LEGISLATION
The Need
Currently in New York, a person who is close to the end of life and who no longer desires medical treatment can seek hospice and palliative care to alleviate pain and suffering while waiting to die. When this care is not sufficient, the person has somewhat unattractive options if they seek to hasten death: it possible to stop eating and drinking, and it is possible to end one’s life by suicide.
More than 25 years ago Oregon adopted a law that provides another, more attractive, end-of-life option. The law sets up a procedure by which a person can ask their doctor for life-ending medication, and the doctor can prescribe these drugs without bearing any professional or legal sanction. The patient’s death is not considered a suicide. The law includes carefully crafted procedures and safeguards to assure that it operates as intended, for mentally competent adults with a terminal illness. The experience in Oregon shows that the law operates without the potential problems that had concerned opponents.
Oregon’s law is “The Oregon Death with Dignity Act”, whose title embodies the term that was used by advocates for this option at the time. The term “medical aid in dying”, which more clearly describes the option, is more commonly used now.
Like hospice and palliative care, medical aid in dying provides a medical option to relieve 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.
A good overview and introduction to medical aid in dying is provided by Compassion & Choices in Introduction to Medical Aid in Dying and a more extensive and in-depth treatment is given in their Policy Book.
Nationwide
About three quarters of Americans (74%) support the option of medical aid in dying, according to the 2020 Gallup Poll. Support is high across all demographic groups. Medical aid in dying is being discussed and debated in the media, with editorial endorsements from major newspapers. Many medical and social organizations support or are neutral on legalization, including the American Public Health Association, the American Medical Women’s and Student Associations, and the American Academy of Hospice and Palliative Medicine.
As of January 2024, medical aid in dying is legal in eleven jurisdictions: California, Colorado, Hawaii, Maine, Montana, New Jersey, New Mexico, Oregon, Vermont, Washington, and the District of Columbia — with Maine and New Jersey having passed their laws in 2019 and New Mexico in 2021. Momentum for the passage of laws is strong elsewhere around the country as well. Over 15 other states are considering medical aid in dying measures and are in varying stages in the legislative process.
The federal government plays a limited role in this area, 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 federal 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.
New York
Since Oregon’s law began operating in 1997, the New York legislature has considered several bills concerning medical aid in dying (as early as 2001, S677). Two bills were introduced early in the 2015–2016 legislative term, and they were later combined into a Medical Aid in Dying Act. That bill was passed in the Assembly Health Committee by a vote of 14 to 11 in May 2016 but did not proceed further.
A slightly revised version was introduced in January 2017, at the beginning of a new legislative term. In the Spring of 2018, the Health Committee held public hearings in Albany and New York City to gain information and insights on the measure and to help gauge public sentiment. Also that Spring, four advocacy organizations — Compassion and Choices, Death with Dignity–Albany, End of Life Choices New York, and Death with Dignity National Center — formed the New York Alliance for Medical Aid in Dying, to speak with one powerful voice to provide further impetus for passing the bill.
The bill was reintroduced in the Senate and the Assembly in January 2019 and again in 2021, but no action was taken during these terms.
In January 2023, the Medical Aid in Dying Act was reintroduced in the Senate (S2445) and the Assembly (A995) by lead sponsors Senator Brad Hoylman-Sigal (D-Manhattan) and Assemblymember Amy Paulin (D-Westchester). When introduced, the bill had 14 sponsors in the Senate and 52 in the Assembly. The bills were amended in May 2023 and are now numbered S2445A and A995A, and these bills have been carried forward to the current 2024 session. At the beginning of the session, the bill had 20 sponsors in the Senate and 64 in the Assembly. The bills were amended again in April 2024 and are now numbered S2445B and A995B
According to a January 2024 poll by YouGov, 72% of New Yorkers support enactment of the Medical Aid in Dying Act, with stronger-than-average support in the Capital region. A survey conducted for Compassion & Choices and released in 2019 shows that more than two-thirds of New York physicians support the proposed legislation. Among organizations, The New York State League of Women Voters, the New York State Academy of Family Physicians, the New York State Public Health Association, and the Latino Commission on AIDS have all endorsed the act. In addition, the New York Civil Liberties Union and the Statewide Senior Action Council, along with others, have voiced support of the legislation.
The Bill
The bill for the Medical Aid in Dying Act is modeled after Oregon’s, as are all the other states’. Variations among the laws reflect a variety of concerns.
- Set forth a procedure in which a qualified, terminally ill adult makes an oral request, and submits a written request, to their physician for a prescription for a life-ending medication. The medicine must be self-administered.
- Require two witnesses to attest that the written request is voluntary.
- Require that the attending physician and a consulting physician both confirm that the patient’s prognosis is terminal, that the patient is acting on their own will, and that the patient has the capacity to make an informed decision. If either physician believes that the patient may lack this capacity, the patient must be referred to a mental health professional to determine the capacity.
- Permit the attending physician to write the prescription after all the procedural steps and safeguards have been completed.
- Protect medical providers from civil or criminal liability and from professional disciplinary action if they fulfill the patient’s request.
- Make clear that participation by doctors, pharmacists, and other health care providers is fully voluntary: they are allowed to decline to fulfill the patient’s request.
- Safeguard against any coercion of patients by establishing felony penalties for coercing or forging a request.
- Stipulate that any action taken in accordance with the bill does not constitute suicide, assisted suicide, mercy killing, or homicide under the law.
- Provide that the cause of death listed on the death certificate of an individual who dies after self-administering the medication will be the underlying terminal illness or condition.
A video interview with Dr. David Pratt presents a physician’s explanation of the proposed New York Medical Aid in Dying Act. This can be viewed at www.youtube.com/watch?v=v8Xqk0whyqA&feature=youtu.be