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A02383 Summary:

BILL NOA02383
 
SAME ASSAME AS S03151
 
SPONSORPaulin
 
COSPNSRRosenthal L, Gottfried, Dinowitz, Galef, Hevesi, Steck, Blake, Lavine, Lupardo, Sepulveda, Harris, Abinanti, Rodriguez, Jaffee, Jones, D'Urso, Miller MG, Ortiz, Arroyo, Simotas, Errigo, Vanel, Quart
 
MLTSPNSRBraunstein, Crouch, 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 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A2383
 
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 decla- ration of witnesses. The section also provides that the written request shall be written in the same language as the 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 profes- sional or other person shall not be subject to civil or criminal liabil- ity 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 may not be conditioned upon or affected by the patient making or rescinding a request for medi- cation under the article, (vi) an insurer shall not provide any informa- tion in communications made to a patient about the availability of medi- cation under the article absent a request by the patient or by his or her attending physician upon the request of such patient, and any commu- nication shall not include both the denial of coverage for treatment 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 condi- tioned 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 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 maintained 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 miscon- duct by any person. Conduct in violation of the article shall be subject to applicable criminal liability under state law, including where appro- pri- 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.   EFFECTIVE DATE: Effective immediately.
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A02383 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          2383
 
                               2017-2018 Regular Sessions
 
                   IN ASSEMBLY
 
                                    January 19, 2017
                                       ___________
 
        Introduced  by  M.  of A. PAULIN, ROSENTHAL, GOTTFRIED, DINOWITZ, GALEF,
          HEVESI, STECK, BLAKE, LAVINE, LUPARDO, SEPULVEDA -- Multi-Sponsored by
          -- M. of A.  BRAUNSTEIN, CROUCH, MAGEE, SKARTADOS  --  read  once  and
          referred to the Committee on Health
 
        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.
    19          2899-o. Safe disposal of unused medications.
    20          2899-p. Death certificate.
    21          2899-q. Reporting.
    22          2899-r. Penalties.
    23          2899-s. Severability.
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD01103-05-7

        A. 2383                             2
 
     1    § 2899-d. Definitions. As used in this article:
     2    1. "Adult" means an individual who is eighteen years of age or older.
     3    2. "Attending physician" means the physician who has primary responsi-
     4  bility for the care of the patient and treatment of the patient's termi-
     5  nal disease.
     6    3.  "Capacity"  or  "capacity  to make an informed decision" means the
     7  ability to understand and appreciate  the  nature  and  consequences  of
     8  health  care decisions, including the benefits and risks of and alterna-
     9  tives to any proposed health care, and to reach an informed decision.
    10    4.   "Consulting physician" means a  physician  who  is  qualified  by
    11  specialty  or  experience to make a professional diagnosis and prognosis
    12  regarding a person's terminal illness.
    13    5. "Health care facility" means a general hospital, nursing  home,  or
    14  residential  health  care  facility  as  defined in section twenty-eight
    15  hundred one of this chapter.
    16    6. "Health care provider"  means  a  person  licensed,  certified,  or
    17  authorized  by  law  to administer health care or dispense medication in
    18  the ordinary course of business or practice of a profession.
    19    7.  "Informed decision" means a decision by a patient who is suffering
    20  from a terminal illness to request and obtain a prescription for medica-
    21  tion that the patient may self-administer to end the patient's life that
    22  is based on an understanding and acknowledgment of  the  relevant  facts
    23  and that is made after being fully informed of:
    24    (a) the patient's medical diagnosis and prognosis;
    25    (b)  the  potential  risks associated with taking the medication to be
    26  prescribed;
    27    (c) the probable result of taking the medication to be prescribed;
    28    (d) the possibility that the patient may  choose  not  to  obtain  the
    29  medication,  or may obtain the medication but may decide not to self-ad-
    30  minister it; and
    31    (e) the feasible alternatives or additional  treatment  opportunities,
    32  including palliative care and hospice care.
    33    8.  "Medical  aid  in dying" means the medical practice of a physician
    34  prescribing medication to a qualified individual that the individual may
    35  choose to self-administer to bring about death.
    36    9. "Medically confirmed" means the medical opinion  of  the  attending
    37  physician  that a patient has a terminal illness has been confirmed by a
    38  consulting physician who has examined  the  patient  and  the  patient's
    39  relevant medical records.
    40    10. "Medication" means medication prescribed by a physician under this
    41  article.
    42    11.  "Mental health professional" means a physician, nurse practition-
    43  er, physician assistant or psychologist, licensed or certified under the
    44  education law acting within his or her scope  of  practice  and  who  is
    45  qualified,  by  training and experience, certification, or board certif-
    46  ication or eligibility, to make a determination  under  section  twenty-
    47  eight  hundred  ninety-nine-i of this article; provided that in the case
    48  of a nurse practitioner or physician assistant, the  professional  shall
    49  not have a collaborative agreement or collaborative relationship with or
    50  be supervised by the attending physician or consulting physician.
    51    12. "Palliative care" means health care treatment, including interdis-
    52  ciplinary  end-of-life  care,  and consultation with patients and family
    53  members, to prevent or relieve pain and suffering  and  to  enhance  the
    54  patient's quality of life, including hospice care under article forty of
    55  this chapter.

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

        A. 2383                             4

     1    (d) provide  information  and  counseling  under  section  twenty-nine
     2  hundred ninety-seven-c of this chapter;
     3    (e) ensure that the patient is making an informed decision by discuss-
     4  ing with the patient: (i) the patient's medical diagnosis and prognosis;
     5  (ii)  the  potential  risks  associated with taking the medication to be
     6  prescribed; (iii) the probable result of taking  the  medication  to  be
     7  prescribed;  (iv)  the possibility that the patient may choose to obtain
     8  the medication but not take it; and (v)  the  feasible  alternatives  or
     9  additional treatment opportunities, including but not limited to pallia-
    10  tive care and hospice care;
    11    (f) discuss with the patient the importance of:
    12    (i)  having  another person present when the patient takes the medica-
    13  tion; and
    14    (ii) not taking the medication in a public place;
    15    (g) inform the patient that he or she  may  rescind  the  request  for
    16  medication at any time and in any manner;
    17    (h)  fulfill  the medical record documentation requirements of section
    18  twenty-eight hundred ninety-nine-j of this article; and
    19    (i) ensure that all appropriate steps are carried  out  in  accordance
    20  with this article before writing a prescription for medication.
    21    2.  Upon  receiving  confirmation  from  a  consulting physician under
    22  section twenty-eight hundred ninety-nine-h of this article  and  subject
    23  to  section  twenty-eight  hundred  ninety-nine-i  of  this article, the
    24  attending physician who makes the determination that the patient  has  a
    25  terminal  illness, has capacity and has made a request for medication as
    26  provided in this article, may personally,  or  by  referral  to  another
    27  physician,  prescribe or order appropriate medication in accordance with
    28  the patient's request under this article, and at the patient's  request,
    29  facilitate  the  filling of the prescription and delivery of the medica-
    30  tion to the patient.
    31    3. In accordance with the direction of  the  prescribing  or  ordering
    32  physician  and the consent of the patient, the patient may self-adminis-
    33  ter the medication to himself or herself. A health care professional  or
    34  other person shall not administer the medication to the patient.
    35    § 2899-g. Right  to  rescind request; requirement to offer opportunity
    36  to rescind.  1. A patient may at any time rescind his or her request for
    37  medication under this article without regard to the patient's capacity.
    38    2. A prescription for  medication  may  not  be  written  without  the
    39  attending  physician offering the qualified individual an opportunity to
    40  rescind the request.
    41    § 2899-h. Consulting physician responsibilities. Before a patient  who
    42  is requesting medication may receive a prescription for medication under
    43  this article, a consulting physician must:
    44    1. examine the patient and his or her relevant medical records;
    45    2.  confirm,  in  writing,  to  the  attending physician: (a) that the
    46  patient has a terminal illness;  (b)  that  the  patient  is  making  an
    47  informed  decision;  (c)  that  the  patient  has  capacity,  or provide
    48  documentation that the consulting physician has referred the patient for
    49  a determination under section twenty-eight hundred ninety-nine-i of this
    50  article; and (d) that the patient  is  acting  voluntarily  and  without
    51  coercion.
    52    § 2899-i. Referral  to mental health professional. 1. If the attending
    53  physician or the consulting physician believes that the patient may lack
    54  capacity, the attending physician or consulting  physician  shall  refer
    55  the  patient  to  a  mental  health  professional for a determination of
    56  whether the patient has capacity. The referring physician  shall  advise

        A. 2383                             5
 
     1  the  patient  that  the report of the mental health professional will be
     2  provided to the attending physician and the consulting physician.
     3    2.  A  mental  health  professional who evaluates a patient under this
     4  section shall report, in writing, to the  attending  physician  and  the
     5  consulting  physician,  his or her conclusions about whether the patient
     6  has capacity to make an informed decision.  If the mental health profes-
     7  sional determines that the patient lacks capacity to  make  an  informed
     8  decision,  the  patient  shall not be deemed a qualified individual, and
     9  the attending physician shall not prescribe medication to the patient.
    10    § 2899-j. Medical  record  documentation  requirements.  An  attending
    11  physician  shall document or file the following in the patient's medical
    12  record:
    13    1. the dates of all oral requests by the patient for medication  under
    14  this article;
    15    2.  the written request by the patient for medication under this arti-
    16  cle;
    17    3. the attending physician's diagnosis and prognosis, determination of
    18  capacity, and determination that the patient is acting  voluntarily  and
    19  without coercion, and has made an informed decision;
    20    4. if applicable, written confirmation of capacity under section twen-
    21  ty-eight hundred ninety-nine-i of this article; and
    22    5.  a note by the attending physician indicating that all requirements
    23  under this article have been met and indicating the steps taken to carry
    24  out the request, including a notation of the  medication  prescribed  or
    25  ordered.
    26    § 2899-k. Form  of  written  request  and  witness  attestation.  1. A
    27  request for medication under this article shall be in substantially  the
    28  following form:
    29                    REQUEST FOR MEDICATION TO END MY LIFE
 
    30    I,  _________________________________,  am  an adult who has capacity,
    31  which means I understand and appreciate the nature and  consequences  of
    32  health  care decisions, including the benefits and risks of and alterna-
    33  tives to any proposed health care, and to reach an informed decision and
    34  to communicate health care decisions to a physician.
    35    I am  suffering  from  ______________________________________________,
    36  which my attending physician has determined is a terminal illness, which
    37  has been medically confirmed by a consulting physician.
    38    I  have  been fully informed of my diagnosis and prognosis, the nature
    39  of the medication to be prescribed and potential associated  risks,  the
    40  expected  result,  and  the  feasible alternatives or treatment opportu-
    41  nities including palliative care and hospice care.
    42    I request that my attending physician prescribe medication  that  will
    43  end  my life if I choose to take it, and I authorize my attending physi-
    44  cian to contact another physician or any pharmacist about my request.
 
    45    INITIAL ONE:
    46    (  ) I have informed or intend to inform my family of my decision.
    47    (  ) I have decided not to inform my family of my decision.
    48    (  ) I have no family to inform of my decision.
    49    I understand that I have the right to rescind this request or  decline
    50  to use the medication at any time.
    51    I  understand the importance of this request, and I expect to die if I
    52  take the medication to be prescribed. I further understand that although
    53  most deaths occur within three hours, my death may take longer,  and  my
    54  attending physician has counseled me about this possibility.

        A. 2383                             6

     1    I  make  this  request  voluntarily,  and without being coerced, and I
     2  accept full responsibility for my actions.
 
     3  Signed: __________________________
 
     4  Dated: ___________________________
 
     5                          DECLARATION OF WITNESSES
 
     6    I  declare that the person signing this "Request for Medication to End
     7  My Life":
     8    (a) is personally known to me or has provided proof of identity;
     9    (b) voluntarily signed the "Request for Medication to End My Life"  in
    10  my presence or acknowledged to me that he or she signed it; and
    11    (c)  to  the  best of my knowledge and belief, has capacity and is not
    12  being coerced to sign the "Request for Medication to End My Life".
    13    I am not the attending physician or consulting physician of the person
    14  signing the "Request for Medication to End My Life" or,  if  applicable,
    15  the  mental health professional who provides a capacity determination of
    16  the person signing the "Request for Medication to End My  Life"  at  the
    17  time the "Request for Medication to End My Life" was signed.
 
    18         ________________________ Witness 1, Date: ________________
 
    19         ________________________ Witness 2, Date: _________________
 
    20    NOTE:  Only  one of the two witnesses may (i) be a relative (by blood,
    21  marriage or adoption) of the person signing the "Request for  Medication
    22  to  End My Life", (ii) be entitled to any portion of the person's estate
    23  upon death under any will or by operation of law, or (iii) own, operate,
    24  or be employed at a health care facility where the person  is  receiving
    25  treatment or is a resident.
    26    2. (a) The "Request for Medication to End My Life" shall be written in
    27  the  same  language  as any conversations, consultations, or interpreted
    28  conversations or consultations between a patient and at least one of his
    29  or her attending or consulting physicians.
    30    (b) Notwithstanding paragraph (a) of  this  subdivision,  the  written
    31  "Request  for Medication to End My Life" may be prepared in English even
    32  when the conversations or consultations or interpreted conversations  or
    33  consultations  were  conducted  in  a language other than English if the
    34  English language form includes an attached declaration by the interpret-
    35  er of the conversation or consultation, which shall be in  substantially
    36  the following form:
 
    37                          INTERPRETER'S DECLARATION
 
    38    I, _______[insert name of interpreter]______, am fluent in English and
    39  [insert target language].
    40    On  [insert date], at approximately [insert time], I read the "Request
    41  for Medication to End My Life" to [name of patient]  in  [insert  target
    42  language].
    43    [Name of patient] affirmed to me that he/she understood the content of
    44  the  "Request for Medication to End My Life" and affirmed his/her desire
    45  to sign the "Request for Medication to  End  My  Life"  voluntarily  and
    46  without  coercion  and that the request to sign the "Request for Medica-

        A. 2383                             7
 
     1  tion to End My Life" followed discussions  with  his/her  attending  and
     2  consulting physicians.
     3    I declare that I am fluent in English and [insert target language] and
     4  further  declare under penalty of perjury that the foregoing is true and
     5  correct and that false statements made herein are punishable.
 
     6  Executed at [insert city, county and  state]  on  this  [insert  day  of
     7  month] of [insert month], [insert year].

     8  __________________________ [Signature of Interpreter]
 
     9  __________________________ [Printed name of Interpreter]
 
    10  __________________________ [Address of Interpreter]
 
    11  __________________________
 
    12    (c)  An interpreter whose services are provided under paragraph (b) of
    13  this subdivision shall not (i) be related to the patient who  signs  the
    14  "Request  for Medication to End My Life" by blood, marriage or adoption,
    15  (ii) be entitled at the time the "Request for Medication to End My Life"
    16  is signed by the patient to any portion of the  estate  of  the  patient
    17  upon  death under any will or by operation of law, or (iii) be an owner,
    18  operator or employee of a health care  facility  where  the  patient  is
    19  receiving treatment or is a resident.
    20    § 2899-l. Protection and immunities. 1. A physician, pharmacist, other
    21  health  care  professional or other person shall not be subject to civil
    22  or criminal liability or professional disciplinary action by any govern-
    23  ment entity for taking any reasonable good-faith action or  refusing  to
    24  act  under this article, including, but not limited to:  (a) engaging in
    25  discussions with a patient relating to the risks and benefits of end-of-
    26  life options in the circumstances described in this article, (b) provid-
    27  ing a patient, upon request, with a  referral  to  another  health  care
    28  provider, (c) being present when a qualified individual self-administers
    29  medication, (d) refraining from acting to prevent the qualified individ-
    30  ual  from  self-administering  such  medication,  or (e) refraining from
    31  acting to resuscitate the qualified individual after he or she  self-ad-
    32  ministers such medication.
    33    2. Nothing in this section shall limit civil or criminal liability for
    34  negligence, recklessness or intentional misconduct.
    35    § 2899-m. Permissible  refusals  and prohibitions. 1. (a) A physician,
    36  nurse, pharmacist, other health care provider or other person shall  not
    37  be  under  any duty, by law or contract, to participate in the provision
    38  of medication to a patient under this article.
    39    (b) If a health care provider is unable or unwilling to participate in
    40  the provision of medication to a patient  under  this  article  and  the
    41  patient  transfers  care to a new health care provider, the prior health
    42  care provider shall transfer or arrange for the transfer, upon  request,
    43  of  a  copy  of the patient's relevant medical records to the new health
    44  care provider.
    45    2.(a) A private health care facility  may  prohibit  the  prescribing,
    46  dispensing,  ordering  or  self-administering  of  medication under this
    47  article while the patient is being treated in or while  the  patient  is
    48  residing in the health care facility if:
    49    (i)  the  prescribing,  dispensing,  ordering or self-administering is
    50  contrary to a formally adopted policy of the facility that is  expressly

        A. 2383                             8
 
     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    3.  Where  a health care facility has adopted a prohibition under this
    12  subdivision, any health care provider or employee of  the  facility  who
    13  violates the prohibition may be subject to sanctions otherwise available
    14  to  the  facility,  provided  the  facility  has previously notified the
    15  health care provider or employee of the prohibition in writing.
    16    § 2899-n. Relation to other laws and contracts.  1. (a) A patient  who
    17  requests  medication  under  this  article  shall  not,  because of that
    18  request, be considered to be a person who is suicidal, and self-adminis-
    19  tering medication under this article shall not be deemed to be  suicide,
    20  for any purpose.
    21    (b)  Action  taken  in  accordance  with  this  article  shall  not be
    22  construed for any  purpose  to  constitute  suicide,  assisted  suicide,
    23  attempted  suicide, promoting a suicide attempt, mercy killing, or homi-
    24  cide under the law, including as an accomplice or  accessory  or  other-
    25  wise.
    26    2.  (a)  No  provision in a contract, will or other agreement, whether
    27  written or oral, to the extent the  provision  would  affect  whether  a
    28  person  may  make  or rescind a request for medication or take any other
    29  action under this article, shall be valid.
    30    (b) No obligation owing under any contract  shall  be  conditioned  or
    31  affected  by the making or rescinding of a request by a person for medi-
    32  cation or taking any other action under this article.
    33    3. (a) A person and his or her beneficiaries shall not be denied bene-
    34  fits under a life insurance policy for actions taken in accordance  with
    35  this article.
    36    (b) The sale, procurement or issuance of a life or health insurance or
    37  annuity  policy, or the rate charged for a policy may not be conditioned
    38  upon or affected by a patient making or rescinding a request for medica-
    39  tion under this article.
    40    4. An insurer shall not provide any information in communications made
    41  to a patient about the availability of  medication  under  this  article
    42  absent  a  request  by  the patient or by his or her attending physician
    43  upon the request of such patient. Any communication  shall  not  include
    44  both  the  denial  of  coverage  for treatment and information as to the
    45  availability of medication under this article.
    46    5. The sale, procurement, or issue  of  any  professional  malpractice
    47  insurance  policy or the rate charged for the policy shall not be condi-
    48  tioned upon or affected by whether the insured does or does not take  or
    49  participate in any action under this article.
    50    § 2899-o. Safe  disposal  of  unused medications. The department shall
    51  make regulations providing for the safe disposal of  unused  medications
    52  prescribed, dispensed or ordered under this article.
    53    § 2899-p. Death  certificate.   1. If otherwise authorized by law, the
    54  attending physician may sign the qualified  individual's  death  certif-
    55  icate.

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