|SAME AS||SAME AS S05814-A|
|COSPNSR||Dinowitz, Galef, Zebrowski, Gottfried, Blake, Hevesi, Steck, Sepulveda|
|MLTSPNSR||Braunstein, Crouch, Duprey, Skartados|
|Add Art 28-F §§2899-d - 2899-p, Pub Health L|
|Relates to the patient self-determination act; authorizes a physician with a bona fide physician-patient relationship with a patient with a terminal illness or condition to prescribe a lethal dose of the medication to be self-administered; defines terminal illness or condition to be an illness or condition which can reasonably be expected to cause death within six months, whether or not treatment is provided; provides immunity to health care providers.|
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STATE OF NEW YORK ________________________________________________________________________ 5261--C 2015-2016 Regular Sessions IN ASSEMBLY February 13, 2015 ___________ Introduced by M. of A. PAULIN, DINOWITZ, GALEF, ZEBROWSKI, GOTTFRIED, BLAKE -- Multi-Sponsored by -- M. of A. BRAUNSTEIN, CROUCH, DUPREY, SKARTADOS -- read once and referred to the Committee on Health -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee -- again reported from said committee with amendments, ordered reprinted as amended and recommitted to said committee -- 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 committee AN ACT to amend the public health law, in relation to patient self-det- ermination at end of life 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 "patient 2 self-determination 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 AID IN DYING 7 Section 2899-d. Definitions. 8 2899-e. Written request for medication. 9 2899-f. Written request signed and witnessed. 10 2899-g. Attending physician responsibilities. 11 2899-h. Counseling referral. 12 2899-i. Medical record documentation requirements. 13 2899-j. Residency requirement. 14 2899-k. Protection of health care providers and facilities. 15 2899-l. Relation to other laws and contracts. 16 2899-m. Safe disposal of unused medications. 17 2899-n. Death certificate. 18 2899-o. Reporting. EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD07446-23-6A. 5261--C 2 1 2899-p. Severability. 2 § 2899-d. Definitions. As used in this article: 3 1. "Adult" means an individual who is twenty-one years of age or 4 older. 5 2. "Attending physician" means the physician who has primary responsi- 6 bility for the care of the patient and treatment of the patient's termi- 7 nal disease. 8 3. "Capacity" means the ability to understand and appreciate the 9 nature and consequences of health care decisions, including the benefits 10 and risks of and alternatives to any proposed health care, and to reach 11 an informed decision and to communicate health care decisions to a 12 physician, including communication through persons familiar with the 13 patient's manner of communicating if those persons are available. 14 4. "Counseling" means one or more consultations as necessary between a 15 state licensed psychiatrist or psychologist and a patient for the 16 purpose of determining that the patient has capacity and is not suffer- 17 ing from a psychiatric or psychological disorder or depression causing 18 impaired judgment. 19 5. "Health care facility" means a general hospital, nursing home, or 20 residential health care facility as defined in section twenty-eight 21 hundred one of this chapter. 22 6. "Health care provider" means a person or entity licensed, certi- 23 fied, or authorized by law to administer health care or dispense medica- 24 tion in the ordinary course of business or practice of a profession. 25 7. "Impaired judgment" means that a person lacks the ability to under- 26 stand and appreciate the nature and consequences of health care deci- 27 sions, including the benefits and risks of and alternatives to any 28 proposed health care, and to reach an informed decision. 29 8. "Medication" means medication capable of ending and to be used with 30 the intent of ending the patient's life, including any ancillary medica- 31 tion intended to minimize the patient's discomfort. 32 9. "Palliative care" means health care treatment, including interdis- 33 ciplinary end-of-life care, and consultation with patients and family 34 members, to prevent or relieve pain and suffering and to enhance the 35 patient's quality of life, including hospice care under article forty of 36 this chapter. 37 10. "Patient" means a person who is twenty-one years of age or older, 38 a resident of New York state, and under the care of a physician. 39 11. "Physician" means an individual licensed to practice medicine in 40 New York state. 41 12. "Terminal illness or condition" means an illness or condition 42 which can reasonably be expected to cause death within six months, 43 whether or not treatment is provided. 44 § 2899-e. Written request for medication. 1. An adult who has capaci- 45 ty, is a resident of this state, and has been determined by the attend- 46 ing physician and, if applicable, consulting physician to be suffering 47 from a terminal illness or condition, may make a written request for and 48 consent to self-administer medication for the purpose of ending his or 49 her life in accordance with this article. 50 2. No person shall qualify under this article solely because of age or 51 disability. 52 § 2899-f. Written request signed and witnessed. 1. A request for medi- 53 cation under this article shall be signed and dated by the patient and 54 witnessed by at least two individuals who, in the presence of the 55 patient, attest that to the best of their knowledge and belief the 56 patient has capacity, is acting voluntarily, and is not being coerced toA. 5261--C 3 1 sign the request. The department may develop a suggested form for a 2 request under this article. 3 2. One of the witnesses shall be a person who is not: 4 (a) a relative of the patient by blood, marriage or adoption; 5 (b) a person who at the time the request is signed would be entitled 6 to any portion of the estate of the patient upon death under any will or 7 by operation of law; or 8 (c) an owner, operator or employee of a health care facility where the 9 patient is receiving treatment or is a resident. 10 3. The patient's attending physician or, if applicable, consulting 11 physician at the time the request is signed shall not be a witness. 12 § 2899-g. Attending physician responsibilities. 1. The attending 13 physician shall: 14 (a) make the determination of whether a patient has a terminal illness 15 or condition, has capacity, and has made the request voluntarily; 16 (b) request that the patient demonstrate New York state residency; 17 (c) refer the patient for counseling, if appropriate, under section 18 twenty-eight hundred ninety-nine-h of this article; 19 (d) provide information and counseling under section twenty-nine 20 hundred ninety-seven-c of this chapter; and 21 (e) fulfill the medical record documentation requirements of section 22 twenty-eight hundred ninety-nine-i of this article. 23 2. Subject to section twenty-eight hundred ninety-nine-h of this arti- 24 cle, the attending physician who makes the determination that the 25 patient has a terminal illness or condition, has capacity and has made a 26 request for medication as provided in section twenty-eight hundred nine- 27 ty-nine-e of this article, may personally, or by direction to another 28 physician, prescribe, dispense or order appropriate medication in 29 accordance with the patient's request under this article, and at the 30 patient's request, facilitate the filling of the prescription and deliv- 31 ery of the medication to the patient. 32 3. In accordance with the direction of the prescribing, dispensing or 33 ordering physician and the consent of the patient, the patient may 34 administer the medication to himself or herself. A health care profes- 35 sional shall not administer the medication to the patient but, acting 36 within the scope of his or her lawful practice, may facilitate the 37 patient in self-administering the medication. 38 § 2899-h. Counseling referral. If in the opinion of the attending 39 physician a patient may be suffering from a psychiatric or psychological 40 disorder or depression causing impaired judgment, such physician shall 41 refer the patient for counseling. No medication to end a patient's life 42 shall be prescribed, dispensed or ordered until the person performing 43 the counseling determines that the patient is not suffering from a 44 psychiatric or psychological disorder or depression causing impaired 45 judgment and has capacity. 46 § 2899-i. Medical record documentation requirements. The following 47 shall be documented or filed in the patient's medical record: 48 1. all oral requests by a patient for medication to end his or her 49 life; 50 2. all written requests by a patient for medication to end his or her 51 life; 52 3. the attending physician's diagnosis and prognosis, and determi- 53 nation whether the patient has capacity and is acting voluntarily; 54 4. a report of the outcome and determinations made during counseling, 55 if performed; andA. 5261--C 4 1 5. a note by the attending physician indicating whether all require- 2 ments under this article have been met and indicating the steps taken to 3 carry out the request, including a notation of the medication 4 prescribed, dispensed or ordered. 5 § 2899-j. Residency requirement. Only requests made by New York state 6 residents under the provisions of this article shall be granted. Factors 7 demonstrating New York state residency shall include but shall not be 8 limited to: 9 1. Possession of a New York state driver's license; 10 2. Registration to vote in New York state; 11 3. Evidence that the person owns or leases property in New York state; 12 or 13 4. Filing of a New York state tax return for the most recent tax year. 14 § 2899-k. Protection of health care providers and facilities. 1. A 15 physician, pharmacist, other health care professional or other person 16 shall not be subject to civil or criminal liability or professional 17 disciplinary action, and shall not be subject to discipline, suspension, 18 loss of license, loss of privileges, or other penalty by any health care 19 facility or health care provider, for taking any reasonable good-faith 20 action or refusing to act under this article, including: (a) engaging in 21 discussions with a patient relating to the risks and benefits of end-of- 22 life options in the circumstances described in this article, (b) being 23 present when a patient self-administers medication, (c) refraining from 24 acting to prevent the patient from self-administering such medication, 25 or (d) refraining from acting to resuscitate or rescue the patient after 26 he or she self-administers such medication. However, paragraphs (c) and 27 (d) of this subdivision shall not apply where there are reasonable 28 grounds to believe, under the circumstances, that the patient has 29 rescinded his or her request or consent to self-administer medication 30 under this article or communicates a desire that the lethal action of 31 the medication be reversed. 32 2. A physician, nurse, pharmacist, or other person shall not be under 33 any duty, by law or contract, to participate in the provision of medica- 34 tion to a patient under this article. 35 3. A private health care facility may prohibit the self-administering 36 of medication under the article while the patient is being treated or 37 residing in the health care facility if: 38 (a) such prescribing, dispensing, ordering or self-administering is 39 contrary to a formally adopted policy of such facility that is expressly 40 based on sincerely held religious beliefs or sincerely held moral 41 convictions central to the facility's operating principles; 42 (b) such facility has informed the patient of such policy prior to or 43 upon admission, if reasonably possible; and 44 (c) if the patient requests, the patient is transferred promptly to 45 another health care facility that is reasonably accessible under the 46 circumstances and willing to permit the prescribing, dispensing, order- 47 ing and self-administering of medication under this article with respect 48 to the patient. 49 4. A health care facility that prohibits the self-administering of 50 medication under this article while the patient is being treated or 51 residing in the health care facility under this section may prohibit a 52 physician from prescribing, dispensing or ordering medication for self- 53 administering while the patient is being treated or residing in the 54 health care facility, provided the health care facility has notified the 55 physician in writing of its policy to prohibit such actions. Notwith- 56 standing subdivision one of this section, any person who violates aA. 5261--C 5 1 policy established by a health care facility under this section may be 2 subject to sanctions otherwise allowable under law, contract and facili- 3 ty policy. 4 § 2899-l. Relation to other laws and contracts. 1. (a) A patient who 5 self-administers medication under this article shall not be considered 6 to be a person who is suicidal, and self-administering medication under 7 this article shall not be deemed to be suicide, for any purpose. 8 (b) Action taken in accordance with this article shall not be 9 construed for any purpose to constitute suicide, assisted suicide, 10 attempted suicide, promoting a suicide attempt, mercy killing, or homi- 11 cide under the law, including as an accomplice or accessory or other- 12 wise. 13 2. A request by a patient to his or her attending physician to provide 14 medication under this article shall not, by itself, provide the basis 15 for the appointment of a guardian or conservator. 16 3. (a) No provision in a contract, will or other agreement, whether 17 written or oral, to the extent the provision would affect whether a 18 person may make or rescind a request for medication or take any other 19 action under this article, shall be valid. 20 (b) No obligation owing under any contract shall be conditioned or 21 affected by the making or rescinding of a request by a person for medi- 22 cation or taking any other action under this article. 23 4. A person and his or her beneficiaries shall not be denied benefits 24 under a life insurance policy for actions taken in accordance with this 25 article. 26 5. An insurer shall not provide any information in communications made 27 to a person about the availability of medication under this article 28 absent a request by such person or by his or her attending physician 29 upon the request of such person. Any communication shall not include 30 both the denial of treatment and information as to the availability of 31 medication under this article. 32 6. The sale, procurement, or issue of any professional malpractice 33 insurance policy or the rate charged for the policy shall not be condi- 34 tioned upon or affected by whether the insured does or does not take or 35 participate in any action under this article. 36 § 2899-m. Safe disposal of unused medications. The department shall 37 make regulations providing for the safe disposal of unused medications 38 prescribed, dispensed or ordered under this article. 39 § 2899-n. Death certificate. In the event that a patient dies as a 40 result of medication self-administered under this article, the death 41 certificate shall indicate that the cause of death was the underlying 42 terminal illness or condition of the patient. However, where there are 43 reasonable grounds to believe, under the circumstances, that the patient 44 rescinded his or her request or consent to self-administer medication 45 under this article or communicated a desire that the lethal action of 46 the medication be reversed, and the patient nevertheless died from the 47 self-administration of the medication, the self-administration of the 48 medication may be listed as the cause of death. 49 § 2899-o. Reporting. 1. The commissioner shall annually review a 50 sample of the records maintained under section twenty-eight hundred 51 ninety-nine-i of this article. The department may adopt regulations 52 establishing reporting requirements for physicians taking action under 53 this article to determine utilization and compliance with this article. 54 The information collected under this section shall be confidential and 55 shall be collected in a manner that protects the privacy of the patient,A. 5261--C 6 1 his or her family, and any health care provider acting in connection 2 with such patient under this article. 3 2. The department shall prepare a report annually containing relevant 4 data regarding utilization and compliance with this article and shall 5 post such report on its website. 6 § 2899-p. Severability. If any provision of this article or any appli- 7 cation of any provision of this article, is held to be invalid, or to 8 violate or be inconsistent with any federal law or regulation, that 9 shall not affect the validity or effectiveness of any other provision of 10 this article, or of any other application of any provision of this arti- 11 cle, which can be given effect without that provision or application; 12 and to that end, the provisions and applications of this article are 13 severable. 14 § 3. This act shall take effect immediately.