A00995 Summary:

BILL NOA00995C
 
SAME ASSAME AS S02445-C
 
SPONSORPaulin
 
COSPNSRRosenthal L, Dinowitz, Hevesi, Steck, Lavine, Lupardo, Rivera, Thiele, Epstein, Seawright, Woerner, Reyes, Darling, Cruz, Sayegh, Aubry, Davila, Dickens, Stern, Burdick, Gallagher, Kelles, Gonzalez-Rojas, Mitaynes, Mamdani, Clark, Burke, Anderson, Jean-Pierre, Sillitti, Jackson, Pretlow, Septimo, Glick, Gibbs, Tapia, Lunsford, Cunningham, Levenberg, Simone, Bores, Forrest, Shrestha, Shimsky, Raga, Rajkumar, Kim, Hunter, Stirpe, Chandler-Waterman, Ardila, Lee, Taylor, Meeks, Otis, Alvarez, Dais, Jacobson, Gunther
 
MLTSPNSRBraunstein, Bronson, Burgos, Hyndman, Ramos, Zinerman
 
Add Art 28-F §§2899-d - 2899-s, Pub Health L
 
Relates to the medical aid in dying act; relates to a terminally ill patient's request for and use of medication for medical aid in dying.
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A00995 Actions:

BILL NOA00995C
 
01/12/2023referred to health
05/25/2023amend and recommit to health
05/25/2023print number 995a
01/03/2024referred to health
04/08/2024amend and recommit to health
04/08/2024print number 995b
04/30/2024amend and recommit to health
04/30/2024print number 995c
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A00995 Committee Votes:

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A00995 Floor Votes:

There are no votes for this bill in this legislative session.
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A00995 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A995C
 
SPONSOR: Paulin
  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 patient may request medication to be self-administered for the purpose of hastening 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-administering 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 subdi- vision, if a patient who wishes to use medication under the article requests, the patient shall be transferred promptly to another health care facility that is reasonably accessible under the circumstances and willing to permit the prescribing, dispensing, ordering or self-adminis- tering of medication with respect to the patient. Whe re 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 prohibition 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 pers\n 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 the 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 article shall 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 effec- tive date.   JUSTIFICATION: The highly publicized, planned death of Brittany Maynard has highlighted the need for terminally ill patients to be able to access aid in dying. Ms. Maynard, who was a native of California, was forced to move to Oregon to gain control of her dying process. Her death, and the accompa- nying press attention, led the California legislature to pass, and Governor Jerry Brown to sign, an aid in dying law on October 5, 2015. The national debate that accompanied Ms. Maynard's plight focused the nation on the desire of patients with a terminal illness to determine for themselves - how and when they die. These patients, when mentally competent, should be afforded this right. Patients should not be forced to relocate to another state or to leave the country to control how their lives end. Patients seek to die with dignity, on their own terms, typically in their own homes, surrounded by their family and other loved ones. New Yorkers strongly support empowering terminally-ill, mentally compe- tent patients to control their own death. A 2015 poll found that 77% of all New Yorkers support aid in dying, including 75% of Catholics, 72% of Republicans, 67% of self-identified Conservatives, and 78% of New York- ers upstate. Nationally, according to HealthDay/Harris poll findings released in December 2014, 74% of American adults believe that terminally ill patients in great. pain should have the right to end their lives (14% were opposed). Gallup, which has been polling this issue since 1947, has found that a majority of Americans have supported aid in dying since 1973. Their most recent poll found 68% of Americans support aid in dying. Similar results were found in a recent survey of Americans by LifeWay Research (69% of those polled agree that physicians should be allowed to assist terminally ill patients in ending their life and 67% agree that it is morally acceptable for a person to ask for a physi- cian's aid in taking his or her own life.) Physicians also support aid in dying. In a recent survey conducted by Medscape, 54% of physicians in the U.S. believe that aid in dying should be permitted, while only 31% opposed it. The Medical Aid in Dying Act will enable mentally competent, terminally ill patients to choose to self-administer medication to bring about a peaceful death. It also provides their physician, when acting in good faith in accordance with the proVisions of the Act, protections from civil and criminal liability and professional disciplinary action. At least seven states - Oregon, Vermont, Washington, California, Monta- na, New Jersey and Colorado - allow physician assisted aid in dying. More than 65% of Colorado voters approved the ballot initiative to provide for aid in dying. Not only did the mayor of the District of Columbia signed a medical aid in dying act, but legislators in multiple states throughout the nation have aid in dying bills pending. Aid in dying legislation is supported by the American Public Health Association, the American Medical Women's Association, the American Medical Student Association, the American College of Legal Medicine, and Lamda Legal.   LEGISLATIVE HISTORY: 2023: A.995a, referred to Health / Same as S. 2445a, referred to Health. 2022: A.4321a, referred to Health / Same as 5.6471, referred to Health. 2020-21:A.4331,Referred to Health/S.647l,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.
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A00995 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                         995--C
 
                               2023-2024 Regular Sessions
 
                   IN ASSEMBLY
 
                                    January 12, 2023
                                       ___________
 
        Introduced  by  M.  of A. PAULIN, L. ROSENTHAL, DINOWITZ, HEVESI, STECK,
          LAVINE, LUPARDO, RIVERA, THIELE, EPSTEIN, SEAWRIGHT,  WOERNER,  REYES,
          DARLING,   CRUZ,  SAYEGH,  AUBRY,  DAVILA,  DICKENS,  STERN,  BURDICK,
          GALLAGHER, KELLES, GONZALEZ-ROJAS, MITAYNES,  MAMDANI,  CLARK,  BURKE,
          ANDERSON,  JEAN-PIERRE,  SILLITTI,  JACKSON,  PRETLOW, SEPTIMO, GLICK,
          GIBBS, TAPIA, LUNSFORD, CUNNINGHAM, LEVENBERG, SIMONE, BORES, FORREST,
          SHRESTHA, SHIMSKY, RAGA, RAJKUMAR, KIM, HUNTER,  STIRPE,  CHANDLER-WA-
          TERMAN,  ARDILA,  LEE, TAYLOR, MEEKS, OTIS, ALVAREZ -- Multi-Sponsored
          by -- M. of A. BRAUNSTEIN, BRONSON, BURGOS, HYNDMAN,  RAMOS,  ZINERMAN
          --  read  once  and  referred  to the Committee on Health -- committee
          discharged, bill amended, ordered reprinted as amended and recommitted
          to said committee -- recommitted to the Committee on Health in accord-
          ance with Assembly Rule  3,  sec.  2  --  committee  discharged,  bill
          amended,  ordered reprinted as amended and recommitted to said commit-
          tee -- again reported from said  committee  with  amendments,  ordered
          reprinted as amended and recommitted to said committee
 
        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
 
          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:
 
     1    Section  1.  This  act shall be known and may be cited as the "medical
     2  aid in dying act".
     3    § 2. The public health law is amended by adding a new article 28-F  to
     4  read as follows:
     5                                ARTICLE 28-F
     6                            MEDICAL AID IN DYING
     7  Section 2899-d. Definitions.
     8          2899-e. Request process.
     9          2899-f. Attending physician responsibilities.
    10          2899-g. Right  to rescind request; requirement to offer opportu-
    11                    nity to rescind.

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD02188-08-4

        A. 995--C                           2
 
     1          2899-h. Consulting physician responsibilities.
     2          2899-i. Referral to mental health professional.
     3          2899-j. Medical record documentation requirements.
     4          2899-k. Form of written request and witness attestation.
     5          2899-l. Protection and immunities.
     6          2899-m. Permissible refusals and prohibitions.
     7          2899-n. Relation to other laws and contracts.
     8          2899-o. Safe disposal of unused medications.
     9          2899-p. Death certificate.
    10          2899-q. Reporting.
    11          2899-r. Penalties.
    12          2899-s. Severability.
    13    § 2899-d. Definitions. As used in this article:
    14    1. "Adult" means an individual who is eighteen years of age or older.
    15    2. "Attending physician" means the physician who has primary responsi-
    16  bility for the care of the patient and treatment of the patient's termi-
    17  nal illness or condition.
    18    3.  "Decision-making  capacity"  means  the  ability to understand and
    19  appreciate the nature and consequences of health care decisions, includ-
    20  ing the benefits and risks of and alternatives to  any  proposed  health
    21  care, including medical aid in dying, and to reach an informed decision.
    22    4.    "Consulting  physician"  means  a  physician who is qualified by
    23  specialty or experience to make a professional diagnosis  and  prognosis
    24  regarding a person's terminal illness or condition.
    25    5.  "Health  care facility" means a general hospital, nursing home, or
    26  residential health care facility  as  defined  in  section  twenty-eight
    27  hundred  one  of  this  chapter, or a hospice as defined in section four
    28  thousand two of this chapter; provided that for the purposes of  section
    29  twenty  eight  hundred  ninety-nine-m  of  this article, "hospice" shall
    30  refer only to a facility providing in-patient hospice care or a  hospice
    31  residence.
    32    6.  "Health  care  provider"  means  a  person licensed, certified, or
    33  authorized by law to administer health care or  dispense  medication  in
    34  the ordinary course of business or practice of a profession.
    35    7.  "Informed decision" means a decision by a patient who is suffering
    36  from   a   terminal  illness  or  condition  to  request  and  obtain  a
    37  prescription for medication that the patient may self-administer to  end
    38  the  patient's life that is based on an understanding and acknowledgment
    39  of the relevant facts and that is made voluntarily, of the patient's own
    40  volition and without coercion, after being fully informed of:
    41    (a) the patient's medical diagnosis and prognosis;
    42    (b) the potential risks associated with taking the  medication  to  be
    43  prescribed;
    44    (c) the probable result of taking the medication to be prescribed;
    45    (d)  the  possibility  that  the  patient may choose not to obtain the
    46  medication, or may obtain the medication but may decide not to  self-ad-
    47  minister it; and
    48    (e)  the  feasible  alternatives  and  appropriate  treatment options,
    49  including but not limited to palliative care and hospice care.
    50    8. "Medical aid in dying" means the medical practice  of  a  physician
    51  prescribing medication to a qualified individual that the individual may
    52  choose to self-administer to bring about death.
    53    9.  "Medically  confirmed"  means the medical opinion of the attending
    54  physician that a patient has a terminal illness  or  condition  and  has
    55  made  an  informed  decision  which  has  been confirmed by a consulting

        A. 995--C                           3
 
     1  physician who has  examined  the  patient  and  the  patient's  relevant
     2  medical records.
     3    10. "Medication" means medication prescribed by a physician under this
     4  article.
     5    11.  "Mental health professional" means a licensed physician, who is a
     6  diplomate or eligible to be certified by a national board of psychiatry,
     7  psychiatric nurse practitioner, or psychologist, licensed  or  certified
     8  under  the education law acting within such mental health professional's
     9  scope of practice and who is  qualified,  by  training  and  experience,
    10  certification, or board certification or eligibility, to make a determi-
    11  nation under section twenty-eight hundred ninety-nine-i of this article.
    12    12. "Palliative care" means health care treatment, including interdis-
    13  ciplinary  end-of-life  care,  and consultation with patients and family
    14  members, to prevent or relieve pain and suffering  and  to  enhance  the
    15  patient's quality of life, including hospice care under article forty of
    16  this chapter.
    17    13.  "Patient"  means  a  person who is eighteen years of age or older
    18  under the care of a physician.
    19    14. "Physician" means an individual licensed to practice  medicine  in
    20  New York state.
    21    15.  "Qualified individual" means a patient with a terminal illness or
    22  condition, who has decision-making capacity, has made an informed  deci-
    23  sion,  and  has  satisfied  the requirements of this article in order to
    24  obtain a prescription for medication.
    25    16. "Self-administer"  means  a  qualified  individual's  affirmative,
    26  conscious,  and  voluntary  act to ingest medication under this article.
    27  Self-administration  does  not  include  lethal  injection   or   lethal
    28  infusion.
    29    17.  "Terminal  illness or condition" means an incurable and irrevers-
    30  ible illness or condition that has been medically  confirmed  and  will,
    31  within reasonable medical judgment, produce death within six months.
    32    18.  "Third-party  health  care  payer"  has  its ordinary meaning and
    33  includes, but is not limited to, an insurer, organization or corporation
    34  licensed or certified under article thirty-two,  forty-three  or  forty-
    35  seven  of  the insurance law, or article forty-four of the public health
    36  law; or an entity such as a pharmacy benefits manager,  fiscal  adminis-
    37  trator,  or  administrative  services  provider that participates in the
    38  administration of a third-party health care payer system.
    39    § 2899-e. Request process.   1. Oral and written  request.  A  patient
    40  wishing  to  request  medication  under  this article shall make an oral
    41  request and submit a written request to the patient's  attending  physi-
    42  cian.
    43    2.  Making a written request. A patient may make a written request for
    44  and consent to self-administer medication for the purpose of ending such
    45  patient's life in accordance with this article if the patient:
    46    (a) has been determined by the attending physician to have a  terminal
    47  illness  or  condition  and  which  has  been  medically  confirmed by a
    48  consulting physician; and
    49    (b) based on an  informed  decision,  expresses  voluntarily,  of  the
    50  patient's  own  volition and without coercion the request for medication
    51  to end such patient's life.
    52    3. Written request signed and witnessed. (a)  A  written  request  for
    53  medication  under  this article shall be signed and dated by the patient
    54  and witnessed by at least  two  adults  who,  in  the  presence  of  the
    55  patient, attest that to the best of the persons knowledge and belief the
    56  patient  has  decision-making capacity, is acting voluntarily, is making

        A. 995--C                           4
 
     1  the request for medication of the patient's  own  volition  and  is  not
     2  being  coerced  to  sign  the  request.  The written request shall be in
     3  substantially the form described in section twenty-eight  hundred  nine-
     4  ty-nine-k of this article.
     5    (b) Both witnesses shall be adults who are not:
     6    (i) a relative of the patient by blood, marriage or adoption;
     7    (ii)  a person who at the time the request is signed would be entitled
     8  to any portion of the estate of the patient upon death under any will or
     9  by operation of law;
    10    (iii) an owner, operator, employee  or  independent  contractor  of  a
    11  health  care  facility  where the patient is receiving treatment or is a
    12  resident;
    13    (iv) a domestic partner of the  patient,  as  defined  in  subdivision
    14  seven of section twenty-nine hundred ninety-four-a of this chapter;
    15    (v)  an  agent  under  the  patient's  health care proxy as defined in
    16  subdivision five of section twenty-nine hundred eighty of this  chapter;
    17  or
    18    (vi)  an  agent  acting  under  a power of attorney for the patient as
    19  defined in section 5-1501 of the general obligations law.
    20    (c) The attending physician, consulting physician and, if  applicable,
    21  the  mental  health professional who provides a decision-making capacity
    22  determination of the patient under this article shall not be a witness.
    23    4. No person shall qualify for medical aid in dying under this article
    24  solely because of age or disability.
    25    5. Requests for a medical aid-in-dying prescription must  be  made  by
    26  the  qualified  individual  and may not be made by any other individual,
    27  including the qualified individual's health care agent, or  other  agent
    28  or surrogate, or via advance healthcare directive.
    29    § 2899-f. Attending   physician  responsibilities.  1.  The  attending
    30  physician shall examine the patient and the patient's  relevant  medical
    31  records and:
    32    (a)  make  a determination of whether a patient has a terminal illness
    33  or condition, has decision-making capacity, has made an  informed  deci-
    34  sion  and has made the request voluntarily of the patient's own volition
    35  and without coercion;
    36    (b) inform the patient of  the  requirement  under  this  article  for
    37  confirmation  by  a  consulting  physician,  and  refer the patient to a
    38  consulting physician upon the patient's request;
    39    (c) refer the patient to a  mental  health  professional  pursuant  to
    40  section  twenty-eight  hundred  ninety-nine-i  of  this  article  if the
    41  attending physician believes that the patient may  lack  decision-making
    42  capacity to make an informed decision;
    43    (d)  provide  information  and  counseling  under  section twenty-nine
    44  hundred ninety-seven-c of this chapter;
    45    (e) ensure that the patient is making an informed decision by discuss-
    46  ing with the patient: (i) the patient's medical diagnosis and prognosis;
    47  (ii) the potential risks associated with taking  the  medication  to  be
    48  prescribed;  (iii)  the  probable  result of taking the medication to be
    49  prescribed; (iv) the possibility that the patient may choose  to  obtain
    50  the medication but not take it; (v) the feasible alternatives and appro-
    51  priate  treatment  options, including but not limited to (1) information
    52  and counseling regarding palliative and  hospice  care  and  end-of-life
    53  options  appropriate  to  the patient, including but not limited to: the
    54  range of options appropriate to the patient; the  prognosis,  risks  and
    55  benefits  of  the  various  options;  and  the patient's legal rights to
    56  comprehensive pain and symptom management at the end of  life;  and  (2)

        A. 995--C                           5
 
     1  information  regarding  treatment  options  appropriate  to the patient,
     2  including the prognosis, risks and benefits  of  the  various  treatment
     3  options;
     4    (f)  offer  to  refer  the  patient  for  other  appropriate treatment
     5  options, including but not limited to palliative care and hospice care;
     6    (g) provide health literate  and  culturally  appropriate  educational
     7  material regarding hospice and palliative care that has been prepared by
     8  the  department  in  consultation  with  representatives  of hospice and
     9  palliative care providers from all regions of New York state,  and  that
    10  is  available  on  the  department's  website  for  access and download,
    11  provided, however, an otherwise eligible patient cannot be  denied  care
    12  under this article if these materials are not developed by the effective
    13  date of this article;
    14    (h) discuss with the patient the importance of:
    15    (i)  having  another person present when the patient takes the medica-
    16  tion and the restriction that no  person  other  than  the  patient  may
    17  administer the medication;
    18    (ii) not taking the medication in a public place; and
    19    (iii)  informing  the  patient's  family  of the patient's decision to
    20  request and take medication that will end the patient's life; a  patient
    21  who declines or is unable to notify family shall not have such patient's
    22  request for medication denied for that reason;
    23    (i)  inform  the patient that such patient may rescind the request for
    24  medication at any time and in any manner;
    25    (j) fulfill the medical record documentation requirements  of  section
    26  twenty-eight hundred ninety-nine-j of this article; and
    27    (k)  ensure  that  all appropriate steps are carried out in accordance
    28  with this article before writing a prescription for medication.
    29    2. Upon receiving  confirmation  from  a  consulting  physician  under
    30  section  twenty-eight  hundred ninety-nine-h of this article and subject
    31  to section twenty-eight  hundred  ninety-nine-i  of  this  article,  the
    32  attending  physician  who  determines  that  the  patient has a terminal
    33  illness or condition, has decision-making capacity and has made a volun-
    34  tary request for medication as provided in this article, may personally,
    35  or by referral to another  physician,  prescribe  or  order  appropriate
    36  medication  in accordance with the patient's request under this article,
    37  and at the patient's request, facilitate the filling of the prescription
    38  and delivery of the medication to the patient.
    39    3. In accordance with the direction of  the  prescribing  or  ordering
    40  physician  and the consent of the patient, the patient may self-adminis-
    41  ter the medication to themselves. A health care  professional  or  other
    42  person shall not administer the medication to the patient.
    43    § 2899-g. Right  to  rescind request; requirement to offer opportunity
    44  to rescind.  1. A patient may at any time rescind the request for  medi-
    45  cation  under this article without regard to the patient's decision-mak-
    46  ing capacity.
    47    2. A prescription for  medication  may  not  be  written  without  the
    48  attending  physician offering the qualified individual an opportunity to
    49  rescind the request.
    50    § 2899-h. Consulting physician responsibilities. Before a patient  who
    51  is requesting medication may receive a prescription for medication under
    52  this article, a consulting physician must:
    53    1. examine the patient and such patient's relevant medical records;
    54    2.  confirm,  in  writing, to the attending physician and the patient,
    55  whether: (a) the patient has a terminal illness or  condition;  (b)  the
    56  patient  is  making  an informed decision; (c) the patient has decision-

        A. 995--C                           6
 
     1  making capacity, or provide documentation that the consulting  physician
     2  has  referred the patient for a determination under section twenty-eight
     3  hundred ninety-nine-i of this article; and (d)  the  patient  is  acting
     4  voluntarily, of the patient's own volition and without coercion.
     5    § 2899-i. Referral  to mental health professional. 1. If the attending
     6  physician or the consulting physician determines that  the  patient  may
     7  lack  decision-making  capacity  to  make  an informed decision due to a
     8  condition, including, but not limited to, a psychiatric or psychological
     9  disorder, or other condition causing impaired judgement,  the  attending
    10  physician  or  consulting  physician shall refer the patient to a mental
    11  health professional for a determination of whether the patient has deci-
    12  sion-making capacity to make an informed decision. The referring  physi-
    13  cian  shall  advise  the  patient  that  the report of the mental health
    14  professional will  be  provided  to  the  attending  physician  and  the
    15  consulting physician.
    16    2.  A  mental  health  professional who evaluates a patient under this
    17  section shall report, in writing, to the  attending  physician  and  the
    18  consulting  physician,  the  mental  health  professional's  independent
    19  conclusions about whether the patient has  decision-making  capacity  to
    20  make  an informed decision, provided that if, at the time of the report,
    21  the patient has not yet been referred to a  consulting  physician,  then
    22  upon  referral  the  attending  physician  shall  provide the consulting
    23  physician with a copy of the mental health professional's report. If the
    24  mental health professional determines that the patient  lacks  decision-
    25  making  capacity  to make an informed decision, the patient shall not be
    26  deemed a qualified individual, and the  attending  physician  shall  not
    27  prescribe medication to the patient.
    28    3. A determination made pursuant to this section that an adult patient
    29  lacks  decision-making capacity shall not be construed as a finding that
    30  the patient lacks decision-making capacity for any other purpose.
    31    § 2899-j. Medical  record  documentation  requirements.  An  attending
    32  physician  shall document or file the following in the patient's medical
    33  record:
    34    1. the dates of all oral requests by the patient for medication  under
    35  this article;
    36    2.  the written request by the patient for medication under this arti-
    37  cle, including the declaration of witnesses and  interpreter's  declara-
    38  tion, if applicable;
    39    3. the attending physician's diagnosis and prognosis, determination of
    40  decision-making  capacity,  and determination that the patient is acting
    41  voluntarily, of the patient's own volition and without coercion, and has
    42  made an informed decision;
    43    4. if applicable, written  confirmation  of  decision-making  capacity
    44  under section twenty-eight hundred ninety-nine-i of this article; and
    45    5.  a note by the attending physician indicating that all requirements
    46  under this article have been met and indicating the steps taken to carry
    47  out the request, including a notation of the  medication  prescribed  or
    48  ordered.
    49    § 2899-k. Form  of  written  request  and  witness  attestation.  1. A
    50  request for medication under this article shall be in substantially  the
    51  following form:
    52                    REQUEST FOR MEDICATION TO END MY LIFE
 
    53    I,  _________________________________,  am  an adult who has decision-
    54  making capacity, which means I understand and appreciate the nature  and
    55  consequences  of health care decisions, including the benefits and risks

        A. 995--C                           7
 
     1  of and alternatives to  any  proposed  health  care,  and  to  reach  an
     2  informed  decision  and to communicate health care decisions to a physi-
     3  cian.
     4    I  have  been  diagnosed  with  (insert diagnosis), which my attending
     5  physician has determined is a terminal illness or condition,  which  has
     6  been medically confirmed by a consulting physician.
     7    I  have  been fully informed of my diagnosis and prognosis, the nature
     8  of the medication to be prescribed and potential associated  risks,  the
     9  expected  result,  and  the  feasible alternatives and treatment options
    10  including but not limited to palliative care and hospice care.
    11    I request that my attending physician prescribe medication  that  will
    12  end  my life if I choose to take it, and I authorize my attending physi-
    13  cian to contact another physician or any pharmacist about my request.
 
    14    INITIAL ONE:
    15    (  ) I have informed or intend to inform one or  more  members  of  my
    16  family of my decision.
    17    (   ) I have decided not to inform any member of my family of my deci-
    18  sion.
    19    (  ) I have no family to inform of my decision.
    20    I understand that I have the right to rescind this request or  decline
    21  to use the medication at any time.
    22    I  understand the importance of this request, and I expect to die if I
    23  take the medication to be prescribed. I further understand that although
    24  most deaths occur within three hours, my death may take longer,  and  my
    25  attending physician has counseled me about this possibility.
    26    I  make this request voluntarily, of my own volition and without being
    27  coerced, and I accept full responsibility for my actions.
 
    28  Signed: __________________________
 
    29  Dated: ___________________________
 
    30                          DECLARATION OF WITNESSES

    31    I declare that the person signing this "Request for Medication to  End
    32  My Life":
    33    (a) is personally known to me or has provided proof of identity;
    34    (b)  voluntarily signed the "Request for Medication to End My Life" in
    35  my presence or acknowledged to me that the person signed it; and
    36    (c) to the best of my knowledge and belief, has decision-making capac-
    37  ity and is making the "Request for Medication to End My Life"  voluntar-
    38  ily,  of  the person's own volition and is not being coerced to sign the
    39  "Request for Medication to End My Life".
    40    I am not the attending physician or consulting physician of the person
    41  signing the "Request for Medication to End My Life" or,  if  applicable,
    42  the  mental  health professional who provides a decision-making capacity
    43  determination of the person signing the "Request for Medication  to  End
    44  My  Life"  at  the  time the "Request for Medication to End My Life" was
    45  signed.
    46    I further declare under penalty of perjury that  the  statements  made
    47  herein are true and correct and false statements made herein are punish-
    48  able.
 
    49  Witness 1, Date:

        A. 995--C                           8
 
     1  (Printed name)
 
     2  (Address)
 
     3  (Telephone number)
 
     4    I further declare that I am not (i) related to the above-named patient
     5  by  blood,  marriage  or adoption, (ii) entitled at the time the patient
     6  signed the "Request for Medication to End My Life" to any portion of the
     7  estate of the patient upon such patient's death under  any  will  or  by
     8  operation  of  law, or (iii) an owner, operator, employee or independent
     9  contractor of a health care facility  where  the  patient  is  receiving
    10  treatment or is a resident.
 
    11  Witness 2, Date:
 
    12  (Printed name)
 
    13  (Address)
 
    14  (Telephone number)
 
    15    I further declare that I am not (i) related to the above-named patient
    16  by  blood,  marriage  or adoption, (ii) entitled at the time the patient
    17  signed the "Request for Medication to End My Life" to any portion of the
    18  estate of the patient upon such patient's death under  any  will  or  by
    19  operation  of  law, or (iii) an owner, operator, employee or independent
    20  contractor of a health care facility  where  the  patient  is  receiving
    21  treatment or is a resident.
    22    2. (a) The "Request for Medication to End My Life" shall be written in
    23  the  same  language  as any conversations, consultations, or interpreted
    24  conversations or consultations between a patient and at least one of the
    25  patient's attending or consulting physicians.
    26    (b) Notwithstanding paragraph (a) of  this  subdivision,  the  written
    27  "Request  for Medication to End My Life" may be prepared in English even
    28  when the conversations or consultations or interpreted conversations  or
    29  consultations  were  conducted  in a language other than English or with
    30  auxiliary aids or  hearing,  speech  or  visual  aids,  if  the  English
    31  language form includes an attached declaration by the interpreter of the
    32  conversation  or  consultation,  which  shall  be  in  substantially the
    33  following form:
 
    34                          INTERPRETER'S DECLARATION
 
    35    I, (insert name of interpreter), (mark as applicable):
    36    (  ) for a patient whose conversations or consultations or interpreted
    37  conversations or consultations were conducted in a language  other  than
    38  English and the "Request for Medication to End My Life" is in English: I
    39  declare that I am fluent in English and (insert target language). I have
    40  the  requisite  language  and interpreter skills to be able to interpret
    41  effectively, accurately and impartially information shared and  communi-
    42  cations  between  the  attending  or  consulting  physician and (name of
    43  patient).
    44    I certify that on (insert date), at  approximately  (insert  time),  I
    45  interpreted  the  communications  and  information  conveyed between the
    46  physician and (name of patient) as accurately and completely to the best

        A. 995--C                           9
 
     1  of my knowledge and ability and read the "Request for Medication to  End
     2  My Life" to (name of patient) in (insert target language).
     3    (Name  of  patient)  affirmed  to me such patient's desire to sign the
     4  "Request for Medication  to  End  My  Life"  voluntarily,  of  (name  of
     5  patient)'s own volition and without coercion.
     6    (  )  for  a  patient  with  a speech, hearing or vision disability: I
     7  declare that I have the requisite language, reading  and/or  interpreter
     8  skills  to  communicate  with  the patient and to be able to read and/or
     9  interpret effectively, accurately and impartially information shared and
    10  communications that occurred on (insert date) between the  attending  or
    11  consulting physician and (name of patient).
    12    I  certify  that  on  (insert date), at approximately (insert time), I
    13  read and/or interpreted  the  communications  and  information  conveyed
    14  between the physician and (name of patient) impartially and as accurate-
    15  ly  and  completely  to  the best of my knowledge and ability and, where
    16  needed for effective communication, read or interpreted the "Request for
    17  Medication to End my Life" to (name of patient).
    18    (Name of patient) affirmed to me such patient's  desire  to  sign  the
    19  "Request  for  Medication  to  End  My  Life"  voluntarily,  of (name of
    20  patient)'s own volition and without coercion.
    21    I further declare under penalty of perjury that (i) the  foregoing  is
    22  true  and  correct;  (ii)  I  am not (A) related to (name of patient) by
    23  blood, marriage or adoption, (B) entitled at the time (name of  patient)
    24  signed the "Request for Medication to End My Life" to any portion of the
    25  estate  of (name of patient) upon such patient's death under any will or
    26  by operation of law, or (C) an owner, operator, employee or  independent
    27  contractor  of a health care facility where (name of patient) is receiv-
    28  ing treatment or is a resident, except that if I am an employee or inde-
    29  pendent contractor at such health care facility,  providing  interpreter
    30  services is part of my job description at such health care facility or I
    31  have  been trained to provide interpreter services and (name of patient)
    32  requested that I provide interpreter services to such  patient  for  the
    33  purposes  stated  in  this  Declaration; and (iii) false statements made
    34  herein are punishable.
 
    35  Executed at (insert city, county and  state)  on  this  (insert  day  of
    36  month) of (insert month), (insert year).
 
    37  (Signature of Interpreter)
 
    38  (Printed name of Interpreter)

    39  (ID # or Agency Name)
 
    40  (Address of Interpreter)
 
    41  (Language Spoken by Interpreter)
 
    42    (c)  An interpreter whose services are provided under paragraph (b) of
    43  this subdivision shall not (i) be related to the patient who  signs  the
    44  "Request  for Medication to End My Life" by blood, marriage or adoption,
    45  (ii) be entitled at the time the "Request for Medication to End My Life"
    46  is signed by the patient to any portion of the  estate  of  the  patient
    47  upon  death under any will or by operation of law, or (iii) be an owner,
    48  operator, employee or independent contractor of a health  care  facility
    49  where the patient is receiving treatment or is a resident; provided that

        A. 995--C                          10

     1  an  employee  or  independent  contractor  whose  job description at the
     2  health care facility includes interpreter services or who is trained  to
     3  provide  interpreter  services and who has been requested by the patient
     4  to  serve  as  an interpreter under this article shall not be prohibited
     5  from serving as an interpreter under this article.
     6    § 2899-l. Protection and immunities. 1. A physician, pharmacist, other
     7  health care provider or other person shall  not  be  subject  to  civil,
     8  administrative,  or criminal liability or penalty or professional disci-
     9  plinary action by any government entity for taking any reasonable  good-
    10  faith  action  or refusing to act under this article, including, but not
    11  limited to:  (a) engaging in discussions with a patient relating to  the
    12  risks and benefits of end-of-life options in the circumstances described
    13  in  this article, (b) providing a patient, upon request, with a referral
    14  to another health care provider, (c)  being  present  when  a  qualified
    15  individual  self-administers  medication,  (d) refraining from acting to
    16  prevent the qualified individual from  self-administering  such  medica-
    17  tion,  or  (e) refraining from acting to resuscitate the qualified indi-
    18  vidual after the qualified individual self-administers such medication.
    19    2. A health care provider or other person  shall  not  be  subject  to
    20  employment,  credentialing,  or contractual liability or penalty for any
    21  reasonable good-faith action or refusing  to  act  under  this  article,
    22  including, but not limited to:
    23    (a)  engaging  in discussions with a patient relating to the risks and
    24  benefits of end-of-life options in the circumstances described  in  this
    25  article;
    26    (b)  providing  a  patient,  upon  request, with a referral to another
    27  health care provider;
    28    (c) being present when a qualified individual self-administers medica-
    29  tion;
    30    (d) refraining from acting to prevent the  qualified  individual  from
    31  self-administering such medication; or
    32    (e)  refraining  from  acting  to resuscitate the qualified individual
    33  after the qualified individual self-administers such medication.  Howev-
    34  er,  this  subdivision  does  not bar a health care facility from acting
    35  under paragraph (c) of subdivision two of section  twenty-eight  hundred
    36  ninety-nine-m of this article.
    37    3. Nothing in this section shall limit civil, administrative, or crim-
    38  inal  liability  or  penalty or any professional disciplinary action, or
    39  employment, credentialing,  or  contractual  liability  or  penalty  for
    40  negligence, recklessness or intentional misconduct.
    41    § 2899-m. Permissible  refusals  and prohibitions. 1. (a) A physician,
    42  nurse, pharmacist, other health care provider or other person shall  not
    43  be  under  any duty, by law or contract, to participate in the provision
    44  of medication to a patient under this article.
    45    (b) If a health care provider is unable or unwilling to participate in
    46  the provision of medication to a patient  under  this  article  and  the
    47  patient  transfers  care to a new health care provider, the prior health
    48  care provider shall transfer or arrange for the transfer, upon  request,
    49  of  a  copy  of the patient's relevant medical records to the new health
    50  care provider.
    51    2. (a) A private health care facility may  prohibit  the  prescribing,
    52  dispensing,  ordering  or  self-administering  of  medication under this
    53  article while the patient is being treated in or while  the  patient  is
    54  residing in the health care facility if:
    55    (i)  the  prescribing,  dispensing,  ordering or self-administering is
    56  contrary to a formally adopted policy of the facility that is  expressly

        A. 995--C                          11
 
     1  based  on  sincerely held religious beliefs or moral convictions central
     2  to the facility's operating principles; and
     3    (ii)  the  facility  has  informed the patient of such policy prior to
     4  admission or as soon as reasonably possible.
     5    (b) Where a facility has adopted a prohibition under this subdivision,
     6  if a patient who wishes to use medication under this  article  requests,
     7  the patient shall be transferred promptly to another health care facili-
     8  ty  that is reasonably accessible under the circumstances and willing to
     9  permit the prescribing, dispensing, ordering and  self-administering  of
    10  medication under this article with respect to the patient.
    11    (c)  Where a health care facility has adopted a prohibition under this
    12  subdivision,  any  health  care  provider  or  employee  or  independent
    13  contractor  of  the facility who violates the prohibition may be subject
    14  to sanctions otherwise available to the facility, provided the  facility
    15  has  previously notified the health care provider, employee or independ-
    16  ent contractor of the prohibition in writing.
    17    § 2899-n. Relation to other laws and contracts. 1. (a) A  patient  who
    18  requests  medication  under  this  article  shall  not,  because of that
    19  request, be considered to be a person who is suicidal, and self-adminis-
    20  tering medication under this article shall not be deemed to be  suicide,
    21  for any purpose.
    22    (b)  Action  taken  in  accordance  with  this  article  shall  not be
    23  construed for any  purpose  to  constitute  suicide,  assisted  suicide,
    24  attempted  suicide, promoting a suicide attempt, euthanasia, mercy kill-
    25  ing, or homicide under the law, including as an accomplice or  accessory
    26  or otherwise.
    27    2.  (a)  No  provision  in a contract, other agreement or testamentary
    28  instrument, whether written or oral, to the extent the  provision  would
    29  affect  whether a person may make or rescind a request for medication or
    30  take any other action under this article, shall be valid.
    31    (b) No obligation owing under any contract, other agreement or  testa-
    32  mentary  instrument  shall  be  conditioned or affected by the making or
    33  rescinding of a request by a person for medication or taking  any  other
    34  action under this article.
    35    3.  (a)  A  person and such person's beneficiaries shall not be denied
    36  benefits under a life insurance policy for actions taken  in  accordance
    37  with this article.
    38    (b)  The  sale, procurement or issuance of a life insurance or annuity
    39  policy or third-party health care payer policy or coverage, or the  rate
    40  charged  for  a  policy  or  coverage,  shall not be conditioned upon or
    41  affected by a patient making or  rescinding  a  request  for  medication
    42  under this article.
    43    (c) This article shall not limit the effect of a life insurance policy
    44  provision  concerning incontestability pursuant to article thirty-two of
    45  the insurance law or any rights or  obligations  concerning  a  material
    46  misrepresentation in accordance with article thirty-one of the insurance
    47  law.
    48    (d) No third-party health care payer may deny coverage for any service
    49  or  item  that  would  otherwise  be  covered  by the policy because the
    50  patient has or has not chosen to request or use  medication  under  this
    51  article.
    52    4.  An  insurer or third-party health care payer shall not provide any
    53  information in communications made to a patient about  the  availability
    54  of  medication  under this article absent a request by the patient or by
    55  such patient's attending physician upon the request of such patient. Any
    56  communication shall not include both the denial of coverage  for  treat-

        A. 995--C                          12
 
     1  ment  and  information  as  to the availability of medication under this
     2  article.  This subdivision does not bar the inclusion of information  as
     3  to the coverage of medication and professional services under this arti-
     4  cle  in  information  generally stating what is covered by a third-party
     5  health care payer or provided in response to a request by the patient or
     6  by such patient's attending physician upon the request of the patient.
     7    5. The sale, procurement, or issue  of  any  professional  malpractice
     8  insurance  policy or the rate charged for the policy shall not be condi-
     9  tioned upon or affected by whether the insured does or does not take  or
    10  participate in any action under this article.
    11    § 2899-o. Safe  disposal  of  unused  medications.    A person who has
    12  custody or control of any unused medication prescribed under this  arti-
    13  cle after the death of the qualified individual shall personally deliver
    14  the  unused  medication  for  disposal to the nearest qualified facility
    15  that properly disposes of controlled substances or shall dispose  of  it
    16  by lawful means in accordance with regulations made by the commissioner,
    17  regulations  made  by or guidelines of the commissioner of education, or
    18  guidelines of a federal drug enforcement administration  approved  take-
    19  back  program. A qualified facility that properly disposes of controlled
    20  substances shall accept and dispose of any medication delivered to it as
    21  provided hereunder regardless of whether such medication is a controlled
    22  substance. The commissioner may make regulations as may  be  appropriate
    23  for  the  safe  disposal  of unused medications prescribed, dispensed or
    24  ordered under this article as provided in this section.
    25    § 2899-p. Death certificate.  1. If otherwise authorized by  law,  the
    26  attending  physician  may  sign the qualified individual's death certif-
    27  icate.
    28    2. The cause of death listed on a qualified individual's death certif-
    29  icate who dies after self-administering medication  under  this  article
    30  will be the underlying terminal illness or condition.
    31    § 2899-q. Reporting.  1.  The  commissioner  shall  annually  review a
    32  sample of the records maintained  under  sections  twenty-eight  hundred
    33  ninety-nine-j  and  twenty-eight  hundred ninety-nine-p of this article.
    34  The commissioner shall adopt regulations establishing reporting require-
    35  ments for physicians taking  action  under  this  article  to  determine
    36  utilization  and compliance with this article. The information collected
    37  under this subdivision shall not constitute a  public  record  available
    38  for  public inspection and shall be confidential and collected and main-
    39  tained in a manner  that  protects  the  privacy  of  the  patient,  the
    40  patient's family, and any health care provider acting in connection with
    41  such  patient  under  this  article, except that such information may be
    42  disclosed to a governmental agency as  authorized  or  required  by  law
    43  relating  to professional discipline, protection of public health or law
    44  enforcement.
    45    2. The commissioner shall prepare a report annually  containing  rele-
    46  vant  data  regarding  utilization  and compliance with this article and
    47  shall send such report to the legislature, and post such report  on  the
    48  department's website.
    49    § 2899-r. Penalties.  1. Nothing in this article shall be construed to
    50  limit professional discipline or civil liability resulting from  conduct
    51  in  violation of this article, negligent conduct, or intentional miscon-
    52  duct by any person.
    53    2. Conduct in violation of this article shall be subject to applicable
    54  criminal liability under state law,  including,  where  appropriate  and
    55  without  limitation,  offenses constituting homicide, forgery, coercion,
    56  and related offenses, or federal law.

        A. 995--C                          13
 
     1    § 2899-s. Severability. If any provision of this article or any appli-
     2  cation of any provision of this article, is held to be  invalid,  or  to
     3  violate  or  be  inconsistent  with  any federal law or regulation, that
     4  shall not affect the validity or effectiveness of any other provision of
     5  this article, or of any other application of any provision of this arti-
     6  cle,  which  can  be given effect without that provision or application;
     7  and to that end, the provisions and applications  of  this  article  are
     8  severable.
     9    § 3. This act shall take effect immediately.
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