Please note: A video interview with Dr. David Pratt presents a physician’s explanation of, and support for, the proposed New York Medical Aid in Dying Act in a Q & A format. This streaming video can be viewed at https://www.youtube.com/watch?v=v8Xqk0whyqA&feature=youtu.be
Q. What is death with dignity? What does it mean?
A. The phrase death with dignity has come to refer to a peaceful and humane death. It is also referred to as aid in dying. The term is often linked with legislation that provides for medical aid in dying, but can also refer to the belief that one’s end-of-life wishes should be honored and there should be no unwanted treatments.
Q. Where is medical aid in dying legal?
A. It is legal in Washington State, Oregon, California, Montana and Vermont. At this time, legislation has been proposed in an additional 26 states.
Q. How does it work? What are the basics of the law?
A. Like hospice and palliative care, medical aid in dying provides an additional medical option to reduce suffering and give comfort at the end of life. However, medical aid in dying is an entirely patient-directed medical practice from beginning to end. It permits a qualified, terminally ill adult to request and obtain a prescription from his physician for medication that the patient can self-administer to hasten death if his suffering becomes too great, whether from pain or from loss of quality of life. There are many safeguards, including measures that:
- Require that two physicians confirm that the patient’s prognosis is terminal.
- Require two witnesses to attest that the request is voluntary, and two doctors to attest that the patient is mentally competent to make the request and is acting on his own will.
- Stipulate that participation by doctors and pharmacists is fully voluntary.
- Safeguard against any coercion of patients by establishing felony penalties for coercing or forging a request.
- Honor a patient’s right to rescind the request at any time.
- Stipulate that any action taken in accordance with the bill does not constitute suicide, assisted suicide, mercy killing or homicide under any criminal law of this state. The death certificate of an eligible adult who accesses aid in dying will indicate the terminal illness as the cause of death, not the aid-in-dying medication.
Q. Does the proposed law cover debilitating diseases such as ALS, Huntington’s, and Alzheimer’s?
A. No. The existing laws in Oregon, Washington, California and Vermont do not cover these illnesses. No state in the U.S. has actively addressed these issues, which are considered too “radical” to be palatable to legislators or to the public because they open up many questions along with the possibility of abuse of the law. Experts in the legislative and political process in New York strongly advise against adding these measures, which divert efforts to pass viable legislation.
Q. How is this intervention different from hospice or palliative care?
A. Aid in dying provides an additional medical option to reduce suffering and give comfort at the end of life, particularly if pain cannot be controlled through medication. While most hospice patients die in hospitals or other facilities, patients who use medical aid in dying almost always die at home.
Q. Isn’t this law just another term for euthanasia?
A. No! Euthanasia involves administration of a life-ending intervention by another person, and it is illegal in all states. Aid in dying is directed and administered by the patient, and it is gaining legal acceptance in various states.
Q. Could a participating doctor jeopardize his or her medical license?
A. No. The proposed legislation provides protections from criminal or civil liability and from professional disciplinary action. It also allows doctors to “opt out” and not participate.
Q. Could a minor child request this intervention or be provided end-of-life medication by a parent or guardian?
A. No. The legislation requires that the patient be an adult who is of sound mind and able to make the request themselves.
Q. How does the legislative process work for passing bills?
A. A bill must go through the following steps to become law:
- Sponsorship by a legislator (unless proposed by the Governor or the Attorney General).
- Drafting into suitable language and introduction in the respective house.
- Review and revision by appropriate committee(s); redrafting of language as changes are made.
- Review by Senate Finance or Assembly Ways and Means committees if there is a fiscal implication to the bill.
- Tracking by the rules committee, which controls the flow of legislation through each house.
- Floor vote, often preceded by debate. Passage in both houses sends the bill to the Governor for signature. If the bill is vetoed, it may be reintroduced in a subsequent session (often with modifications); a 2/3 majority vote of each house can also override the veto.
It is important to note that advocacy efforts are critical at many steps along the way — NOT just at the point of the Governor’s consideration. A bill that has a broad sponsorship base has a higher likelihood of success. Furthermore, committee actions are vital to the “life or death” of a proposed bill, so advocating with committee members and staff, legislative staff members, and broad-based constituencies of the legislators themselves are vital to the successful passage of a bill.
Q: What are the chances that the law will be passed in New York?
A. The New York Medical End of Life Options Act is being sponsored by Assembly Member Amy Paulin and Senator Diane Savino. The bill was proposed in the last session and was approved by the Assembly Health Committee. This is a big first step, but because the Spring session ended without the bill progressing, we will need to re-introduce it. There is growing momentum, which has certainly been helped by the new California law. We will continue to push for passage in NY, but often these big changes take repeated attempts. It’s important to keep up the pressure on our legislators and keep the issue front and center and to make sure they know that their constituents support the bill.
Q. What is Death with Dignity-Albany? Is it part of one of the national organizations?
A. Death with Dignity-Albany is a local, grassroots group that is independent of any of the larger national organizations. Its mission is to provide a forum for learning, discussion and advocacy for end of life issues. While we have good relationships with the national organizations, we have chosen to remain independent so we can tailor our work to our local area’s interests. We do, however, participate in lobbying efforts organized by larger groups such as Compassion & Choices.
Q. Why are there so many different groups that deal with death with dignity? Why not one big group?
A. This is still a relatively new field, and various groups have evolved over the same period of time. Compassion & Choices is clearly the largest national organization and has well-funded and well-developed programs including advocacy, lobbying, and providing a wealth of information and tools to the public. They are very skilled at getting media visibility for the issues. Death with Dignity National Center is also a large national group that provides similar resources. There are other groups, such as The Conversation Project, which focuses on helping people clarify and then communicate their end-of-life wishes to their loved ones. And here in NY there is also End of Life Choices New York, which focuses on legal and legislative approaches to death with dignity. All of these organizations do good work and have slightly different niches. And the more activity there is, the more momentum is generated.
Q. Where can I get the necessary forms to protect my quality of life?
A. Advance Directive forms are available online at http://www.health.ny.gov/ or can be obtained from your attorney. The Attorney General’s office also has a comprehensive publication available online in PDF format on planning healthcare in advance. Follow this link to access it:
https://www.ag.ny.gov/sites/default/files/pdfs/publications/Planning_Your_Health_Care_in_Advance.pdf
Q. How can I learn more and get involved in making medical aid in dying legal in New York?
A. Become an advocate! There are many ways that you can have an impact.
- Talk to your friends and family and tell them why this is so important.
- Educate yourself about the issues.
- Join Death with Dignity–Albany to meet others who support this legislation and join in our advocacy efforts. To receive notices of educational events and opportunities for advocacy, click on the Subscribe to Newsletter button at the bottom of this page.
Last Revised: August 14, 2016