults by specifying what is included as a decision regarding a protected person’s health, including end-of-life decisions, for court-ordered guardians.
Background
Established in Iowa Code chapter 231E, the Office of Public Guardian (OPG) may act as an individual’s guardian, conservator, or representative payee. Under current law, a court may grant a guardian the ability to make decisions regarding the care, maintenance, health, education, welfare, and safety of the protected person except as otherwise limited by the court, which the guardian may exercise thereafter without prior court approval.
Assumptions
- The OPG anticipates increased costs of approximately $25 per client, per month, for between 110 and 220 existing clients resulting in an annual cost increase between $33,000 and $66,000. These fees are paid to the OPG by the Department of Health and Human Services (HHS).
- The OPG anticipates an additional one to two applications for public guardianship services per month with an average case opening fee of $2,500 and continuing costs of $350 per month for an estimated annual cost increase between $53,000 and $106,000.
- The OPG anticipates increased call volumes to Adult Protective Services, the expense of which is expected to be absorbed within current operating expenses.
Fiscal Impact
The total fiscal impact of HF 2577 would be approximately $129,000 per year in increased case costs to the HHS.
Sources
- Department of Health and Human Services
- Legislative Services Agency
- Guardianships, Hospice and End-of-Life Care and Decisions · March 6, 2024 · $129,000
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90th General Assembly