ALBANY — The New York state legislature is poised to pass a bill that would allow terminally ill people to seek a medication to end their lives, a process called medical aid in dying.
On Tuesday, the Assembly voted for the first time to advance a bill, carried by Assemblywoman Amy Paulin, D-Westchester, that would allow a terminally ill patient to ask for a prescription for a lethal medication, to be taken at home on their own terms.
Under the terms of the bill, any adult age 18 or older with “decision-making capacity,” who has been diagnosed by a physician with a terminal illness with no more than six months to live, confirmed with another physician, can submit an oral and written request to be prescribed lethal medication.
The request must be witnessed by two adults who can attest to the patient’s mental acuity and voluntary request to end their life. The witnesses cannot be family or a spouse, and are not in a position to benefit from the estate of the patient once they die. Neither witness can be an owner, operator or employee of the medical facility where the patient is being treated, and they cannot be the physician prescribing the medication.
The law is written to exclude age or disability as qualifiers for medically assisted death, and only the patient seeking the prescription can submit the request. The law also requires that the patient be the one to administer the lethal medication. No other person can help with that process. Doctors would be instructed to tell the patient to have another person present when they take the drugs and that they cannot do so in a public place.
The bill would also require doctors to run through all available options with a patient before signing a prescription for the lethal medication, including discussing hospice and palliative care. It also provides precise language for the written request to be provided to requesting patients and their witnesses.
PROTECTION FOR DOCTORS
The bill does not specify the lethal medication to be provided.
The bill is written to ensure that no doctors, nurses, psychiatrists or pharmacists lose their licenses for participating in the medically assisted death process. It also specifies that the patient’s death certificate will indicate their cause of death to be their terminal illness, not medical assistance.
Assemblywoman Jen Lunsford, D-East Rochester, explained in a press conference on Tuesday that this will allow the families of those who die with medical assistance to still benefit from their life insurance policies.
“This gives families an opportunity to die on their own terms, when they want to and how they want to, without impacting their life insurance,” Lunsford said. “It will leave their family with benefits that if they made this choice outside of the law, they would not receive, and that is an incredible gift we are giving to New Yorkers.”
ROOTED IN LOVE
The bill’s backers say they’re motivated by love and respect for ill and dying New Yorkers.
“Medical aid in dying is an effort that is rooted in love,” Assemblymember Amanda Septimo, D-Bronx, said. “Today we will vote on that to say that we love New Yorkers, and we are here to stand up for every single one.”
For more than a decade, lawmakers in the state Capitol have sought to add New York to the growing list of states and countries that offer some sort of medically assisted death, sometimes called doctor assisted suicide, to sick people with no prospects of getting better. Efforts have been stymied for years. A combination of practical and moral objections have been cited by lawmakers, legislative leaders and governors.
The state Association on Independent Living is opposed to the legislation, which they argue puts the physically and mentally disabled at risk. They argue that a majority of physicians already believe that the disabled live with a lower quality of life, and posit that any safeguards put in place in New York will be quickly erased.
“We have already seen in other places that people with disabilities are offered assisted suicide in place of home care, caregiver respite, or home accessibility modifications,” said Alex Thompson, director of advocacy at NYAIL. “New York should be prioritizing medical aid in living, not promoting suicide as a substitute.”
Assemblyman Scott A. Gray, R-Watertown, had many reasons to oppose the bill, and voted no on it Tuesday.
CONCERNS
Gray said he has both personal and fundamental reasons for opposing the legislation, and cited his own personal experience with people nearing the supposed end of their lives.
“My mother had small cell cancer. The doctor told her she could live six months to two years, and she died in six weeks,” he said.
But his mother-in-law, who lives with Gray in Watertown, has been twice told she was at the end of her life and given information on hospice care — and has lived for years since those diagnoses with a perfectly stable quality of life.
“Twice we have been through an inaccurate diagnosis, and had we just succumbed to the belief, she would have been sent to hospice and they’d be giving her morphine,” he said.
Gray said that doctors’ predictions for when a terminal illness will claim a person’s life are an inexact science, and that prescribing lethal medication for people who could live for years yet isn’t something he can support. He also has concerns over misdiagnoses and medical professionals missing key parts of a patient’s condition.
Gray also cites a number of specific and material concerns with the language of the legislation. The bill has no guidelines for when a lethal prescription should be used, and while it does call for a patient to take the drugs with another person present, the forms outlined in the bill would also permit the patient to move forward with medically assisted death without any one else in their life knowing, even people in the same home as them.
CHECKS AND BALANCES
The bill’s backers have cited statistics showing that up to 40% of people who get lethal prescriptions in similar programs in other states and countries don’t actually take the drugs. Gray said he has concerns about introducing these lethal medications to the general population without some checks and balances on where they are and how they’re used or disposed of. If someone is prescribed the lethal medication, doesn’t inform their family, and dies without using it, that medication goes unchecked.
“There is no method for follow up to find out if the medication has been used, what the status is, and I think that is fatal,” Gray said. “Everyone talks about safe drug disposal, but what happens when nobody knows it exists?”
Gray also cites concerns over the move to attribute a medically assisted death to the terminal disease the individual was diagnosed with rather than the lethal drugs.
“Ultimately you’re asking the doctor to sign off on something as the cause of death that was not,” he said. “That’s a huge issue.”
If the person takes the lethal drugs without informing any family, an autopsy would show they died from taking the medication rather than their disease, further complicating matters in Gray’s opinion.
‘THIS IS NOT ASSISTED SUICIDE’
But the bill’s supporters say they’re convinced this is the right approach, achieved over years of writing and rewriting the bill in an effort to get it passed.
Assemblyman Alfred E. Taylor, D-Bronx, who is also a Christian pastor, said that he hasn’t always supported this bill or similar ones, but has come around after years of reflecting on the issue. He said part of the reason he supports the bill now is because it’s been thoughtfully crafted.
“I want to clarify, this is not assisted suicide,” he said. “This is like nothing in the nation that has ever happened, because after 30 years, we’ve done it right. Nobody is doing anything but the individual that feels he or she wants to take advantage of it.”
After passing in the Assembly, the bill now will move through the Senate. Paulin and her colleagues supporting the Senate version of the bill said they have confidence that the bill will pass in that chamber.
Speaking with reporters later Tuesday, Senate Majority Leader Andrea A. Stewart-Cousins, D-Yonkers, said that her chamber has been discussing the bill to bring it up for a vote, but wouldn’t commit to doing so this session.
“It has to be a conversation,” she said, noting that she won’t call a bill to the floor unless she’s sure it will pass the chamber.
It also requires the governor’s signature for final approval.
Paulin said her understanding is that Gov. Kathleen C. Hochul is likely to sign the bill.
“She’s supportive, but I haven’t gotten a personal call,” she said.