The death-with-dignity movement has gained a great deal of momentum recent years. Surveys now show that 77% of New Yorkers support medical aid in dying, and that doctors across the country support it by a 54 to 31% margin. It is being discussed and debated in the media, with editorial endorsements from The New York Times, The Economist, The Wall Street Journal, the Washington Post, the Los Angeles Times and the San Francisco Chronicle. In the Capital Region, aid in dying has been endorsed by the Albany Times Union and the Schenectady Gazette. Many medical organizations support or are neutral on aid in dying, including the American Public Health Association, the American Medical Women’s and Student Associations, the American Academy of Hospice and Palliative Medicine and the California Medical Association.
Aid in dying is an entirely patient-directed medical practice from beginning to end. Like hospice and palliative care, aid in dying provides an additional medical option to reduce suffering and give comfort at the end of life. Family members whose loved ones have exercised this option have characterized the process as peaceful and humane. They describe it as the kind of death most Americans say they want for themselves when the time comes.
As of early 2017, medical aid in dying is legal in Oregon, Washington (state), Montana, Vermont, California, Colorado, and Washington D.C. Progress has been made by means of state referendums, legislative action, and court rulings. Momentum, perhaps due to the recent successes and to increasing public support, seems to be developing in other states around the country as well.
The Oregon law, first in the nation, has served as a model for the other states. The Death with Dignity National Center says “State legislators around the country look to the Oregon Death with Dignity Act as a guide for good reason. Oregon’s law has been in effect since 1997, and the years of data show the law is safe and utilized the way it’s intended with no evidence of a slippery slope for vulnerable Oregonians.”
In Hawaii state Senate committees have been moving forward on a medical aid in dying bill, although prospects in the House are currently given just a 50-50 chance. The possibility of the Maryland legislature re-considering a bill could be influenced by the state medical society, which had been opposed to such legislation in the past. But, last year the society moved to a neutral position. Similarly, in Massachusetts the state medical society, which has historically been opposed, is now re-surveying its members. It was their opposition that helped to defeat a medical aid in dying ballot measure five years ago. The New Jersey Assembly, by a decisive vote approved legislation last year. That bill is now in Senate committees. If it passes both houses, however, the legislation is likely to get a promised veto from Gov. Chris Christie. Three years ago a New Mexico court effort aimed at declaring such an end of life option as an individual right succeeded at a lower court level. But that decision was challenged and eventually reversed last year by the state’s highest court. As a result companion bills to provide legal authority for medical aid in dying were introduced in the two houses of the state Legislature in January 2017.
The federal government plays a narrow legislative role, because the issues mostly are state-level concerns (except for the District of Columbia and military bases). The Supreme Court ruled against doctors and patients who claimed a constitutional right to medical aid in dying in 1997, but it later ruled against a federal government attempt to block doctors from participating under Oregon’s law. The appointment of Neil Gorsuch to the Supreme Court in early 2017 drew concern because of his 2006 book that presented legal and philosophical arguments against “assisted suicide and euthanasia.”
The New York legislature has considered bills concerning physician-assisted aid in dying several times over the years since Oregon’s law was enacted in 1997. In the last legislative session two bills were introduced early, and then combined into the Medical Aid in Dying Act that was introduced in May, 2016. That bill was passed in the Assembly Health Committee by a vote of 14 to 11. A slightly revised version was introduced at the beginning of the new session that began in January, 2017, and it is available on the Assembly Website. Although no action was taken in the Spring 2017 session, a robust campaign continues in New York and organizational support has increased.
The bill is similar to Oregon’s law. It would allow a mentally competent adult, who has a terminal illness with a prognosis of living six month or less, the option to request a prescription for life-ending medication that would be self-administered in order to reduce suffering and to bring about a peaceful and humane death.
The bill would:
A) Allow a qualified, terminally ill adult to request and obtain a prescription from his physician for the medication, and to rescind the request at any time.
B) Require that two physicians confirm that the patient’s prognosis is terminal.
C) 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.
D) Allow medical providers to decline to fulfill the patient’s request, and protect them from civil or criminal liability and from professional disciplinary action if they do fulfill it. Participation by doctors and pharmacists is fully voluntary.
E) Safeguard against any coercion of patients by establishing felony penalties for coercing or forging a request.
F) 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.
For a summary of the status and history of legislation in New York, see https://www.deathwithdignity.org/states/new-york/
Frequently Asked Questions
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. How would 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. 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. 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. 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 in New York?
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. 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.