The New York State Senate

                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  10059

                          I N  A S S E M B L Y

                              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:

  Section 1. This act shall be known and may be cited  as  the  "medical
aid in dying act".
  S  2. The public health law is amended by adding a new article 28-F to
read as follows:
                              ARTICLE 28-F
                          MEDICAL AID IN DYING
SECTION 2899-D. DEFINITIONS.
        2899-E. WRITTEN REQUEST FOR MEDICATION.
        2899-F. REQUEST PROCESS.
        2899-G. ATTENDING PHYSICIAN RESPONSIBILITIES.
        2899-H. RIGHT TO RESCIND REQUEST; REQUIREMENT TO OFFER  OPPORTU-
                  NITY TO RESCIND.
        2899-I. CONSULTING PHYSICIAN RESPONSIBILITIES.
        2899-J. CONFIRMATION OF CAPACITY; REFERRAL.
        2899-K. MEDICAL RECORD DOCUMENTATION REQUIREMENTS.
        2899-L. FORM OF WRITTEN REQUEST AND WITNESS ATTESTATION.
        2899-M. PROTECTION AND IMMUNITIES.
        2899-N. PERMISSIBLE REFUSALS AND PROHIBITIONS.
        2899-O. RELATION TO OTHER LAWS AND CONTRACTS.
        2899-P. SAFE DISPOSAL OF UNUSED MEDICATIONS.
        2899-Q. DEATH CERTIFICATE.
        2899-R. REPORTING.
        2899-S. PENALTIES.
        2899-T. SEVERABILITY.
  S 2899-D. DEFINITIONS. AS USED IN THIS ARTICLE:
  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

  2. "ATTENDING PHYSICIAN" MEANS THE PHYSICIAN WHO HAS PRIMARY RESPONSI-
BILITY FOR THE CARE OF THE PATIENT AND TREATMENT OF THE PATIENT'S TERMI-
NAL DISEASE.
  3.  "CAPACITY"  OR  "CAPACITY  TO MAKE AN INFORMED DECISION" MEANS THE
ABILITY TO UNDERSTAND AND APPRECIATE  THE  NATURE  AND  CONSEQUENCES  OF
HEALTH  CARE DECISIONS, INCLUDING THE BENEFITS AND RISKS OF AND ALTERNA-
TIVES TO ANY PROPOSED HEALTH CARE, AND TO REACH AN INFORMED DECISION AND
TO COMMUNICATE HEALTH CARE DECISIONS TO A PHYSICIAN, INCLUDING  COMMUNI-
CATION THROUGH PERSONS FAMILIAR WITH THE PATIENT'S MANNER OF COMMUNICAT-
ING IF THOSE PERSONS ARE AVAILABLE.
  4.    "CONSULTING  PHYSICIAN"  MEANS  A  PHYSICIAN WHO IS QUALIFIED BY
SPECIALTY OR EXPERIENCE TO MAKE A PROFESSIONAL DIAGNOSIS  AND  PROGNOSIS
REGARDING A PERSON'S TERMINAL ILLNESS.
  5.  "HEALTH  CARE FACILITY" MEANS A GENERAL HOSPITAL, NURSING HOME, OR
RESIDENTIAL HEALTH CARE FACILITY  AS  DEFINED  IN  SECTION  TWENTY-EIGHT
HUNDRED ONE OF THIS CHAPTER.
  6.  "HEALTH  CARE  PROVIDER"  MEANS  A  PERSON LICENSED, CERTIFIED, OR
AUTHORIZED BY LAW TO ADMINISTER HEALTH CARE OR  DISPENSE  MEDICATION  IN
THE ORDINARY COURSE OF BUSINESS OR PRACTICE OF A PROFESSION.
  7.  "INFORMED DECISION" MEANS A DECISION BY A PATIENT WHO IS SUFFERING
FROM A TERMINAL ILLNESS TO REQUEST AND OBTAIN A PRESCRIPTION FOR MEDICA-
TION THAT THE PATIENT MAY SELF-ADMINISTER TO END THE PATIENT'S LIFE THAT
IS  BASED  ON  AN UNDERSTANDING AND ACKNOWLEDGMENT OF THE RELEVANT FACTS
AND THAT IS MADE AFTER BEING FULLY INFORMED OF:
  (A) THE PATIENT'S MEDICAL DIAGNOSIS AND PROGNOSIS;
  (B) THE POTENTIAL RISKS ASSOCIATED WITH TAKING THE  MEDICATION  TO  BE
PRESCRIBED;
  (C) THE PROBABLE RESULT OF TAKING THE MEDICATION TO BE PRESCRIBED;
  (D)  THE  POSSIBILITY  THAT  THE  PATIENT MAY CHOOSE NOT TO OBTAIN THE
MEDICATION, OR MAY OBTAIN THE MEDICATION BUT MAY DECIDE NOT TO  SELF-AD-
MINISTER IT; AND
  (E)  THE  FEASIBLE ALTERNATIVES OR ADDITIONAL TREATMENT OPPORTUNITIES,
INCLUDING PALLIATIVE CARE AND HOSPICE CARE.
  8. "MEDICAL AID IN DYING" MEANS THE MEDICAL PRACTICE  OF  A  PHYSICIAN
PRESCRIBING MEDICATION TO A QUALIFIED INDIVIDUAL THAT THE INDIVIDUAL MAY
CHOOSE TO SELF-ADMINISTER TO BRING ABOUT DEATH.
  9.  "MEDICALLY  CONFIRMED"  MEANS THE MEDICAL OPINION OF THE ATTENDING
PHYSICIAN THAT A PATIENT HAS A TERMINAL ILLNESS HAS BEEN CONFIRMED BY  A
CONSULTING  PHYSICIAN  WHO  HAS  EXAMINED  THE PATIENT AND THE PATIENT'S
RELEVANT MEDICAL RECORDS.
  10. "MEDICATION" MEANS MEDICATION PRESCRIBED BY A PHYSICIAN UNDER THIS
ARTICLE.
  11. "MENTAL HEALTH PROFESSIONAL" MEANS A PHYSICIAN, NURSE  PRACTITION-
ER, PHYSICIAN ASSISTANT OR PSYCHOLOGIST, LICENSED OR CERTIFIED UNDER THE
EDUCATION  LAW  ACTING  WITHIN  HIS  OR HER SCOPE OF PRACTICE AND WHO IS
QUALIFIED, BY TRAINING AND EXPERIENCE, CERTIFICATION, OR  BOARD  CERTIF-
ICATION   OR   ELIGIBILITY,   TO  MAKE  A  DETERMINATION  UNDER  SECTION
TWENTY-EIGHT HUNDRED NINETY-NINE-J OF THIS ARTICLE; PROVIDED THAT IN THE
CASE OF A NURSE PRACTITIONER OR PHYSICIAN  ASSISTANT,  THE  PROFESSIONAL
SHALL  NOT  HAVE A COLLABORATIVE AGREEMENT OR COLLABORATIVE RELATIONSHIP
WITH OR BE SUPERVISED BY THE ATTENDING PHYSICIAN  OR  CONSULTING  PHYSI-
CIAN.
  12. "PALLIATIVE CARE" MEANS HEALTH CARE TREATMENT, INCLUDING INTERDIS-
CIPLINARY  END-OF-LIFE  CARE,  AND CONSULTATION WITH PATIENTS AND FAMILY
MEMBERS, TO PREVENT OR RELIEVE PAIN AND SUFFERING  AND  TO  ENHANCE  THE

A. 10059                            3

PATIENT'S QUALITY OF LIFE, INCLUDING HOSPICE CARE UNDER ARTICLE FORTY OF
THIS CHAPTER.
  13.  "PATIENT"  MEANS  A  PERSON WHO IS EIGHTEEN YEARS OF AGE OR OLDER
UNDER THE CARE OF A PHYSICIAN.
  14. "PHYSICIAN" MEANS AN INDIVIDUAL LICENSED TO PRACTICE  MEDICINE  IN
NEW YORK STATE.
  15.  "QUALIFIED  INDIVIDUAL"  MEANS A PATIENT WITH A TERMINAL ILLNESS,
WHO HAS CAPACITY, HAS MADE AN INFORMED DECISION, AND HAS  SATISFIED  THE
REQUIREMENTS OF THIS ARTICLE IN ORDER TO OBTAIN A PRESCRIPTION FOR MEDI-
CATION.
  16.  "SELF-ADMINISTER"  MEANS  A  QUALIFIED  INDIVIDUAL'S AFFIRMATIVE,
CONSCIOUS, AND VOLUNTARY ACT OF USING MEDICATION UNDER THIS ARTICLE.
  17. "TERMINAL ILLNESS" MEANS AN ILLNESS THAT WILL,  WITHIN  REASONABLE
MEDICAL  JUDGMENT,  RESULT  IN  DEATH  WITHIN SIX MONTHS, WHETHER OR NOT
TREATMENT IS PROVIDED.
  S 2899-E. WRITTEN REQUEST FOR MEDICATION. 1.  A  PATIENT  MAY  MAKE  A
WRITTEN  REQUEST  FOR  AND CONSENT TO SELF-ADMINISTER MEDICATION FOR THE
PURPOSE OF ENDING HIS OR HER LIFE IN ACCORDANCE WITH THIS ARTICLE IF THE
PATIENT:
  (A) HAS BEEN DETERMINED BY THE ATTENDING PHYSICIAN TO HAVE A  TERMINAL
ILLNESS  AND  WHICH  HAS BEEN MEDICALLY CONFIRMED BY A CONSULTING PHYSI-
CIAN; AND
  (B) VOLUNTARILY EXPRESSES THE REQUEST FOR MEDICATION.
  2. NO PERSON SHALL QUALIFY FOR MEDICAL AID IN DYING UNDER THIS ARTICLE
SOLELY BECAUSE OF AGE OR DISABILITY.
  S 2899-F. REQUEST PROCESS.   1. ORAL AND WRITTEN  REQUEST.  A  PATIENT
WISHING  TO  REQUEST  MEDICATION  UNDER  THIS ARTICLE SHALL MAKE AN ORAL
REQUEST AND SUBMIT A WRITTEN REQUEST TO THE PATIENT'S  ATTENDING  PHYSI-
CIAN.
  2.  WRITTEN REQUEST SIGNED AND WITNESSED. (A) A REQUEST FOR MEDICATION
UNDER THIS ARTICLE  SHALL  BE  SIGNED  AND  DATED  BY  THE  PATIENT  AND
WITNESSED  BY  AT  LEAST TWO ADULTS WHO, IN THE PRESENCE OF THE PATIENT,
ATTEST THAT TO THE BEST OF HIS OR HER KNOWLEDGE AND BELIEF  THE  PATIENT
HAS  CAPACITY,  IS  ACTING VOLUNTARILY, AND IS NOT BEING COERCED TO SIGN
THE REQUEST. THE WRITTEN REQUEST SHALL  BE  IN  SUBSTANTIALLY  THE  FORM
DESCRIBED IN SECTION TWENTY-EIGHT HUNDRED NINETY-NINE-L OF THIS ARTICLE.
  (B) ONE OF THE WITNESSES SHALL BE AN ADULT WHO IS NOT:
  (I) A RELATIVE OF THE PATIENT BY BLOOD, MARRIAGE OR ADOPTION;
  (II)  A PERSON WHO AT THE TIME THE REQUEST IS SIGNED WOULD BE ENTITLED
TO ANY PORTION OF THE ESTATE OF THE PATIENT UPON DEATH UNDER ANY WILL OR
BY OPERATION OF LAW; OR
  (III) AN OWNER, OPERATOR OR EMPLOYEE OF A HEALTH CARE  FACILITY  WHERE
THE PATIENT IS RECEIVING TREATMENT OR IS A RESIDENT.
  (C)  THE ATTENDING PHYSICIAN, CONSULTING PHYSICIAN AND, IF APPLICABLE,
THE MENTAL HEALTH PROFESSIONAL WHO PROVIDES A CAPACITY DETERMINATION  OF
THE PATIENT UNDER THIS ARTICLE SHALL NOT BE A WITNESS.
  S 2899-G. ATTENDING   PHYSICIAN  RESPONSIBILITIES.  1.  THE  ATTENDING
PHYSICIAN SHALL:
  (A) MAKE THE  DETERMINATION  OF  WHETHER  A  PATIENT  HAS  A  TERMINAL
ILLNESS,  HAS  CAPACITY,  HAS MADE AN INFORMED DECISION AND HAS MADE THE
REQUEST VOLUNTARILY AND WITHOUT COERCION;
  (B) INFORM THE PATIENT OF  THE  REQUIREMENT  UNDER  THIS  ARTICLE  FOR
CONFIRMATION  BY  A  CONSULTING  PHYSICIAN,  AND  REFER THE PATIENT TO A
CONSULTING PHYSICIAN UPON THE PATIENT'S REQUEST;
  (C) REFER THE PATIENT TO A  MENTAL  HEALTH  PROFESSIONAL  PURSUANT  TO
SECTION  TWENTY-EIGHT  HUNDRED  NINETY-NINE-J  OF  THIS  ARTICLE  IF THE

A. 10059                            4

ATTENDING PHYSICIAN BELIEVES THAT THE PATIENT LACKS CAPACITY TO MAKE  AN
INFORMED DECISION;
  (D)  PROVIDE  INFORMATION  AND  COUNSELING  UNDER  SECTION TWENTY-NINE
HUNDRED NINETY-SEVEN-C OF THIS CHAPTER;
  (E) ENSURE THAT THE PATIENT IS MAKING AN INFORMED DECISION BY DISCUSS-
ING WITH THE PATIENT: (I) THE PATIENT'S MEDICAL DIAGNOSIS AND PROGNOSIS;
(II) THE POTENTIAL RISKS ASSOCIATED WITH TAKING  THE  MEDICATION  TO  BE
PRESCRIBED;  (III)  THE  PROBABLE  RESULT OF TAKING THE MEDICATION TO BE
PRESCRIBED; (IV) THE POSSIBILITY THAT THE PATIENT MAY CHOOSE  TO  OBTAIN
THE  MEDICATION  BUT  NOT  TAKE IT; AND (V) THE FEASIBLE ALTERNATIVES OR
ADDITIONAL TREATMENT OPPORTUNITIES, INCLUDING BUT NOT LIMITED TO PALLIA-
TIVE CARE AND HOSPICE CARE;
  (F) DISCUSS WITH THE PATIENT THE IMPORTANCE OF:
  (I) HAVING ANOTHER PERSON PRESENT WHEN THE PATIENT TAKES  THE  MEDICA-
TION; AND
  (II) NOT TAKING THE MEDICATION IN A PUBLIC PLACE;
  (G)  INFORM  THE  PATIENT  THAT  HE OR SHE MAY RESCIND THE REQUEST FOR
MEDICATION AT ANY TIME AND IN ANY MANNER;
  (H) FULFILL THE MEDICAL RECORD DOCUMENTATION REQUIREMENTS  OF  SECTION
TWENTY-EIGHT HUNDRED NINETY-NINE-K OF THIS ARTICLE; AND
  (I)  ENSURE  THAT  ALL APPROPRIATE STEPS ARE CARRIED OUT IN ACCORDANCE
WITH THIS ARTICLE BEFORE WRITING A PRESCRIPTION FOR MEDICATION.
  2. UPON RECEIVING  CONFIRMATION  FROM  A  CONSULTING  PHYSICIAN  UNDER
SECTION  TWENTY-EIGHT  HUNDRED NINETY-NINE-I OF THIS ARTICLE AND SUBJECT
TO SECTION TWENTY-EIGHT  HUNDRED  NINETY-NINE-J  OF  THIS  ARTICLE,  THE
ATTENDING  PHYSICIAN  WHO MAKES THE DETERMINATION THAT THE PATIENT HAS A
TERMINAL ILLNESS, HAS CAPACITY AND HAS MADE A REQUEST FOR MEDICATION  AS
PROVIDED  IN  THIS  ARTICLE,  MAY  PERSONALLY, OR BY REFERRAL TO ANOTHER
PHYSICIAN, PRESCRIBE OR ORDER APPROPRIATE MEDICATION IN ACCORDANCE  WITH
THE  PATIENT'S REQUEST UNDER THIS ARTICLE, AND AT THE PATIENT'S REQUEST,
FACILITATE THE FILLING OF THE PRESCRIPTION AND DELIVERY OF  THE  MEDICA-
TION TO THE PATIENT.
  3.  IN  ACCORDANCE  WITH  THE DIRECTION OF THE PRESCRIBING OR ORDERING
PHYSICIAN AND THE CONSENT OF THE PATIENT, THE PATIENT MAY  SELF-ADMINIS-
TER  THE MEDICATION TO HIMSELF OR HERSELF. A HEALTH CARE PROFESSIONAL OR
OTHER PERSON SHALL NOT ADMINISTER THE MEDICATION TO THE PATIENT.
  S 2899-H. RIGHT TO RESCIND REQUEST; REQUIREMENT TO  OFFER  OPPORTUNITY
TO RESCIND.  1. A PATIENT MAY AT ANY TIME RESCIND HIS OR HER REQUEST FOR
MEDICATION UNDER THIS ARTICLE WITHOUT REGARD TO THE PATIENT'S CAPACITY.
  2.  A  PRESCRIPTION  FOR  MEDICATION  MAY  NOT  BE WRITTEN WITHOUT THE
ATTENDING PHYSICIAN OFFERING THE QUALIFIED INDIVIDUAL AN OPPORTUNITY  TO
RESCIND THE REQUEST.
  S 2899-I. CONSULTING  PHYSICIAN RESPONSIBILITIES. BEFORE A PATIENT WHO
IS REQUESTING MEDICATION MAY RECEIVE A PRESCRIPTION FOR MEDICATION UNDER
THIS ARTICLE, A CONSULTING PHYSICIAN MUST:
  1. EXAMINE THE PATIENT AND HIS OR HER RELEVANT MEDICAL RECORDS;
  2. CONFIRM, IN WRITING, TO  THE  ATTENDING  PHYSICIAN:  (A)  THAT  THE
PATIENT  HAS  A  TERMINAL  ILLNESS;  (B)  THAT  THE PATIENT IS MAKING AN
INFORMED DECISION;  (C)  THAT  THE  PATIENT  HAS  CAPACITY,  OR  PROVIDE
DOCUMENTATION THAT THE CONSULTING PHYSICIAN HAS REFERRED THE PATIENT FOR
A DETERMINATION UNDER SECTION TWENTY-EIGHT HUNDRED NINETY-NINE-J OF THIS
ARTICLE;  AND  (D)  THAT  THE  PATIENT IS ACTING VOLUNTARILY AND WITHOUT
COERCION.
  S 2899-J. CONFIRMATION OF CAPACITY;  REFERRAL.  1.  IF  THE  ATTENDING
PHYSICIAN OR THE CONSULTING PHYSICIAN BELIEVES THAT THE PATIENT MAY LACK
CAPACITY,  THE  ATTENDING  PHYSICIAN OR CONSULTING PHYSICIAN SHALL REFER

A. 10059                            5

THE PATIENT TO A MENTAL  HEALTH  PROFESSIONAL  FOR  A  DETERMINATION  OF
WHETHER  THE  PATIENT HAS CAPACITY. THE REFERRING PHYSICIAN SHALL ADVISE
THE PATIENT THAT THE REPORT OF THE MENTAL HEALTH  PROFESSIONAL  WILL  BE
PROVIDED  TO THE ATTENDING PHYSICIAN, AND TO THE CONSULTING PHYSICIAN IF
HE OR SHE IS THE PHYSICIAN WHO REQUESTED THE DETERMINATION.
  2. A MENTAL HEALTH PROFESSIONAL WHO EVALUATES  A  PATIENT  UNDER  THIS
SECTION  SHALL  REPORT,  IN  WRITING, TO THE PHYSICIAN WHO REQUESTED THE
EVALUATION, HIS OR HER CONCLUSIONS ABOUT WHETHER THE PATIENT HAS CAPACI-
TY TO MAKE AN INFORMED DECISION. IF THE WRITTEN REPORT  IS  PROVIDED  TO
THE  CONSULTING  PHYSICIAN,  THE  CONSULTING  PHYSICIAN  SHALL  PROMPTLY
PROVIDE A COPY OF THE REPORT TO THE ATTENDING PHYSICIAN. IF  THE  MENTAL
HEALTH  PROFESSIONAL  DETERMINES THAT THE PATIENT LACKS CAPACITY TO MAKE
AN INFORMED DECISION, THE PATIENT SHALL NOT BE DEEMED A QUALIFIED  INDI-
VIDUAL,  AND  THE  ATTENDING PHYSICIAN SHALL NOT PRESCRIBE MEDICATION TO
THE PATIENT.
  S 2899-K. MEDICAL  RECORD  DOCUMENTATION  REQUIREMENTS.  AN  ATTENDING
PHYSICIAN  SHALL DOCUMENT OR FILE THE FOLLOWING IN THE PATIENT'S MEDICAL
RECORD:
  1. THE DATES OF ALL ORAL REQUESTS BY THE PATIENT FOR MEDICATION  UNDER
THIS ARTICLE;
  2.  THE WRITTEN REQUEST BY THE PATIENT FOR MEDICATION UNDER THIS ARTI-
CLE;
  3. THE ATTENDING PHYSICIAN'S DIAGNOSIS AND PROGNOSIS, DETERMINATION OF
CAPACITY, AND DETERMINATION THAT THE PATIENT IS ACTING  VOLUNTARILY  AND
WITHOUT COERCION, AND HAS MADE AN INFORMED DECISION;
  4. IF APPLICABLE, WRITTEN CONFIRMATION OF CAPACITY UNDER SECTION TWEN-
TY-EIGHT HUNDRED NINETY-NINE-J OF THIS ARTICLE; AND
  5.  A NOTE BY THE ATTENDING PHYSICIAN INDICATING THAT ALL REQUIREMENTS
UNDER THIS ARTICLE HAVE BEEN MET AND INDICATING THE STEPS TAKEN TO CARRY
OUT THE REQUEST, INCLUDING A NOTATION OF THE  MEDICATION  PRESCRIBED  OR
ORDERED.
  S 2899-L. FORM  OF  WRITTEN  REQUEST  AND  WITNESS  ATTESTATION.  1. A
REQUEST FOR MEDICATION UNDER THIS ARTICLE SHALL BE IN SUBSTANTIALLY  THE
FOLLOWING FORM:
                  REQUEST FOR MEDICATION TO END MY LIFE

  I,  _________________________________,  AM  AN ADULT WHO HAS CAPACITY,
WHICH MEANS I UNDERSTAND AND APPRECIATE THE NATURE AND  CONSEQUENCES  OF
HEALTH  CARE DECISIONS, INCLUDING THE BENEFITS AND RISKS OF AND ALTERNA-
TIVES TO ANY PROPOSED HEALTH CARE, AND TO REACH AN INFORMED DECISION AND
TO COMMUNICATE HEALTH CARE DECISIONS TO A PHYSICIAN.
  I AM  SUFFERING  FROM  ______________________________________________,
WHICH MY ATTENDING PHYSICIAN HAS DETERMINED IS A TERMINAL ILLNESS, WHICH
HAS BEEN MEDICALLY CONFIRMED BY A CONSULTING PHYSICIAN.
  I  HAVE  BEEN FULLY INFORMED OF MY DIAGNOSIS AND PROGNOSIS, THE NATURE
OF THE MEDICATION TO BE PRESCRIBED AND POTENTIAL ASSOCIATED  RISKS,  THE
EXPECTED  RESULT,  AND  THE  FEASIBLE ALTERNATIVES OR TREATMENT OPPORTU-
NITIES INCLUDING PALLIATIVE CARE AND HOSPICE CARE.
  I REQUEST THAT MY ATTENDING PHYSICIAN PRESCRIBE MEDICATION  THAT  WILL
END  MY LIFE IF I CHOOSE TO TAKE IT, AND I AUTHORIZE MY ATTENDING PHYSI-
CIAN TO CONTACT ANOTHER PHYSICIAN OR ANY PHARMACIST ABOUT MY REQUEST.

  INITIAL ONE:
  (  ) I HAVE INFORMED OR INTEND TO INFORM MY FAMILY OF MY DECISION.
  (  ) I HAVE DECIDED NOT TO INFORM MY FAMILY OF MY DECISION.
  (  ) I HAVE NO FAMILY TO INFORM OF MY DECISION.

A. 10059                            6

  I UNDERSTAND THAT I HAVE THE RIGHT TO RESCIND THIS REQUEST OR  DECLINE
TO USE THE MEDICATION AT ANY TIME.
  I  UNDERSTAND THE IMPORTANCE OF THIS REQUEST, AND I EXPECT TO DIE IF I
TAKE THE MEDICATION TO BE PRESCRIBED. I FURTHER UNDERSTAND THAT ALTHOUGH
MOST DEATHS OCCUR WITHIN THREE HOURS, MY DEATH MAY TAKE LONGER,  AND  MY
ATTENDING PHYSICIAN HAS COUNSELED ME ABOUT THIS POSSIBILITY.
  I  MAKE  THIS  REQUEST  VOLUNTARILY,  AND WITHOUT BEING COERCED, AND I
ACCEPT FULL RESPONSIBILITY FOR MY ACTIONS.

SIGNED: __________________________

DATED: ___________________________

                        DECLARATION OF WITNESSES

  I DECLARE THAT THE PERSON SIGNING THIS "REQUEST FOR MEDICATION TO  END
MY LIFE":
  (A) IS PERSONALLY KNOWN TO ME OR HAS PROVIDED PROOF OF IDENTITY;
  (B)  VOLUNTARILY SIGNED THE "REQUEST FOR MEDICATION TO END MY LIFE" IN
MY PRESENCE OR ACKNOWLEDGED TO ME THAT HE OR SHE SIGNED IT; AND
  (C) TO THE BEST OF MY KNOWLEDGE AND BELIEF, HAS CAPACITY  AND  IS  NOT
BEING COERCED TO SIGN THE "REQUEST FOR MEDICATION TO END MY LIFE".
  I AM NOT THE ATTENDING PHYSICIAN OR CONSULTING PHYSICIAN OF THE PERSON
SIGNING  THE  "REQUEST FOR MEDICATION TO END MY LIFE" OR, IF APPLICABLE,
THE MENTAL HEALTH PROFESSIONAL WHO PROVIDES A CAPACITY DETERMINATION  OF
THE  PERSON  SIGNING  THE "REQUEST FOR MEDICATION TO END MY LIFE" AT THE
TIME THE "REQUEST FOR MEDICATION TO END MY LIFE" WAS SIGNED.

       ________________________ WITNESS 1, DATE: ________________

       ________________________ WITNESS 2, DATE: _________________

  NOTE: ONLY ONE OF THE TWO WITNESSES MAY (I) BE A RELATIVE  (BY  BLOOD,
MARRIAGE  OR ADOPTION) OF THE PERSON SIGNING THE "REQUEST FOR MEDICATION
TO END MY LIFE", (II) BE ENTITLED TO ANY PORTION OF THE PERSON'S  ESTATE
UPON DEATH UNDER ANY WILL OR BY OPERATION OF LAW, OR (III) OWN, OPERATE,
OR  BE  EMPLOYED AT A HEALTH CARE FACILITY WHERE THE PERSON IS RECEIVING
TREATMENT OR IS A RESIDENT.
  2. (A) THE "REQUEST FOR MEDICATION TO END MY LIFE" SHALL BE WRITTEN IN
THE SAME LANGUAGE AS ANY CONVERSATIONS,  CONSULTATIONS,  OR  INTERPRETED
CONVERSATIONS OR CONSULTATIONS BETWEEN A PATIENT AND AT LEAST ONE OF HIS
OR HER ATTENDING OR CONSULTING PHYSICIANS.
  (B)  NOTWITHSTANDING  PARAGRAPH  (A)  OF THIS SUBDIVISION, THE WRITTEN
"REQUEST FOR MEDICATION TO END MY LIFE" MAY BE PREPARED IN ENGLISH  EVEN
WHEN  THE CONVERSATIONS OR CONSULTATIONS OR INTERPRETED CONVERSATIONS OR
CONSULTATIONS WERE CONDUCTED IN A LANGUAGE OTHER  THAN  ENGLISH  IF  THE
ENGLISH LANGUAGE FORM INCLUDES AN ATTACHED DECLARATION BY THE INTERPRET-
ER  OF THE CONVERSATION OR CONSULTATION, WHICH SHALL BE IN SUBSTANTIALLY
THE FOLLOWING FORM:

                        INTERPRETER'S DECLARATION

  I, _______[INSERT NAME OF INTERPRETER]______, AM FLUENT IN ENGLISH AND
[INSERT TARGET LANGUAGE].

A. 10059                            7

  ON [INSERT DATE], AT APPROXIMATELY [INSERT TIME], I READ THE  "REQUEST
FOR  MEDICATION  TO  END MY LIFE" TO [NAME OF PATIENT] IN [INSERT TARGET
LANGUAGE].
  [NAME OF PATIENT] AFFIRMED TO ME THAT HE/SHE UNDERSTOOD THE CONTENT OF
THE  "REQUEST FOR MEDICATION TO END MY LIFE" AND AFFIRMED HIS/HER DESIRE
TO SIGN THE "REQUEST FOR MEDICATION TO  END  MY  LIFE"  VOLUNTARILY  AND
WITHOUT  COERCION  AND THAT THE REQUEST TO SIGN THE "REQUEST FOR MEDICA-
TION TO END MY LIFE" FOLLOWED DISCUSSIONS  WITH  HIS/HER  ATTENDING  AND
CONSULTING PHYSICIANS.
  I DECLARE THAT I AM FLUENT IN ENGLISH AND [INSERT TARGET LANGUAGE] AND
FURTHER  DECLARE UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND
CORRECT AND THAT FALSE STATEMENTS MADE HEREIN ARE PUNISHABLE.

EXECUTED AT [INSERT CITY, COUNTY AND  STATE]  ON  THIS  [INSERT  DAY  OF
MONTH] OF [INSERT MONTH], [INSERT YEAR].

__________________________ [SIGNATURE OF INTERPRETER]

__________________________ [PRINTED NAME OF INTERPRETER]

__________________________ [ADDRESS OF INTERPRETER]

__________________________

  (C)  AN INTERPRETER WHOSE SERVICES ARE PROVIDED UNDER PARAGRAPH (B) OF
THIS SUBDIVISION SHALL NOT (I) BE RELATED TO THE PATIENT WHO  SIGNS  THE
"REQUEST  FOR MEDICATION TO END MY LIFE" BY BLOOD, MARRIAGE OR ADOPTION,
(II) BE ENTITLED AT THE TIME THE "REQUEST FOR MEDICATION TO END MY LIFE"
IS SIGNED BY THE PATIENT TO ANY PORTION OF THE  ESTATE  OF  THE  PATIENT
UPON  DEATH UNDER ANY WILL OR BY OPERATION OF LAW, OR (III) BE AN OWNER,
OPERATOR OR EMPLOYEE OF A HEALTH CARE  FACILITY  WHERE  THE  PATIENT  IS
RECEIVING TREATMENT OR IS A RESIDENT.
  S 2899-M. PROTECTION AND IMMUNITIES. 1. 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 GOVERN-
MENT ENTITY FOR TAKING ANY REASONABLE GOOD-FAITH ACTION OR  REFUSING  TO
ACT  UNDER THIS ARTICLE, INCLUDING, BUT NOT LIMITED TO:  (A) ENGAGING IN
DISCUSSIONS WITH A  PATIENT  RELATING  TO  THE  RISKS  AND  BENEFITS  OF
END-OF-LIFE  OPTIONS IN THE CIRCUMSTANCES DESCRIBED IN THIS ARTICLE, (B)
PROVIDING A PATIENT, UPON REQUEST, WITH A  REFERRAL  TO  ANOTHER  HEALTH
CARE PROVIDER, (C) BEING PRESENT WHEN A QUALIFIED INDIVIDUAL SELF-ADMIN-
ISTERS  MEDICATION,  (D) REFRAINING FROM ACTING TO PREVENT THE QUALIFIED
INDIVIDUAL FROM SELF-ADMINISTERING SUCH MEDICATION,  OR  (E)  REFRAINING
FROM  ACTING  TO  RESUSCITATE  THE  QUALIFIED INDIVIDUAL AFTER HE OR SHE
SELF-ADMINISTERS SUCH MEDICATION.
  2. NOTHING IN THIS SECTION SHALL LIMIT CIVIL OR CRIMINAL LIABILITY FOR
NEGLIGENCE, RECKLESSNESS OR INTENTIONAL MISCONDUCT.
  S 2899-N. PERMISSIBLE REFUSALS AND PROHIBITIONS. 1. (A)  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 UNDER THIS ARTICLE.
  (B) IF A HEALTH CARE PROVIDER IS UNABLE OR UNWILLING TO PARTICIPATE IN
THE  PROVISION  OF  MEDICATION  TO  A PATIENT UNDER THIS ARTICLE 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,

A. 10059                            8

OF A COPY OF THE PATIENT'S RELEVANT MEDICAL RECORDS TO  THE  NEW  HEALTH
CARE PROVIDER.
  2.(A)  A  PRIVATE  HEALTH  CARE FACILITY MAY PROHIBIT THE PRESCRIBING,
DISPENSING, ORDERING OR  SELF-ADMINISTERING  OF  MEDICATION  UNDER  THIS
ARTICLE  WHILE  THE  PATIENT IS BEING TREATED IN OR WHILE THE PATIENT IS
RESIDING IN THE HEALTH CARE FACILITY IF:
  (I) THE PRESCRIBING, DISPENSING,  ORDERING  OR  SELF-ADMINISTERING  IS
CONTRARY  TO A FORMALLY ADOPTED POLICY OF THE FACILITY THAT IS EXPRESSLY
BASED ON SINCERELY HELD RELIGIOUS BELIEFS OR MORAL  CONVICTIONS  CENTRAL
TO THE FACILITY'S OPERATING PRINCIPLES; AND
  (II)  THE  FACILITY  HAS  INFORMED THE PATIENT OF SUCH POLICY PRIOR TO
ADMISSION OR AS SOON AS REASONABLY POSSIBLE.
  (B) WHERE A FACILITY HAS ADOPTED A PROHIBITION UNDER THIS SUBDIVISION,
IF A PATIENT WHO WISHES TO USE MEDICATION UNDER THIS  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 AND  SELF-ADMINISTERING  OF
MEDICATION UNDER THIS ARTICLE WITH RESPECT TO THE PATIENT.
  3.  WHERE  A HEALTH CARE FACILITY HAS ADOPTED A PROHIBITION UNDER THIS
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 PROHIBITION IN WRITING.
  S 2899-O. RELATION TO OTHER LAWS AND CONTRACTS.  1. (A) A PATIENT  WHO
REQUESTS  MEDICATION  UNDER  THIS  ARTICLE  SHALL  NOT,  BECAUSE OF THAT
REQUEST, BE CONSIDERED TO BE A PERSON WHO IS SUICIDAL, AND SELF-ADMINIS-
TERING MEDICATION UNDER THIS ARTICLE SHALL NOT BE DEEMED TO BE  SUICIDE,
FOR ANY PURPOSE.
  (B)  ACTION  TAKEN  IN  ACCORDANCE  WITH  THIS  ARTICLE  SHALL  NOT BE
CONSTRUED FOR ANY  PURPOSE  TO  CONSTITUTE  SUICIDE,  ASSISTED  SUICIDE,
ATTEMPTED  SUICIDE, PROMOTING A SUICIDE ATTEMPT, MERCY KILLING, OR HOMI-
CIDE UNDER THE LAW, INCLUDING AS AN ACCOMPLICE OR  ACCESSORY  OR  OTHER-
WISE.
  2.  (A)  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 THIS ARTICLE, SHALL BE VALID.
  (B) NO OBLIGATION OWING UNDER ANY CONTRACT  SHALL  BE  CONDITIONED  OR
AFFECTED  BY THE MAKING OR RESCINDING OF A REQUEST BY A PERSON FOR MEDI-
CATION OR TAKING ANY OTHER ACTION UNDER THIS ARTICLE.
  3. (A) A PERSON AND HIS OR HER BENEFICIARIES SHALL NOT BE DENIED BENE-
FITS UNDER A LIFE INSURANCE POLICY FOR ACTIONS TAKEN IN ACCORDANCE  WITH
THIS ARTICLE.
  (B) THE SALE, PROCUREMENT OR ISSUANCE OF A LIFE OR HEALTH INSURANCE OR
ANNUITY  POLICY, OR THE RATE CHARGED FOR A POLICY MAY NOT BE CONDITIONED
UPON OR AFFECTED BY A PATIENT MAKING OR RESCINDING A REQUEST FOR MEDICA-
TION UNDER THIS ARTICLE.
  4. AN INSURER SHALL NOT PROVIDE ANY INFORMATION IN COMMUNICATIONS MADE
TO A PATIENT ABOUT THE AVAILABILITY OF  MEDICATION  UNDER  THIS  ARTICLE
ABSENT  A  REQUEST  BY  THE PATIENT OR BY HIS OR HER ATTENDING PHYSICIAN
UPON THE REQUEST OF SUCH PATIENT. ANY COMMUNICATION  SHALL  NOT  INCLUDE
BOTH  THE  DENIAL  OF  COVERAGE  FOR TREATMENT AND INFORMATION AS TO THE
AVAILABILITY OF MEDICATION UNDER THIS ARTICLE.
  5. THE SALE, PROCUREMENT, OR ISSUE  OF  ANY  PROFESSIONAL  MALPRACTICE
INSURANCE  POLICY OR THE RATE CHARGED FOR THE POLICY SHALL NOT BE CONDI-

A. 10059                            9

TIONED UPON OR AFFECTED BY WHETHER THE INSURED DOES OR DOES NOT TAKE  OR
PARTICIPATE IN ANY ACTION UNDER THIS ARTICLE.
  S 2899-P. SAFE  DISPOSAL  OF  UNUSED MEDICATIONS. THE DEPARTMENT SHALL
MAKE REGULATIONS PROVIDING FOR THE SAFE DISPOSAL OF  UNUSED  MEDICATIONS
PRESCRIBED, DISPENSED OR ORDERED UNDER THIS ARTICLE.
  S 2899-Q. DEATH  CERTIFICATE.   1. IF OTHERWISE AUTHORIZED BY LAW, THE
ATTENDING PHYSICIAN MAY SIGN THE QUALIFIED  INDIVIDUAL'S  DEATH  CERTIF-
ICATE.
  2. THE CAUSE OF DEATH LISTED ON A QUALIFIED INDIVIDUAL'S DEATH CERTIF-
ICATE  WHO  DIES  AFTER SELF-ADMINISTERING MEDICATION UNDER THIS ARTICLE
WILL BE THE UNDERLYING TERMINAL ILLNESS.
  S 2899-R. REPORTING. 1.  THE  COMMISSIONER  SHALL  ANNUALLY  REVIEW  A
SAMPLE  OF  THE  RECORDS  MAINTAINED  UNDER SECTION TWENTY-EIGHT HUNDRED
NINETY-NINE-K OF THIS ARTICLE. THE COMMISSIONER SHALL ADOPT  REGULATIONS
ESTABLISHING  REPORTING  REQUIREMENTS FOR PHYSICIANS TAKING ACTION UNDER
THIS ARTICLE TO DETERMINE UTILIZATION AND COMPLIANCE WITH THIS  ARTICLE.
THE  INFORMATION  COLLECTED  UNDER  THIS  SECTION SHALL NOT CONSTITUTE A
PUBLIC RECORD AVAILABLE FOR PUBLIC INSPECTION AND SHALL BE  CONFIDENTIAL
AND  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 THIS ARTICLE, EXCEPT THAT SUCH INFOR-
MATION  MAY  BE  DISCLOSED  TO  A  GOVERNMENTAL  AGENCY AS AUTHORIZED OR
REQUIRED BY LAW  RELATING  TO  PROFESSIONAL  DISCIPLINE,  PROTECTION  OF
PUBLIC HEALTH OR LAW ENFORCEMENT.
  2.  THE  COMMISSIONER SHALL PREPARE A REPORT ANNUALLY CONTAINING RELE-
VANT DATA REGARDING UTILIZATION AND COMPLIANCE  WITH  THIS  ARTICLE  AND
SHALL POST SUCH REPORT ON THE DEPARTMENT'S WEBSITE.
  S 2899-S. PENALTIES.  1. NOTHING IN THIS ARTICLE SHALL BE CONSTRUED TO
LIMIT PROFESSIONAL DISCIPLINE OR CIVIL LIABILITY RESULTING FROM  CONDUCT
IN  VIOLATION OF THIS ARTICLE, NEGLIGENT CONDUCT, OR INTENTIONAL MISCON-
DUCT BY ANY PERSON.
  2. CONDUCT IN VIOLATION OF THIS ARTICLE SHALL BE SUBJECT TO APPLICABLE
CRIMINAL LIABILITY UNDER STATE LAW,  INCLUDING,  WHERE  APPROPRIATE  AND
WITHOUT  LIMITATION,  OFFENSES CONSTITUTING HOMICIDE, FORGERY, COERCION,
AND RELATED OFFENSES, OR FEDERAL LAW.
  S 2899-T. SEVERABILITY. IF ANY PROVISION OF THIS ARTICLE OR ANY APPLI-
CATION OF ANY PROVISION OF THIS ARTICLE, IS HELD TO BE  INVALID,  OR  TO
VIOLATE  OR  BE  INCONSISTENT  WITH  ANY FEDERAL LAW OR REGULATION, THAT
SHALL NOT AFFECT THE VALIDITY OR EFFECTIVENESS OF ANY OTHER PROVISION OF
THIS ARTICLE, OR OF ANY OTHER APPLICATION OF ANY PROVISION OF THIS ARTI-
CLE, WHICH CAN BE GIVEN EFFECT WITHOUT THAT  PROVISION  OR  APPLICATION;
AND  TO  THAT  END,  THE PROVISIONS AND APPLICATIONS OF THIS ARTICLE ARE
SEVERABLE.
  S 3. This act shall take effect immediately.