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S03685 Summary:

Add Art 29-cccc SS2994-aaa - 294-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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S03685 Text:

                STATE OF NEW YORK
                               2015-2016 Regular Sessions
                    IN SENATE
                                    February 13, 2015
        Introduced  by  Sens. SAVINO, HOYLMAN -- read twice and ordered printed,
          and when printed to be committed 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-CCCC
     4  to read as follows:
     5                               ARTICLE 29-CCCC
     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.
    22          2994-nnn. Immunities; prohibitions on certain healthcare provid-
    23                      ers; notification; permissible sanctions.
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.

        S. 3685                             2
     1          2994-ooo. Non-sanctionable activities.
     2          2994-ppp. Penalties.
     3          2994-qqq. Severability.
     4    §  2994-aaa. Definitions. As used in this article, the following words
     5  and phrases shall have the following meanings:
     6    1. "Adult" means an individual who is eighteen years of age or older.
     7    2. "Aid-in-dying medication" means medication prescribed by  a  physi-
     8  cian to a qualified individual, which the patient may choose to self-ad-
     9  minister  to  bring  about a peaceful death if they find their suffering
    10  due to a terminal illness to be unbearable.
    11    3. "Attending physician" means the physician who has primary responsi-
    12  bility for the care of an individual and treatment of  the  individual's
    13  terminal illness.
    14    4.  "Capacity"  means that in the opinion of an individual's attending
    15  physician, consulting physician, psychiatrist, or psychologist the indi-
    16  vidual has the ability to make and communicate an informed  decision  to
    17  healthcare  providers, including communication through a person familiar
    18  with the individual's manner of communicating if that person  is  avail-
    19  able.
    20    5.  "Consulting  physician"  means  a  physician  who  is qualified by
    21  specialty or experience to make a professional diagnosis  and  prognosis
    22  regarding an individual's illness.
    23    6.  "Counseling"  means one or more consultations as necessary between
    24  an individual and a psychiatrist or psychologist licensed in this  state
    25  for  the  purpose of determining that the individual is competent and is
    26  not suffering from a psychiatric or psychological disorder or depression
    27  causing impaired judgment.
    28    7. "Healthcare provider" or "provider" means a person licensed, certi-
    29  fied, or otherwise authorized or permitted by law to administer  health-
    30  care  or dispense medication in the ordinary course of business or prac-
    31  tice of a  profession,  nurse  practitioners  and  physician  assistants
    32  notwithstanding, and includes a healthcare facility.
    33    8. "Informed decision" means a decision by a terminally ill individual
    34  to  request and obtain a prescription for medication that the individual
    35  may self-administer to end the individual's life that  is  based  on  an
    36  understanding  and acknowledgment of the relevant facts and that is made
    37  after being fully informed by the attending physician of:
    38    (a) the individual's medical diagnosis and prognosis;
    39    (b) the potential risks associated with taking the  medication  to  be
    40  prescribed;
    41    (c) the probable result of taking the medication to be prescribed;
    42    (d) the possibility that they may not choose to obtain the medication,
    43  or may obtain the medication but may decide not to take it; and
    44    (e)  the  feasible alternatives or additional treatment opportunities,
    45  including but not limited to comfort care, hospice care and pain manage-
    46  ment.
    47    9. "Medically confirmed" means the medical opinion  of  the  attending
    48  physician  has been confirmed by a consulting physician who has examined
    49  the individual and the individual's relevant medical records.
    50    10. "Physician" means a doctor of medicine or osteopathy  licensed  to
    51  practice medicine in this state.
    52    11.  "Qualified  individual"  means  a terminally ill adult possessing
    53  capacity who has satisfied the requirements of this article.
    54    12. "Self-administer"  means  a  qualified  individual's  affirmative,
    55  conscious  act of using the medication to bring about their own peaceful
    56  and humane death.

        S. 3685                             3
     1    13. "Terminal illness" means an  incurable  and  irreversible  illness
     2  that  has  been  medically confirmed and will, within reasonable medical
     3  judgment, result in death within six months.
     4    §  2994-bbb.  Right to request aid-in-dying medication. 1. A qualified
     5  individual possessing capacity may make a documented request to  receive
     6  a prescription for aid-in-dying medication if:
     7    (a)  the  qualified  individual's attending physician and a consulting
     8  physician have determined the qualified individual to be suffering  from
     9  a terminal illness; and
    10    (b)  the  qualified  individual  has voluntarily expressed the wish to
    11  receive a prescription for aid-in-dying medication.
    12    2. A person may not qualify under the provisions of this article sole-
    13  ly because of age or disability.
    14    § 2994-ccc. Request process. 1.  A  qualified  individual  wishing  to
    15  receive  a  prescription  for  aid-in-dying  medication pursuant to this
    16  article shall submit a written request and make an oral request to their
    17  attending physician.
    18    2. A valid written request  for  aid-in-dying  medication  under  this
    19  article must be:
    20    (a) in substantially the form described in section twenty-nine hundred
    21  ninety-four-jjj of this article;
    22    (b)  signed  and dated by the qualified individual seeking the medica-
    23  tion; and
    24    (c) witnessed by at least two other individuals who, in  the  presence
    25  of  the qualified individual, attest that to the best of their knowledge
    26  and belief the qualified individual:
    27    (i) possesses capacity;
    28    (ii) is acting voluntarily; and
    29    (iii) is not being coerced to sign the request.
    30    3. One of the witnesses must be an individual who is not:
    31    (a)  related  to  the  qualified  individual  by  blood,  marriage  or
    32  adoption;
    33    (b)  at the time the request is signed, entitled to any portion of the
    34  qualified individual's estate upon death  of  the  qualified  individual
    35  under a will or any operation of law; or
    36    (c) an owner, operator, or employee of a healthcare facility where the
    37  qualified  individual is receiving medical treatment or where the quali-
    38  fied individual resides.
    39    4. Neither the qualified  individual's  attending  physician  nor  any
    40  consulting  physician  may  be  a  witness  to  the signing of a written
    41  request.
    42    § 2994-ddd. Right to rescind request; requirement to offer opportunity
    43  to rescind. 1.  A qualified individual may at  any  time  rescind  their
    44  request  for  aid-in-dying  medication  without  regard to the qualified
    45  individual's mental state.
    46    2. A prescription for aid-in-dying medication under this  article  may
    47  not  be  written  without the attending physician offering the qualified
    48  individual an opportunity to rescind the request.
    49    § 2994-eee. Attending physician responsibilities. The attending physi-
    50  cian shall:
    51    1. make the initial determination of whether an adult making a request
    52  under this article:
    53    (a) has capacity;
    54    (b) has a terminal illness; and
    55    (c) has voluntarily  made  the  request  for  aid-in-dying  medication
    56  pursuant to this article;

        S. 3685                             4
     1    2.  ensure  to  the  greatest  degree  possible that the individual is
     2  making an informed decision by discussing with the individual:
     3    (a) the individual's medical diagnosis and prognosis;
     4    (b)  the potential risks associated with taking the aid-in-dying medi-
     5  cation to be prescribed;
     6    (c) the probable result of taking the aid-in-dying  medication  to  be
     7  prescribed;
     8    (d) the possibility that they can choose to obtain the medication, but
     9  not take it; and
    10    (e)  the  feasible alternatives or additional treatment opportunities,
    11  including but not limited  to  comfort  care,  hospice  care,  and  pain
    12  management;
    13    3.  refer the individual to a consulting physician for medical confir-
    14  mation of the diagnosis, and for a  determination  that  the  individual
    15  possesses capacity and is acting voluntarily;
    16    4.  refer  the  individual  to counseling, if appropriate, pursuant to
    17  section twenty-nine hundred ninety-four-hhh of this article;
    18    5. ensure to  the  greatest  degree  possible  that  the  individual's
    19  request  does  not  arise  from  coercion  or undue influence by another
    20  person;
    21    6. counsel the individual about the importance of:
    22    (a) having another person present  when  they  take  the  aid-in-dying
    23  medication prescribed pursuant to this article; and
    24    (b) not taking the aid-in-dying medication in a public place;
    25    7. inform the individual that they may rescind the request for aid-in-
    26  dying medication at any time and in any manner;
    27    8.  offer  the  individual  an  opportunity to rescind the request for
    28  medication before prescribing the aid-in-dying medication;
    29    9. verify, immediately prior to writing the prescription  for  medica-
    30  tion, that the individual is making an informed decision;
    31    10.  ensure  that  all appropriate steps are carried out in accordance
    32  with this article before writing a prescription for aid-in-dying medica-
    33  tion; and
    34    11. prescribe aid-in-dying medication by, with the qualified  individ-
    35  ual's written consent, contacting a pharmacist, informing the pharmacist
    36  of  the  prescription,  and  forwarding  the written prescription to the
    37  pharmacist, who shall dispense the medications to either  the  qualified
    38  individual or a person expressly designated by the qualified individual.
    39    §  2994-fff. Death certificate. 1. Unless otherwise prohibited by law,
    40  the attending  physician  may  sign  the  qualified  individual's  death
    41  certificate.
    42    2. The cause of death listed on a qualified individual's death certif-
    43  icate  who  uses aid-in-dying medication will be the underlying terminal
    44  illness.
    45    § 2994-ggg. Consulting physician confirmation.  Before  a  patient  is
    46  qualified  under  the provisions of this article, a consulting physician
    47  shall examine the patient and his or her relevant  medical  records  and
    48  confirm,  in  writing,  the  attending  physician's  diagnosis  that the
    49  patient is suffering from  a  terminal  disease,  and  verify  that  the
    50  patient is capable, is acting voluntarily and has made an informed deci-
    51  sion.
    52    §  2994-hhh.  Counseling  referral. If in the opinion of the attending
    53  physician or the consulting physician an  individual  may  be  suffering
    54  from  a  psychiatric  or  psychological  disorder  or depression causing
    55  impaired judgment, either physician shall refer the  patient  for  coun-
    56  seling.  No aid-in-dying medication shall be prescribed until the person

        S. 3685                             5
     1  performing the counseling determines that the patient is  not  suffering
     2  from  a  psychiatric  or  psychological  disorder  or depression causing
     3  impaired judgment.
     4    §  2994-iii. Informed decision required. An individual may not receive
     5  a prescription for aid-in-dying  medication  pursuant  to  this  article
     6  unless they have made an informed decision as defined in this article.
     7    §  2994-jjj. Form of request. 1. A request for aid-in-dying medication
     8  as authorized by this article must be  in  substantially  the  following
     9  form:
    10                    REQUEST FOR MEDICATION TO END MY LIFE
    11                      IN A HUMANE AND DIGNIFIED MANNER
    12    I, _________________________________, am an adult of sound mind.
    13  I am suffering from ______________________________________________,
    14  which my attending physician has determined is in its terminal phase and
    15  which has been medically confirmed.
    16    I  have  been fully informed of my diagnosis and prognosis, the nature
    17  of the aid-in-dying medication to be prescribed and potential associated
    18  risks, the expected result, and the feasible alternatives or  additional
    19  treatment  opportunities  including  comfort care, hospice care and pain
    20  management.
    21    I request that my attending physician prescribe medication  that  will
    22  end my life in a humane and dignified manner if I choose to take it, and
    23  I  authorize  my  attending physician to contact any pharmacist about my
    24  request.
    25  INITIAL ONE:
    26        I have informed my family of my decision and taken their  opinions
    27  into consideration.
    28        I have decided not to inform my family of my decision.
    29        I have no family to inform of my decision.
    30    I  understand  that  I  have  the right to rescind this request at any
    31  time.
    32    I understand the full import of this request, and I expect to die if I
    33  take the aid-in-dying medication to be prescribed. I further  understand
    34  that  although  most  deaths occur within three hours, my death may take
    35  longer, and my attending physician has counseled me about this possibil-
    36  ity.
    37    I make this request voluntarily and without reservation, and I  accept
    38  full moral responsibility for my actions.
    39  Signed: ___________________
    40  Dated: ___________________
    41    2. Pursuant to paragraph (a) of subdivision two of section twenty-nine
    42  hundred  ninety-four-ccc  of  this  article,  each witness must complete
    43  documentation in substantially the following form:
    44                          DECLARATION OF WITNESSES
    45    We declare that the person signing this request:
    46    (a) is personally known to us or has provided proof of identity;
    47    (b) signed this request in our presence;
    48    (c) is an individual whom we believe to be of sound mind and not under
    49  duress, fraud, or undue influence; and
    50    (d) is not an individual for whom either of us is the attending physi-
    51  cian.
    52    ______________________ Witness 1, Date: _______

        S. 3685                             6
     1    ______________________ Witness 2, Date: _______
     2    NOTE:  One  witness  may  not  be  a  relative  (by blood, marriage or
     3  adoption) of the person signing this request, may not be entitled to any
     4  portion of the person's estate upon death, and may not own, operate,  or
     5  be  employed  at  a healthcare facility where the person is a patient or
     6  where the person resides.
     7    § 2994-kkk. Standard of care. Physicians and medical  personnel  shall
     8  provide  medical  services  under this article that meet the standard of
     9  care for end of life medical care.
    10    § 2994-lll. Effect on construction of wills, contracts  and  statutes.
    11  1.  A  provision in a contract, will or other agreement, whether written
    12  or oral, to the extent the provision would affect whether a  person  may
    13  make or rescind a request for aid-in-dying medication, is not valid.
    14    2.  An  obligation owing under any currently existing contract may not
    15  be conditioned or affected by  an  individual  making  or  rescinding  a
    16  request for aid-in-dying medication.
    17    § 2994-mmm. Insurance or annuity policies. 1. The sale, procurement or
    18  issuance  of  a life, health or accident insurance or annuity policy, or
    19  the rate charged for a policy may not be conditioned upon or affected by
    20  a person making or rescinding a request for aid-in-dying medication.
    21    2. A qualified individual's  act  of  self-administering  aid-in-dying
    22  medication  may  not  have  an  effect  upon a life, health, or accident
    23  insurance or annuity policy other than that of a natural death from  the
    24  underlying illness.
    25    §  2994-nnn. Immunities; prohibitions on certain healthcare providers;
    26  notification; permissible sanctions. 1. A person is not subject to civil
    27  or criminal liability or professional disciplinary  action  for  partic-
    28  ipating  in  good faith compliance with this article, including an indi-
    29  vidual who is present when a qualified individual  self-administers  the
    30  prescribed aid-in-dying medication.
    31    2.  A  healthcare provider or professional organization or association
    32  may not subject an individual to censure, discipline,  suspension,  loss
    33  of  license, loss of privileges, loss of membership or other penalty for
    34  participating or refusing to participate in good faith  compliance  with
    35  this article.
    36    3.  A request by an individual for or provision by an attending physi-
    37  cian of medication in good faith compliance with the provisions of  this
    38  article  does  not  constitute neglect or elder abuse for any purpose of
    39  law, or provide the sole basis for the  appointment  of  a  guardian  or
    40  conservator.
    41    4.  A healthcare provider may choose whether to participate in provid-
    42  ing aid-in-dying medication to a qualified individual pursuant  to  this
    43  article. If a healthcare provider is unable or unwilling to carry out an
    44  individual's  request  under  this  article and the individual transfers
    45  care to a new healthcare provider, the prior healthcare  provider  shall
    46  transfer,  upon  request,  a  copy  of the individual's relevant medical
    47  records to the new healthcare provider.
    48    5. Nothing in this section shall prevent a  healthcare  provider  from
    49  providing  an individual with healthcare services that do not constitute
    50  participation in this article.
    51    § 2994-ooo. Non-sanctionable activities. A healthcare provider may not
    52  be sanctioned for:
    53    1. making an initial determination that an individual has  a  terminal
    54  illness and informing them of the medical prognosis;
    55    2. providing information about the New York End of Life Options Act to
    56  a patient upon the request of the individual;

        S. 3685                             7
     1    3.  providing  an individual, upon request, with a referral to another
     2  physician; or
     3    4.  contracting with an individual to act outside the course and scope
     4  of the provider's capacity as an employee or independent contractor of a
     5  healthcare provider that prohibits activities under this article.
     6    § 2994-ppp. Penalties. 1. A person who without  authorization  of  the
     7  qualified individual willfully alters or forges a request for medication
     8  or  conceals or destroys a rescission of that request with the intent or
     9  effect of causing the qualified individual's death is guilty of a  class
    10  A felony.
    11    2. A person who coerces or exerts undue influence on a qualified indi-
    12  vidual  to request medication to end the qualified individual's life, or
    13  to destroy a rescission of a request, is guilty of a class A felony.
    14    3. Except as provided in subdivisions one and two of this section,  it
    15  shall be a class A misdemeanor for a person without authorization of the
    16  individual  to willfully alter, forge, conceal or destroy an instrument,
    17  the reinstatement or revocation of an instrument, or any other  evidence
    18  or  document  reflecting the individual's desires and interests with the
    19  intent or effect of affecting a healthcare decision.
    20    4. This article does not limit further  liability  for  civil  damages
    21  resulting  from other negligent conduct or intentional misconduct by any
    22  person.
    23    5. The penalties in this article do not  preclude  criminal  penalties
    24  applicable  under other provisions of law for conduct that is inconsist-
    25  ent with this article.
    26    § 2994-qqq. Severability. If any clause, sentence, paragraph,  section
    27  or  part  of  this  article  shall be adjudged by any court of competent
    28  jurisdiction to be invalid, such judgment shall not  affect,  impair  or
    29  invalidate the remainder thereof, but shall be confined in its operation
    30  to  the  clause,  sentence, paragraph, section or part thereof, directly
    31  involved in the controversy in  which  such  judgment  shall  have  been
    32  rendered.
    33    §  3.  This act shall take effect on the ninetieth day next succeeding
    34  the date upon which it shall have become a law.
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