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A03598 Summary:

SPONSORRosenthal L (MS)
COSPNSRGottfried, Steck, Hooper, Ortiz, Hevesi
Add Art 29-CCCC §§2994-aaa - 2994-qqq, Pub Health L
Establishes the New York end of life options act; authorizes the prescription of aid-in-dying medication to individuals with terminal illnesses; terminal illness means incurable and irreversible illness that has been medically confirmed that will result in death within six months; form must be signed by the qualified individual and by two witnesses; no liability or sanctions where the health care provider participates in good faith.
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A03598 Memo:

submitted in accordance with Assembly Rule III, Sec 1(f)
SPONSOR: Rosenthal (MS)
  TITLE OF BILL: An act to amend the public health law, in relation to establishing the "New York end of life options act"   PURPOSE: This bill makes aid-in-dying an open and legitimate option for terminal- ly ill individuals in New York State.   SUMMARY OF SPECIFIC PROVISIONS: Section one sets forth the short title of this act, the "New York End of Life Options Act." Section two creates a new article 29-CCCC of the Public Health Law. Section three sets forth the effective date.   JUSTIFICATION: This bill would give a mentally competent, terminally ill adult in New York State the option to request a prescription for aid-in-dying medica- tion that they can take - when and whether they choose - if their suffering becomes unbearable. The medical option of aid in dying will improve end-of-life care overall and will benefit those who choose to access it. This will establish a process that honors a patient's right to make informed decisions about dying and respects the individual's beliefs after receiving a terminal diagnosis. It will allow only qualified, terminally ill, and mentally competent adults to request and obtain a prescription from their physician for medication that the patient can self-administer to bring about a peaceful and humane death. Two physi- cians must confirm the prognosis is terminal. It will require two witnesses to attest that the request is voluntary. It will protect physicians from civil or criminal liability and from professional disci- plinary action if they fulfill a qualified patient's request. Partic- ipation by doctors would be fully voluntary. It will also provide safe- guards against any coercion of patients and would establish felony penalties for coercing or forging a request. It will further honor a\ patient's right to rescind the request at any time.   LEGISLATIVE HISTORY: 2015-16: A.2129-A - Referred to Health   FISCAL IMPLICATIONS: None to the State.   EFFECTIVE DATE: This bill shall take effect on the ninetieth day next succeeding the date upon which it shall had become a law.
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A03598 Text:

                STATE OF NEW YORK
                               2017-2018 Regular Sessions
                   IN ASSEMBLY
                                    January 27, 2017
          SI  -- Multi-Sponsored by -- M. of A. ARROYO -- read once and referred
          to the Committee on Health
        AN ACT to amend the public health law, in relation to  establishing  the
          "New York end of life options act"

          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  "New  York
     2  end of life options act".
     3    § 2. The public health law is amended by adding a new article 29-CCCCC
     4  to read as follows:
     5                              ARTICLE 29-CCCCC
     6                      NEW YORK END OF LIFE OPTIONS ACT
     7  Section 2994-aaa. Definitions.
     8          2994-bbb. Right to request aid-in-dying medication.
     9          2994-ccc. Request process.
    10          2994-ddd. Right  to rescind request; requirement to offer oppor-
    11                      tunity to rescind.
    12          2994-eee. Attending physician responsibilities.
    13          2994-fff. Death certificate.
    14          2994-ggg. Consulting physician confirmation.
    15          2994-hhh. Counseling referral.
    16          2994-iii. Informed decision required.
    17          2994-jjj. Form of request.
    18          2994-kkk. Standard of care.
    19          2994-lll. Effect on construction of wills, contracts  and  stat-
    20                      utes.
    21          2994-mmm. Insurance or annuity policies.
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.

        A. 3598                             2

     1          2994-nnn. Immunities; prohibitions on certain healthcare provid-
     2                      ers; notification; permissible sanctions.
     3          2994-ooo. Non-sanctionable activities.
     4          2994-ppp. Penalties.
     5          2994-qqq. Severability.
     6    §  2994-aaa. Definitions. As used in this article, the following words
     7  and phrases shall have the following meanings:
     8    1. "Adult" means an individual who is eighteen years of age or older.
     9    2. "Aid-in-dying medication" means medication prescribed by  a  physi-
    10  cian to a qualified individual, which the patient may choose to self-ad-
    11  minister  to  bring  about a peaceful death if they find their suffering
    12  due to a terminal illness to be unbearable.
    13    3. "Attending physician" means the physician who has primary responsi-
    14  bility for the care of an individual and treatment of  the  individual's
    15  terminal illness.
    16    4.  "Capacity"  means that in the opinion of an individual's attending
    17  physician, consulting physician, psychiatrist, or psychologist the indi-
    18  vidual has the ability to make and communicate an informed  decision  to
    19  healthcare  providers, including communication through a person familiar
    20  with the individual's manner of communicating if that person  is  avail-
    21  able.
    22    5.  "Consulting  physician"  means  a  physician  who  is qualified by
    23  specialty or experience to make a professional diagnosis  and  prognosis
    24  regarding an individual's illness.
    25    6.  "Counseling"  means one or more consultations as necessary between
    26  an individual and a psychiatrist or psychologist licensed in this  state
    27  for  the  purpose of determining that the individual is competent and is
    28  not suffering from a psychiatric or psychological disorder or depression
    29  causing impaired judgment.
    30    7. "Healthcare provider" or "provider" means a person licensed, certi-
    31  fied, or otherwise authorized or permitted by law to administer  health-
    32  care  or dispense medication in the ordinary course of business or prac-
    33  tice of a  profession,  nurse  practitioners  and  physician  assistants
    34  notwithstanding, and includes a healthcare facility.
    35    8. "Informed decision" means a decision by a terminally ill individual
    36  to  request and obtain a prescription for medication that the individual
    37  may self-administer to end the individual's life that  is  based  on  an
    38  understanding  and acknowledgment of the relevant facts and that is made
    39  after being fully informed by the attending physician of:
    40    (a) the individual's medical diagnosis and prognosis;
    41    (b) the potential risks associated with taking the  medication  to  be
    42  prescribed;
    43    (c) the probable result of taking the medication to be prescribed;
    44    (d) the possibility that they may not choose to obtain the medication,
    45  or may obtain the medication but may decide not to take it; and
    46    (e)  the  feasible alternatives or additional treatment opportunities,
    47  including but not limited to comfort care, hospice care and pain manage-
    48  ment.
    49    9. "Medically confirmed" means the medical opinion  of  the  attending
    50  physician  has been confirmed by a consulting physician who has examined
    51  the individual and the individual's relevant medical records.
    52    10. "Physician" means a doctor of medicine or osteopathy  licensed  to
    53  practice medicine in this state.
    54    11.  "Qualified  individual"  means  a terminally ill adult possessing
    55  capacity who has satisfied the requirements of this article.

        A. 3598                             3
     1    12. "Self-administer"  means  a  qualified  individual's  affirmative,
     2  conscious  act of using the medication to bring about their own peaceful
     3  and humane death.
     4    13.  "Terminal  illness"  means  an incurable and irreversible illness
     5  that has been medically confirmed and will,  within  reasonable  medical
     6  judgment, result in death within six months.
     7    §  2994-bbb.  Right to request aid-in-dying medication. 1. A qualified
     8  individual possessing capacity may make a documented request to  receive
     9  a prescription for aid-in-dying medication if:
    10    (a)  the  qualified  individual's attending physician and a consulting
    11  physician have determined the qualified individual to be suffering  from
    12  a terminal illness; and
    13    (b)  the  qualified  individual  has voluntarily expressed the wish to
    14  receive a prescription for aid-in-dying medication.
    15    2. A person may not qualify under the provisions of this article sole-
    16  ly because of age or disability.
    17    § 2994-ccc. Request process. 1.  A  qualified  individual  wishing  to
    18  receive  a  prescription  for  aid-in-dying  medication pursuant to this
    19  article shall submit a written request and make an oral request to their
    20  attending physician.
    21    2. A valid written request  for  aid-in-dying  medication  under  this
    22  article must be:
    23    (a) in substantially the form described in section twenty-nine hundred
    24  ninety-four-jjj of this article;
    25    (b)  signed  and dated by the qualified individual seeking the medica-
    26  tion; and
    27    (c) witnessed by at least two other individuals who, in  the  presence
    28  of  the qualified individual, attest that to the best of their knowledge
    29  and belief the qualified individual:
    30    (i) possesses capacity;
    31    (ii) is acting voluntarily; and
    32    (iii) is not being coerced to sign the request.
    33    3. One of the witnesses must be an individual who is not:
    34    (a)  related  to  the  qualified  individual  by  blood,  marriage  or
    35  adoption;
    36    (b)  at the time the request is signed, entitled to any portion of the
    37  qualified individual's estate upon death  of  the  qualified  individual
    38  under a will or any operation of law; or
    39    (c) an owner, operator, or employee of a healthcare facility where the
    40  qualified  individual is receiving medical treatment or where the quali-
    41  fied individual resides.
    42    4. Neither the qualified  individual's  attending  physician  nor  any
    43  consulting  physician  may  be  a  witness  to  the signing of a written
    44  request.
    45    § 2994-ddd. Right to rescind request; requirement to offer opportunity
    46  to rescind. 1.  A qualified individual may at  any  time  rescind  their
    47  request  for  aid-in-dying  medication  without  regard to the qualified
    48  individual's mental state.
    49    2. A prescription for aid-in-dying medication under this  article  may
    50  not  be  written  without the attending physician offering the qualified
    51  individual an opportunity to rescind the request.
    52    § 2994-eee. Attending physician responsibilities. The attending physi-
    53  cian shall:
    54    1. make the initial determination of whether an adult making a request
    55  under this article:
    56    (a) has capacity;

        A. 3598                             4
     1    (b) has a terminal illness; and
     2    (c)  has  voluntarily  made  the  request  for aid-in-dying medication
     3  pursuant to this article;
     4    2. ensure to the greatest  degree  possible  that  the  individual  is
     5  making an informed decision by discussing with the individual:
     6    (a) the individual's medical diagnosis and prognosis;
     7    (b)  the potential risks associated with taking the aid-in-dying medi-
     8  cation to be prescribed;
     9    (c) the probable result of taking the aid-in-dying  medication  to  be
    10  prescribed;
    11    (d) the possibility that they can choose to obtain the medication, but
    12  not take it; and
    13    (e)  the  feasible alternatives or additional treatment opportunities,
    14  including but not limited  to  comfort  care,  hospice  care,  and  pain
    15  management;
    16    3.  refer the individual to a consulting physician for medical confir-
    17  mation of the diagnosis, and for a  determination  that  the  individual
    18  possesses capacity and is acting voluntarily;
    19    4.  refer  the  individual  to counseling, if appropriate, pursuant to
    20  section twenty-nine hundred ninety-four-hhh of this article;
    21    5. ensure to  the  greatest  degree  possible  that  the  individual's
    22  request  does  not  arise  from  coercion  or undue influence by another
    23  person;
    24    6. counsel the individual about the importance of:
    25    (a) having another person present  when  they  take  the  aid-in-dying
    26  medication prescribed pursuant to this article; and
    27    (b) not taking the aid-in-dying medication in a public place;
    28    7. inform the individual that they may rescind the request for aid-in-
    29  dying medication at any time and in any manner;
    30    8.  offer  the  individual  an  opportunity to rescind the request for
    31  medication before prescribing the aid-in-dying medication;
    32    9. verify, immediately prior to writing the prescription  for  medica-
    33  tion, that the individual is making an informed decision;
    34    10.  ensure  that  all appropriate steps are carried out in accordance
    35  with this article before writing a prescription for aid-in-dying medica-
    36  tion; and
    37    11. prescribe aid-in-dying medication by, with the qualified  individ-
    38  ual's written consent, contacting a pharmacist, informing the pharmacist
    39  of  the  prescription,  and  forwarding  the written prescription to the
    40  pharmacist, who shall dispense the medications to either  the  qualified
    41  individual or a person expressly designated by the qualified individual.
    42    §  2994-fff. Death certificate. 1. Unless otherwise prohibited by law,
    43  the attending  physician  may  sign  the  qualified  individual's  death
    44  certificate.
    45    2. The cause of death listed on a qualified individual's death certif-
    46  icate  who  uses aid-in-dying medication will be the underlying terminal
    47  illness.
    48    § 2994-ggg. Consulting physician confirmation.  Before  a  patient  is
    49  qualified  under  the provisions of this article, a consulting physician
    50  shall examine the patient and his or her relevant  medical  records  and
    51  confirm,  in  writing,  the  attending  physician's  diagnosis  that the
    52  patient is suffering from  a  terminal  disease,  and  verify  that  the
    53  patient is capable, is acting voluntarily and has made an informed deci-
    54  sion.
    55    §  2994-hhh.  Counseling  referral. If in the opinion of the attending
    56  physician or the consulting physician an  individual  may  be  suffering

        A. 3598                             5
     1  from  a  psychiatric  or  psychological  disorder  or depression causing
     2  impaired judgment, either physician shall refer the  patient  for  coun-
     3  seling.  No aid-in-dying medication shall be prescribed until the person
     4  performing  the  counseling determines that the patient is not suffering
     5  from a psychiatric  or  psychological  disorder  or  depression  causing
     6  impaired judgment.
     7    §  2994-iii. Informed decision required. An individual may not receive
     8  a prescription for aid-in-dying  medication  pursuant  to  this  article
     9  unless they have made an informed decision as defined in this article.
    10    §  2994-jjj. Form of request. 1. A request for aid-in-dying medication
    11  as authorized by this article must be  in  substantially  the  following
    12  form:
    13                    REQUEST FOR MEDICATION TO END MY LIFE
    14                      IN A HUMANE AND DIGNIFIED MANNER
    15    I, _________________________________, am an adult of sound mind.
    16  I am suffering from ______________________________________________,
    17  which my attending physician has determined is in its terminal phase and
    18  which has been medically confirmed.
    19    I  have  been fully informed of my diagnosis and prognosis, the nature
    20  of the aid-in-dying medication to be prescribed and potential associated
    21  risks, the expected result, and the feasible alternatives or  additional
    22  treatment  opportunities  including  comfort care, hospice care and pain
    23  management.
    24    I request that my attending physician prescribe medication  that  will
    25  end my life in a humane and dignified manner if I choose to take it, and
    26  I  authorize  my  attending physician to contact any pharmacist about my
    27  request.
    28  INITIAL ONE:
    29        I have informed my family of my decision and taken their  opinions
    30  into consideration.
    31        I have decided not to inform my family of my decision.
    32        I have no family to inform of my decision.
    33    I  understand  that  I  have  the right to rescind this request at any
    34  time.
    35    I understand the full import of this request, and I expect to die if I
    36  take the aid-in-dying medication to be prescribed. I further  understand
    37  that  although  most  deaths occur within three hours, my death may take
    38  longer, and my attending physician has counseled me about this possibil-
    39  ity.
    40    I make this request voluntarily and without reservation, and I  accept
    41  full moral responsibility for my actions.
    42  Signed: ___________________
    43  Dated: ___________________
    44    2. Pursuant to paragraph (a) of subdivision two of section twenty-nine
    45  hundred  ninety-four-ccc  of  this  article,  each witness must complete
    46  documentation in substantially the following form:
    47                          DECLARATION OF WITNESSES
    48    We declare that the person signing this request:
    49    (a) is personally known to us or has provided proof of identity;
    50    (b) signed this request in our presence;
    51    (c) is an individual whom we believe to be of sound mind and not under
    52  duress, fraud, or undue influence; and

        A. 3598                             6
     1    (d) is not an individual for whom either of us is the attending physi-
     2  cian.
     3    ______________________ Witness 1, Date: _______
     4    ______________________ Witness 2, Date: _______
     5    NOTE:  One  witness  may  not  be  a  relative  (by blood, marriage or
     6  adoption) of the person signing this request, may not be entitled to any
     7  portion of the person's estate upon death, and may not own, operate,  or
     8  be  employed  at  a healthcare facility where the person is a patient or
     9  where the person resides.
    10    § 2994-kkk. Standard of care. Physicians and medical  personnel  shall
    11  provide  medical  services  under this article that meet the standard of
    12  care for end of life medical care.
    13    § 2994-lll. Effect on construction of wills, contracts  and  statutes.
    14  1.  A  provision in a contract, will or other agreement, whether written
    15  or oral, to the extent the provision would affect whether a  person  may
    16  make or rescind a request for aid-in-dying medication, is not valid.
    17    2.  An  obligation owing under any currently existing contract may not
    18  be conditioned or affected by  an  individual  making  or  rescinding  a
    19  request for aid-in-dying medication.
    20    § 2994-mmm. Insurance or annuity policies. 1. The sale, procurement or
    21  issuance  of  a life, health or accident insurance or annuity policy, or
    22  the rate charged for a policy may not be conditioned upon or affected by
    23  a person making or rescinding a request for aid-in-dying medication.
    24    2. A qualified individual's  act  of  self-administering  aid-in-dying
    25  medication  may  not  have  an  effect  upon a life, health, or accident
    26  insurance or annuity policy other than that of a natural death from  the
    27  underlying illness.
    28    §  2994-nnn. Immunities; prohibitions on certain healthcare providers;
    29  notification; permissible sanctions. 1. A person is not subject to civil
    30  or criminal liability or professional disciplinary  action  for  partic-
    31  ipating  in  good faith compliance with this article, including an indi-
    32  vidual who is present when a qualified individual  self-administers  the
    33  prescribed aid-in-dying medication.
    34    2.  A  healthcare provider or professional organization or association
    35  may not subject an individual to censure, discipline,  suspension,  loss
    36  of  license, loss of privileges, loss of membership or other penalty for
    37  participating or refusing to participate in good faith  compliance  with
    38  this article.
    39    3.  A request by an individual for or provision by an attending physi-
    40  cian of medication in good faith compliance with the provisions of  this
    41  article  does  not  constitute neglect or elder abuse for any purpose of
    42  law, or provide the sole basis for the  appointment  of  a  guardian  or
    43  conservator.
    44    4.  A healthcare provider may choose whether to participate in provid-
    45  ing aid-in-dying medication to a qualified individual pursuant  to  this
    46  article. If a healthcare provider is unable or unwilling to carry out an
    47  individual's  request  under  this  article and the individual transfers
    48  care to a new healthcare provider, the prior healthcare  provider  shall
    49  transfer,  upon  request,  a  copy  of the individual's relevant medical
    50  records to the new healthcare provider.
    51    5. Nothing in this section shall prevent a  healthcare  provider  from
    52  providing  an individual with healthcare services that do not constitute
    53  participation in this article.
    54    § 2994-ooo. Non-sanctionable activities. A healthcare provider may not
    55  be sanctioned for:

        A. 3598                             7
     1    1. making an initial determination that an individual has  a  terminal
     2  illness and informing them of the medical prognosis;
     3    2. providing information about the New York End of Life Options Act to
     4  a patient upon the request of the individual;
     5    3.  providing  an individual, upon request, with a referral to another
     6  physician; or
     7    4. contracting with an individual to act outside the course and  scope
     8  of the provider's capacity as an employee or independent contractor of a
     9  healthcare provider that prohibits activities under this article.
    10    §  2994-ppp.  Penalties.  1. A person who without authorization of the
    11  qualified individual willfully alters or forges a request for medication
    12  or conceals or destroys a rescission of that request with the intent  or
    13  effect  of causing the qualified individual's death is guilty of a class
    14  A felony.
    15    2. A person who coerces or exerts undue influence on a qualified indi-
    16  vidual to request medication to end the qualified individual's life,  or
    17  to destroy a rescission of a request, is guilty of a class A felony.
    18    3.  Except as provided in subdivisions one and two of this section, it
    19  shall be a class A misdemeanor for a person without authorization of the
    20  individual to willfully alter, forge, conceal or destroy an  instrument,
    21  the  reinstatement or revocation of an instrument, or any other evidence
    22  or document reflecting the individual's desires and interests  with  the
    23  intent or effect of affecting a healthcare decision.
    24    4.  This  article  does  not limit further liability for civil damages
    25  resulting from other negligent conduct or intentional misconduct by  any
    26  person.
    27    5.  The  penalties  in this article do not preclude criminal penalties
    28  applicable under other provisions of law for conduct that is  inconsist-
    29  ent with this article.
    30    §  2994-qqq. Severability. If any clause, sentence, paragraph, section
    31  or part of this article shall be adjudged  by  any  court  of  competent
    32  jurisdiction  to  be  invalid, such judgment shall not affect, impair or
    33  invalidate the remainder thereof, but shall be confined in its operation
    34  to the clause, sentence, paragraph, section or  part  thereof,  directly
    35  involved  in  the  controversy  in  which  such judgment shall have been
    36  rendered.
    37    § 3. This act shall take effect on the ninetieth day  next  succeeding
    38  the date upon which it shall have become a law.
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