A10059 Summary:

BILL NOA10059
 
SAME ASSAME AS S07579
 
SPONSORPaulin
 
COSPNSRRosenthal, Gottfried, Dinowitz, Galef, Hevesi, Steck, Zebrowski, Blake
 
MLTSPNSRBraunstein, Crouch, Duprey, Skartados
 
Add Art 28-F 2899-d - 2899-t, Pub Health L
 
Relates to the medical aid in dying act; relates to a terminally ill patient's request for and use of medication for medical aid in dying.
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A10059 Actions:

BILL NOA10059
 
05/10/2016referred to health
05/23/2016reported referred to codes
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A10059 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A10059
 
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 circumstances in which an adult may make a writ- ten request for medication for the purpose of ending his or her life in accordance with the provisions of the article. § 2899-f sets forth the request process, which requires the patient to 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-g sets forth the responsibilities of the attending physician. § 2899-h 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-i sets forth the responsibilities of the consulting physician. § 2899-j 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-k sets forth the items that must be documented or filed in the patient's medical record. § 2899-1 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 the 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-m 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-n 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-o provides that (i) a patient who self-administers 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 condi- tioned 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 arti- cle, and the sale, procurement or issuance of a life or health insurance or annuity policy or the rate charged for the policy may not be 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-p 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-q 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-r provides for the annual review by the commissioner of health of a sample of the records maintained under section twenty-eight hundred ninety-nine-k of the article. The commissioner shall adopt regulations establishing reporting requirements for physicians taking action under the article to determine utilization and compliance with the article. The information collected under the section shall not constitute a public record available for public inspection and shall be confidential and shall be collected and maintained in a manner that protects the privacy of the patient, his or her family, and any health care provider acting in connection with such patient under the article, except that such information may be disclosed to a governmental agency as authorized or required by law relating to professional discipline, protection of public health or law enforcement. The commissioner shall prepare a report annually containing relevant data regarding utilization and compliance with the article and shall post such report on its website. §2899-s 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-t 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. 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. Five states - Oregon, Vermont, Washington, California and Montana allow physician assisted aid in dying. In addition, New Mexico had a court rule that patients have a constitutional right to aid in dying; that decision is under appeal. Aid in dying legislation recently passed the New Jersey Assembly, and legislators in more than 20 states, including all of New England, Mary- land, 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: New bill.   FISCAL IMPLICATIONS: None.   EFFECTIVE DATE: Effective immediately.
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A10059 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          10059
 
                   IN ASSEMBLY
 
                                      May 10, 2016
                                       ___________
 
        Introduced  by  M.  of  A.  PAULIN,  GOTTFRIED, DINOWITZ, GALEF, HEVESI,
          STECK, ZEBROWSKI, BLAKE -- Multi-Sponsored by -- M. of A.  BRAUNSTEIN,
          CROUCH,  DUPREY,  SKARTADOS -- read once and referred to the Committee
          on Health
 
        AN ACT to amend the public health law, in relation to a  terminally  ill
          patient's request for and use of medication for medical aid in dying

          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
 
     1    Section 1. This act shall be known and may be cited  as  the  "medical
     2  aid in dying act".
     3    §  2. The public health law is amended by adding a new article 28-F to
     4  read as follows:
     5                                ARTICLE 28-F
     6                            MEDICAL AID IN DYING
     7  Section 2899-d. Definitions.
     8          2899-e. Written request for medication.
     9          2899-f. Request process.
    10          2899-g. Attending physician responsibilities.
    11          2899-h. Right to rescind request; requirement to offer  opportu-
    12                    nity to rescind.
    13          2899-i. Consulting physician responsibilities.
    14          2899-j. Confirmation of capacity; referral.
    15          2899-k. Medical record documentation requirements.
    16          2899-l. Form of written request and witness attestation.
    17          2899-m. Protection and immunities.
    18          2899-n. Permissible refusals and prohibitions.
    19          2899-o. Relation to other laws and contracts.
    20          2899-p. Safe disposal of unused medications.
    21          2899-q. Death certificate.
    22          2899-r. Reporting.
    23          2899-s. Penalties.
    24          2899-t. Severability.
    25    § 2899-d. Definitions. As used in this article:
    26    1. "Adult" means an individual who is eighteen years of age or older.

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD07446-31-6

        A. 10059                            2
 
     1    2. "Attending physician" means the physician who has primary responsi-
     2  bility for the care of the patient and treatment of the patient's termi-
     3  nal disease.
     4    3.  "Capacity"  or  "capacity  to make an informed decision" means the
     5  ability to understand and appreciate  the  nature  and  consequences  of
     6  health  care decisions, including the benefits and risks of and alterna-
     7  tives to any proposed health care, and to reach an informed decision and
     8  to communicate health care decisions to a physician, including  communi-
     9  cation through persons familiar with the patient's manner of communicat-
    10  ing if those persons are available.
    11    4.    "Consulting  physician"  means  a  physician who is qualified by
    12  specialty or experience to make a professional diagnosis  and  prognosis
    13  regarding a person's terminal illness.
    14    5.  "Health  care facility" means a general hospital, nursing home, or
    15  residential health care facility  as  defined  in  section  twenty-eight
    16  hundred one of this chapter.
    17    6.  "Health  care  provider"  means  a  person licensed, certified, or
    18  authorized by law to administer health care or  dispense  medication  in
    19  the ordinary course of business or practice of a profession.
    20    7.  "Informed decision" means a decision by a patient who is suffering
    21  from a terminal illness to request and obtain a prescription for medica-
    22  tion that the patient may self-administer to end the patient's life that
    23  is  based  on  an understanding and acknowledgment of the relevant facts
    24  and that is made after being fully informed of:
    25    (a) the patient's medical diagnosis and prognosis;
    26    (b) the potential risks associated with taking the  medication  to  be
    27  prescribed;
    28    (c) the probable result of taking the medication to be prescribed;
    29    (d)  the  possibility  that  the  patient may choose not to obtain the
    30  medication, or may obtain the medication but may decide not to  self-ad-
    31  minister it; and
    32    (e)  the  feasible alternatives or additional treatment opportunities,
    33  including palliative care and hospice care.
    34    8. "Medical aid in dying" means the medical practice  of  a  physician
    35  prescribing medication to a qualified individual that the individual may
    36  choose to self-administer to bring about death.
    37    9.  "Medically  confirmed"  means the medical opinion of the attending
    38  physician that a patient has a terminal illness has been confirmed by  a
    39  consulting  physician  who  has  examined  the patient and the patient's
    40  relevant medical records.
    41    10. "Medication" means medication prescribed by a physician under this
    42  article.
    43    11. "Mental health professional" means a physician, nurse  practition-
    44  er, physician assistant or psychologist, licensed or certified under the
    45  education  law  acting  within  his  or her scope of practice and who is
    46  qualified, by training and experience, certification, or  board  certif-
    47  ication  or  eligibility,  to make a determination under section twenty-
    48  eight hundred ninety-nine-j of this article; provided that in  the  case
    49  of  a  nurse practitioner or physician assistant, the professional shall
    50  not have a collaborative agreement or collaborative relationship with or
    51  be supervised by the attending physician or consulting physician.
    52    12. "Palliative care" means health care treatment, including interdis-
    53  ciplinary end-of-life care, and consultation with  patients  and  family
    54  members,  to  prevent  or  relieve pain and suffering and to enhance the
    55  patient's quality of life, including hospice care under article forty of
    56  this chapter.

        A. 10059                            3
 
     1    13. "Patient" means a person who is eighteen years  of  age  or  older
     2  under the care of a physician.
     3    14.  "Physician"  means an individual licensed to practice medicine in
     4  New York state.
     5    15. "Qualified individual" means a patient with  a  terminal  illness,
     6  who  has  capacity, has made an informed decision, and has satisfied the
     7  requirements of this article in order to obtain a prescription for medi-
     8  cation.
     9    16. "Self-administer"  means  a  qualified  individual's  affirmative,
    10  conscious, and voluntary act of using medication under this article.
    11    17.  "Terminal  illness" means an illness that will, within reasonable
    12  medical judgment, result in death within  six  months,  whether  or  not
    13  treatment is provided.
    14    § 2899-e. Written  request  for  medication.  1.  A patient may make a
    15  written request for and consent to self-administer  medication  for  the
    16  purpose of ending his or her life in accordance with this article if the
    17  patient:
    18    (a)  has been determined by the attending physician to have a terminal
    19  illness and which has been medically confirmed by  a  consulting  physi-
    20  cian; and
    21    (b) voluntarily expresses the request for medication.
    22    2. No person shall qualify for medical aid in dying under this article
    23  solely because of age or disability.
    24    § 2899-f. Request  process.    1.  Oral and written request. A patient
    25  wishing to request medication under this  article  shall  make  an  oral
    26  request  and  submit a written request to the patient's attending physi-
    27  cian.
    28    2. Written request signed and witnessed. (a) A request for  medication
    29  under  this  article  shall  be  signed  and  dated  by  the patient and
    30  witnessed by at least two adults who, in the presence  of  the  patient,
    31  attest  that  to the best of his or her knowledge and belief the patient
    32  has capacity, is acting voluntarily, and is not being  coerced  to  sign
    33  the  request.  The  written  request  shall be in substantially the form
    34  described in section twenty-eight hundred ninety-nine-l of this article.
    35    (b) One of the witnesses shall be an adult who is not:
    36    (i) a relative of the patient by blood, marriage or adoption;
    37    (ii) a person who at the time the request is signed would be  entitled
    38  to any portion of the estate of the patient upon death under any will or
    39  by operation of law; or
    40    (iii)  an  owner, operator or employee of a health care facility where
    41  the patient is receiving treatment or is a resident.
    42    (c) The attending physician, consulting physician and, if  applicable,
    43  the  mental health professional who provides a capacity determination of
    44  the patient under this article shall not be a witness.
    45    § 2899-g. Attending  physician  responsibilities.  1.  The   attending
    46  physician shall:
    47    (a)  make  the  determination  of  whether  a  patient  has a terminal
    48  illness, has capacity, has made an informed decision and  has  made  the
    49  request voluntarily and without coercion;
    50    (b)  inform  the  patient  of  the  requirement under this article for
    51  confirmation by a consulting physician,  and  refer  the  patient  to  a
    52  consulting physician upon the patient's request;
    53    (c)  refer  the  patient  to  a mental health professional pursuant to
    54  section twenty-eight  hundred  ninety-nine-j  of  this  article  if  the
    55  attending  physician believes that the patient lacks capacity to make an
    56  informed decision;

        A. 10059                            4
 
     1    (d) provide  information  and  counseling  under  section  twenty-nine
     2  hundred ninety-seven-c of this chapter;
     3    (e) ensure that the patient is making an informed decision by discuss-
     4  ing with the patient: (i) the patient's medical diagnosis and prognosis;
     5  (ii)  the  potential  risks  associated with taking the medication to be
     6  prescribed; (iii) the probable result of taking  the  medication  to  be
     7  prescribed;  (iv)  the possibility that the patient may choose to obtain
     8  the medication but not take it; and (v)  the  feasible  alternatives  or
     9  additional treatment opportunities, including but not limited to pallia-
    10  tive care and hospice care;
    11    (f) discuss with the patient the importance of:
    12    (i)  having  another person present when the patient takes the medica-
    13  tion; and
    14    (ii) not taking the medication in a public place;
    15    (g) inform the patient that he or she  may  rescind  the  request  for
    16  medication at any time and in any manner;
    17    (h)  fulfill  the medical record documentation requirements of section
    18  twenty-eight hundred ninety-nine-k of this article; and
    19    (i) ensure that all appropriate steps are carried  out  in  accordance
    20  with this article before writing a prescription for medication.
    21    2.  Upon  receiving  confirmation  from  a  consulting physician under
    22  section twenty-eight hundred ninety-nine-i of this article  and  subject
    23  to  section  twenty-eight  hundred  ninety-nine-j  of  this article, the
    24  attending physician who makes the determination that the patient  has  a
    25  terminal  illness, has capacity and has made a request for medication as
    26  provided in this article, may personally,  or  by  referral  to  another
    27  physician,  prescribe or order appropriate medication in accordance with
    28  the patient's request under this article, and at the patient's  request,
    29  facilitate  the  filling of the prescription and delivery of the medica-
    30  tion to the patient.
    31    3. In accordance with the direction of  the  prescribing  or  ordering
    32  physician  and the consent of the patient, the patient may self-adminis-
    33  ter the medication to himself or herself. A health care professional  or
    34  other person shall not administer the medication to the patient.
    35    § 2899-h. Right  to  rescind request; requirement to offer opportunity
    36  to rescind.  1. A patient may at any time rescind his or her request for
    37  medication under this article without regard to the patient's capacity.
    38    2. A prescription for  medication  may  not  be  written  without  the
    39  attending  physician offering the qualified individual an opportunity to
    40  rescind the request.
    41    § 2899-i. Consulting physician responsibilities. Before a patient  who
    42  is requesting medication may receive a prescription for medication under
    43  this article, a consulting physician must:
    44    1. examine the patient and his or her relevant medical records;
    45    2.  confirm,  in  writing,  to  the  attending physician: (a) that the
    46  patient has a terminal illness;  (b)  that  the  patient  is  making  an
    47  informed  decision;  (c)  that  the  patient  has  capacity,  or provide
    48  documentation that the consulting physician has referred the patient for
    49  a determination under section twenty-eight hundred ninety-nine-j of this
    50  article; and (d) that the patient  is  acting  voluntarily  and  without
    51  coercion.
    52    § 2899-j. Confirmation  of  capacity;  referral.  1.  If the attending
    53  physician or the consulting physician believes that the patient may lack
    54  capacity, the attending physician or consulting  physician  shall  refer
    55  the  patient  to  a  mental  health  professional for a determination of
    56  whether the patient has capacity. The referring physician  shall  advise

        A. 10059                            5
 
     1  the  patient  that  the report of the mental health professional will be
     2  provided to the attending physician, and to the consulting physician  if
     3  he or she is the physician who requested the determination.
     4    2.  A  mental  health  professional who evaluates a patient under this
     5  section shall report, in writing, to the  physician  who  requested  the
     6  evaluation, his or her conclusions about whether the patient has capaci-
     7  ty  to  make  an informed decision. If the written report is provided to
     8  the  consulting  physician,  the  consulting  physician  shall  promptly
     9  provide  a  copy of the report to the attending physician. If the mental
    10  health professional determines that the patient lacks capacity  to  make
    11  an  informed decision, the patient shall not be deemed a qualified indi-
    12  vidual, and the attending physician shall not  prescribe  medication  to
    13  the patient.
    14    § 2899-k. Medical  record  documentation  requirements.  An  attending
    15  physician shall document or file the following in the patient's  medical
    16  record:
    17    1.  the dates of all oral requests by the patient for medication under
    18  this article;
    19    2. the written request by the patient for medication under this  arti-
    20  cle;
    21    3. the attending physician's diagnosis and prognosis, determination of
    22  capacity,  and  determination that the patient is acting voluntarily and
    23  without coercion, and has made an informed decision;
    24    4. if applicable, written confirmation of capacity under section twen-
    25  ty-eight hundred ninety-nine-j of this article; and
    26    5. a note by the attending physician indicating that all  requirements
    27  under this article have been met and indicating the steps taken to carry
    28  out  the  request,  including a notation of the medication prescribed or
    29  ordered.
    30    § 2899-l. Form of  written  request  and  witness  attestation.  1.  A
    31  request  for medication under this article shall be in substantially the
    32  following form:
    33                    REQUEST FOR MEDICATION TO END MY LIFE
 
    34    I, _________________________________, am an adult  who  has  capacity,
    35  which  means  I understand and appreciate the nature and consequences of
    36  health care decisions, including the benefits and risks of and  alterna-
    37  tives to any proposed health care, and to reach an informed decision and
    38  to communicate health care decisions to a physician.
    39    I  am  suffering  from ______________________________________________,
    40  which my attending physician has determined is a terminal illness, which
    41  has been medically confirmed by a consulting physician.
    42    I have been fully informed of my diagnosis and prognosis,  the  nature
    43  of  the  medication to be prescribed and potential associated risks, the
    44  expected result, and the feasible  alternatives  or  treatment  opportu-
    45  nities including palliative care and hospice care.
    46    I  request  that my attending physician prescribe medication that will
    47  end my life if I choose to take it, and I authorize my attending  physi-
    48  cian to contact another physician or any pharmacist about my request.
 
    49    INITIAL ONE:
    50    (  ) I have informed or intend to inform my family of my decision.
    51    (  ) I have decided not to inform my family of my decision.
    52    (  ) I have no family to inform of my decision.
    53    I  understand that I have the right to rescind this request or decline
    54  to use the medication at any time.

        A. 10059                            6
 
     1    I understand the importance of this request, and I expect to die if  I
     2  take the medication to be prescribed. I further understand that although
     3  most  deaths  occur within three hours, my death may take longer, and my
     4  attending physician has counseled me about this possibility.
     5    I  make  this  request  voluntarily,  and without being coerced, and I
     6  accept full responsibility for my actions.
 
     7  Signed: __________________________
 
     8  Dated: ___________________________

     9                          DECLARATION OF WITNESSES
 
    10    I declare that the person signing this "Request for Medication to  End
    11  My Life":
    12    (a) is personally known to me or has provided proof of identity;
    13    (b)  voluntarily signed the "Request for Medication to End My Life" in
    14  my presence or acknowledged to me that he or she signed it; and
    15    (c) to the best of my knowledge and belief, has capacity  and  is  not
    16  being coerced to sign the "Request for Medication to End My Life".
    17    I am not the attending physician or consulting physician of the person
    18  signing  the  "Request for Medication to End My Life" or, if applicable,
    19  the mental health professional who provides a capacity determination  of
    20  the  person  signing  the "Request for Medication to End My Life" at the
    21  time the "Request for Medication to End My Life" was signed.
 
    22         ________________________ Witness 1, Date: ________________
 
    23         ________________________ Witness 2, Date: _________________
 
    24    NOTE: Only one of the two witnesses may (i) be a relative  (by  blood,
    25  marriage  or adoption) of the person signing the "Request for Medication
    26  to End My Life", (ii) be entitled to any portion of the person's  estate
    27  upon death under any will or by operation of law, or (iii) own, operate,
    28  or  be  employed at a health care facility where the person is receiving
    29  treatment or is a resident.
    30    2. (a) The "Request for Medication to End My Life" shall be written in
    31  the same language as any conversations,  consultations,  or  interpreted
    32  conversations or consultations between a patient and at least one of his
    33  or her attending or consulting physicians.
    34    (b)  Notwithstanding  paragraph  (a)  of this subdivision, the written
    35  "Request for Medication to End My Life" may be prepared in English  even
    36  when  the conversations or consultations or interpreted conversations or
    37  consultations were conducted in a language other  than  English  if  the
    38  English language form includes an attached declaration by the interpret-
    39  er  of the conversation or consultation, which shall be in substantially
    40  the following form:
 
    41                          INTERPRETER'S DECLARATION

    42    I, _______[insert name of interpreter]______, am fluent in English and
    43  [insert target language].
    44    On [insert date], at approximately [insert time], I read the  "Request
    45  for  Medication  to  End My Life" to [name of patient] in [insert target
    46  language].

        A. 10059                            7
 
     1    [Name of patient] affirmed to me that he/she understood the content of
     2  the "Request for Medication to End My Life" and affirmed his/her  desire
     3  to  sign  the  "Request  for  Medication to End My Life" voluntarily and
     4  without coercion and that the request to sign the "Request  for  Medica-
     5  tion  to  End  My  Life" followed discussions with his/her attending and
     6  consulting physicians.
     7    I declare that I am fluent in English and [insert target language] and
     8  further declare under penalty of perjury that the foregoing is true  and
     9  correct and that false statements made herein are punishable.
 
    10  Executed  at  [insert  city,  county  and  state] on this [insert day of
    11  month] of [insert month], [insert year].
 
    12  __________________________ [Signature of Interpreter]
 
    13  __________________________ [Printed name of Interpreter]
 
    14  __________________________ [Address of Interpreter]
 
    15  __________________________
 
    16    (c) An interpreter whose services are provided under paragraph (b)  of
    17  this  subdivision  shall not (i) be related to the patient who signs the
    18  "Request for Medication to End My Life" by blood, marriage or  adoption,
    19  (ii) be entitled at the time the "Request for Medication to End My Life"
    20  is  signed  by  the  patient to any portion of the estate of the patient
    21  upon death under any will or by operation of law, or (iii) be an  owner,
    22  operator  or  employee  of  a  health care facility where the patient is
    23  receiving treatment or is a resident.
    24    § 2899-m. Protection and immunities. 1. A physician, pharmacist, other
    25  health care professional or other person shall not be subject  to  civil
    26  or criminal liability or professional disciplinary action by any govern-
    27  ment  entity  for taking any reasonable good-faith action or refusing to
    28  act under this article, including, but not limited to:  (a) engaging  in
    29  discussions with a patient relating to the risks and benefits of end-of-
    30  life options in the circumstances described in this article, (b) provid-
    31  ing  a  patient,  upon  request,  with a referral to another health care
    32  provider, (c) being present when a qualified individual self-administers
    33  medication, (d) refraining from acting to prevent the qualified individ-
    34  ual from self-administering such  medication,  or  (e)  refraining  from
    35  acting  to resuscitate the qualified individual after he or she self-ad-
    36  ministers such medication.
    37    2. Nothing in this section shall limit civil or criminal liability for
    38  negligence, recklessness or intentional misconduct.
    39    § 2899-n. Permissible refusals and prohibitions. 1. (a)  A  physician,
    40  nurse,  pharmacist, other health care provider or other person shall not
    41  be under any duty, by law or contract, to participate in  the  provision
    42  of medication to a patient under this article.
    43    (b) If a health care provider is unable or unwilling to participate in
    44  the  provision  of  medication  to  a patient under this article and the
    45  patient transfers care to a new health care provider, the  prior  health
    46  care  provider shall transfer or arrange for the transfer, upon request,
    47  of a copy of the patient's relevant medical records to  the  new  health
    48  care provider.
    49    2.(a)  A  private  health  care facility may prohibit the prescribing,
    50  dispensing, ordering or  self-administering  of  medication  under  this

        A. 10059                            8
 
     1  article  while  the  patient is being treated in or while the patient is
     2  residing in the health care facility if:
     3    (i)  the  prescribing,  dispensing,  ordering or self-administering is
     4  contrary to a formally adopted policy of the facility that is  expressly
     5  based  on  sincerely held religious beliefs or moral convictions central
     6  to the facility's operating principles; and
     7    (ii) the facility has informed the patient of  such  policy  prior  to
     8  admission or as soon as reasonably possible.
     9    (b) Where a facility has adopted a prohibition under this subdivision,
    10  if  a  patient who wishes to use medication under this article requests,
    11  the patient shall be transferred promptly to another health care facili-
    12  ty that is reasonably accessible under the circumstances and willing  to
    13  permit  the  prescribing, dispensing, ordering and self-administering of
    14  medication under this article with respect to the patient.
    15    3. Where a health care facility has adopted a prohibition  under  this
    16  subdivision,  any  health  care provider or employee of the facility who
    17  violates the prohibition may be subject to sanctions otherwise available
    18  to the facility, provided  the  facility  has  previously  notified  the
    19  health care provider or employee of the prohibition in writing.
    20    § 2899-o. Relation  to other laws and contracts.  1. (a) A patient who
    21  requests medication under  this  article  shall  not,  because  of  that
    22  request, be considered to be a person who is suicidal, and self-adminis-
    23  tering  medication under this article shall not be deemed to be suicide,
    24  for any purpose.
    25    (b) Action  taken  in  accordance  with  this  article  shall  not  be
    26  construed  for  any  purpose  to  constitute  suicide, assisted suicide,
    27  attempted suicide, promoting a suicide attempt, mercy killing, or  homi-
    28  cide  under  the  law, including as an accomplice or accessory or other-
    29  wise.
    30    2. (a) No provision in a contract, will or  other  agreement,  whether
    31  written  or  oral,  to  the  extent the provision would affect whether a
    32  person may make or rescind a request for medication or  take  any  other
    33  action under this article, shall be valid.
    34    (b)  No  obligation  owing  under any contract shall be conditioned or
    35  affected by the making or rescinding of a request by a person for  medi-
    36  cation or taking any other action under this article.
    37    3. (a) A person and his or her beneficiaries shall not be denied bene-
    38  fits  under a life insurance policy for actions taken in accordance with
    39  this article.
    40    (b) The sale, procurement or issuance of a life or health insurance or
    41  annuity policy, or the rate charged for a policy may not be  conditioned
    42  upon or affected by a patient making or rescinding a request for medica-
    43  tion under this article.
    44    4. An insurer shall not provide any information in communications made
    45  to  a  patient  about  the availability of medication under this article
    46  absent a request by the patient or by his  or  her  attending  physician
    47  upon  the  request  of such patient. Any communication shall not include
    48  both the denial of coverage for treatment  and  information  as  to  the
    49  availability of medication under this article.
    50    5.  The  sale,  procurement,  or issue of any professional malpractice
    51  insurance policy or the rate charged for the policy shall not be  condi-
    52  tioned  upon or affected by whether the insured does or does not take or
    53  participate in any action under this article.
    54    § 2899-p. Safe disposal of unused medications.  The  department  shall
    55  make  regulations  providing for the safe disposal of unused medications
    56  prescribed, dispensed or ordered under this article.

        A. 10059                            9
 
     1    § 2899-q. Death certificate.  1. If otherwise authorized by  law,  the
     2  attending  physician  may  sign the qualified individual's death certif-
     3  icate.
     4    2. The cause of death listed on a qualified individual's death certif-
     5  icate  who  dies  after self-administering medication under this article
     6  will be the underlying terminal illness.
     7    § 2899-r. Reporting. 1.  The  commissioner  shall  annually  review  a
     8  sample  of  the  records  maintained  under section twenty-eight hundred
     9  ninety-nine-k of this article. The commissioner shall adopt  regulations
    10  establishing  reporting  requirements for physicians taking action under
    11  this article to determine utilization and compliance with this  article.
    12  The  information  collected  under  this  section shall not constitute a
    13  public record available for public inspection and shall be  confidential
    14  and  collected  and  maintained in a manner that protects the privacy of
    15  the patient, his or her family, and any health care provider  acting  in
    16  connection with such patient under this article, except that such infor-
    17  mation  may  be  disclosed  to  a  governmental  agency as authorized or
    18  required by law  relating  to  professional  discipline,  protection  of
    19  public health or law enforcement.
    20    2.  The  commissioner shall prepare a report annually containing rele-
    21  vant data regarding utilization and compliance  with  this  article  and
    22  shall post such report on the department's website.
    23    § 2899-s. Penalties.  1. Nothing in this article shall be construed to
    24  limit professional discipline or civil liability resulting from  conduct
    25  in  violation of this article, negligent conduct, or intentional miscon-
    26  duct by any person.
    27    2. Conduct in violation of this article shall be subject to applicable
    28  criminal liability under state law,  including,  where  appropriate  and
    29  without  limitation,  offenses constituting homicide, forgery, coercion,
    30  and related offenses, or federal law.
    31    § 2899-t. Severability. If any provision of this article or any appli-
    32  cation of any provision of this article, is held to be  invalid,  or  to
    33  violate  or  be  inconsistent  with  any federal law or regulation, that
    34  shall not affect the validity or effectiveness of any other provision of
    35  this article, or of any other application of any provision of this arti-
    36  cle, which can be given effect without that  provision  or  application;
    37  and  to  that  end,  the provisions and applications of this article are
    38  severable.
    39    § 3. This act shall take effect immediately.
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