A02383 Summary:

BILL NOA02383A
 
SAME ASSAME AS S03151-A
 
SPONSORPaulin
 
COSPNSRRosenthal L, Gottfried, Dinowitz, Galef, Hevesi, Steck, Blake, Lavine, Lupardo, Sepulveda, Abinanti, Rodriguez, Jaffee, Jones, D'Urso, Miller MG, Ortiz, Arroyo, Simotas, Vanel, Quart, Rivera, Miller ML, Thiele, Mosley
 
MLTSPNSRBraunstein, Crouch, Lifton, Magee, Skartados
 
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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A02383 Actions:

BILL NOA02383A
 
01/19/2017referred to health
01/03/2018referred to health
02/20/2018amend and recommit to health
02/20/2018print number 2383a
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A02383 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A2383A
 
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 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 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 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 physician believes that the patient may lack capacity, such physician shall refer the patient to a mental health professional for a determi- nation of whether the patient has capacity. If the mental health profes- sional 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. 2899-j sets forth the items that must be documented or filed in the patient's medical record. § 2899-k sets forth the form of written request for medication and declaration of witnesses. The section also provides that the written request shall be written in the same language as any conversations or consultations 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-l provides that a physician, pharmacist, other health care professional or other person shall not be subject to civil or criminal liability or professional disciplinary action by any government entity for taking any reasonable good-faith action or refusing to act under the article, including without limitation, 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 quali- fied 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 making 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 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 misconduct by any person. Conduct in violation of the article shall be subject to applicable criminal liability under state law, including where appropri- ate 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: 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. Six states - Oregon, Vermont, Washington, California, Montana and Colo- rado allow physician assisted aid in dying. More than 65% of Colorado voters approved the ballot initiative this past November to provide for aid in dying. And last month the mayor of the District of Columbia signed a medical aid in dying act. Aid in dying legislation recently passed the New Jersey Assembly, and legislators in 19 states, including all of New England, Maryland, North Carolina, Tennessee, Oklahoma, Utah, Wyoming and Missouri, 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: A.10059, 2016 reported referred to Codes. Same as S.7579, 2016 referred to Health.   FISCAL IMPLICATIONS: None.
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A02383 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                         2383--A
 
                               2017-2018 Regular Sessions
 
                   IN ASSEMBLY
 
                                    January 19, 2017
                                       ___________
 
        Introduced by M. of A. PAULIN, L. ROSENTHAL, GOTTFRIED, DINOWITZ, GALEF,
          HEVESI,  STECK,  BLAKE,  LAVINE, LUPARDO, SEPULVEDA, HARRIS, ABINANTI,
          RODRIGUEZ, JAFFEE, JONES, D'URSO, M. G. MILLER, ORTIZ,  ARROYO,  SIMO-
          TAS,  ERRIGO,  VANEL,  QUART  -- Multi-Sponsored by -- M. of A. BRAUN-
          STEIN, CROUCH, MAGEE, SKARTADOS --  read  once  and  referred  to  the
          Committee  on  Health  --  recommitted  to  the Committee on Health in
          accordance with Assembly Rule 3, sec. 2 -- committee discharged,  bill
          amended,  ordered reprinted as amended and recommitted to said commit-
          tee
 
        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.
    12          2899-h. Consulting physician responsibilities.
    13          2899-i. Referral to mental health professional.
    14          2899-j. Medical record documentation requirements.
    15          2899-k. Form of written request and witness attestation.
    16          2899-l. Protection and immunities.
    17          2899-m. Permissible refusals and prohibitions.
    18          2899-n. Relation to other laws and contracts.
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD01103-12-8

        A. 2383--A                          2
 
     1          2899-o. Safe disposal of unused medications.
     2          2899-p. Death certificate.
     3          2899-q. Reporting.
     4          2899-r. Penalties.
     5          2899-s. Severability.
     6    § 2899-d. Definitions. As used in this article:
     7    1. "Adult" means an individual who is eighteen years of age or older.
     8    2. "Attending physician" means the physician who has primary responsi-
     9  bility for the care of the patient and treatment of the patient's termi-
    10  nal illness or condition.
    11    3.  "Capacity"  means  the  ability  to  understand and appreciate the
    12  nature and consequences of health care decisions, including the benefits
    13  and risks of and alternatives to any proposed health care, and to  reach
    14  an informed decision.
    15    4.    "Consulting  physician"  means  a  physician who is qualified by
    16  specialty or experience to make a professional diagnosis  and  prognosis
    17  regarding a person's terminal illness or condition.
    18    5.  "Health  care facility" means a general hospital, nursing home, or
    19  residential health care facility  as  defined  in  section  twenty-eight
    20  hundred one of this chapter.
    21    6.  "Health  care  provider"  means  a  person licensed, certified, or
    22  authorized by law to administer health care or  dispense  medication  in
    23  the ordinary course of business or practice of a profession.
    24    7.  "Informed decision" means a decision by a patient who is suffering
    25  from   a   terminal  illness  or  condition  to  request  and  obtain  a
    26  prescription for medication that the patient may self-administer to  end
    27  the  patient's life that is based on an understanding and acknowledgment
    28  of the relevant facts and that is made voluntarily, of the patient's own
    29  volition and without coercion, after being fully informed of:
    30    (a) the patient's medical diagnosis and prognosis;
    31    (b) the potential risks associated with taking the  medication  to  be
    32  prescribed;
    33    (c) the probable result of taking the medication to be prescribed;
    34    (d)  the  possibility  that  the  patient may choose not to obtain the
    35  medication, or may obtain the medication but may decide not to  self-ad-
    36  minister it; and
    37    (e)  the  feasible  alternatives  and  appropriate  treatment options,
    38  including but not limited to palliative care and hospice care.
    39    8. "Medical aid in dying" means the medical practice  of  a  physician
    40  prescribing medication to a qualified individual that the individual may
    41  choose to self-administer to bring about death.
    42    9.  "Medically  confirmed"  means the medical opinion of the attending
    43  physician that a patient has a terminal illness  or  condition  and  has
    44  made  an  informed  decision  which  has  been confirmed by a consulting
    45  physician who has  examined  the  patient  and  the  patient's  relevant
    46  medical records.
    47    10. "Medication" means medication prescribed by a physician under this
    48  article.
    49    11.  "Mental health professional" means a physician, nurse practition-
    50  er, physician assistant or psychologist, licensed or certified under the
    51  education law acting within his or her scope  of  practice  and  who  is
    52  qualified,  by  training and experience, certification, or board certif-
    53  ication or eligibility, to make a determination  under  section  twenty-
    54  eight  hundred  ninety-nine-i of this article; provided that in the case
    55  of a nurse practitioner or physician assistant, the  professional  shall

        A. 2383--A                          3
 
     1  not have a collaborative agreement or collaborative relationship with or
     2  be supervised by the attending physician or consulting physician.
     3    12. "Palliative care" means health care treatment, including interdis-
     4  ciplinary  end-of-life  care,  and consultation with patients and family
     5  members, to prevent or relieve pain and suffering  and  to  enhance  the
     6  patient's quality of life, including hospice care under article forty of
     7  this chapter.
     8    13.  "Patient"  means  a  person who is eighteen years of age or older
     9  under the care of a physician.
    10    14. "Physician" means an individual licensed to practice  medicine  in
    11  New York state.
    12    15.  "Qualified individual" means a patient with a terminal illness or
    13  condition, who has capacity, has made  an  informed  decision,  and  has
    14  satisfied  the  requirements  of  this  article  in  order  to  obtain a
    15  prescription for medication.
    16    16. "Self-administer"  means  a  qualified  individual's  affirmative,
    17  conscious, and voluntary act of using medication under this article.
    18    17.  "Terminal  illness or condition" means an incurable and irrevers-
    19  ible illness or condition that has been medically  confirmed  and  will,
    20  within reasonable medical judgment, produce death within six months.
    21    § 2899-e. Request  process.    1.  Oral and written request. A patient
    22  wishing to request medication under this  article  shall  make  an  oral
    23  request  and  submit a written request to the patient's attending physi-
    24  cian.
    25    2. Making a written request. A patient may make a written request  for
    26  and  consent to self-administer medication for the purpose of ending his
    27  or her life in accordance with this article if the patient:
    28    (a) has been determined by the attending physician to have a  terminal
    29  illness  or  condition  and  which  has  been  medically  confirmed by a
    30  consulting physician; and
    31    (b) based on an  informed  decision,  expresses  voluntarily,  of  the
    32  patient's  own  volition and without coercion the request for medication
    33  to end his or her life.
    34    3. Written request signed and witnessed. (a)  A  written  request  for
    35  medication  under  this article shall be signed and dated by the patient
    36  and witnessed by at least  two  adults  who,  in  the  presence  of  the
    37  patient,  attest that to the best of his or her knowledge and belief the
    38  patient has capacity, is acting voluntarily, is making the  request  for
    39  medication  of  his or her own volition and is not being coerced to sign
    40  the request. The written request shall  be  in  substantially  the  form
    41  described in section twenty-eight hundred ninety-nine-k of this article.
    42    (b) One of the witnesses shall be an adult who is not:
    43    (i) a relative of the patient by blood, marriage or adoption;
    44    (ii)  a person who at the time the request is signed would be entitled
    45  to any portion of the estate of the patient upon death under any will or
    46  by operation of law; or
    47    (iii) an owner, operator, employee  or  independent  contractor  of  a
    48  health  care  facility  where the patient is receiving treatment or is a
    49  resident.
    50    (c) The attending physician, consulting physician and, if  applicable,
    51  the  mental health professional who provides a capacity determination of
    52  the patient under this article shall not be a witness.
    53    4. No person shall qualify for medical aid in dying under this article
    54  solely because of age or disability.

        A. 2383--A                          4
 
     1    § 2899-f. Attending  physician  responsibilities.  1.  The   attending
     2  physician  shall  examine  the  patient  and his or her relevant medical
     3  records and:
     4    (a)  make  a determination of whether a patient has a terminal illness
     5  or condition, has capacity, has made an informed decision and  has  made
     6  the  request voluntarily of the patient's own volition and without coer-
     7  cion;
     8    (b) inform the patient of  the  requirement  under  this  article  for
     9  confirmation  by  a  consulting  physician,  and  refer the patient to a
    10  consulting physician upon the patient's request;
    11    (c) refer the patient to a  mental  health  professional  pursuant  to
    12  section  twenty-eight  hundred  ninety-nine-i  of  this  article  if the
    13  attending physician believes that the patient may lack capacity to  make
    14  an informed decision;
    15    (d)  provide  information  and  counseling  under  section twenty-nine
    16  hundred ninety-seven-c of this chapter;
    17    (e) ensure that the patient is making an informed decision by discuss-
    18  ing with the patient: (i) the patient's medical diagnosis and prognosis;
    19  (ii) the potential risks associated with taking  the  medication  to  be
    20  prescribed;  (iii)  the  probable  result of taking the medication to be
    21  prescribed; (iv) the possibility that the patient may choose  to  obtain
    22  the  medication  but  not take it; and (v) the feasible alternatives and
    23  appropriate treatment options, including but not limited to (1) informa-
    24  tion and counseling regarding palliative and hospice  care  and  end-of-
    25  life  options  appropriate to the patient, including but not limited to:
    26  the range of options appropriate to the patient;  the  prognosis,  risks
    27  and  benefits  of the various options; and the patient's legal rights to
    28  comprehensive pain and symptom management at the end of  life;  and  (2)
    29  information  regarding  treatment  options  appropriate  to the patient,
    30  including the prognosis, risks and benefits  of  the  various  treatment
    31  options;
    32    (f) discuss with the patient the importance of:
    33    (i)  having  another person present when the patient takes the medica-
    34  tion and the restriction that no  person  other  than  the  patient  may
    35  administer the medication;
    36    (ii) not taking the medication in a public place; and
    37    (iii)  informing  the  patient's  family  of the patient's decision to
    38  request and take medication that will end the patient's life; a  patient
    39  who  declines  or  is  unable to notify family shall not have his or her
    40  request for medication denied for that reason;
    41    (g) inform the patient that he or she  may  rescind  the  request  for
    42  medication at any time and in any manner;
    43    (h)  fulfill  the medical record documentation requirements of section
    44  twenty-eight hundred ninety-nine-j of this article; and
    45    (i) ensure that all appropriate steps are carried  out  in  accordance
    46  with this article before writing a prescription for medication.
    47    2.  Upon  receiving  confirmation  from  a  consulting physician under
    48  section twenty-eight hundred ninety-nine-h of this article  and  subject
    49  to  section  twenty-eight  hundred  ninety-nine-i  of  this article, the
    50  attending physician who determines  that  the  patient  has  a  terminal
    51  illness  or condition, has capacity and has made a voluntary request for
    52  medication as provided in this article, may personally, or  by  referral
    53  to  another  physician,  prescribe  or  order  appropriate medication in
    54  accordance with the patient's request under this  article,  and  at  the
    55  patient's request, facilitate the filling of the prescription and deliv-
    56  ery of the medication to the patient.

        A. 2383--A                          5
 
     1    3.  In  accordance  with  the direction of the prescribing or ordering
     2  physician and the consent of the patient, the patient may  self-adminis-
     3  ter  the medication to himself or herself. A health care professional or
     4  other person shall not administer the medication to the patient.
     5    § 2899-g. Right  to  rescind request; requirement to offer opportunity
     6  to rescind.  1. A patient may at any time rescind his or her request for
     7  medication under this article without regard to the patient's capacity.
     8    2. A prescription for  medication  may  not  be  written  without  the
     9  attending  physician offering the qualified individual an opportunity to
    10  rescind the request.
    11    § 2899-h. Consulting physician responsibilities. Before a patient  who
    12  is requesting medication may receive a prescription for medication under
    13  this article, a consulting physician must:
    14    1. examine the patient and his or her relevant medical records;
    15    2.  confirm,  in  writing, to the attending physician and the patient,
    16  whether: (a) the patient has a terminal illness or  condition;  (b)  the
    17  patient is making an informed decision; (c) the patient has capacity, or
    18  provide  documentation  that  the  consulting physician has referred the
    19  patient for a determination under section twenty-eight  hundred  ninety-
    20  nine-i  of  this  article; and (d) the patient is acting voluntarily, of
    21  the patient's own volition and without coercion.
    22    § 2899-i. Referral to mental health professional. 1. If the  attending
    23  physician or the consulting physician believes that the patient may lack
    24  capacity,  the  attending  physician or consulting physician shall refer
    25  the patient to a mental  health  professional  for  a  determination  of
    26  whether  the  patient  has  capacity  to  make an informed decision. The
    27  referring physician shall advise the patient  that  the  report  of  the
    28  mental  health  professional will be provided to the attending physician
    29  and the consulting physician.
    30    2. A mental health professional who evaluates  a  patient  under  this
    31  section  shall  report,  in  writing, to the attending physician and the
    32  consulting physician, his or her independent conclusions  about  whether
    33  the patient has capacity to make an informed decision, provided that if,
    34  at  the  time  of the report, the patient has not yet been referred to a
    35  consulting physician, then upon referral the attending  physician  shall
    36  provide  the  consulting  physician  with  a  copy  of the mental health
    37  professional's report. If the mental health professional determines that
    38  the patient lacks capacity to make an  informed  decision,  the  patient
    39  shall  not be deemed a qualified individual, and the attending physician
    40  shall not prescribe medication to the patient.
    41    § 2899-j. Medical  record  documentation  requirements.  An  attending
    42  physician  shall document or file the following in the patient's medical
    43  record:
    44    1. the dates of all oral requests by the patient for medication  under
    45  this article;
    46    2.  the written request by the patient for medication under this arti-
    47  cle, including the declaration of witnesses and  interpreter's  declara-
    48  tion, if applicable;
    49    3. the attending physician's diagnosis and prognosis, determination of
    50  capacity,  and  determination that the patient is acting voluntarily, of
    51  the patient's own  volition  and  without  coercion,  and  has  made  an
    52  informed decision;
    53    4. if applicable, written confirmation of capacity under section twen-
    54  ty-eight hundred ninety-nine-i of this article; and
    55    5.  a note by the attending physician indicating that all requirements
    56  under this article have been met and indicating the steps taken to carry

        A. 2383--A                          6
 
     1  out the request, including a notation of the  medication  prescribed  or
     2  ordered.
     3    § 2899-k. Form  of  written  request  and  witness  attestation.  1. A
     4  request for medication under this article shall be in substantially  the
     5  following form:
     6                    REQUEST FOR MEDICATION TO END MY LIFE
 
     7    I,  _________________________________,  am  an adult who has capacity,
     8  which means I understand and appreciate the nature and  consequences  of
     9  health  care decisions, including the benefits and risks of and alterna-
    10  tives to any proposed health care, and to reach an informed decision and
    11  to communicate health care decisions to a physician.
    12    I have been diagnosed with ______________(insert diagnosis), which  my
    13  attending  physician  has determined is a terminal illness or condition,
    14  which has been medically confirmed by a consulting physician.
    15    I have been fully informed of my diagnosis and prognosis,  the  nature
    16  of  the  medication to be prescribed and potential associated risks, the
    17  expected result, and the feasible  alternatives  and  treatment  options
    18  including but not limited to palliative care and hospice care.
    19    I  request  that my attending physician prescribe medication that will
    20  end my life if I choose to take it, and I authorize my attending  physi-
    21  cian to contact another physician or any pharmacist about my request.
 
    22    INITIAL ONE:
    23    (    )  I  have informed or intend to inform one or more members of my
    24  family of my decision.
    25    (  ) I have decided not to inform any member of my family of my  deci-
    26  sion.
    27    (  ) I have no family to inform of my decision.
    28    I  understand that I have the right to rescind this request or decline
    29  to use the medication at any time.
    30    I understand the importance of this request, and I expect to die if  I
    31  take the medication to be prescribed. I further understand that although
    32  most  deaths  occur within three hours, my death may take longer, and my
    33  attending physician has counseled me about this possibility.
    34    I make this request voluntarily, of my own volition and without  being
    35  coerced, and I accept full responsibility for my actions.
 
    36  Signed: __________________________
 
    37  Dated: ___________________________
 
    38                          DECLARATION OF WITNESSES
 
    39    I  declare that the person signing this "Request for Medication to End
    40  My Life":
    41    (a) is personally known to me or has provided proof of identity;
    42    (b) voluntarily signed the "Request for Medication to End My Life"  in
    43  my presence or acknowledged to me that he or she signed it; and
    44    (c) to the best of my knowledge and belief, has capacity and is making
    45  the  "Request  for Medication to End My Life" voluntarily, of his or her
    46  own volition and is not being coerced to sign the "Request  for  Medica-
    47  tion to End My Life".
    48    I am not the attending physician or consulting physician of the person
    49  signing  the  "Request for Medication to End My Life" or, if applicable,
    50  the mental health professional who provides a capacity determination  of

        A. 2383--A                          7
 
     1  the  person  signing  the "Request for Medication to End My Life" at the
     2  time the "Request for Medication to End My Life" was signed.
     3    I  further  declare  under penalty of perjury that the statements made
     4  herein are true and correct and false statements made herein are punish-
     5  able.
 
     6  __________________________ Witness 1, Date: ________________
 
     7  __________________________ (Printed name)
 
     8  __________________________ (Address)

     9  __________________________ (Telephone number)
 
    10    I further declare that I am not (i) related to the above-named patient
    11  by blood, marriage or adoption, (ii) entitled at the  time  the  patient
    12  signed the "Request for Medication to End My Life" to any portion of the
    13  estate  of the patient upon his/her death under any will or by operation
    14  of law, or (iii) an owner, operator, employee or independent  contractor
    15  of a health care facility where the patient is receiving treatment or is
    16  a resident.
 
    17  __________________________ Witness 2, Date: _________________
 
    18  __________________________ (Printed name)
 
    19  __________________________ (Address)
 
    20  __________________________ (Telephone number)

    21    NOTE:  Only  one of the two witnesses may (i) be a relative (by blood,
    22  marriage or adoption) of the person signing the "Request for  Medication
    23  to  End My Life", (ii) be entitled to any portion of the person's estate
    24  upon death under any will or by operation of law, or (iii) own, operate,
    25  be employed or be an independent contractor at a  health  care  facility
    26  where the person is receiving treatment or is a resident.
    27    2. (a) The "Request for Medication to End My Life" shall be written in
    28  the  same  language  as any conversations, consultations, or interpreted
    29  conversations or consultations between a patient and at least one of his
    30  or her attending or consulting physicians.
    31    (b) Notwithstanding paragraph (a) of  this  subdivision,  the  written
    32  "Request  for Medication to End My Life" may be prepared in English even
    33  when the conversations or consultations or interpreted conversations  or
    34  consultations  were  conducted  in a language other than English or with
    35  auxiliary aids or  hearing,  speech  or  visual  aids,  if  the  English
    36  language form includes an attached declaration by the interpreter of the
    37  conversation  or  consultation,  which  shall  be  in  substantially the
    38  following form:
 
    39                          INTERPRETER'S DECLARATION
 
    40    I, ___________ (insert name of interpreter)_____  ,(mark  as  applica-
    41  ble):
    42    (  ) for a patient whose conversations or consultations or interpreted
    43  conversations  or  consultations were conducted in a language other than
    44  English and the "Request for Medication to End My Life" is in English: I

        A. 2383--A                          8
 
     1  declare that I am fluent in English and (insert target language). I have
     2  the requisite language and interpreter skills to be  able  to  interpret
     3  effectively,  accurately and impartially information shared and communi-
     4  cations  between  the  attending  or  consulting  physician and (name of
     5  patient).
     6    I certify that on (insert date), at  approximately  (insert  time),  I
     7  interpreted  the  communications  and  information  conveyed between the
     8  physician and (name of patient) as accurately and completely to the best
     9  of my knowledge and ability and read the "Request for Medication to  End
    10  My Life" to (name of patient) in (insert target language).
    11    (Name  of  patient) affirmed to me his/her desire to sign the "Request
    12  for Medication to End My Life" voluntarily, of (name of  patient)'s  own
    13  volition and without coercion.
    14    (  )  for  a  patient  with  a speech, hearing or vision disability: I
    15  declare that I have the requisite language, reading  and/or  interpreter
    16  skills  to  communicate  with  the patient and to be able to read and/or
    17  interpret effectively, accurately and impartially information shared and
    18  communications that occurred on (insert date) between the  attending  or
    19  consulting physician and (name of patient).
    20    I  certify  that  on  (insert date), at approximately (insert time), I
    21  read and/or interpreted  the  communications  and  information  conveyed
    22  between the physician and (name of patient) impartially and as accurate-
    23  ly  and  completely  to  the best of my knowledge and ability and, where
    24  needed for effective communication, read or interpreted the "Request for
    25  Medication to End my Life" to (name of patient).
    26    (Name of patient) affirmed to me his/her desire to sign  the  "Request
    27  for  Medication  to End My Life" voluntarily, of (name of patient)'s own
    28  volition and without coercion.
    29    I further declare under penalty of perjury that (i) the  foregoing  is
    30  true  and  correct;  (ii)  I  am not (A) related to (name of patient) by
    31  blood, marriage or adoption, (B) entitled at the time (name of  patient)
    32  signed the "Request for Medication to End My Life" to any portion of the
    33  estate  of  (name  of  patient)  upon his/her death under any will or by
    34  operation of law, or (C) an owner,  operator,  employee  or  independent
    35  contractor  of a health care facility where (name of patient) is receiv-
    36  ing treatment or is a resident, except that if I am an employee or inde-
    37  pendent contractor at such health care facility,  providing  interpreter
    38  services is part of my job description at such health care facility or I
    39  have  been trained to provide interpreter services and (name of patient)
    40  requested that  I  provide  interpreter  services  to  him/her  for  the
    41  purposes  stated  in  this  Declaration; and (iii) false statements made
    42  herein are punishable.

    43  Executed at (insert city, county and  state)  on  this  (insert  day  of
    44  month) of (insert month), (insert year).
 
    45  __________________________ (Signature of Interpreter)
 
    46  __________________________ (Printed name of Interpreter)
 
    47  __________________________ (ID # or Agency Name)
 
    48  __________________________ (Address of Interpreter)
 
    49  __________________________ (Language Spoken by Interpreter)

        A. 2383--A                          9
 
     1    (c)  An interpreter whose services are provided under paragraph (b) of
     2  this subdivision shall not (i) be related to the patient who  signs  the
     3  "Request  for Medication to End My Life" by blood, marriage or adoption,
     4  (ii) be entitled at the time the "Request for Medication to End My Life"
     5  is  signed  by  the  patient to any portion of the estate of the patient
     6  upon death under any will or by operation of law, or (iii) be an  owner,
     7  operator,  employee  or independent contractor of a health care facility
     8  where the patient is receiving treatment or is a resident; provided that
     9  an employee or independent  contractor  whose  job  description  at  the
    10  health  care facility includes interpreter services or who is trained to
    11  provide interpreter services and who has been requested by  the  patient
    12  to  serve  as  an interpreter under this article shall not be prohibited
    13  from serving as a witness under this article.
    14    § 2899-l. Protection and immunities. 1. A physician, pharmacist, other
    15  health care professional or other person shall not be subject  to  civil
    16  or criminal liability or professional disciplinary action by any govern-
    17  ment  entity  for taking any reasonable good-faith action or refusing to
    18  act under this article, including, but not limited to:  (a) engaging  in
    19  discussions with a patient relating to the risks and benefits of end-of-
    20  life options in the circumstances described in this article, (b) provid-
    21  ing  a  patient,  upon  request,  with a referral to another health care
    22  provider, (c) being present when a qualified individual self-administers
    23  medication, (d) refraining from acting to prevent the qualified individ-
    24  ual from self-administering such  medication,  or  (e)  refraining  from
    25  acting  to resuscitate the qualified individual after he or she self-ad-
    26  ministers such medication.
    27    2. Nothing in this section shall limit civil or criminal liability for
    28  negligence, recklessness or intentional misconduct.
    29    § 2899-m. Permissible refusals and prohibitions. 1. (a)  A  physician,
    30  nurse,  pharmacist, other health care provider or other person shall not
    31  be under any duty, by law or contract, to participate in  the  provision
    32  of medication to a patient under this article.
    33    (b) If a health care provider is unable or unwilling to participate in
    34  the  provision  of  medication  to  a patient under this article and the
    35  patient transfers care to a new health care provider, the  prior  health
    36  care  provider shall transfer or arrange for the transfer, upon request,
    37  of a copy of the patient's relevant medical records to  the  new  health
    38  care provider.
    39    2.  (a)  A  private health care facility may prohibit the prescribing,
    40  dispensing, ordering or  self-administering  of  medication  under  this
    41  article  while  the  patient is being treated in or while the patient is
    42  residing in the health care facility if:
    43    (i) the prescribing, dispensing,  ordering  or  self-administering  is
    44  contrary  to a formally adopted policy of the facility that is expressly
    45  based on sincerely held religious beliefs or moral  convictions  central
    46  to the facility's operating principles; and
    47    (ii)  the  facility  has  informed the patient of such policy prior to
    48  admission or as soon as reasonably possible.
    49    (b) Where a facility has adopted a prohibition under this subdivision,
    50  if a patient who wishes to use medication under this  article  requests,
    51  the patient shall be transferred promptly to another health care facili-
    52  ty  that is reasonably accessible under the circumstances and willing to
    53  permit the prescribing, dispensing, ordering and  self-administering  of
    54  medication under this article with respect to the patient.
    55    3.  Where  a health care facility has adopted a prohibition under this
    56  subdivision,  any  health  care  provider  or  employee  or  independent

        A. 2383--A                         10
 
     1  contractor  of  the facility who violates the prohibition may be subject
     2  to sanctions otherwise available to the facility, provided the  facility
     3  has  previously notified the health care provider, employee or independ-
     4  ent contractor of the prohibition in writing.
     5    § 2899-n. Relation  to  other laws and contracts. 1. (a) A patient who
     6  requests medication under  this  article  shall  not,  because  of  that
     7  request, be considered to be a person who is suicidal, and self-adminis-
     8  tering  medication under this article shall not be deemed to be suicide,
     9  for any purpose.
    10    (b) Action  taken  in  accordance  with  this  article  shall  not  be
    11  construed  for  any  purpose  to  constitute  suicide, assisted suicide,
    12  attempted suicide, promoting a suicide attempt, euthanasia, mercy  kill-
    13  ing,  or homicide under the law, including as an accomplice or accessory
    14  or otherwise.
    15    2. (a) No provision in a contract, will or  other  agreement,  whether
    16  written  or  oral,  to  the  extent the provision would affect whether a
    17  person may make or rescind a request for medication or  take  any  other
    18  action under this article, shall be valid.
    19    (b)  No  obligation  owing  under any contract shall be conditioned or
    20  affected by the making or rescinding of a request by a person for  medi-
    21  cation or taking any other action under this article.
    22    3. (a) A person and his or her beneficiaries shall not be denied bene-
    23  fits  under a life insurance policy for actions taken in accordance with
    24  this article.
    25    (b) Notwithstanding the provisions of any law or contract,  the  sale,
    26  procurement or issuance of a life or health insurance or annuity policy,
    27  or  the  rate  charged  for  a  policy, shall not be conditioned upon or
    28  affected by a patient making or  rescinding  a  request  for  medication
    29  under this article.
    30    4. An insurer shall not provide any information in communications made
    31  to  a  patient  about  the availability of medication under this article
    32  absent a request by the patient or by his  or  her  attending  physician
    33  upon  the  request  of such patient. Any communication shall not include
    34  both the denial of coverage for treatment  and  information  as  to  the
    35  availability of medication under this article.
    36    5.  The  sale,  procurement,  or issue of any professional malpractice
    37  insurance policy or the rate charged for the policy shall not be  condi-
    38  tioned  upon or affected by whether the insured does or does not take or
    39  participate in any action under this article.
    40    § 2899-o. Safe disposal of unused  medications.    A  person  who  has
    41  custody  or control of any unused medication prescribed under this arti-
    42  cle after the death of the qualified individual shall personally deliver
    43  the unused medication for disposal to  the  nearest  qualified  facility
    44  that  properly  disposes of controlled substances or shall dispose of it
    45  by lawful means in accordance with regulations made by the commissioner,
    46  regulations made by or guidelines of the commissioner of  education,  or
    47  guidelines  of  a federal drug enforcement administration approved take-
    48  back program. A qualified facility that properly disposes of  controlled
    49  substances shall accept and dispose of any medication delivered to it as
    50  provided hereunder regardless of whether such medication is a controlled
    51  substance.  The  commissioner may make regulations as may be appropriate
    52  for the safe disposal of unused  medications  prescribed,  dispensed  or
    53  ordered under this article as provided in this section.
    54    § 2899-p. Death  certificate.   1. If otherwise authorized by law, the
    55  attending physician may sign the qualified  individual's  death  certif-
    56  icate.

        A. 2383--A                         11
 
     1    2. The cause of death listed on a qualified individual's death certif-
     2  icate  who  dies  after self-administering medication under this article
     3  will be the underlying terminal illness or condition.
     4    § 2899-q. Reporting.  1.  The  commissioner  shall  annually  review a
     5  sample of the records maintained  under  sections  twenty-eight  hundred
     6  ninety-nine-j  and  twenty-eight  hundred ninety-nine-p of this article.
     7  The commissioner shall adopt regulations establishing reporting require-
     8  ments for physicians taking  action  under  this  article  to  determine
     9  utilization  and compliance with this article. The information collected
    10  under this subdivision shall not constitute a  public  record  available
    11  for  public inspection and shall be confidential and collected and main-
    12  tained in a manner that protects the privacy of the patient, his or  her
    13  family,  and  any  health  care  provider acting in connection with such
    14  patient  under  this  article,  except  that  such  information  may  be
    15  disclosed  to  a  governmental  agency  as authorized or required by law
    16  relating to professional discipline, protection of public health or  law
    17  enforcement.
    18    2.  The  commissioner shall prepare a report annually containing rele-
    19  vant data regarding utilization and compliance  with  this  article  and
    20  shall post such report on the department's website.
    21    § 2899-r. Penalties.  1. Nothing in this article shall be construed to
    22  limit professional discipline or civil liability resulting from  conduct
    23  in  violation of this article, negligent conduct, or intentional miscon-
    24  duct by any person.
    25    2. Conduct in violation of this article shall be subject to applicable
    26  criminal liability under state law,  including,  where  appropriate  and
    27  without  limitation,  offenses constituting homicide, forgery, coercion,
    28  and related offenses, or federal law.
    29    § 2899-s. Severability. If any provision of this article or any appli-
    30  cation of any provision of this article, is held to be  invalid,  or  to
    31  violate  or  be  inconsistent  with  any federal law or regulation, that
    32  shall not affect the validity or effectiveness of any other provision of
    33  this article, or of any other application of any provision of this arti-
    34  cle, which can be given effect without that  provision  or  application;
    35  and  to  that  end,  the provisions and applications of this article are
    36  severable.
    37    § 3. This act shall take effect immediately.
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