A medication-assisted suicide bill has passed the state Assembly after nearly 10 years of lobbying and discussions.

The Medical Aid In Dying bill has been the subject of debate for years in Albany, first introduced by Assemblywoman Amy Paulin, D-Scarsdale, alongside another piece of legislation introduced by Assemblywoman Linda Rosenthal, D-New York City, that would have established the New York end of life options act. Paulin has introduced the bill every session since, but it wasn’t until this week that Assembly leadership brought the legislation to the floor for a vote. Paulin’s bill now has to make it through the state Senate and then be approved by Gov. Kathy Hochul in order to become law.

“Thank you to the speaker, who not only when I asked gave me a path to put this before us today but who guaranteed that path and worked with me to create a path,” Paulin said before this week’s vote. “I am so indebted and appreciative.”

Medical aid in dying is already permitted in 10 states, including California, Colorado, Hawai’i, Maine, Montana, New Jersey, New Mexico, Oregon, Vermont and Washington, as well as Washington, D.C. Vermont and Oregon permit any qualifying American to travel to their state for the practice, according to the Associated Press, while at least 12 states had pending bills that would legalize the practice. New York was among that group.

Only about 8,700 people have used physician-assisted death since Oregon became the first state to legalize it in 1997, according to the advocacy group Compassion & Choices. Most are cancer cases; others include heart and respiratory diseases. A third of people prescribed the medications don’t end up using them, according to a 2024 Associated Press report.

OPPOSITION

Opponents, including many religious groups and lawmakers, have moral objections with the very concept of someone ending their life. Even with safeguards in place, they argue, the decision could be made for the wrong reasons, including depression or pressure from family burdened by their caretaking.

Andrew Molitor and Joe Sempolinski, the region’s state Assembly members, were among those who voted against the bill in an 81-67 vote that was not strictly along party lines after a little more than five hours of debate earlier this week.

Molitor, R-Westfield, said physician-assisted suicide in New York state poses a threat to vulnerable state residents and undermines the state’s moral foundation. He took part in a lengthy debate with Paulin before voting against A.136.

“I cannot support legislation that legalizes the deliberate termination of life under the guise of compassion,” Molitor said in a news release after the vote. “When mental health care, palliative treatment and effective pain management are available and should be prioritized, sanctioning death as a form of relief reflects indifference – not compassion.”

At least two states have gone in the opposite direction. Kansas passed legislation last year to further criminalize those who help someone with their physician-assisted death. West Virginia asked voters last November to enshrine its current ban into the state constitution, with the proposition passing 50.49% to 49.56%.

“It’s normalizing suicide, and it’s incentivizing individuals to end their lives,” Danielle Pimentel of Americans United for Life told the Associated Press in 2024. Pimentel raised concerns that pain isn’t the top reason people choose an early departure, adding that policy should focus on bettering end-of-life care.

Sempolinski, R-Canisteo, also debated Paulin on the Assembly floor before casting his vote against A.136.

“I think part of the reason why there’s so many loopholes and problems and concerns is for the entirety of civilization, doctors’ sole role has been to promote life, extend life, to provide health,” Sempolinski said. “And now we are taking that preventative profession and asking it to do the exact opposite of the reason that it exists. When you try to pervert that and reverse that, it simply doesn’t work and you run to all these reasons why you’re going to have people fall through the cracks, all these problems that my friends keep bringing up, all these loopholes. So we’re trying to take an entire body of law and thousands of years of history and flip it.”

WHAT THE BILL DOES

The Medical Aid in Dying Act would provide a mentally competent, terminally ill adult who has been given a prognosis of six months or less to live the ability to request medication from their treating physician for medical aid in dying. The legislation includes safeguards, which would require both an oral request and a witnessed written request for the medication, as well as requiring at least two physicians to determine that the patient has the capacity to make an informed decision on this request. Insurers would be prohibited from recommending or providing information on medical aid in dying to patients, including alongside denial of coverage notices for other treatments. Insurers would only be permitted to provide patients with information on medical aid in dying when the patient or their physician expressly requests such information or within general coverage information. Additionally, the legislation would provide legal protections for the patients and their physicians.

Paulin’s legislation creates a process that would begin with a patient’s request for medication that would end their life. That request has to be both oral and written, signed and dated by the patient and witnessed by at least two adults. Witnesses could not include the patient’s attending physician, consulting physician or the mental health professional who provides a capacity determination that is required under Paulin’s bill.

Patients can rescind their request for life-ending medication at any time and an attending physician can’t write a prescription for life-ending medication without first offering the patient a chance to reverse the request. If a physician thinks a patient lacks decision-making capacity to make an informed decision the doctor is required to refer the patient to a mental health professional to make a determination. A patient deemed unable to make an informed decision would not be allowed to end their life. Before medication is prescribed, there must be a written request form on file as well as a declaration from witnesses.

The law exempts physicians, pharmacists and other health care professionals from civil, administrative or criminal liability, though lawsuits could still be brought in cases of negligence, recklessness or intentional misconduct. Health care professionals are also not under any duty or contract to participate in giving the medication to a patient. Paulin’s bill exempts a physician, nurse, pharmacist or other health care provider from having to participate in the provision of medication to a patient, though care providers that won’t participate have to transfer or arrange for the transfer of a copy of the patient’s relevant medical records to a new health care provider.

A private health care facility may prohibit the prescribing,.dispensing, ordering or self-administering of medication under the article while the patient is being treated in or while the patient is residing in such facilities. Health care facilities that adopt a prohibition would have to transfer patients who want to use medication to end their lives to another facility that is “reasonably accessible” and willing to comply with the patient’s request. Employees of health care facilities that have adopted a prohibition against participating in medication-assisted suicide can face penalties from the facility, as long as employees have been notified of the prohibition in writing.

“This is about giving individuals autonomy, dignity and choice at the end of their lives,” said Assembly Speaker Carl Heastie. “This legislation will give people the ability to choose to go peacefully in their sleep, and ensure there are critical safeguards in place. Thank you to Assemblymember Amy Paulin for her tireless advocacy and hard work on this legislation.”