NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A136
SPONSOR: Paulin (MS) TITLE OF BILL:
An act to amend the public health law, in relation to a terminally ill
patient's request for and use of medication for medical aid in dying
PURPOSE:
To provide that a mentally competent, terminally ill adult with a prog-
nosis of six months or less to live may request medication from their
treating physician that they can decide to self-administer to hasten the
patient's death provided the requirements set forth in the act are met,
and to provide certain protection and immunities to health care provid-
ers and other persons, including a physician who prescribes medication
in compliance with the provisions of the article to the terminally ill
patient to be self-administered by the patient.
SUMMARY OF SPECIFIC PROVISIONS:
Section 1 provides .that this act shall be known and may be cited as the
"Medical Aid in Dying Act".
Section 2 amends the Public Health Law by adding a new article 28-F,
Medical Aid in Dying, comprised of the following sections:
§ 2899-d sets forth definitions.
2899-e sets forth the request process by which a patient may request
medication for the purpose of ending his or her life in accordance with
this article. The patient wishing to request such medication shall make
an oral request and submit a written request, which shall be signed and
dated by the patient and witnessed by at least two adults as provided in
such section, identifying persons who shall not serve as witnesses. The
patient's attending physician, consulting physician and, if applicable,
the mental health professional who provides a capacity determination of
the patient under the article shall not act as a witness.
§ 2899-f sets forth the responsibilities of the attending physician.
2899-g provides that a patient may at any time rescind a request for
medication without regard to the patient's decision-making capacity, and
that the attending physician may not write a prescription for medication
without first offering the patient an opportunity to rescind the
request.
2899-h sets forth the responsibilities of the consulting physician.
2899-i provides that if the attending physician or the consulting physi-
cian determines that the patient may lack decision-making capacity to
make an informed decision due to a condition, including, but not limited
to, a psychiatric or psychological disorder, or other condition causing
impaired judgment, such physician shall refer the patient to a mental
health professional for a determination of whether the patient has deci-
sion-making capacity. If the mental health professional determines that
the patient lacks capacity to make an informed decision, the patient
shall not be deemed a qualified individual and the attending physician
shall not prescribe medication to the patient. A determination made
pursuant to this section that an adult patient lacks decision-making
capacity shall not be construed as a finding that the patient lacks
decision-making capacity for any other purpose.
§ 2899-j sets forth the items that must be documented or filed in the
patients medical record.
2899-k sets forth the form of written request for medication and decla-
ration of witnesses. The section also provides that the written request
shall be written in the same language as any conversations or consulta-
tions between a patient and at least one of his or her attending or
consulting physicians, provided that the written request may be in
English, even if the conversations or consultations were conducted in a
language other than English, if the form of written request includes the
form of interpreter's declaration set forth in the section.
§ 2899-1 provides that a physician, pharmacist, other health care
professional or other person shall not be subject to civil, administra-
tive or criminal liability or penalty or professional disciplinary
action by any government entity for taking any reasonable good- faith
action or refusing to act under the article, including without limita-
tion, engaging in discussions with a patient relating to the risks and
benefits of end-of-life options in the circumstances described in the
article and being present when a qualified individual self-administers
medication. The section further provides that nothing in the section
shall limit civil or criminal liability for negligence, recklessness or
intentional misconduct.
§ 2899-m provides that a physician, nurse, pharmacist, other health care
provider or other person shall not be under any duty by law or contract
to participate in the provision of medication to a patient. If a health
care provider is unable or unwilling to participate in the provision of
medication to a patient and the patient transfers care to a new health
care provider, the prior health care provider shall transfer or arrange
for the transfer, upon request, of a copy of the patient's relevant
medical records to the new health care provider. A private health care
facility may prohibit the prescribing,.dispensing, ordering or self-ad-
ministering of medication under the article while the patient is being
treated in or while the patient is residing in such facility if the
requirements set forth in the section have been met. In addition, where
a health care facility has adopted a prohibition under the subdivision,
if a patient who wishes to use medication under the article requests,
the patient shall be transferred promptly to another health care facili-
ty that is reasonably accessible under the circumstances and willing to
permit the prescribing, dispensing, ordering or self-administering of
medication with respect to the patient. Where a health care facility has
adopted a prohibition under the subdivision, any health care provider or
employee of the facility who violates the prohibition may be subject to
sanctions otherwise available to the facility, provided the facility has
previously notified the health care provider or employee of the prohibi-
tion in writing.
§ 2899-n provides that (i) a patient who requests medication under the
article will not, because of that request, be considered a person who is
suicidal, and self-administering medication under the article shall not
be deemed to be suicide for any purpose, (ii) action taken in accordance
with the article shall not be construed for any purpose to constitute
suicide, assisted suicide, attempted suicide, promoting a suicide
attempt, mercy killing, or homicide under the law, including as an
accomplice or accessory or otherwise, (iii) no provision in a contract,
will or other agreement, whether written or oral, to the extent the
provision would affect whether a person may make or rescind a request
for medication or take any other action under the article, shall be
valid, (iv) no obligation owing under any contract will be conditioned
upon or affected by the making or rescinding of a request by a person
for medication or taking any other action under the article, (v) a
person and his or her beneficiaries shall not be denied benefits under a
life insurance policy for actions taken in accordance with the article,
and the sale, procurement or issuance of a life or health insurance or
annuity policy or the rate charged for the policy shall not be condi-
tioned upon or affected by the patient pinking or rescinding a request
for medication under the article, (vi) an insurer shall not provide any
information in communications made to a patient about the availability
of medication under the article absent a request by the patient or by
his or her attending physician upon the request of such patient, and any
communication shall not include both the denial of coverage for treat-
ment and information as to the availability of medication under the
article, and (vii) the sale, procurement or issue of any professional
malpractice insurance policy or the rate charged for the policy shall
not be conditioned upon or affected by whether the insured does or does
not take or participate in any action under he article.
§ 2899-o provides that the department of health shall make regulations
providing for the safe disposal of unused medications prescribed,
dispensed or ordered under the article.
§ 2899-p provides that if otherwise authorized by law, the attending
physician may sign the qualified individual's death certificate. The
cause of death listed on a qualified individual's death certificate who
dies after self-administering medication under the article will be the
underlying terminal illness.
§ 2899-q provides for the annual review by the commissioner of health of
a sample of the records maintained under section twenty-eight hundred
ninety-nine-j and twenty-eight hundred ninety-nine-p of the article. The
commissioner shall adopt regulations establishing reporting requirements
for physicians taking action under the article to determine utilization
and compliance with the article. The information collected under the
section shall not constitute a public record available for public
inspection and shall be confidential and shall be collected and main-
tained in a manner that protects the privacy of the patient, his or her
family, and any health care provider acting in connection with such
patient under the article, except that such information may be disclosed
to a governmental agency as authorized or required by law relating to
professional discipline, protection of public health or law enforcement.
The commissioner shall prepare a report annually containing relevant
data regarding utilization and compliance with the article and shall
send such report to the legislature and post such report on its website.
§ 2899-r provides that nothing in the article shall be construed to
limit professional discipline or civil liability resulting from conduct
in violation of the article, negligent conduct, or intentional miscon-
duct by any person. Conduct in violation of the articles hall be subject
to applicable criminal liability under state law, including where appro-
priate and without limitation, offenses constituting homicide, forgery,
coercion, and related offenses, or federal law.
§ 2899-s provides the severability clause. Section 3 sets forth the
effective date.
JUSTIFICATION:
Faced with a terminal diagnosis, when no curative treatment options
exist, New Yorkers deserve the full range of options for care at the end
of life. The law would authorize medical aid in dying for terminally ill
adults with less than six months to live who have been determined by two
doctors to be mentally capable to make an informed decision.
Medical aid in dying allows a mentally capable, terminally ill adult to
request a prescription from their healthcare provider for a medication
that they can choose to ingest to die peacefully. The multi-step request
process, strict eligibility criteria, and other safeguards embedded in
this legislation ensure that patients pursuing the option, healthcare
providers who deliver care pursuant to the law, and those who refrain
from participating in medical aid in dying are all protected.
Authorizing the full range of end-of-life options, including medical aid
in dying, allows people to engage in open conversations with their
healthcare providers, their loved ones and their faith leaders about the
end of life experience they want.
Nearly 30 years ago, Oregon passed the nation's first law allowing
terminally ill, mentally capable adults with a prognosis of six months
or less to request a prescription for medication they can take to die
peacefully. Currently, 10 states and Washington, D.C., have authorized
the option of medical aid in dying.
These laws have worked in states that have adopted them, without any of
the ill-effects predicted by opponents. There has not been a single
substantiated incident of coercion or abuse associated with medical aid
in dying laws. With more than a quarter century of data since Oregon
implemented its law, and years of experience in 10 other authorized
jurisdictions, we no longer have to hypothesize about what will happen
if this medical practice is authorized in New York. We know: Medical aid
in dying protects patients, affords dying people autonomy, and improves
care across the end-of-life spectrum.
Support for medical aid in dying is growing. Each year since 1996, Gall-
up has issued results of a survey on opinions related to end-of- life
options.The latest data from Gallup shows that the vast majority of
adults surveyed believe in expanded end-of-life options, and
that support has grown steadily over the past three decades. Polling
conducted by Susquehanna Polling & Research reported that 68% of voters
support medical aid in dying as an end-of-life care option. When
respondents were asked if they want the option of medical aid in dying
personally for themselves, 67% said yes. Additionally, nearly 8 out of
10 U.S. residents (79%) who self-identify as having a disability agree
that medical aid in dying "should be legal for terminally ill, mentally
capable adults who chose to self-ingest medication to die peacefully."
New York voters overwhelmingly support the option of medical aid in
dying. In a YouGov poll conducted January 18-31, 2024, 72% of New York
voters, including 73% of voters with disabilities, said they support the
Medical Aid in Dying Act. Majority support is consistent across the
state (with support ranging from 64% to 76%), the political spectrum
(Democrats: 78%; Republicans: 59%), the racial spectrum (white voters:
73%, Black voters: 66%, Hispanic voters: 69%, Asian voters: 76%, and
other races: 54%) and religious spectrum (Catholic: 65%, Protestant:
61%, other religions: 76%, and no religion: 87%). Healthcare providers
in New York support this option. The Medical Society of the State of New
York (MSSNY) support this legislation, as does the New York State Acade-
my of Family Physicians. A 2018 Medscape survey of New York physicians
found that 56 percent of doctors support medical aid in dying. Their
support increased to 67 percent when physicians learned about the bill
provisions. The New York State Nurses Union (NYSNA) also supports the
bill.
So too, do lawyers in New York. The New York State Bar Association
convened a Task Force on Medical Aid in Dying and conducted a thorough
6-month investigation in 2023; the Task Force concluded by recommending
support for the Medical Aid in Dying Act, and the NYSBA House of Deleg-
ates voted to support the bill in 2024.
Medical aid in dying and hospice is not an either/or proposition. In
2023, 87% of patients who utilized medical aid in dying in Oregon were
enrolled in hospice care, and were able to die at home. Oregon leads the
nation in hospice care, with double the utilization rate of the national
average; New York ranks last among states, and second-to-last, just
ahead of Puerto Rico, in terms of appropriate hospice utilization
according to the latest report from the National Hospice & Palliative
Care Organization.
Close to 60 organizations that represent many aspects of civil society
across New York State support medical aid in dying. They include: 1 in
9 Long Island Breast Cancer Action Coalition, AIDS Coalition to Unleash
Power (ACT UP NY), ALS United Greater New York, The Arc New York, Adel-
phi NY Statewide Breast Cancer Program, Adirondack Voters for Change,
Black Nonbelievers of NYC, Breast Cancer Coalition of Rochester, Buffalo
Unitarian United Church, Capital District Humanist Society, Catholics
Vote Common Good, CCoHope Indivisible, Completed Life Initiative,
Congregation B'nai Yisrael, Death with Dignity Albany, End of Life
Choices New York, Four Freedoms Democratic Club, Gay Men's Health Crisis
(GMHC), Harlem United, Hispanic Health Network, Housing Works, Indivis-
ible Scarsdale, Indivisible Westchester, Indivisible Westchester
Districts 6 & 7, Indivisible Yorktown, Jim Owles Liberal Democratic
Club, Larchmont Mamaroneck Indivisible, Latino Commission on AIDS, Lati-
nos for Healthcare Equity, League of Women Voters of NYS, Medical Socie-
ty of the State of New York (MSSNY), Mobilizing Preachers & Communities
(MPAC), New York Civil Liberties Union (NYCLU), New York Unitarian Univ-
ersalist Justice, New York Society for Ethical Culture, New York State
Academy of Family Physicians, New York State Association of Counties,
New York State Bar Association, New York State Council of Churches, New
York State Nurses Association, New York State Public Health Association,
NOW-NY, NYCD16 Indivisible, New York State Nurses Association (NYSNA),
Planned Parenthood Empire State Acts (PPESA), Rainbow Seniors ROC, SAGE
- NY (Advocacy & Services for LGBT Elders), Sadhana: Coalition of
Progressive Hindus, Secular Coalition of America--New York Chapter,
SHARE Cancer Support, StateWide Senior Action Council, St. Francis
Community of Faith, Tompkins County Legislature, United University
Professors- Committee on Active Retiree, Membership & New Paltz chapter,
Up2Us, Village Independent Democrats, West chester Coalition for Legal
Abortion/Choice Matters, Women's Bar Association of the State of New
York, WESPAC Foundation.
LEGISLATIVE HISTORY:
2023-24: A.995c, referred to Health / Same as S. 2445c, referred to
Health.
2022: A.4321a, referred to Health / Same as S.6471, referred to Health.
2020-21:A.4331,Referred to Health/S.6471,Referred to Health
2019-20:A.2694,Referred to Health /S.3947,Referred to Health
2017-18:A.2383-A, Referred to Health / S.3151-A, Referred to Health
2016: A.10059, Referred to Codes / S.7579, Referred to Health
FISCAL IMPLICATIONS:
None to the State.
EFFECTIVE DATE:
This act shall take effect immediately.
