NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A2383A
SPONSOR: Paulin (MS) TITLE OF BILL:
An act to amend the public health law, in relation to a terminally ill
patient's request for and use of medication for medical aid in dying
PURPOSE:
To provide that a mentally competent, terminally ill patient may request
medication to be self-administered for the purpose of hastening the
patient's death provided the requirements set forth in the act are met,
and to provide certain protection and immunities to health care provid-
ers and other persons, including a physician who prescribes medication
in compliance with the provisions of the article to the terminally ill
patient to be self-administered by the patient.
SUMMARY OF PROVISIONS:
Section 1 provides that this act shall be known and may be cited as the
"Medical Aid in Dying Act".
Section 2 amends the Public Health Law by adding a new article 28-F,
Medical Aid in Dying, comprised of the following sections:
2899-d sets forth definitions.
2899-e sets forth the request process by which a patient may request
medication for the purpose of ending his or her life in accordance with
this article. The patient wishing to request such medication shall make
an oral request and submit a written request, which shall be signed and
dated by the patient and witnessed by at least two adults as provided in
such section, identifying persons who shall not serve as witnesses. The
patient's attending physician, consulting physician and, if applicable,
the mental health professional who provides a capacity determination of
the patient under the article shall not act as a witness.
§ 2899-f sets forth the responsibilities of the attending physician.
§ 2899-g provides that a patient may at any time rescind a request for
medication without regard to the patient's capacity, and that the
attending physician may not write a prescription for medication without
first offering the patient an opportunity to rescind the request.
§ 2899-h sets forth the responsibilities of the consulting physician.
§ 2899-i provides that if the attending physician or the consulting
physician believes that the patient may lack capacity, such physician
shall refer the patient to a mental health professional for a determi-
nation of whether the patient has capacity. If the mental health profes-
sional determines that the patient lacks capacity to make an informed
decision, the patient shall not be deemed a qualified individual and the
attending physician shall not prescribe medication to the patient.
2899-j sets forth the items that must be documented or filed in the
patient's medical record.
§ 2899-k sets forth the form of written request for medication and
declaration of witnesses. The section also provides that the written
request shall be written in the same language as any conversations or
consultations between a patient and at least one of his or her attending
or consulting physicians, provided that the written request may be in
English, even if the conversations or consultations were conducted in a
language other than English, if the form of written request includes the
form of interpreter's declaration set forth in the section.
§ 2899-l provides that a physician, pharmacist, other health care
professional or other person shall not be subject to civil or criminal
liability or professional disciplinary action by any government entity
for taking any reasonable good-faith action or refusing to act under the
article, including without limitation, engaging in discussions with a
patient relating to the risks and benefits of end-of-life options in the
circumstances described in the article and being present when a quali-
fied individual self-administers medication. The section further
provides that nothing in the section shall limit civil or criminal
liability for negligence, recklessness or intentional misconduct.
§ 2899-m provides that a physician, nurse, pharmacist, other health care
provider or other person shall not be under any duty by law or contract
to participate in the provision of medication to a patient. If a health
care provider is unable or unwilling to participate in the provision of
medication to a patient and the patient transfers care to a new health
care provider, the prior health care provider shall transfer or arrange
for the transfer, upon request, of a copy of the patient's relevant
medical records to the new health care provider. A private health care
facility may prohibit the prescribing, dispensing, ordering or self-ad-
ministering of medication under the article while the patient is being
treated in or while the patient is residing in such facility if the
requirements set forth in the section have been met. In addition, where
a health care facility has adopted a prohibition under the subdivision,
if a patient who wishes to use medication under the article requests,
the patient shall be transferred promptly to another health care facili-
ty that is reasonably accessible under the circumstances and willing to
permit the prescribing, dispensing, ordering or self-administering of
medication with respect to the patient. Where a health care facility has
adopted a prohibition under the subdivision, any health care provider or
employee of the facility who violates the prohibition may be subject to
sanctions otherwise available to the facility, provided the facility has
previously notified the health care provider or employee of the prohibi-
tion in writing.
§ 2899-n provides that (i) a patient who requests medication under the
article will not, because of that request, be considered a person who is
suicidal, and self-administering medication under the article shall not
be deemed to be suicide for any purpose, (ii) action taken in accordance
with the article shall not be construed for any purpose to constitute
suicide, assisted suicide, attempted suicide, promoting a suicide
attempt, mercy killing, or homicide under the law, including as an
accomplice or accessory or otherwise, (iii) no provision in a contract,
will or other agreement, whether written or oral, to the extent the
provision would affect whether a person may make or rescind a request
for medication or take any other action under the article, shall be
valid, (iv) no obligation owing under any contract will be conditioned
upon or affected by the making or rescinding of a request by a person
for medication or taking any other action under the article, (v) a
person and his or her beneficiaries shall not be denied benefits under a
life insurance policy for actions taken in accordance with the article,
and the sale, procurement or issuance of a life or health insurance or
annuity policy or the rate charged for the policy shall not be condi-
tioned upon or affected by the patient making or rescinding a request
for medication under the article, (vi) an insurer shall not provide any
information in communications made to a patient about the availability
of medication under the article absent a request by the patient or by
his or her attending physician upon the request of such patient, and any
communication shall not include both the denial of coverage for treat-
ment and information as to the availability of medication under the
article, and (vii) the sale, procurement or issue of any professional
malpractice insurance policy or the rate charged for the policy shall
not be conditioned upon or affected by whether the insured does or does
not take or participate in any action under the article. 2899-o
provides that the department of health shall make regulations providing
for the safe disposal of unused medications prescribed, dispensed or
ordered under the article.
2899-p provides that if otherwise authorized by law, the attending
physician may sign the qualified individual's death certificate. The
cause of death listed on a qualified individual's death certificate who
dies after self-administering medication under the article will be the
underlying terminal illness.
§ 2899-q provides for the annual review by the commissioner of health of
a sample of the records maintained under section twenty-eight hundred
ninety-nine-j and twenty-eight hundred ninety-nine-p of the article. The
commissioner shall adopt regulations establishing reporting requirements
for physicians taking action under the article to determine utilization
and compliance with the article. The information collected under the
section shall not constitute a public record available for public
inspection and shall be confidential and shall be collected and main-
tained in a manner that protects the privacy of the patient, his or her
family, and any health care provider acting in connection with such
patient under the article, except that such information may be disclosed
to a governmental agency as authorized or required by law relating to
professional discipline, protection of public health or law enforcement.
The commissioner shall prepare a report annually containing relevant
data regarding utilization and compliance with the article and shall
post such report on its website.
2899-r provides that nothing in the article shall be construed to limit
professional discipline or civil liability resulting from conduct in
violation of the article, negligent conduct, or intentional misconduct
by any person. Conduct in violation of the article shall be subject to
applicable criminal liability under state law, including where appropri-
ate and without limitation, offenses constituting homicide, forgery,
coercion, and related offenses, or federal law.
§ 2899-s provides the severability clause. Section 3 sets forth the
effective date.
JUSTIFICATION:
The highly publicized, planned death of Brittany Maynard has highlighted
the need for terminally ill patients to be able to access aid in dying.
Ms. Maynard, who was a native of California, was forced to move to
Oregon to gain control of her dying process. Her death, and the accompa-
nying press attention, led the California legislature to pass, and
Governor Jerry Brown to sign, an aid in dying law on October 5, 2015.
The national debate that accompanied Ms. Maynard's plight focused the
nation on the desire of patients with a terminal illness to determine
for themselves - how and when they die. These patients, when mentally
competent, should be afforded this right. Patients should not be forced
to relocate to another state or to leave the country to control how
their lives end. Patients seek to die with dignity, on their own terms,
typically in their own homes, surrounded by their family and other loved
ones.
New Yorkers strongly support empowering terminally-ill, mentally compe-
tent patients to control their own death. A 2015 poll found that 77% of
all New Yorkers support aid in dying, including 75% of Catholics, 72% of
Republicans, 67% of self-identified Conservatives, and 78% of New York-
ers upstate.
Nationally, according to HealthDay/Harris poll findings released in
December 2014, 74% of American adults believe that terminally ill
patients in great pain should have the right to end their lives (14%
were opposed). Gallup, which has been polling this issue since 1947, has
found that a majority of Americans have supported aid in dying since
1973. Their most recent poll found 68% of Americans support aid in
dying. Similar results were found in a recent survey of Americans by
LifeWay Research (69% of those polled agree that physicians should be
allowed to assist terminally ill patients in ending their life and 67%
agree that it is morally acceptable for a person to ask for a physi-
cian's aid in taking his or her own life.)
Physicians also support aid in dying. In a recent survey conducted by
Medscape, 54% of physicians in the U.S. believe that aid in dying should
be permitted, while only 31% opposed it.
The Medical Aid in Dying Act will enable mentally competent, terminally
ill patients to choose to self-administer medication to bring about a
peaceful death. It also provides their physician, when acting in good
faith in accordance with the provisions of the Act, protections from
civil and criminal liability and professional disciplinary action.
Six states - Oregon, Vermont, Washington, California, Montana and Colo-
rado allow physician assisted aid in dying. More than 65% of Colorado
voters approved the ballot initiative this past November to provide for
aid in dying. And last month the mayor of the District of Columbia
signed a medical aid in dying act.
Aid in dying legislation recently passed the New Jersey Assembly, and
legislators in 19 states, including all of New England, Maryland, North
Carolina, Tennessee, Oklahoma, Utah, Wyoming and Missouri, have aid in
dying bills pending.
Aid in dying legislation is supported by the American Public Health
Association, the American Medical Women's Association, the American
Medical Student Association, the American College of Legal Medicine, and
Lamda Legal.
LEGISLATIVE HISTORY:
A.10059, 2016 reported referred to Codes.
Same as S.7579, 2016 referred to Health.
FISCAL IMPLICATIONS:
None.
STATE OF NEW YORK
________________________________________________________________________
2383--A
2017-2018 Regular Sessions
IN ASSEMBLY
January 19, 2017
___________
Introduced by M. of A. PAULIN, L. ROSENTHAL, GOTTFRIED, DINOWITZ, GALEF,
HEVESI, STECK, BLAKE, LAVINE, LUPARDO, SEPULVEDA, HARRIS, ABINANTI,
RODRIGUEZ, JAFFEE, JONES, D'URSO, M. G. MILLER, ORTIZ, ARROYO, SIMO-
TAS, ERRIGO, VANEL, QUART -- Multi-Sponsored by -- M. of A. BRAUN-
STEIN, CROUCH, MAGEE, SKARTADOS -- read once and referred to the
Committee on Health -- recommitted to the Committee on Health in
accordance with Assembly Rule 3, sec. 2 -- committee discharged, bill
amended, ordered reprinted as amended and recommitted to said commit-
tee
AN ACT to amend the public health law, in relation to a terminally ill
patient's request for and use of medication for medical aid in dying
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. This act shall be known and may be cited as the "medical
2 aid in dying act".
3 § 2. The public health law is amended by adding a new article 28-F to
4 read as follows:
5 ARTICLE 28-F
6 MEDICAL AID IN DYING
7 Section 2899-d. Definitions.
8 2899-e. Request process.
9 2899-f. Attending physician responsibilities.
10 2899-g. Right to rescind request; requirement to offer opportu-
11 nity to rescind.
12 2899-h. Consulting physician responsibilities.
13 2899-i. Referral to mental health professional.
14 2899-j. Medical record documentation requirements.
15 2899-k. Form of written request and witness attestation.
16 2899-l. Protection and immunities.
17 2899-m. Permissible refusals and prohibitions.
18 2899-n. Relation to other laws and contracts.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD01103-12-8
A. 2383--A 2
1 2899-o. Safe disposal of unused medications.
2 2899-p. Death certificate.
3 2899-q. Reporting.
4 2899-r. Penalties.
5 2899-s. Severability.
6 § 2899-d. Definitions. As used in this article:
7 1. "Adult" means an individual who is eighteen years of age or older.
8 2. "Attending physician" means the physician who has primary responsi-
9 bility for the care of the patient and treatment of the patient's termi-
10 nal illness or condition.
11 3. "Capacity" means the ability to understand and appreciate the
12 nature and consequences of health care decisions, including the benefits
13 and risks of and alternatives to any proposed health care, and to reach
14 an informed decision.
15 4. "Consulting physician" means a physician who is qualified by
16 specialty or experience to make a professional diagnosis and prognosis
17 regarding a person's terminal illness or condition.
18 5. "Health care facility" means a general hospital, nursing home, or
19 residential health care facility as defined in section twenty-eight
20 hundred one of this chapter.
21 6. "Health care provider" means a person licensed, certified, or
22 authorized by law to administer health care or dispense medication in
23 the ordinary course of business or practice of a profession.
24 7. "Informed decision" means a decision by a patient who is suffering
25 from a terminal illness or condition to request and obtain a
26 prescription for medication that the patient may self-administer to end
27 the patient's life that is based on an understanding and acknowledgment
28 of the relevant facts and that is made voluntarily, of the patient's own
29 volition and without coercion, after being fully informed of:
30 (a) the patient's medical diagnosis and prognosis;
31 (b) the potential risks associated with taking the medication to be
32 prescribed;
33 (c) the probable result of taking the medication to be prescribed;
34 (d) the possibility that the patient may choose not to obtain the
35 medication, or may obtain the medication but may decide not to self-ad-
36 minister it; and
37 (e) the feasible alternatives and appropriate treatment options,
38 including but not limited to palliative care and hospice care.
39 8. "Medical aid in dying" means the medical practice of a physician
40 prescribing medication to a qualified individual that the individual may
41 choose to self-administer to bring about death.
42 9. "Medically confirmed" means the medical opinion of the attending
43 physician that a patient has a terminal illness or condition and has
44 made an informed decision which has been confirmed by a consulting
45 physician who has examined the patient and the patient's relevant
46 medical records.
47 10. "Medication" means medication prescribed by a physician under this
48 article.
49 11. "Mental health professional" means a physician, nurse practition-
50 er, physician assistant or psychologist, licensed or certified under the
51 education law acting within his or her scope of practice and who is
52 qualified, by training and experience, certification, or board certif-
53 ication or eligibility, to make a determination under section twenty-
54 eight hundred ninety-nine-i of this article; provided that in the case
55 of a nurse practitioner or physician assistant, the professional shall
A. 2383--A 3
1 not have a collaborative agreement or collaborative relationship with or
2 be supervised by the attending physician or consulting physician.
3 12. "Palliative care" means health care treatment, including interdis-
4 ciplinary end-of-life care, and consultation with patients and family
5 members, to prevent or relieve pain and suffering and to enhance the
6 patient's quality of life, including hospice care under article forty of
7 this chapter.
8 13. "Patient" means a person who is eighteen years of age or older
9 under the care of a physician.
10 14. "Physician" means an individual licensed to practice medicine in
11 New York state.
12 15. "Qualified individual" means a patient with a terminal illness or
13 condition, who has capacity, has made an informed decision, and has
14 satisfied the requirements of this article in order to obtain a
15 prescription for medication.
16 16. "Self-administer" means a qualified individual's affirmative,
17 conscious, and voluntary act of using medication under this article.
18 17. "Terminal illness or condition" means an incurable and irrevers-
19 ible illness or condition that has been medically confirmed and will,
20 within reasonable medical judgment, produce death within six months.
21 § 2899-e. Request process. 1. Oral and written request. A patient
22 wishing to request medication under this article shall make an oral
23 request and submit a written request to the patient's attending physi-
24 cian.
25 2. Making a written request. A patient may make a written request for
26 and consent to self-administer medication for the purpose of ending his
27 or her life in accordance with this article if the patient:
28 (a) has been determined by the attending physician to have a terminal
29 illness or condition and which has been medically confirmed by a
30 consulting physician; and
31 (b) based on an informed decision, expresses voluntarily, of the
32 patient's own volition and without coercion the request for medication
33 to end his or her life.
34 3. Written request signed and witnessed. (a) A written request for
35 medication under this article shall be signed and dated by the patient
36 and witnessed by at least two adults who, in the presence of the
37 patient, attest that to the best of his or her knowledge and belief the
38 patient has capacity, is acting voluntarily, is making the request for
39 medication of his or her own volition and is not being coerced to sign
40 the request. The written request shall be in substantially the form
41 described in section twenty-eight hundred ninety-nine-k of this article.
42 (b) One of the witnesses shall be an adult who is not:
43 (i) a relative of the patient by blood, marriage or adoption;
44 (ii) a person who at the time the request is signed would be entitled
45 to any portion of the estate of the patient upon death under any will or
46 by operation of law; or
47 (iii) an owner, operator, employee or independent contractor of a
48 health care facility where the patient is receiving treatment or is a
49 resident.
50 (c) The attending physician, consulting physician and, if applicable,
51 the mental health professional who provides a capacity determination of
52 the patient under this article shall not be a witness.
53 4. No person shall qualify for medical aid in dying under this article
54 solely because of age or disability.
A. 2383--A 4
1 § 2899-f. Attending physician responsibilities. 1. The attending
2 physician shall examine the patient and his or her relevant medical
3 records and:
4 (a) make a determination of whether a patient has a terminal illness
5 or condition, has capacity, has made an informed decision and has made
6 the request voluntarily of the patient's own volition and without coer-
7 cion;
8 (b) inform the patient of the requirement under this article for
9 confirmation by a consulting physician, and refer the patient to a
10 consulting physician upon the patient's request;
11 (c) refer the patient to a mental health professional pursuant to
12 section twenty-eight hundred ninety-nine-i of this article if the
13 attending physician believes that the patient may lack capacity to make
14 an informed decision;
15 (d) provide information and counseling under section twenty-nine
16 hundred ninety-seven-c of this chapter;
17 (e) ensure that the patient is making an informed decision by discuss-
18 ing with the patient: (i) the patient's medical diagnosis and prognosis;
19 (ii) the potential risks associated with taking the medication to be
20 prescribed; (iii) the probable result of taking the medication to be
21 prescribed; (iv) the possibility that the patient may choose to obtain
22 the medication but not take it; and (v) the feasible alternatives and
23 appropriate treatment options, including but not limited to (1) informa-
24 tion and counseling regarding palliative and hospice care and end-of-
25 life options appropriate to the patient, including but not limited to:
26 the range of options appropriate to the patient; the prognosis, risks
27 and benefits of the various options; and the patient's legal rights to
28 comprehensive pain and symptom management at the end of life; and (2)
29 information regarding treatment options appropriate to the patient,
30 including the prognosis, risks and benefits of the various treatment
31 options;
32 (f) discuss with the patient the importance of:
33 (i) having another person present when the patient takes the medica-
34 tion and the restriction that no person other than the patient may
35 administer the medication;
36 (ii) not taking the medication in a public place; and
37 (iii) informing the patient's family of the patient's decision to
38 request and take medication that will end the patient's life; a patient
39 who declines or is unable to notify family shall not have his or her
40 request for medication denied for that reason;
41 (g) inform the patient that he or she may rescind the request for
42 medication at any time and in any manner;
43 (h) fulfill the medical record documentation requirements of section
44 twenty-eight hundred ninety-nine-j of this article; and
45 (i) ensure that all appropriate steps are carried out in accordance
46 with this article before writing a prescription for medication.
47 2. Upon receiving confirmation from a consulting physician under
48 section twenty-eight hundred ninety-nine-h of this article and subject
49 to section twenty-eight hundred ninety-nine-i of this article, the
50 attending physician who determines that the patient has a terminal
51 illness or condition, has capacity and has made a voluntary request for
52 medication as provided in this article, may personally, or by referral
53 to another physician, prescribe or order appropriate medication in
54 accordance with the patient's request under this article, and at the
55 patient's request, facilitate the filling of the prescription and deliv-
56 ery of the medication to the patient.
A. 2383--A 5
1 3. In accordance with the direction of the prescribing or ordering
2 physician and the consent of the patient, the patient may self-adminis-
3 ter the medication to himself or herself. A health care professional or
4 other person shall not administer the medication to the patient.
5 § 2899-g. Right to rescind request; requirement to offer opportunity
6 to rescind. 1. A patient may at any time rescind his or her request for
7 medication under this article without regard to the patient's capacity.
8 2. A prescription for medication may not be written without the
9 attending physician offering the qualified individual an opportunity to
10 rescind the request.
11 § 2899-h. Consulting physician responsibilities. Before a patient who
12 is requesting medication may receive a prescription for medication under
13 this article, a consulting physician must:
14 1. examine the patient and his or her relevant medical records;
15 2. confirm, in writing, to the attending physician and the patient,
16 whether: (a) the patient has a terminal illness or condition; (b) the
17 patient is making an informed decision; (c) the patient has capacity, or
18 provide documentation that the consulting physician has referred the
19 patient for a determination under section twenty-eight hundred ninety-
20 nine-i of this article; and (d) the patient is acting voluntarily, of
21 the patient's own volition and without coercion.
22 § 2899-i. Referral to mental health professional. 1. If the attending
23 physician or the consulting physician believes that the patient may lack
24 capacity, the attending physician or consulting physician shall refer
25 the patient to a mental health professional for a determination of
26 whether the patient has capacity to make an informed decision. The
27 referring physician shall advise the patient that the report of the
28 mental health professional will be provided to the attending physician
29 and the consulting physician.
30 2. A mental health professional who evaluates a patient under this
31 section shall report, in writing, to the attending physician and the
32 consulting physician, his or her independent conclusions about whether
33 the patient has capacity to make an informed decision, provided that if,
34 at the time of the report, the patient has not yet been referred to a
35 consulting physician, then upon referral the attending physician shall
36 provide the consulting physician with a copy of the mental health
37 professional's report. If the mental health professional determines that
38 the patient lacks capacity to make an informed decision, the patient
39 shall not be deemed a qualified individual, and the attending physician
40 shall not prescribe medication to the patient.
41 § 2899-j. Medical record documentation requirements. An attending
42 physician shall document or file the following in the patient's medical
43 record:
44 1. the dates of all oral requests by the patient for medication under
45 this article;
46 2. the written request by the patient for medication under this arti-
47 cle, including the declaration of witnesses and interpreter's declara-
48 tion, if applicable;
49 3. the attending physician's diagnosis and prognosis, determination of
50 capacity, and determination that the patient is acting voluntarily, of
51 the patient's own volition and without coercion, and has made an
52 informed decision;
53 4. if applicable, written confirmation of capacity under section twen-
54 ty-eight hundred ninety-nine-i of this article; and
55 5. a note by the attending physician indicating that all requirements
56 under this article have been met and indicating the steps taken to carry
A. 2383--A 6
1 out the request, including a notation of the medication prescribed or
2 ordered.
3 § 2899-k. Form of written request and witness attestation. 1. A
4 request for medication under this article shall be in substantially the
5 following form:
6 REQUEST FOR MEDICATION TO END MY LIFE
7 I, _________________________________, am an adult who has capacity,
8 which means I understand and appreciate the nature and consequences of
9 health care decisions, including the benefits and risks of and alterna-
10 tives to any proposed health care, and to reach an informed decision and
11 to communicate health care decisions to a physician.
12 I have been diagnosed with ______________(insert diagnosis), which my
13 attending physician has determined is a terminal illness or condition,
14 which has been medically confirmed by a consulting physician.
15 I have been fully informed of my diagnosis and prognosis, the nature
16 of the medication to be prescribed and potential associated risks, the
17 expected result, and the feasible alternatives and treatment options
18 including but not limited to palliative care and hospice care.
19 I request that my attending physician prescribe medication that will
20 end my life if I choose to take it, and I authorize my attending physi-
21 cian to contact another physician or any pharmacist about my request.
22 INITIAL ONE:
23 ( ) I have informed or intend to inform one or more members of my
24 family of my decision.
25 ( ) I have decided not to inform any member of my family of my deci-
26 sion.
27 ( ) I have no family to inform of my decision.
28 I understand that I have the right to rescind this request or decline
29 to use the medication at any time.
30 I understand the importance of this request, and I expect to die if I
31 take the medication to be prescribed. I further understand that although
32 most deaths occur within three hours, my death may take longer, and my
33 attending physician has counseled me about this possibility.
34 I make this request voluntarily, of my own volition and without being
35 coerced, and I accept full responsibility for my actions.
36 Signed: __________________________
37 Dated: ___________________________
38 DECLARATION OF WITNESSES
39 I declare that the person signing this "Request for Medication to End
40 My Life":
41 (a) is personally known to me or has provided proof of identity;
42 (b) voluntarily signed the "Request for Medication to End My Life" in
43 my presence or acknowledged to me that he or she signed it; and
44 (c) to the best of my knowledge and belief, has capacity and is making
45 the "Request for Medication to End My Life" voluntarily, of his or her
46 own volition and is not being coerced to sign the "Request for Medica-
47 tion to End My Life".
48 I am not the attending physician or consulting physician of the person
49 signing the "Request for Medication to End My Life" or, if applicable,
50 the mental health professional who provides a capacity determination of
A. 2383--A 7
1 the person signing the "Request for Medication to End My Life" at the
2 time the "Request for Medication to End My Life" was signed.
3 I further declare under penalty of perjury that the statements made
4 herein are true and correct and false statements made herein are punish-
5 able.
6 __________________________ Witness 1, Date: ________________
7 __________________________ (Printed name)
8 __________________________ (Address)
9 __________________________ (Telephone number)
10 I further declare that I am not (i) related to the above-named patient
11 by blood, marriage or adoption, (ii) entitled at the time the patient
12 signed the "Request for Medication to End My Life" to any portion of the
13 estate of the patient upon his/her death under any will or by operation
14 of law, or (iii) an owner, operator, employee or independent contractor
15 of a health care facility where the patient is receiving treatment or is
16 a resident.
17 __________________________ Witness 2, Date: _________________
18 __________________________ (Printed name)
19 __________________________ (Address)
20 __________________________ (Telephone number)
21 NOTE: Only one of the two witnesses may (i) be a relative (by blood,
22 marriage or adoption) of the person signing the "Request for Medication
23 to End My Life", (ii) be entitled to any portion of the person's estate
24 upon death under any will or by operation of law, or (iii) own, operate,
25 be employed or be an independent contractor at a health care facility
26 where the person is receiving treatment or is a resident.
27 2. (a) The "Request for Medication to End My Life" shall be written in
28 the same language as any conversations, consultations, or interpreted
29 conversations or consultations between a patient and at least one of his
30 or her attending or consulting physicians.
31 (b) Notwithstanding paragraph (a) of this subdivision, the written
32 "Request for Medication to End My Life" may be prepared in English even
33 when the conversations or consultations or interpreted conversations or
34 consultations were conducted in a language other than English or with
35 auxiliary aids or hearing, speech or visual aids, if the English
36 language form includes an attached declaration by the interpreter of the
37 conversation or consultation, which shall be in substantially the
38 following form:
39 INTERPRETER'S DECLARATION
40 I, ___________ (insert name of interpreter)_____ ,(mark as applica-
41 ble):
42 ( ) for a patient whose conversations or consultations or interpreted
43 conversations or consultations were conducted in a language other than
44 English and the "Request for Medication to End My Life" is in English: I
A. 2383--A 8
1 declare that I am fluent in English and (insert target language). I have
2 the requisite language and interpreter skills to be able to interpret
3 effectively, accurately and impartially information shared and communi-
4 cations between the attending or consulting physician and (name of
5 patient).
6 I certify that on (insert date), at approximately (insert time), I
7 interpreted the communications and information conveyed between the
8 physician and (name of patient) as accurately and completely to the best
9 of my knowledge and ability and read the "Request for Medication to End
10 My Life" to (name of patient) in (insert target language).
11 (Name of patient) affirmed to me his/her desire to sign the "Request
12 for Medication to End My Life" voluntarily, of (name of patient)'s own
13 volition and without coercion.
14 ( ) for a patient with a speech, hearing or vision disability: I
15 declare that I have the requisite language, reading and/or interpreter
16 skills to communicate with the patient and to be able to read and/or
17 interpret effectively, accurately and impartially information shared and
18 communications that occurred on (insert date) between the attending or
19 consulting physician and (name of patient).
20 I certify that on (insert date), at approximately (insert time), I
21 read and/or interpreted the communications and information conveyed
22 between the physician and (name of patient) impartially and as accurate-
23 ly and completely to the best of my knowledge and ability and, where
24 needed for effective communication, read or interpreted the "Request for
25 Medication to End my Life" to (name of patient).
26 (Name of patient) affirmed to me his/her desire to sign the "Request
27 for Medication to End My Life" voluntarily, of (name of patient)'s own
28 volition and without coercion.
29 I further declare under penalty of perjury that (i) the foregoing is
30 true and correct; (ii) I am not (A) related to (name of patient) by
31 blood, marriage or adoption, (B) entitled at the time (name of patient)
32 signed the "Request for Medication to End My Life" to any portion of the
33 estate of (name of patient) upon his/her death under any will or by
34 operation of law, or (C) an owner, operator, employee or independent
35 contractor of a health care facility where (name of patient) is receiv-
36 ing treatment or is a resident, except that if I am an employee or inde-
37 pendent contractor at such health care facility, providing interpreter
38 services is part of my job description at such health care facility or I
39 have been trained to provide interpreter services and (name of patient)
40 requested that I provide interpreter services to him/her for the
41 purposes stated in this Declaration; and (iii) false statements made
42 herein are punishable.
43 Executed at (insert city, county and state) on this (insert day of
44 month) of (insert month), (insert year).
45 __________________________ (Signature of Interpreter)
46 __________________________ (Printed name of Interpreter)
47 __________________________ (ID # or Agency Name)
48 __________________________ (Address of Interpreter)
49 __________________________ (Language Spoken by Interpreter)
A. 2383--A 9
1 (c) An interpreter whose services are provided under paragraph (b) of
2 this subdivision shall not (i) be related to the patient who signs the
3 "Request for Medication to End My Life" by blood, marriage or adoption,
4 (ii) be entitled at the time the "Request for Medication to End My Life"
5 is signed by the patient to any portion of the estate of the patient
6 upon death under any will or by operation of law, or (iii) be an owner,
7 operator, employee or independent contractor of a health care facility
8 where the patient is receiving treatment or is a resident; provided that
9 an employee or independent contractor whose job description at the
10 health care facility includes interpreter services or who is trained to
11 provide interpreter services and who has been requested by the patient
12 to serve as an interpreter under this article shall not be prohibited
13 from serving as a witness under this article.
14 § 2899-l. Protection and immunities. 1. A physician, pharmacist, other
15 health care professional or other person shall not be subject to civil
16 or criminal liability or professional disciplinary action by any govern-
17 ment entity for taking any reasonable good-faith action or refusing to
18 act under this article, including, but not limited to: (a) engaging in
19 discussions with a patient relating to the risks and benefits of end-of-
20 life options in the circumstances described in this article, (b) provid-
21 ing a patient, upon request, with a referral to another health care
22 provider, (c) being present when a qualified individual self-administers
23 medication, (d) refraining from acting to prevent the qualified individ-
24 ual from self-administering such medication, or (e) refraining from
25 acting to resuscitate the qualified individual after he or she self-ad-
26 ministers such medication.
27 2. Nothing in this section shall limit civil or criminal liability for
28 negligence, recklessness or intentional misconduct.
29 § 2899-m. Permissible refusals and prohibitions. 1. (a) A physician,
30 nurse, pharmacist, other health care provider or other person shall not
31 be under any duty, by law or contract, to participate in the provision
32 of medication to a patient under this article.
33 (b) If a health care provider is unable or unwilling to participate in
34 the provision of medication to a patient under this article and the
35 patient transfers care to a new health care provider, the prior health
36 care provider shall transfer or arrange for the transfer, upon request,
37 of a copy of the patient's relevant medical records to the new health
38 care provider.
39 2. (a) A private health care facility may prohibit the prescribing,
40 dispensing, ordering or self-administering of medication under this
41 article while the patient is being treated in or while the patient is
42 residing in the health care facility if:
43 (i) the prescribing, dispensing, ordering or self-administering is
44 contrary to a formally adopted policy of the facility that is expressly
45 based on sincerely held religious beliefs or moral convictions central
46 to the facility's operating principles; and
47 (ii) the facility has informed the patient of such policy prior to
48 admission or as soon as reasonably possible.
49 (b) Where a facility has adopted a prohibition under this subdivision,
50 if a patient who wishes to use medication under this article requests,
51 the patient shall be transferred promptly to another health care facili-
52 ty that is reasonably accessible under the circumstances and willing to
53 permit the prescribing, dispensing, ordering and self-administering of
54 medication under this article with respect to the patient.
55 3. Where a health care facility has adopted a prohibition under this
56 subdivision, any health care provider or employee or independent
A. 2383--A 10
1 contractor of the facility who violates the prohibition may be subject
2 to sanctions otherwise available to the facility, provided the facility
3 has previously notified the health care provider, employee or independ-
4 ent contractor of the prohibition in writing.
5 § 2899-n. Relation to other laws and contracts. 1. (a) A patient who
6 requests medication under this article shall not, because of that
7 request, be considered to be a person who is suicidal, and self-adminis-
8 tering medication under this article shall not be deemed to be suicide,
9 for any purpose.
10 (b) Action taken in accordance with this article shall not be
11 construed for any purpose to constitute suicide, assisted suicide,
12 attempted suicide, promoting a suicide attempt, euthanasia, mercy kill-
13 ing, or homicide under the law, including as an accomplice or accessory
14 or otherwise.
15 2. (a) No provision in a contract, will or other agreement, whether
16 written or oral, to the extent the provision would affect whether a
17 person may make or rescind a request for medication or take any other
18 action under this article, shall be valid.
19 (b) No obligation owing under any contract shall be conditioned or
20 affected by the making or rescinding of a request by a person for medi-
21 cation or taking any other action under this article.
22 3. (a) A person and his or her beneficiaries shall not be denied bene-
23 fits under a life insurance policy for actions taken in accordance with
24 this article.
25 (b) Notwithstanding the provisions of any law or contract, the sale,
26 procurement or issuance of a life or health insurance or annuity policy,
27 or the rate charged for a policy, shall not be conditioned upon or
28 affected by a patient making or rescinding a request for medication
29 under this article.
30 4. An insurer shall not provide any information in communications made
31 to a patient about the availability of medication under this article
32 absent a request by the patient or by his or her attending physician
33 upon the request of such patient. Any communication shall not include
34 both the denial of coverage for treatment and information as to the
35 availability of medication under this article.
36 5. The sale, procurement, or issue of any professional malpractice
37 insurance policy or the rate charged for the policy shall not be condi-
38 tioned upon or affected by whether the insured does or does not take or
39 participate in any action under this article.
40 § 2899-o. Safe disposal of unused medications. A person who has
41 custody or control of any unused medication prescribed under this arti-
42 cle after the death of the qualified individual shall personally deliver
43 the unused medication for disposal to the nearest qualified facility
44 that properly disposes of controlled substances or shall dispose of it
45 by lawful means in accordance with regulations made by the commissioner,
46 regulations made by or guidelines of the commissioner of education, or
47 guidelines of a federal drug enforcement administration approved take-
48 back program. A qualified facility that properly disposes of controlled
49 substances shall accept and dispose of any medication delivered to it as
50 provided hereunder regardless of whether such medication is a controlled
51 substance. The commissioner may make regulations as may be appropriate
52 for the safe disposal of unused medications prescribed, dispensed or
53 ordered under this article as provided in this section.
54 § 2899-p. Death certificate. 1. If otherwise authorized by law, the
55 attending physician may sign the qualified individual's death certif-
56 icate.
A. 2383--A 11
1 2. The cause of death listed on a qualified individual's death certif-
2 icate who dies after self-administering medication under this article
3 will be the underlying terminal illness or condition.
4 § 2899-q. Reporting. 1. The commissioner shall annually review a
5 sample of the records maintained under sections twenty-eight hundred
6 ninety-nine-j and twenty-eight hundred ninety-nine-p of this article.
7 The commissioner shall adopt regulations establishing reporting require-
8 ments for physicians taking action under this article to determine
9 utilization and compliance with this article. The information collected
10 under this subdivision shall not constitute a public record available
11 for public inspection and shall be confidential and collected and main-
12 tained in a manner that protects the privacy of the patient, his or her
13 family, and any health care provider acting in connection with such
14 patient under this article, except that such information may be
15 disclosed to a governmental agency as authorized or required by law
16 relating to professional discipline, protection of public health or law
17 enforcement.
18 2. The commissioner shall prepare a report annually containing rele-
19 vant data regarding utilization and compliance with this article and
20 shall post such report on the department's website.
21 § 2899-r. Penalties. 1. Nothing in this article shall be construed to
22 limit professional discipline or civil liability resulting from conduct
23 in violation of this article, negligent conduct, or intentional miscon-
24 duct by any person.
25 2. Conduct in violation of this article shall be subject to applicable
26 criminal liability under state law, including, where appropriate and
27 without limitation, offenses constituting homicide, forgery, coercion,
28 and related offenses, or federal law.
29 § 2899-s. Severability. If any provision of this article or any appli-
30 cation of any provision of this article, is held to be invalid, or to
31 violate or be inconsistent with any federal law or regulation, that
32 shall not affect the validity or effectiveness of any other provision of
33 this article, or of any other application of any provision of this arti-
34 cle, which can be given effect without that provision or application;
35 and to that end, the provisions and applications of this article are
36 severable.
37 § 3. This act shall take effect immediately.
