New York’s medical aid-in-dying law takes effect after years of debate

New York’s Medical Aid in Dying Act went into effect on Wednesday, allowing terminally ill state residents with a prognosis of six months or less to obtain medication to end their own lives.

New York is the 14th U.S. jurisdiction, including the District of Columbia, to legalize the practice.

The legislation, first introduced nearly a decade ago by then-state senator Brad Hoylman-Sigal, who is Jewish and now serves as Manhattan borough president, was the subject of years of political debate. Gov. Kathy Hochul signed the measure into law in February after negotiating additional safeguards.

The law requires a mandatory mental health evaluation, a five-day waiting period between issuance and filling of the prescription, and repeated confirmation from the prescribing physician that the patient wishes to proceed. Physicians also must discuss alternatives, including hospice and palliative care.

Eligible patients must be at least 18 years old, New York residents, diagnosed with a terminal illness expected to result in death within six months and capable of making medical decisions and self-administering the medication. They must submit both oral and written requests. Two physicians must determine that the patient meets the eligibility requirements.

Several orders of Catholic nuns, represented by the Becket Fund for Religious Liberty, sued to block parts of the law, arguing that it amounts to “assisted suicide” and could force religious health-care providers to violate their beliefs. Shortly before the law took effect, New York agreed not to enforce the challenged provisions against those ministries while the lawsuit proceeds.

The law also allows physicians, pharmacists, hospitals and other health-care providers to decline participation for moral, ethical or religious reasons. Religious health-care institutions may opt out as well.

Maimonides Medical Center, the major Brooklyn hospital serving many Orthodox Jewish patients, including those from neighboring Borough Park, has not publicly announced a policy on implementing the law.

The Alzheimer’s community is “probably where the political fight will go” now, Arthur Caplan, founding head of the Division of Medical Ethics at NYU Grossman School of Medicine and current professor of bioethics, told JNS. Alzheimer Disease and related dementias are not legally considered terminal illnesses, he said, the way some cancers are.

About 7 million Americans are living with Alzheimer’s disease, according to the Alzheimer’s Association.

Caplan, who is Jewish and describes himself as secular, said he initially opposed Oregon’s physician-assisted dying law, the nation’s first, when it was under consideration in the 1990s.

“I worried it would be abused, that people who are disabled or mentally ill would be rushed to die, like the Nazis did,” he told JNS. “I also worried that people would not have the option to go to hospice because there weren’t enough of them.”

Over time, however, his view changed as hospice care became more widely available and pain management improved. After seeing no evidence of widespread abuse in Oregon or Washington, he said, he came to support medical aid in dying.

“It isn’t assisted suicide,” Caplan told JNS. “It is managing dying in a more humane way.”

Caplan, who also founded the Center for Bioethics and the Department of Medical Ethics at the University of Pennsylvania, said claims of widespread abuse involving people with mental illness or disabilities are “usually critics looking for trouble” and are not supported by available data.

“People are not usually in a rush to end their lives,” he told JNS. “It should be rare that people take this option.”

Now “there is more noise about wanting to be included” in the law from people with intractable mental illness, Caplan said.

Caplan opposes expanding eligibility beyond terminal illness.

“We should not follow the Netherlands or Belgium, which allow you to get aid in dying if you claim suffering that cannot be alleviated,” he told JNS. “That can include depression. People there have gotten aid in dying for incredibly unpersuasive reasons, like, ‘I’m blind and don’t want to deal with it anymore.’”

Caplan said he is especially sensitive to concerns from the disability community because he contracted polio as a child. After spending a year hospitalized, the disease went into remission. Decades later, he developed post-polio syndrome and now uses a walker and wheelchair.

“I don’t expect there will be a rush of requests” from patients wanting to act under the legislation, Caplan told JNS. “The number of people dying with six months or less to live is not big. And a lot of people are still wary of doing this on ethical grounds.”

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