New York State SmartTranscripts:

[Crystal D. Peoples-Stokes (Majority Leader)]: Speaker, would you please call the house to order?

[Presiding Officer (Acting Speaker/Chair)]: The house will come to order. Good afternoon, colleagues and guests. In the absence of clergy, let us pause for a moment of silence. Visitors invited to join members in the Pledge of Allegiance. A quorum being present, the clerk will read the journal of Tuesday, February 3. Miss People Stokes?

[Crystal D. Peoples-Stokes (Majority Leader)]: To dispense with the further reading of the journal of Tuesday, February 3 and at the same stand approved.

[Presiding Officer (Acting Speaker/Chair)]: Without objection, so ordered.

[Crystal D. Peoples-Stokes (Majority Leader)]: Thank you so much. Colleagues that are in the chambers as well as our guests, I have a quote I'd like to share with you today. This one is from Julia Anna Julia Cooper. She is a pioneer educator and an author, well known for a very influential book that was written in 1892. It's called a book from the voice of the South. Her quote can actually be found on your passport. I know most of us have one of those. And her words for us today, the cause of freedom is not the cause of a race or a sect, a party or a class. It is the cause of humankind, the very birthright of humanity. Again, these words from Anna Julia Cooper, an educator and writer from the past. Madam speaker, colleagues have on their desk a main calendar. We are going to start by taking up resolutions to seat our newest members. From the 36th Assembly District, have Diana Moreno. And from the 74th Assembly District, we have Keith Powers. At a later date, we will do a more thorough and formal introduction of our new colleagues, which we're very happy to see. But right now, we would just like to welcome them as new members to our chambers. Mister speaker?

[Carl E. Heastie (Speaker of the Assembly)]: Okay. The clerk will read.

[Reading Clerk]: Assembly number 927, mister Hasty. Assembly resolution in relation to the election and seating of Deanna C. Moreno as member of the assembly from the 36th Assembly District.

[Carl E. Heastie (Speaker of the Assembly)]: The clerk will record the vote. Are there any other votes? Announce the results.

[Reading Clerk]: Ayes, one twenty seven, noes, zero.

[Carl E. Heastie (Speaker of the Assembly)]: Miss Peekel Stokes.

[Crystal D. Peoples-Stokes (Majority Leader)]: Madam speaker, if we could now, before you do any housekeeping and or other introductions, if you could just call the rules committee to the Speaker's Conference Room.

[Carl E. Heastie (Speaker of the Assembly)]: We have a second thoughts, Keith.

[Crystal D. Peoples-Stokes (Majority Leader)]: Oh, okay. There's another resolution. Okay. On

[Carl E. Heastie (Speaker of the Assembly)]: the second resolution, the clerk will read.

[Reading Clerk]: Assembly number 928, mister Hasty, legislative resolution in relation to the election and seating of Keith Powers as a member of the assembly from the 74th Assembly District.

[Carl E. Heastie (Speaker of the Assembly)]: Clerk will it call the vote? Announce the results.

[Reading Clerk]: Ayes, one twenty nine, nos, zero.

[Carl E. Heastie (Speaker of the Assembly)]: The resolution is adopted. So I just wanna say welcome officially to our two colleagues our two new colleagues. Joining the people's house is a privilege that only a 150 of us in this great state of New York are lucky to do it. So we do great things here. We have great members on both sides of the aisle. So I just wanna say welcome to the family.

[Presiding Officer (Acting Speaker/Chair)]: Miss PeopleStopes?

[Crystal D. Peoples-Stokes (Majority Leader)]: If I could again, madam speaker, before any housekeeping or introductions, can you call the rules committee to meet off the floor? This committee is going to produce an a calendar, which we are going to take up today, And then we're gonna take up calendar resolutions on page three. Majority members should be aware that there will be a need for a conference immediately following our work on the floor today. And as always, we will consult with our colleagues on the other side of the aisle to determine what their needs may be. There may be a need, madam speaker, to announce a further floor activity. If that is the case, I will do so at that time. However, that's a general outline of where we're going today. If you could now begin by calling that rules committee.

[Presiding Officer (Acting Speaker/Chair)]: Thank you. Rules committee to the Speakers Conference Room. Rules committee members, please make your way quietly to the Speakers Conference Room. We don't have any housekeeping. We have several introductions that we'll be limiting to two minutes each. We will start with miss Clark for the purpose of an introduction.

[Sarah Clark (Member, AD 136)]: Thank you, madam speaker. I have the fantastic privilege today of welcoming a school group from the one thirty sixth Assembly District Aquinas Institute. This is the diversity club there that is a club solely dedicated to learning about diverse experiences, voices, and ensuring we create a very inclusive world. It is a special privilege for me because the co presidents are Ryan Wieper and my sophomore daughter Grace Clark, who helped lead this club and all the great work they're doing. And a huge shout out to all my members that came and spoke with them today. Our body is such a diverse body of voices, ideas, policy, backgrounds, occupations, passions, and they really got to see that firsthand by everyone who spoke with them today, asking a lot of wonderful questions and really ensuring that our next generation has the same commitment to diversity, inclusion, and elevating everyone's voice to make all New Yorkers better. And so would you please welcome them here to the chamber today?

[Presiding Officer (Acting Speaker/Chair)]: On behalf of miss Clark, the speaker, and all members, welcome young people to the assembly chamber. We hope you had a great opportunity to speak to members today, learn a bit about what we're doing, and how you can advocate and amplify your voices. We extend the privileges of the floor to you and hope you enjoy the proceedings today. Thank you so very much for traveling the three hours to be here with us today. Thank you. Ms. Rez, for the purpose of an introduction.

[Karines Reyes (Member)]: Thank you, madam speaker. It is my distinct honor to rise today and introduce to this chamber the Consul General of Mexico in New York City, Marcos Bucio and his staff. The Consulate of Mexico serves as a vital bridge between our state and our one of our largest ethnic groups in the state, Mexico, and New York share a deep cultural and historical ties strengthened by the contributions of millions of Mexican nationals who live, work, and raise families across our state. With us today is consul general for Mexico's consulate in New York City, Marcos Bucio. He is joined by his chief of staff, Francisco Barra, and his political affairs advisor, Juaneri Silva. Through the leadership of Consul General Marcos Busio, the Mexican consulate has played a critical role in supporting its community, promoting cross border cooperation, and advancing dialogue on issues that matter to both our governments, from trade and labor, to education, culture and public service. Marcos Bucio was a former deputy and member of the Mexican Congress from 1997 to 2000. He was recently named the president of the Council for Latin American Consulates of New York City. The presence of the consul general here today reflects the strength and the relationship between Mexico and the state of New York, and our shared commitment to collaboration and opportunity for all. Madam Speaker, please join me in welcoming the honorable consul general of Mexico to our chambers, and please extend all the cordialities of the house.

[Presiding Officer (Acting Speaker/Chair)]: On behalf of miss Reyes, the speaker, and all members, welcome, sir, our distinguished guests from Mexico. We welcome you to our assembly chamber and extend the privileges of the floor to you. We do hope you enjoyed our proceedings today. Thank you so very much for joining us. Mister DiPietro, for the purpose of an introduction.

[David DiPietro (Member)]: Thank you, madam speaker. Rise, I've got some personal friends and some constituents that I was able to who have really enjoyed seeing the Hall Of Flags, the million dollar staircase, enjoying the just enjoying the capital. Danielle Cassass, Steven Gillen, Kim Hermats, Randy Barber, Patty Kelly. Just as we walk them around and show them some sites, I'd like to welcome them to the chambers, please.

[Presiding Officer (Acting Speaker/Chair)]: On behalf of Mr. Dupietro, the speaker and all members, welcome. We appreciate you coming to visit our assembly chamber and extend to you the privileges of the floor. We hope you're able to spend some time today enjoying our proceedings. Thank you for traveling that far distance to come visit us with us today. Thank you so much for joining us. Mister Colton, for the purpose of an introduction.

[William Colton (Member)]: Madam speaker, I am pleased to welcome representatives of GOSH, a small business and restaurant based in Brooklyn. GOSH is known not only for its excellent cultural food specialties, but also for its small strong commitment to giving back and surround and supporting charitable efforts in my district and throughout Brooklyn. The business is owned by Bakhtiar, Khadarov, Timur Yuniv, and Abdurasid Imov. Joining us in the chambers today is their manager, Nordov Arzivov. We thank them for their intepressions and community involvement and meaningful community concerns for our neighborhood in Brooklyn. Madam speaker, I ask that this representative of this entrepreneurship be welcomed and given the casualties of the house.

[Presiding Officer (Acting Speaker/Chair)]: On behalf of mister Colton, the speaker, and all members, welcome Brooklyn restaurateurs to our assembly chamber today. We extend the privileges of the floor to you. Thank you for all you do in the community, with your engagement, definitely boosting economic development. We hope you enjoy the proceedings today. Thank you so very much for joining us. Mister Alvarez, the purpose of an introduction.

[George Alvarez (Member)]: Thank you, my last speaker, for the opportunity to introduce a distinguished guest from Italy, Giovanni Petruchi. Giovanni, for more than twenty five years, has served with great honor as a part of the Vatican security, entrusted him with the protection of four popes, including our current holy father, Pope Leo fourteen, ensuring safety, public order, and stability at the highest level of responsibility. Mister Petrocchi is also the president of the Dominos Jesus Foundation based in New York and Romania, where for the past five years, he has advanced human rights and social justice, building on a lifetime of services, shaped by his experience and civil and ethnic conflicts where he worked to protect civilians, maintain peace, and assist those seeking refugee. Madam speaker, please welcome mister mister Giovanni and extend all the cardiology of the house.

[Presiding Officer (Acting Speaker/Chair)]: On behalf of mister Alvarez, the speaker, and all members, welcome, to the people's house and we extend the privileges of the floor to you. Thank you so much for the very important work that you have done and your long time civic engagement. We hope you enjoy our proceedings today. Thank you so very much for joining us. Page three, calendar resolutions. Clerk will read.

[Reading Clerk]: Assembly resolution nine two four. Mister Ikis, legislative resolution memorializing governor Kathy Hochul to proclaim 02/03/2026 as for Chaplain's Day in the state of New York.

[Presiding Officer (Acting Speaker/Chair)]: Mister Ikis, on the resolution.

[Unidentified Assemblymember ('Mr. Ikis')]: Thank you, madam speaker. Yesterday, February 3, we observed four Chaplains Day. And today, I rise in support of a resolution proclaiming 02/03/2026 as the four Chaplains Day in the state of New York. Four Chaplains Day commemorates the heroic sacrifice of four United States Army chaplains who gave their lives on 02/03/1943, when the American troopship, the SS Dorchester, was torpedoed during World War two. As the ship sank, these men gave up their life preservers so that others might live. The four chaplains were Lieutenant George L. Fox, a Methodist minister, Lieutenant Alexander D. Good, a reformed rabbi, a native of New York, Lieutenant John P. Washington, a Catholic priest, and Lieutenant Clark B. Polling of the Reformed Church in America. In the final moments of the ship, survivors reported that the four chaplains stood together praying hand in hand, a powerful symbol of unity, faith, and selfless service. In 1988, the United States Congress formally designated February 3 as four chaplains day. By adopting this resolution, New York honors their sacrifice and reaffirms the values they represent. Thank you, madam speaker.

[Presiding Officer (Acting Speaker/Chair)]: Thank you. On the resolution, all those in favor signify by saying aye. Opposed? No. The resolution is adopted.

[Reading Clerk]: Assembly resolution nine two five. Miss McMahon, legislative resolution memorializing governor Kathy Hochul to proclaim 02/04/2026 as girls and women in sports Day in the State of New York.

[Presiding Officer (Acting Speaker/Chair)]: Ms. McMahon on the resolution.

[Karen McMahon (Member)]: Thank you Madam Speaker for allowing me to speak on this resolution. I'm honored to introduce the resolution proclaiming Girls and Women in Sports Day and I thank my colleagues who have joined me. This past weekend I was in Philadelphia with my family, my three daughters, all who played sports, mainly basketball. And we were there to watch the unrivaled league which is the WNBA Stars three on three league, their off season league. It drew over 20,000 fans which was a record number of fans for any event ever in the Wells Fargo Arena in Philadelphia. And we got to witness a record setting performance by Marina Mayberry. She's a WNBA player for Connecticut. She scored 27 points in one seven minute quarter of three on three basketball. It was amazing. Women's sports is having a moment. It was inspiring, it was empowering and most importantly it was joyful. All the things that sports should be and the things that women's sports definitely brings to the table. So thank you all for honoring girls and women in sports and all the good things it brings to the world. Thank you.

[Presiding Officer (Acting Speaker/Chair)]: Thank you. The resolution, all those in favor signify by saying aye. Aye. Opposed, no. The resolution is adopted.

[Reading Clerk]: Assembly resolution nine two six. Miss Griffin, legislative resolution memorializing governor Kathy Hochul to proclaim February 2026 as School Counseling Week in the State of New York in conjunction with the observance of National School Counseling Week.

[Presiding Officer (Acting Speaker/Chair)]: On the resolution, all those in favor signify by saying aye. Opposed, no. The resolution is adopted. Miss People Stokes.

[Crystal D. Peoples-Stokes (Majority Leader)]: Madam speaker, colleagues have on your desk an a calendar. I would like to now move to advance that a calendar.

[Presiding Officer (Acting Speaker/Chair)]: On a motion by Ms. People Stokes, the A calendar is advanced. We are gonna be on debate. I need everyone to take their seats, take their conversations to the hallway. Please, if we can make our way to our seats.

[Crystal D. Peoples-Stokes (Majority Leader)]: The eighth calendar now being advanced, if we could call our attention to page four of that calendar and go right to rules report number 77 by miss Paulin.

[Presiding Officer (Acting Speaker/Chair)]: Thank you. Page four, rules report 77. Clerk will read.

[Reading Clerk]: Assembly number 9515, Rules Report 77, Ms. Pollan, an act to amend the public health law and the education law.

[Presiding Officer (Acting Speaker/Chair)]: An explanation has been requested. Ms. Pollan.

[Amy Paulin (Member, bill sponsor)]: Of course. The bill is a chapter amendment to the Medical Aid in Dying Act. The changes are essentially to add safeguards, restrictions, clarifying language and some technical changes.

[Presiding Officer (Acting Speaker/Chair)]: Mister Jensen?

[Josh Jensen (Member)]: Thank you, madam speaker. Will the sponsor yield?

[Presiding Officer (Acting Speaker/Chair)]: Will the sponsor yield?

[Presiding Officer (Acting Speaker/Chair)]: Yes. Sponsor yields.

[Josh Jensen (Member)]: Thank you very much. And I just want to recognize the debate we had last year on the original bill in chief and the appreciation I know of all the public about this chamber and this body's debate on the bill and also recognize that many of the components of this chapter amendment were based on the very serious and sober concerns and thoughts that were brought up on debate. But going on that, I just want to touch on a few of the intricacies of the amendments that are contained in this bill and how it impacts the bill in chief. One of the amendments brought today states that the attending physician must conduct an in person examination absent extraordinary hardship. Does anything in this legislation reference changes to the examination by the consulting physician? Or could that still be done via telehealth or by an out of state doctor?

[Amy Paulin (Member, bill sponsor)]: There's no restrictions on the consulting doctor or the mental health provider.

[Josh Jensen (Member)]: So that would still be that could still be done via telehealth?

[Amy Paulin (Member, bill sponsor)]: Yes.

[Josh Jensen (Member)]: Okay. In the original debate, myself and plenty of our colleagues brought up the possibility of doctor shopping or the creation of a cottage industry to allow individuals to access this care when the original physician may not be willing. Where a patient could seek a doctor and they would give them the six month diagnosis that their original physician wouldn't, If a patient from say the North Country had their original doctor not be willing to grant them a six month terminal diagnosis, but yet a doctor in New York City may be more likely or willing to grant that diagnosis or prescribe this medication, would the fact of travel be considered an extraordinary hardship to waive the in person examination?

[Amy Paulin (Member, bill sponsor)]: So first, the if the attending doctor it wouldn't be if the attending doctor said, Oh, you're going to live longer than six months, I would assume or think that someone would be very happy with that news. And so they would probably not go to another doctor to hear negative news. But let's say that the attending doctor said you have an incurable cancer and you're terminally ill and you are going to die in the next six months. However, that same doctor is not of the mind to participate in this program, medical aid in dying. Then if the patient was interested in pursuing that, then they would be able to go to another doctor because they would be referred by the attending doctor to someone who would give them all of those treatment options. One of the clarifying things in the Chapter Amendment is to ensure that the referral is made. So the end of life options would include hospice, it would include potentially medical aid and dying as well. And that would be in quotes, the new attending physician for the purposes of medical aid and dying. They would still need a consulting doctor to verify and then of course a mental health practitioner

[Carl E. Heastie (Speaker of the Assembly)]: as Understood.

[Josh Jensen (Member)]: And so I guess my previous question was more focused on what would qualify as an extraordinary hardship to waive the in person examination. So under the provisions of these amendments, could you define what would qualify as an extraordinary hardship?

[Amy Paulin (Member, bill sponsor)]: That the person was going to die within the time period that oh you mean for telehealth?

[George Alvarez (Member)]: Yeah.

[Amy Paulin (Member, bill sponsor)]: Oh I see. So yes, you know when someone is terminally ill, they may be too ill to even go next door.

[Josh Jensen (Member)]: Okay.

[Amy Paulin (Member, bill sponsor)]: So, I would say travel.

[Josh Jensen (Member)]: So travel because of the health needs of the individual or the travel meaning distance from Rochester to Poughkeepsie?

[Amy Paulin (Member, bill sponsor)]: I would say that the circumstances for the individual unable to go from one place to another.

[Josh Jensen (Member)]: Okay. And who would derma would the Department of Health, would they come up with in creating the promulgating the rules, would they determine the exact specifics of what would qualify as an insured hardship? Or would that be on a case by case, doctor by doctor provision?

[Amy Paulin (Member, bill sponsor)]: So the rules and regs per this bill require the department to do two things. One, to establish rules for reporting the medically and dying circumstance, right? And from the physicians and the doctors. And then also to deal with medication. There's nothing in here that allows for I guess they could always do rules, but it's not common in the other states. There were no rules around that circumstance. So I would think it would be between the provider and the patient.

[Josh Jensen (Member)]: Okay. So staying on the extraordinary hardship provision, is there anything in this amendment or in your legislative intent to have the Department of Health do an after action or verification on whether or not a waiver of telehealth was appropriately waived if that was the case?

[Amy Paulin (Member, bill sponsor)]: No, I would say no, there's going to be no audit on that or again it's between the provider and the patient.

[Josh Jensen (Member)]: Okay. Under these amendments, one of the changes is that the patient's request must be continue to be voluntary. Yet the patient under the original statute must be able to access this life ending medication independently. How would a physician determine voluntary that's not a word, I'm going go with it when the patient is dependent on family members or caregivers for daily care or that transportation to a prescribing physician?

[Amy Paulin (Member, bill sponsor)]: So, are several steps that are required. The first one is that there would be an oral request that now has to be either audio taped or video taped. The next is a written request that is witnessed by two people that are independent of the family and independent of any financial gain. And you know that's really what is required. There's also now a mandatory mental health evaluation, which I think would add to the level of confidence that we would have that someone was doing this voluntarily.

[Josh Jensen (Member)]: So nothing in terms of the extraordinary hardship would impact the ability of a patient to self direct their care or the taking of the life ending medication? No. Okay. With the mandatory health evaluation provision, would the mental health professionals which I know is either a psychologist or a psychiatrist, are they only examining the patient's ability to consent to accessing medical aid and dying? Or would they also be judging whether the patient is being coerced in any possible ways to take advantage of ending their life?

[Amy Paulin (Member, bill sponsor)]: I would imagine that they could evaluate anything that they deemed appropriate for the recommendation that they would have to give, a written recommendation to, as doctor or as a psychologist to allow this person to proceed with the medical aid and dying medication.

[Josh Jensen (Member)]: And so with the amendment mandating that they have to be examined by a mental health provider, is it only that they have to be examined once, or is there an ongoing mental health evaluation throughout the time from the first visit till they either end their life or pass from natural causes?

[Amy Paulin (Member, bill sponsor)]: We don't really dictate what the number of visits might require. We just basically say they have to have the mental health professional sign off, writtenly, writtenly. I sound like you.

[Josh Jensen (Member)]: We should all be so lucky.

[Amy Paulin (Member, bill sponsor)]: That they have to have a written, that they have

[Mary Beth Walsh (Member)]: to write, you get the point. They

[Josh Jensen (Member)]: have to affirmatively consent to mental Yes. Okay. And I know this is something I brought up on the original debate, but much of this process relies on the judgment of three separate providers. What would happen if there's a situation where the patient sees the attending physician, they see the consulting physician, the mental health provider then has questions about that acuity or about the coercion. And there's a disagreement between the triangle of providers about how they're going to properly move forward with the circumstances of the individualized person's care.

[Amy Paulin (Member, bill sponsor)]: All three providers have to be on the same page.

[Sam Pirozzolo (Member)]: Okay. Would

[Josh Jensen (Member)]: say under that circumstance, say it's the mental health provider who has a change, could a patient then say, I'm going seek a second opinion from another mental health provider? Or is it once that first mental health provider would deem would stop the process, the process has stopped?

[Amy Paulin (Member, bill sponsor)]: I would imagine if that first mental health provider wrote and said, wrote something to the attending and consulting doctor that this person is not capable of making medical decisions, then that would stop the process. But if the person who was seeking that help did not get that written negative, then I don't think there would be anything to preclude them from going to someone else. You know, maybe the mental health professional is uncomfortable with medical aid and dying as well and doesn't want to participate. And then refuses to write the letter. You know, so I would imagine that that person could go to another psychologist or psychiatrist.

[Josh Jensen (Member)]: Okay. In this circumstance, we're using the six month terminal diagnosis as the benchmark for accessing the care. But with the inexact science of medicine, there is the potential for somebody to live past the six months despite that diagnosis. Is there, within the amendments of this bill, is there any trigger that upon the expiration of the original six month diagnosis that there's a reexamination either by the attending physician, the consulting physician, mental health provider, or that the patient has to rerecord the attestation that they have continued acuity to consent to this process?

[Amy Paulin (Member, bill sponsor)]: So what we know from the thirty years experience that we have since Oregon first adopted their law and other states, you know California, very large state so they've had a lot of experience. Many, many, many people have availed themselves. That people don't take this medication until the very end. Because that's when they're in pain, extraordinary pain. Breakthrough pain as they call it. And the so we know that if someone had the good fortune to live longer than six months, it would be it has never been the experience that they would take their life or they would take the medication to end their life earlier than

[Josh Jensen (Member)]: the endpoint. That's what I'm presuming, they live, they feel good despite their diagnosis. They get the diagnosis on January 1, on July 4 they're celebrating Independence Day with their family, but yet they still have the prescription sitting in their medicine cabinet. That was my question, is there any provision in these amendments to address what happens at that point?

[Amy Paulin (Member, bill sponsor)]: Well, think the prescription is something that makes people, makes all patients who are in that circumstance feel protected. They feel protected from what could happen to them at the end of life. So, you know, we also know that about two thirds of the people who get a prescription use it, the other third does not, approximately. So, we know that there's going to be many people who never decide to take the medication. So I think it gives people peace of mind. And that's what really for so many of those months, that's what it's worthwhile goal just in getting the prescription for them and I think for us as legislators passing this bill. The other thing is if they get a terminal diagnosis within six months, think about the process. First they have to do an oral request. Then they have to get it recorded. Then they have to do a written request to witnesses. Then they have to do the consulting doctor. They have to do the mental health provider. All of which takes time. So, they are likely to get this well into those months because the waiting time for each, I don't know about you, but I just, you know, I just went to my I just had my annual physical. And when session was called for a day that I had it, unexpectedly snow week last week, I called and said, could I postpone it? September 8 they said. So, I know that doctor appointments are not easy to get always. And so, there's going to be a natural time period that is incubated into this process And that person is going to be a lot closer to death when they finally get the prescription.

[Josh Jensen (Member)]: Thank you, Madam Chair. Thank you, Madam Speaker.

[Presiding Officer (Acting Speaker/Chair)]: Thank you. Ms. Walsh?

[Mary Beth Walsh (Member)]: Thank you, Madam Speaker. Will the sponsor yield?

[Presiding Officer (Acting Speaker/Chair)]: The sponsor yield?

[Amy Paulin (Member, bill sponsor)]: Happy to.

[Presiding Officer (Acting Speaker/Chair)]: The sponsor yields. Thank you.

[Mary Beth Walsh (Member)]: I want to go through some of the changes that the chapter makes, kind of do that relatively quick. I don't have deep questions on a lot of them, but we'll see where it goes. So the first thing is that the chapter amendment limits medical aid and dying to residents of New York State. What is the threshold for residency? Is that defined in the chapter amendment?

[Amy Paulin (Member, bill sponsor)]: So the only other example we would have in the law to follow is residency for Medicaid. There's a Medicaid residency requirement. So we reached out to local DSS and we said, so what does that mean to you? Like how do you validate that? And we did get a response from my local DSS, you know, that was the easiest for me. And I will tell you what they said. Ah, very good. So all forms of proof must be dated within the last six months of the application. You need two proofs, a current bill or other statement, if you're a postmarked envelope, driver's license if you happen to have one with a current address, a magazine postcard or brochure with a non removable printed label. So essentially mail, that came to you as a resident that's within the six month period.

[Mary Beth Walsh (Member)]: Okay. So just an example that comes to mind is you have an individual that lives in New Jersey. They come to New York State. They wait a couple of days and they go into their into DMV and they get a driver's license. They've would that be enough to establish residency?

[Amy Paulin (Member, bill sponsor)]: Well, need one more thing. But again, that's going to take

[Mary Beth Walsh (Member)]: a little time. You know, DMV also is not a very quick process. You walk out with a temporary driver's Would that be sufficient?

[Amy Paulin (Member, bill sponsor)]: The intent, you know, the thing is there will be I think these are pretty standard. You know, you could do that with Medicaid as well, right? So these are the standard proofs that someone looks at. And I think that, you know, there's if someone is coming well, if they're coming from New Jersey, can stay there.

[Mary Beth Walsh (Member)]: They get example as far as Connecticut. Yeah, thought of that later. Yeah. I'm just trying to get at the idea that this is not going to be established in regulation, correct? I mean this is we're creating legislative history now as we speak and debate The

[Amy Paulin (Member, bill sponsor)]: department could put anything in regulation if they want. Okay. But it would be my suggestion to them that they don't and that they allow someone, for example, like we had member Pat Behee's son, you know, who relocated because he was using medical providers at Sloan, right? And he's relocated to the city and was there for quite some time and had probably lots of mail and bills that came to him at that address. But his intention was to stay there. He was ultimately he died in New York.

[Mary Beth Walsh (Member)]: Yeah, yeah. But he was always a New York resident though, right? I mean it Yes, was just a but question he of the other where in

[Amy Paulin (Member, bill sponsor)]: that are similar to his.

[Mary Beth Walsh (Member)]: I get what you're saying. Yeah, okay. So the chapter amendment moving on, the chapter amendment clarifies as we discussed during debate that a six month prognosis is needed to use medical aided dying and that's going be measured whether or not treatment is provided. So that's one change. And that clarified an issue that was raised in debate on the original bill. Yes. The patient request if oral must be recorded and the recording retained in the patient record. That was a change made by the chapter amendment. The chapter amendment requires that no one with any financial interest in the patient's death, for example, a person who maybe would receive assets under the patient's will or something like that, they cannot act as a witness or as the interpreter. Correct, that's another change that the chapter makes, which I think is a good one. Physical examination is required unless an in person examination would present extraordinary hardship. I just want to clarify that it's only the patient's hardship that we are concerned about, not the doctor, correct? That's correct. So if the doctor doesn't feel like getting in his or her vehicle and driving up to the North Country to see the patient in person, that's not going to qualify as an extraordinary hardship. Too bad so sad.

[Amy Paulin (Member, bill sponsor)]: I think again it's between the provider and the

[Mary Beth Walsh (Member)]: patient, But that would be the most likely common example because someone who is dying is not always mobile. Absolutely, understand that. All right, the mandatory mental health evaluation, am I correct in understanding that the chapter amendment is silent as to what the scope of the mental health evaluation is? That's left at the discretion of the mental health provider as far as what that individual, what that person is looking at or looking for. It just says evaluation. It's an evaluation. Okay. Do you so I noticed that the effective date of this has been kicked out January. Is do you happen to know why that was done? Is there an anticipation that there'll be regulations on any of these things that we're discussing to further provide further clarity? Well,

[Amy Paulin (Member, bill sponsor)]: we do give emergency powers to the department to establish rules and regs. But we did hear from providers like Sloan, as I mentioned, to Assemblyman Jensen, that they needed some time to establish some protocols. And I would imagine that any provider that wants to opt out also wants to establish some protocols or have conversations in their agencies or hospitals or facilities.

[Mary Beth Walsh (Member)]: Thank you so much. I'm sorry there's just a little background noise. Question on insurance. This chapter seemed to be silent on insurance and who would pay for this. So did I miss that from the original bill? Was that addressed? I'm just curious.

[Amy Paulin (Member, bill sponsor)]: No, was not addressed in the original bill nor in this one. Okay. And different states, you know, commercial payers may decide to pay for it, may not decide that we've seen everything, you know, in other states. It does not qualify for Medicaid. Okay. But both Medicaid and Medicare do provide hospice care. And eighty nine percent of the people are usually in hospice at the time when they take the medication or at the time when they're thinking about using it, right?

[Mary Beth Walsh (Member)]: And I get up, and I'm sorry to interrupt you, but it wanted to really was important to me that I catch that statistic and I couldn't hear you. How many what percent of patients are in hospice when they're About eighty nine percent. That's eighty nine percent. Thank you very much. And please continue, I apologize. Wanted to No, make sure I got I

[Amy Paulin (Member, bill sponsor)]: don't remember. I'm done.

[Mary Beth Walsh (Member)]: Oh, okay. All right. Very good. How many of these medical aid and dying suicides are anticipated in, say, year one? Has there been any idea of how many people we're talking about?

[Amy Paulin (Member, bill sponsor)]: No, I mean we have the statistic, I think it's twelve thousand four hundred and fifty five people as of December 2025 in the whole country.

[Mary Beth Walsh (Member)]: In the country.

[Amy Paulin (Member, bill sponsor)]: We have

[Mary Beth Walsh (Member)]: some states that just adopted it, Illinois and Delaware. I don't think they would have even had anybody in those in that data. So it depends, you know, it depends on how fast we can get this going. Does the chapter amendment make any changes made in response to the debate that we had regarding the safe disposal of unused medication? So that's something that will

[Amy Paulin (Member, bill sponsor)]: be regulated. That is one of the things the department will regulate. And I happened because I knew that was a question from last time, I did a little research On the actual drugs, I'm looking for them now, in my pile here. Well, it's I'll just say there's five common drugs. And when I looked at whether there's not on the schedule of you know, serious drugs or I found that most of it was not Schedule II drugs. You know, which is used, for example, for home care for hospice. So or for providers, you know, hospice trains. That is fentanyl for the most part and morphine to alleviate pain. Those are extraordinarily dangerous and serious. And those are on the shelf in someone's home. This, independently, because they don't get mixed together until they're going to be used for medication to end your life, has one of those on there. Morphine, which is similar. The others are not as severely toxic as the fentanyl and morphine, which is used and on the shelf could be even longer than you know, although hospice is typically six months as well, but it could be a year, you know, because our new laws for Medicaid patients is a year. So it's only when it's mixed together in a certain way. And so the department will have to reckon with that as they make their determination about, you know, the regulations to dispose of it.

[Mary Beth Walsh (Member)]: Okay. Does the chapter amendment or the bill in chief though direct the regulatory authorities to develop regulations on the safe disposal of this medication? Yes,

[Amy Paulin (Member, bill sponsor)]: the bill comes

[Presiding Officer (Acting Speaker/Chair)]: Does it

[Mary Beth Walsh (Member)]: say it in the chapter or is it in

[Amy Paulin (Member, bill sponsor)]: the That's in the original bill.

[Mary Beth Walsh (Member)]: The original bill. Okay. Okay. Okay. Now, does the chapter amendment it it does not require nor does the bill in chief require that the death be attended. Correct? I'm sorry? Attended death. It could be an unattended death. Correct?

[Amy Paulin (Member, bill sponsor)]: It could be. It's not usual.

[Mary Beth Walsh (Member)]: But it can be? It could be. Okay. The chapter amendment or the bill in chief require that the patient utilize hospice or palliative care first or at all? No. Okay. All right. I think that those were all of my questions. Thank you very much. And madam speaker, on the bill.

[Presiding Officer (Acting Speaker/Chair)]: On the bill.

[Mary Beth Walsh (Member)]: Okay. So the chapter amendment and I think that this bill is a very good example of the debate that we have. I thought it was a very thoughtful, certainly a very emotional debate, a difficult debate for many of us, myself included. But I think that the chapter amendment in several instances really does reflect some of the concerns that we raised on debate. And so as I constantly explain to people whether in my district or just out in the world, it it is an example of the the check and balance within the assembly body or the legislative body. And I think that that's a positive thing that we can take away. The debate was good. I think that there are certain things in the chapter amendment that I do like, that I do think improved the original bill. I'd like to explain though what has not changed and why I continue to voice my opposition to assisted suicide in New York. As was said, there is no requirement that the death be attended. If it is unattended and unwitnessed, you have the potential trauma to family members or people who discover the body. You don't know if the person died naturally or from the lethal dose. If there is no medication present and you know that a prescription was issued to the patient, you don't know what has happened to it. Was it given to someone else? Would that someone else have qualified for medical aid in dying who has it? That medication is dangerous and precautions for its safekeeping maybe will be developed down the road, but are not known right now what those would be. I'll give a personal example. My mom passed away in 2024 at a very, God bless her, very advanced age. And she was receiving hospice care at that time. She passed away at home. My sister and I were there with her. The first thing we did is we called hospice and they immediately dispatched a hospice nurse to come to the home. When she came to the home, the very first thing she did, other than offer condolences, was to immediately take stock of any medication that my mother had been taking, which included morphine. So she immediately took stock of all of it, you know, weighed it, measured it, logged it in and then immediately disposed of it safely on the property, even before anybody was called for the next steps involved with my care. So because the Chapter Amendment and the Bill in Chief doesn't require that a death be attended, And although I know that the sponsors indicated that a lot of these patients are utilizing hospice or palliative care at the time of their death, which is great, because there is that risk, that big is problem for me with the bill the way that it is right now. I think it could be further corrected and perhaps that correction will come in regulation, but I just don't know it right now and I have a big problem with that. The checks in place to look for informed consent, capacity and the absence of coercion all precede the issuance of the prescription. After that, there are no further checks. And there is no time limit within which the patient must take the meds after they are dispensed. That's also a huge problem for me. In other countries there are repeated further checks on the patient to make sure that the patient still has capacity, still consents and is still not being coerced. I think it was in Canada, there are no further than eight further check-in points with the patient during the process. That additional scrutiny is necessary, in my opinion, and is absent from this legislation. I think that that's especially important since according to the sponsor's debate on the original legislation, 40% of the time the medication is not taken at all. I think I have that number right from the original debate. Originally I gave an example about what do you do with a patient then who has Alzheimer's and has capacity at the time that the prescription is written but who doesn't take it until far later I'd like to continue to use my second 15, thank you at the time that the prescription is written but who doesn't take it until far later when capacity has been lost. There's no requirement that the death be attended by anyone. There's nothing there that says, hey, this prescription was written six months ago and the person is still alive. We should take back the prescription or we should reevaluate for capacity or this person died unattended and we don't know whether or not they used the prescription and now we can't find it. The entire chain of custody for what is by its very nature a lethal dose is very concerning to me and it remains so. The bill lays out ground rules and protections from outside coercion which I think is very, very important as far as direct pressure from interested parties or family members. But I don't think that that's as big of a problem compared to you pressuring yourself as the patient. You don't want your savings depleted, taking care of you in your final days. You want to see your grandchildren or your children receive assets. You don't want to be a mess at the end for your loved ones to see. The legislation doesn't address that kind of internal coercion or societal pressure. And I don't think that the mental health exam that is a requirement that's been added by the chapter, we don't really know what that's going to consist of. And we're really I'm hopeful that that mental health practitioner will consider those things with the patient when meeting with and evaluating the patient. I did not ask and I would have to go back and check, but I'm not, as I stand here right now, completely sure that that mental health evaluation cannot be by telehealth. And if that is the case, if I'm wrong, then I'm wrong. But if that is the case, that that also, as the physical exam can be under extraordinary circumstances done by telehealth, I think I'm even more concerned by the idea that a mental health evaluation could be done through telehealth. I mean, I think that in our attempts sometimes to embrace technology over time, and I felt this way when we were talking about electronic bill signing last week, I think that sometimes we lose something when we're talking about the most important touch points in a person's life. Certainly their life or death couldn't be more critical than that. I would hope that there would be that high touch personal touch that you would have with the patient. It wouldn't just be on a screen somewhere. There's the part of this bill that prohibits and this is not part of the chapter, this is part of the original bill, but it bears repeating. There's a part of the bill that prohibits calling the patient suicidal and self administering medication under this article shall not be deemed to be suicide. You know, I would say that suicide is defined as the act of intentionally causing one's own death. Isn't that exactly what we're talking about? If this is in fact such a dignified autonomous decision, then why are we taking such pains as a legislature in this bill to conceal it? I'm aware that the reason we don't want to call it a suicide is because we want to be sure that the insurance companies will still have to pay out to beneficiaries on life insurance policies, but we should call it what it is. It is government sanctioned suicide. That's what it is. This bill even says that on the death certificate, suicide won't be listed as the cause of death, but rather the underlying terminal illness or condition. Arguably, that's a perjury to commit a fraud on the insurance company. Yes, we are voting on the specifics of this bill, but we are also voting on a principle. And we are not just responding to the impassioned pleas of advocates with deeply personal individual stories, we are legislating for all New Yorkers. I don't believe personally that the state should be a part of taking a life. We haven't had capital punishment in New York since 2004 and the Court of Appeals ruled that it was unconstitutional. I do think that the state has an obligation to protect our most vulnerable New Yorkers from predatory relatives of the state itself and from themselves in some instances. I think that instead of medicilating and dying, we in the legislature should be doing a far, far better job showing that we can provide for assisted living before legislating assisted dying. What does that mean? Well, York currently ranks last I almost said dead last, that's so inappropriate, sorry nationally in terms of hospice and palliative care. I think that that is disgraceful. It is under sourced, it's under staffed and it's underutilized. Before I voted on this legislation, I would want New York to be number one in hospice care and palliative care. I think that I asked a question earlier today to have somebody try to give me the numbers of what New York spends each year. How much do we budget each year for hospice and palliative care? And it's a very, very opaque, kind of murky answer on that. We really know. We know how much the governor appropriates for PSAs. We know how much the governor appropriates for turning New York from potholes to knot holes. But we don't know how much New York State is really spending on its hospice and palliative care program. We don't know. We should know, but we don't know. This bill doesn't require that all reasonable means of treatment have been made, nor does it require that people try high quality hospice care first. And I can speak personally again with regard to my mother and other family members. Hospice and palliative care is such an enormous blessing and we don't utilize it enough. I would love to see some more action on the part of our government to really try to encourage people to understand the service that hospice and palliative care provides and to utilize it in longer than just the last twenty four to forty eight hours before death. Because it is a wonderful supportive help. But that's not this bill, so let me stick with the bill. The legislative process, my friends, is incremental and extremely imperfect. We all know that. So right now, this bill is specifically confined to adults with a terminal illness or condition with six months or less to live who can give informed consent and who can self administer the lethal dose of medication. Folks who advocate for people with intellectual and developmental disabilities have shown concern with this bill, and I believe with the entire concept of assisted suicide, because just simply having it devalues them in a society in which they fight to live. Look at our CDPAP system and the mess that's been caused by switching to a single fiscal intermediary. I was just on a call earlier this week where while the Governor is bragging about saving billions of dollars through that transition, there were real human beings on that Zoom talking about how it's really destroyed them and a lot of people that they know. We pay our direct caregivers, kind of, you know, giving them increases that they don't get, they don't actually get, forcing them to load up their folks and go to the war room each budget cycle, you know, beg to be treated with dignity and respect. And you look at how our state fails them every single time. Could any of us be surprised then if this assisted suicide bill, if people with IIDD are coerced by others or by themselves to just give up. Each and every life has value and as the parent of a child with developmental disabilities who's doing great, but being in that world a little bit and watching him, I know that progress is not always on a straight line. But people can get really derailed by depression. And we're having a press conference tomorrow talking about veteran suicide. We're having the mental health budget hearing right now as we speak and work in this chamber. We're all acutely aware that mental health issues play an important role in how we look at ourselves and what we think as far as our own worth. So having assisted suicide on the books in New York is fundamentally something that I can't support. I think when we look to our neighbors in the North Canada, we can understand this risk of incremental change even more. That country passed a similar law to New York's bill in 2016. Within a few short years, it was expanded to not only allow those with terminal illness, but also those with chronic illnesses such as arthritis to end their lives. In 2027, the law is set to expand to those whose only other underlying condition is mental illness such as depression, anxiety or anorexia. Other states who have previously passed a version of medical aided dying, they are already relaxing their original legislation. So for example, in California, they legalized in 2015. In 2021, the waiting period between requests shortened from fifteen days to forty eight hours. In Colorado, which legalized in 2016, 2017, and 2024 they expanded the bill allowing for advanced practice registered nurse practitioners to prescribe versus just physicians. In Hawaii, which legalized in 2018, they made amendments in 2023 which allow advanced practice nurse practitioners to prescribe and act as attending consulting providers for medical aid and dying. And we know that this is true from the work that we do in this body. We know that we start with one thing and then we change it over time. So that slippery slope is something that's real. It's not just a phrase, it's not just a saying, it's something that as we move forward from today, which we need to do, we need to be really vigilant and aware of that. I think we are opening the door to the next thing and the next by voting yes on this bill today. So in closing, I would rather have us take all of our energy and our love and our compassion for the people that are suffering with incurable illness and unremitting pain and continue to still vote no on assisted suicide. I think we need to work instead, work to make our hospice and palliative care system the best not the last, not the worst, not the least utilized, but the best in the nation. Let us find the resources to do it. And I truly believe in my heart that once we do that, the need for medical aid in dying would go away for the vast, vast majority of these patients. Continuing I'll to vote no, and Madam Speaker, I thank you for your time and thank my colleagues.

[Presiding Officer (Acting Speaker/Chair)]: Thank you. Mr. Gandolfo?

[Jarett Gandolfo (Member)]: Thank you Madam Speaker. Would the sponsor please yield for some questions?

[Presiding Officer (Acting Speaker/Chair)]: Will the sponsor yield? Yes, of course. The sponsor yields.

[Jarett Gandolfo (Member)]: Thank you very much. So, I apologize if some of these sound a little redundant, I'm still going to be looking for a little more clarity on some of them. My colleagues address some of the points I had, but I'd like to pick up at the change definition of a terminal illness. I know the clarifying term whether or not treatment is provided was added, but what exactly does that mean? Does that mean if someone has an illness or condition and they get treatment and their prognosis is still six months to live, they would be eligible? Or if they refuse treatment and their prognosis is six months, would they be eligible?

[Brian D. Manktelow (Member)]: Or is

[Jarett Gandolfo (Member)]: it both?

[Amy Paulin (Member, bill sponsor)]: Okay. It's something that we actually debated that your side of the aisle brought up when we debated the first bill. And this was put in to clarify and get away from the debate, so to speak. So I think the language is really clear now. And what it means is that whether or not you treat or not, you still are going to die within those six months.

[Jarett Gandolfo (Member)]: So how would that fit in with someone, let's say, has type one diabetes and elects to no longer take medication? That could obviously cause some real problems that would lead to someone's death. If an individual with type one diabetes refused treatment and then decided they wanted to elect for medical aid in dying, would they be eligible?

[Amy Paulin (Member, bill sponsor)]: So diabetes does not qualify for a medical aid in dying. It's not considered a terminal illness. It certainly could lead to a terminal illness. If you don't treat diabetes, it could lead to needing dialysis, right?

[Sam Pirozzolo (Member)]: Right.

[Amy Paulin (Member, bill sponsor)]: If someone's on dialysis as a result of diabetes, all they would have to do to which would be a lot shorter than this process is to take them off dialysis and they would die. So I'm not sure it's the best example.

[Jarett Gandolfo (Member)]: Right, but if sorry to cut you off. If someone was on dialysis and they just didn't want to be on dialysis anymore for whatever condition.

[Amy Paulin (Member, bill sponsor)]: They would die.

[Jarett Gandolfo (Member)]: Right, so would they be eligible for medical aid?

[Amy Paulin (Member, bill sponsor)]: They would die before they even But no, if dialysis is a treatment, they wouldn't be eligible.

[Jarett Gandolfo (Member)]: Okay, what about let's say in a scenario of someone with anorexia? And obviously, if you stop eating for an extended period of time, you will die. Would someone like that be eligible for medical aid in dying?

[Amy Paulin (Member, bill sponsor)]: I would say no. I know there was that one instance where they went to court and they argued that know that doctor defended that diagnosis. But I would say not in my opinion.

[Jarett Gandolfo (Member)]: Okay. And then let's say someone suffering from cancer, if they just wanted to stop pursuing treatment whether it's chemo or whatever treatment they're receiving, they would be eligible then?

[Amy Paulin (Member, bill sponsor)]: Again, the definition would hold. It's you know, I think when you go in for a cancer diagnosis, they say it's curable or it's not curable. They actually use those terms. So, if it's incurable, the treatments prolong your life.

[Carl E. Heastie (Speaker of the Assembly)]: Right.

[Amy Paulin (Member, bill sponsor)]: But they don't take away the terminal illness diagnosis. If they're curable, then they're not eligible because treatment would cure them.

[Jarett Gandolfo (Member)]: Okay, but if they refused treatment and they were curable, would they then be eligible

[Amy Paulin (Member, bill sponsor)]: At the point when they became incurable because of its advanced stage, because they didn't treat the underlying cancer. And then at some point it became incurable because it metastasized in their body, then that would be the point that they would be eligible.

[Jarett Gandolfo (Member)]: Okay, thank you for that clarity. Now, on to the required mental health evaluation. I know this is something we discussed in the original debate. I think you clarified to my colleagues that the mental health professional might not only be looking for capacity to make a decision but whether or not there are other factors weighing in, let's say depression, coercion or some kind of undue influence. Did I hear

[Sam Pirozzolo (Member)]: that correctly?

[Amy Paulin (Member, bill sponsor)]: We require in the bill is for the mental health provider to give that service and to write on paper both the consulting and attending physician that they deem that person mentally fit.

[Jarett Gandolfo (Member)]: Just mentally fit, so

[Amy Paulin (Member, bill sponsor)]: I'll look at the exact words so

[Jarett Gandolfo (Member)]: I that we don't don't need the exact language but like would mentally fit include someone who is suffering from depression or is it just understanding

[Amy Paulin (Member, bill sponsor)]: I don't know about you, but I sometimes suffer when I leave here after twenty four hours, you know, a little depression myself. But I still would think of myself as mentally fit to make a treatment decision and I think that's what the psychologist or psychiatrist is thinking about.

[Jarett Gandolfo (Member)]: Okay. Now, is there anything that outlines at what point in the process they see the mental health professionals? Is that after the attending physician, the consulting physician? Where do they fit into the process at which point?

[Amy Paulin (Member, bill sponsor)]: I don't know that we have an order of things, frankly. You know, we just need everything to happen before the prescription is given.

[Jarett Gandolfo (Member)]: Right, okay. And is there a referral made from one of the physicians to the mental health practitioner or?

[Amy Paulin (Member, bill sponsor)]: We don't say that there has to be a referral. Okay. The person could certainly seek out their own.

[Jarett Gandolfo (Member)]: Okay. There's nothing I guess precluding one of the other physicians from making a referral? No. Okay. And hypothetically all three physicians could work in the same healthcare system?

[Presiding Officer (Acting Speaker/Chair)]: Well, if

[Amy Paulin (Member, bill sponsor)]: you're on Long Island, you know right? Northwell dominates? Yes.

[Jarett Gandolfo (Member)]: Okay. Again, we discussed this a little bit in the first debate. So, there's still nothing that really would prevent an attending physician from always referring people to the same consulting physician and now introducing the mental health practitioner from always referring to that same person as well. You kind of have a So closed

[Amy Paulin (Member, bill sponsor)]: I would say that if you're going to an attending physician for a specific kind of cancer, the cancers are very unique, right? And you go to the highest level of expertise that you can. So if you happen to be if you have breast cancer or lung cancer or what have you, you're going to someone who specializes usually in that. Maybe they specialize in more than one. So when they offer you a suggestion on consulting, they're going to be offering you a suggestion on someone who also has that same specialty because otherwise how could they evaluate whether you're going to live or die in six months? So yes, it could be the same referral. But that's because the practice of oncology is unique and special and those doctors do talk to each other because they want to help people live as long as possible and they confer with each other.

[Jarett Gandolfo (Member)]: Right, okay. And another I know you discussed it a little bit with my colleagues before now. The consulting physician, there's just so I have it correct, there's no requirement for an in person evaluation. That's only for the attending physician?

[Amy Paulin (Member, bill sponsor)]: That's correct because of the advancement of the illness perhaps. But also typically what doctors who consult generally do, and we actually have an exception in the law currently for anyone consulting in the education law, we acknowledge that they often look at the tests that were done, the blood tests, the MRIs, the whatever. And they look and they say, oh. And that's they usually just don't look at someone and say, we know what's inside you to know whether or not you're going to live or not in six months, they need all that test. If they needed an additional test, they'd probably call for it. But typically, they're looking at test information. So, they don't always, they don't need the in person exam.

[Jarett Gandolfo (Member)]: Okay, and one thing from listening to the discussion earlier I was not totally clear on. Now, let's say the attending says the patient is eligible, the consulting physician agrees, but the mental health professional has some kind of issue with maybe their mental capacity. That doesn't necessarily stop the process. They could potentially seek out another mental health professional. Did I hear that correctly?

[Amy Paulin (Member, bill sponsor)]: They could, but I would say that it would halt it if the written communication was there. They need a written document saying the person is fine.

[Jarett Gandolfo (Member)]: Right, but if the mental health professional doesn't provide the written attestation that they think the patient is fine, what's stopping the patient from going to find someone who will provide that?

[Amy Paulin (Member, bill sponsor)]: They could.

[Jarett Gandolfo (Member)]: Okay, so they could potentially shop around for someone who's going to agree that they're mentally competent to make the decision.

[Amy Paulin (Member, bill sponsor)]: They absolutely could.

[Jarett Gandolfo (Member)]: Okay. Alright. Thank you for answering my questions. Madam speaker, on the bill, please.

[Presiding Officer (Acting Speaker/Chair)]: On the bill.

[Jarett Gandolfo (Member)]: Madam speaker, I appreciate that some of these changes made here in the chapter amendment are points that were raised on the debate last year. It is a difficult issue to deal with. A lot of people have strong emotions on it and have personal stories about friends and family members that they saw suffering who might have wanted this as a way to end their suffering. I am still concerned though that there are not sufficient guardrails to protect these people who are extremely vulnerable and suffering and in pain to make a decision that might not actually be what's best for them. And especially now upon hearing that the patient could just go doctor shop for someone who is going to give them the answer that they want to make the decision to end their lives. That's extremely concerning to me. So I I will be voting against this chapter amendment. I appreciate the sponsor for answering all of our questions here, but I would encourage my colleagues to vote no as well. Thank you, madam speaker.

[Presiding Officer (Acting Speaker/Chair)]: Thank you. Mister Slater?

[Matthew Slater (Member)]: Thank you, madam speaker. Will the sponsor yield for some questions?

[Presiding Officer (Acting Speaker/Chair)]: Will the sponsor yield?

[Matthew Slater (Member)]: Thank you very much.

[Presiding Officer (Acting Speaker/Chair)]: The sponsor yields.

[Matthew Slater (Member)]: I wanted to just touch upon a couple of items with some of the amendments that we are seeing here today, starting with professional misconduct. And it's my understanding that the bill with the current chapter amendments clarifies that the compliance with the act will not constitute as professional misconduct, but a physician's noncompliance with provisions of this act will be seen as professional misconduct. And I just wanted to have a conversation about that to better explain what we're trying to accomplish there. And so Sorry, your microphone wasn't on. I'm sorry? Your microphone wasn't on. Couldn't hear

[Amy Paulin (Member, bill sponsor)]: Oh, I'm sorry. We saw that as a clarification to the bill, not a change. You know, we just to make it clear that if somebody didn't follow the specifics, you know, that they could be guilty of professional misconduct.

[Matthew Slater (Member)]: If they don't follow the specifics, great. I wanna come back to that in in just a moment to make sure I'm clear. Because what we're saying is, and I guess going back to whether it's the bill in chief or this amendment, the question really is, is it the intent that the failure to participate in prescribing medical aid in dying is considered professional misconduct? Or is it the failure to abide by the full terms? Or is the intent of the act or is it the full terms?

[Amy Paulin (Member, bill sponsor)]: It's not if somebody doesn't want to participate, then they don't participate. It's only for the participating doctors and they have a lot of things to comply with. And if they don't comply 100%, they could be guilty of lots of different things. But one of them is professional misconduct.

[Matthew Slater (Member)]: Because you had said to one of my colleagues earlier today that a physician can opt out. Yes. What does that process look like? How does a physician opt out? That a case by case basis? Or is it just a blanket

[Amy Paulin (Member, bill sponsor)]: policy It could be, that happens it's up to the doctor. It could be case by case for them. Or it could be that they don't want to participate in this at all. Or it could be their institution has said if you want to work in this institution, you can't participate. So, there's a lot of different ways that a medical professional could opt out.

[Matthew Slater (Member)]: Now, is it just the prescribing doctor that has the option to opt out? Or is it any of

[Amy Paulin (Member, bill sponsor)]: the medical professionals? Anybody could opt out.

[Matthew Slater (Member)]: Whether you're a pharmacist or the mental health provider, whoever it might be has the ability to opt out of participating. You could opt out. And if somebody though, in regards to the professional misconduct, is that professional misconduct applied being applied to everybody in the same vein? So whether you're the pharmacist, the mental health provider, or the prescribing doctor, you still are held to the same professional misconduct standards?

[Amy Paulin (Member, bill sponsor)]: If you're opting out, then it doesn't apply to you. If you're not opting out, then whatever the professional standards that are violated, you could be brought up on those charges.

[Matthew Slater (Member)]: Are those criminal or civil charges?

[Amy Paulin (Member, bill sponsor)]: It depends on what you've done wrong. For the most part, the criminal charges, If you coerce someone, if you even if you administered, I mean that would be a violation. It's self administered. You know, the doctor cannot assist. You know, I know that we you know, some members on your side of the aisle have been calling it physician assisted suicide. It is not physician assisted. That would be a violation. A serious one. And could be subject to felony charges and professional misconduct.

[Matthew Slater (Member)]: Understood. Going back to the fact that you could take it by a case by case basis, do any of the providers, is there guidance into how they can establish in the case by case instance so that they are not accused of professional misconduct if they choose to participate in one case but not another?

[Amy Paulin (Member, bill sponsor)]: These doctors do not work in a vacuum. That's why a cancer facility like Sloan said we need a little time to help our doctors make those judgments and those decisions. So I think they're either at I know in the city more than I outside the city, but there's many, many large institutions, Montefiore, Mount Sinai, they all Columbia Presbyterian, they all have positions that are doing this and they're going to help them make appropriate decisions

[Brian D. Manktelow (Member)]: by But does the this protocols they've

[Matthew Slater (Member)]: particular amendment speak to if Montefiore is going to provide guidance to their doctors, does that have to be approved by the Department of Health?

[Amy Paulin (Member, bill sponsor)]: No, I think they're just going to be helpful to the doctors to know what protocols to use.

[Matthew Slater (Member)]: But then how do we validate that the actual guidance that individual hospitals, is what you're telling me, are providing their doctors is in fact A, in accordance with the law and approved by the state so that they do not put themselves in a predicament where if they're doing a case by case basis

[Amy Paulin (Member, bill sponsor)]: I think that the law is very clear on what they have to do. There will be additional requirements that they have to report to the health department, that the health department will determine what those are. The facilities will make decisions about whether or participate. If they choose to participate, they will then likely, as Sloan has indicated to us, have some kinds of protocols that they establish. That is true for every treatment that they use currently. This is just one more tool in the toolbox for someone who's dying.

[Matthew Slater (Member)]: But in regards to the facility, if the facility now is providing the guidance to the individual provider, Excuse me. Is there any exposure for the facility itself since we don't need it approved by the state? And if you're telling me that there can be a case by case opt out, if there is an accusation of professional misconduct, does that not trickle up then to the individual facility since there is no state approval of that guidance? No. There's no exposure to the individual hospitals despite they're the ones who are setting the policy.

[Amy Paulin (Member, bill sponsor)]: They are the ones who really have the most expertise on all of these kinds of treatment options. I would argue that they should be telling the health department what would be appropriate in an end of life circumstance.

[Matthew Slater (Member)]: Understood. I appreciate the interpretation. I also just wanted to touch base on the patient request in regards to witness attestations. What training or guidance, if any, do those witnesses receive to help them identify subtle coercion as opposed to overt force?

[Amy Paulin (Member, bill sponsor)]: I think the fact that we ask for two witnesses, we also specify that they can have no financial gain and a lot of other things. It's a long witness form. And so can they by all of those requirements and those are the same requirements that we've seen in other states, we can feel pretty confident that those forms and the specification that we actually have in the law, you don't see that often. We actually have in the law word for word what those statements say. We can feel I think pretty comfortable that those witnesses are attesting to exactly what's on those forms which is an attestation that the patient has not been coerced.

[Matthew Slater (Member)]: But they received no training. That's the basic question. There's no training to

[Amy Paulin (Member, bill sponsor)]: No do training for the witness. Thank you.

[Matthew Slater (Member)]: And in regards to non eligible witnesses, would they be able to be in the room when, if you're a non eligible witness, if a patient is recording their request, are they able to be present during that time? We don't say. Silent on that. And would an approved witness be required to be there during that recording?

[Amy Paulin (Member, bill sponsor)]: For the audio and visual you're saying?

[Matthew Slater (Member)]: Yes. Do you need do you need one of the approved witnesses?

[Amy Paulin (Member, bill sponsor)]: My my understanding, know, when that provision was suggested by the governor's office, we looked into it and we have a couple of nurses here. And so I asked them how that would work and if it's something they could use. I also asked hospitals and I vetted it. And my understanding is that it would most likely occur in the attending office of the patient and the physician. And it would likely be, what do you say? You know, right there and then. So it's, you know, so could the person do it at home and send it in? Yes. But it's much more likely to occur when the person is doing their oral ask which is going to be in the presence of the attending physician.

[Matthew Slater (Member)]: But either way, doesn't say specifically whether an approved witness is required to be there.

[Amy Paulin (Member, bill sponsor)]: No, that's for the written, that's not for the video

[Matthew Slater (Member)]: only. For the video only. Yeah. Right. So we don't know really who else is with the individual when that video is being taken. No. Or the audio is being recorded. No. Okay. Understood. Great. Well thank you very much for

[Amy Paulin (Member, bill sponsor)]: I will say though that the oral has to be to the provider, right? So in some way it has to get to the provider where the provider feels confident that the person is asking.

[Matthew Slater (Member)]: Understood, but the law is silent on who else is in the room even though it's going to the provider, you don't know who else is there.

[Amy Paulin (Member, bill sponsor)]: Yet the provider will be there. They are an extra person. Whether or not there's a family member or someone else in the room, we're silent.

[Matthew Slater (Member)]: Silent on that. Thank you very much. I appreciate you answering my questions. Speaker, thank you very much for the opportunity to ask these questions.

[Presiding Officer (Acting Speaker/Chair)]: Thank you, mister Bologna.

[Sam Pirozzolo (Member)]: Thank you very much. Madam speaker, would the sponsor yield for a few quick questions?

[Presiding Officer (Acting Speaker/Chair)]: Will the sponsor yield?

[Sam Pirozzolo (Member)]: Sorry.

[Presiding Officer (Acting Speaker/Chair)]: The sponsor yields.

[Sam Pirozzolo (Member)]: Yes. Awkward angle, I apologize.

[Amy Paulin (Member, bill sponsor)]: That's okay. I'll just base my microphone so others can hear me.

[Sam Pirozzolo (Member)]: It's okay. I'm used to people not looking at me when they're talking to me. So it's all good.

[Amy Paulin (Member, bill sponsor)]: How many kids do you have?

[Sam Pirozzolo (Member)]: Alright, so to clarify, and this is touching on some of what my colleagues have asked, there are no changes to the safe disposal portion of this the bill in chief, correct? There's no

[Amy Paulin (Member, bill sponsor)]: amendments No, what's that the would what? Safe

[Sam Pirozzolo (Member)]: disposal portion?

[Amy Paulin (Member, bill sponsor)]: Oh, no. That's still required that the health department sets out rules and regs. Like they probably set out the rules and regs for the hospice providers to dispose. You know, there's rules and regs, pharmacists have them. You know, what you do with schedule two drugs or schedule one drugs for that matter.

[Sam Pirozzolo (Member)]: Thank you very much. So, what I want to focus on is a little bit earlier in the debate, you said that one third of people who are prescribed these medications ultimately don't end up using them. And that's the third I want to focus on here.

[Reading Clerk]: Okay.

[Sam Pirozzolo (Member)]: So, you've also said in previous debate and today that people you know liked having the safety of and the protection, feeling safe of having these in their home and I can appreciate that. And, people would like to you know pass on in their home. Again, I appreciate that as well. My concern is that there is a little bit of ambiguity in terms of well actually there's not ambiguity. You shall take these medications to to be disposed off. Last year, you made a very good point where in a lot of situations, families are, you know, obviously grieving, bereaved, and and, hey, let's get the medication and bring it to a safe disposal location is not exact exactly top of mind. So, I can imagine that there's going to be scenarios in which these drugs are just kind of left there. Are there any what's the liability on that?

[Amy Paulin (Member, bill sponsor)]: So again, I looked into the drugs, right? And there's five drugs. Morphine being the highest on the schedule.

[Jarett Gandolfo (Member)]: Yes.

[Amy Paulin (Member, bill sponsor)]: You know, John could probably, you know, speak better to the severity of the different drugs. But I did see that of those five drugs that only one would rise to a point now where there would be a requirement to have them safely disposed. The others are barbiturates that are often on the shelves of people. And so it's only when they're mixed together in a certain way that they would be lethal. And so if left, I would say we should worry about the morphine like we would worry if somebody was on morphine due to and died suddenly and you didn't call hospice like our colleague did. And so therefore nobody took it off the shelf. It's exactly the same thing. And there's a record though of those drugs. Not very many people are going to be doing this. Only one percent of people who are eligible to die are going to be availing themselves of this. This is you know pretty valid statistic based on our experience in other states. So very few people are going to have this. There's going to be a reporting from the physicians to the health department. I could bet you there's going

[Unidentified Assemblymember ('Mr. Norber')]: to be

[Amy Paulin (Member, bill sponsor)]: an active look where are those drugs based on the protocols and the rules and regs that

[Sam Pirozzolo (Member)]: the health department establishes. So, and I can appreciate that as well. But, I mean, people do crazy things. I mean, a couple years ago, I remember people eating Tide Pods because that was a a trend. So, you know, my my concern is is with these drugs now kind of just out there, and I understand that you have to to mix a solution, but, you know, if you are someone that is mentally struggling with depression, and again, I'm not the prescribed patient, just a family member who is, you know, grieving the loss of a loved one, and you know that these drugs are in the house, you know, you may consider taking them yourself. So, I guess my concern is, and and this is kind of where the the the lack of a very specific plan within the within the text of the bill and leaving up to regulation kind of concerns me a little bit because, you know, there has to be some type of I I understand what you're saying where there has to be some type of, you know, accounting in in with the ISTOP program, we have a lot of things. But what I guess what I'm trying to to to get across here is that you're now putting these drugs out into the atmosphere, into the community, and, you know, people could use them in a way that will harm them. So what is your intent? And as far what is the legislative intent as far as directing is it DOH? To make regulations? Is there a legislative intent that you were hoping that DOH will follow as far as the safe disposal?

[Amy Paulin (Member, bill sponsor)]: Whatever they think is appropriate and safe for the public. You know, just to say what these drugs are, one is Valium. Mhmm. Something that's commonly prescribed and used. So if somebody took the Valium, you know, it's not different than getting a prescription themselves. If you really want to do harm to yourself because you were depressed, you could buy a bottle of aspirin, you know, which is over the counter and take all those pills and kill yourself. So I don't know that the drugs like Valium, phenobarbital, you know, again I look at John, amtrofeline and dioxin are the four that are mixed with the morphine.

[Jarett Gandolfo (Member)]: Yes.

[Amy Paulin (Member, bill sponsor)]: And two of them are not controlled substances at all. So the health department may say, I don't know what they're going to say. But two of them are scheduled for. So That's the Valium, you know, and the phenobarbital.

[Sam Pirozzolo (Member)]: To your point really quick, if if we can do it with aspirin, then if someone can end their life with aspirin, then why do we need this? Why are we even doing this?

[Amy Paulin (Member, bill sponsor)]: Because if somebody ends their life with aspirin, they've committed suicide. They're not dying anyway. I guess they could be, right? But it's not usual. Because someone who is dying wants to live. They want to live till the very last second that they have quality of life and sometimes beyond that. So if they're what we heard when we had a hearing on this is people did shoot themselves and swallow a lot of aspirin. And you know what? Then if they wanted family members around them, if they wanted to die peacefully, they couldn't do it. Because then their family members and anyone present would be assisting the suicide and potentially going to jail if anybody heard about it. So this is to allow a family member to die in peace using a medication that's going to put them to sleep almost instantaneously and allow family members to be there without being at risk for a felony charge.

[Sam Pirozzolo (Member)]: I I appreciate I can appreciate that. I my last question will ultimately be, in the event that there are drugs that are are left, someone does take them, some someone perishes, is there a like, is there anyone that's liable for that? Are there any criminal charges? Is the prescribing doctor, you know, criminally liable? Is the state criminally liable? Are questions that I

[Amy Paulin (Member, bill sponsor)]: In thirty years, with twelve thousand four hundred and fifty five uses medical aid and dying medication, there's not been one instance where somebody else took the meds. And I'm sure that New York's health department is going to be looking at all of the protocols, the way to dispose it, as in other places. And also their current rules and regs for those same kinds of drugs like morphine. So I do not have a concern or a fear that these drugs are going to be arbitrarily used by anybody.

[Sam Pirozzolo (Member)]: Okay. I would just make the argument that just because something never happened doesn't mean it can't or it won't. So, and god forbid, if someone, you know, that someone loved did use these drugs and expired, that would be a tragedy for that family. So I'm just trying to make sure that that all bases are covered, that we're doing our due diligence here in this body so a family does not have to deal with that in the future. Miss pollen thank you so much for answering my questions I really appreciate it thank you madam speaker.

[Presiding Officer (Acting Speaker/Chair)]: Mr. Manklow.

[Brian D. Manktelow (Member)]: Thank thank you, madam speaker. Would his sponsor yield?

[Amy Paulin (Member, bill sponsor)]: Okay, sorry about that. Yes.

[Brian D. Manktelow (Member)]: That's fine. Yeah. Thank you, Assemblywoman.

[Presiding Officer (Acting Speaker/Chair)]: Sponsor yields.

[Brian D. Manktelow (Member)]: Thank you, Madam Speaker. Thank you, Assemblywoman. I just want to make sure I heard this right. Is this covered by insurance or it is not?

[Amy Paulin (Member, bill sponsor)]: It's up to the commercial insurer. Sometimes we've seen them cover it, sometimes not in other states. It's not covered by government sponsored health plans.

[Brian D. Manktelow (Member)]: Do you know what the average cost of this is in other states?

[Amy Paulin (Member, bill sponsor)]: Well, we know that insurance typically covers doctor costs for anything, right? I mean not anything. There's always pre authorization and all that stuff, right? But we know that for the most part commercial and government sponsored plans are going to pay for that. So it's the cost of the medication and we know it's about $800 so it's expensive. It's not inexpensive, but for the most part that's not covered.

[Brian D. Manktelow (Member)]: It's not covered for the most part. So one of my questions going in that direction is across our state we have many different areas and we have some parts of the state where the incomes are much higher than others we have higher income earners lower income earners. A young family or a family that' struggling that doesn' have the money, would they be allowed to do this and how would they get that money?

[Amy Paulin (Member, bill sponsor)]: I think we' seen the statistics and the data seems to point to people who are using this, as you point out, who are statistically at a higher level economically. But certainly family members do raise money. We've seen that across the board. We've seen those donate pages or whatever they're called, right? And so it's possible to raise money if you want to and you want to do this.

[Brian D. Manktelow (Member)]: So like GoFundMe accounts?

[Amy Paulin (Member, bill sponsor)]: Yeah, exactly.

[Brian D. Manktelow (Member)]: So what you're saying then is someone that doesn't have the income, they're on their own to fund themselves to go through the process of taking their life. Earlier my colleague talked about some of the changes in the states that have already made changes to this law. In vermont back in 2022 it was challenged and it was overturned where residents outside of the state now can have access to that type of procedure in Vermont. Do you see that happening here in New York State?

[Amy Paulin (Member, bill sponsor)]: I would think that someone might bring a challenge, yes. And I would say that it will a little bit depend on how the residency requirements are interpreted in New York. If they're flexible like Medicaid, which is what I believe they should be based on our health experience in New York, then perhaps not. But certainly we could be subject to federal litigation as New Jersey is right now.

[Brian D. Manktelow (Member)]: So was the one in Vermont, was that federal litigation as well?

[Matthew Slater (Member)]: Yes.

[Brian D. Manktelow (Member)]: It was? Okay. My next question is we talk about residency all the time. If I'm a physician or will physicians outside of the state be able to do this procedure as well?

[Amy Paulin (Member, bill sponsor)]: It would be hard to be an attending doctor because you need that in person connection. You need to be a resident of New York clearly.

[Brian D. Manktelow (Member)]: Just for clarification, we need to be a resident or the doctor needs to be a resident?

[Amy Paulin (Member, bill sponsor)]: We need, the patient.

[Brian D. Manktelow (Member)]: The patient. But what about, my question is what about the doctor?

[Amy Paulin (Member, bill sponsor)]: I think to be an attending doctor it would be hard to be otherwise because of the travel, because of every also because of the amazing healthcare we have right here in New York. But certainly consulting or even in mental health could be done by telehealth. So it could be if we allow for consulting, clearly, I'm not sure we allow for mental health providers. I would have to look at that additional a different section of the law that I haven't looked at yet.

[Brian D. Manktelow (Member)]: So the original bill in chief, I looked at it again and I see no residency for a doctor being in New York State, a mental health provider.

[Amy Paulin (Member, bill sponsor)]: It's silent.

[Brian D. Manktelow (Member)]: It's not in there?

[Amy Paulin (Member, bill sponsor)]: Silent.

[Brian D. Manktelow (Member)]: Okay. That's one of my concerns because what are we doing, opening up Pandora's box?

[Amy Paulin (Member, bill sponsor)]: But if you're I would just say that if you're dying and the doctor tells you you're going to die in six months and you don't want to die, then you're going to seek out a consulting doctor, matter where they live, to maybe give you a different interpretation of your tests. You know, if I was dying, I would hope that the consultant's doctor said, no, you know, that doctor is wrong. You have five years. You know, so I don't really see the consulting doctor being used to verify the six month in a negative way. I see them seeking out these consulting doctors so that they can maybe get different information.

[Brian D. Manktelow (Member)]: My concern, Assemblywoman, is that if I'm dying and my doctor comes in and tells me I'm dying, I'm probably going to trust what my doctor is telling me, but when we have other families and other individuals that may not have that opportunity to meet with their physician or do not have a physician, they are going to have someone that they don't even know and the physician doesn't know the patient as well. To me I don't know how we make that determination. If I really don't know you, I'm going to tell you, ma'am, you're dying, you only have four months left, but I don't know you. So how do I make that determination if I really don't know you, I don't know your medical history? Think again there's a lot of gray areas here that we cannot answer and maybe we should never answer because I believe our maker probably didn't have this in mind when they created us.

[Amy Paulin (Member, bill sponsor)]: So I would just say that about sixty seven percent of the patients who avail themselves of this are cancer. Another eleven point four percent are neurological diseases. So that makes you know and then there's a miscellaneous, I don't know any oncologist personally. I don't know any neurologist personally. So if I had those conditions, I would have to go to doctors that I didn't know now. So and then rely on them. So I don't think that it's a problem that they don't know the doctors. They're going to get to know them unfortunately in these circumstances. And because you want to go to the best expert you can.

[Brian D. Manktelow (Member)]: Absolutely. And as I said earlier, one of my concerns is if you're a family or an individual on the lower end of the income range or you just don't have the funds, what are we going to do for that individual? How is that individual going to get the same help as someone with money does? I know here in this chamber we talk about being able to provide everything for everyone and making sure we don' discriminate and I have concerns there. My last question is are you familiar with what a cottage industry is?

[Amy Paulin (Member, bill sponsor)]: A what? A cottage industry? Course.

[Brian D. Manktelow (Member)]: Like a special niche? One of my concerns is, if I'm a doctor and I see this coming through, it passes here in New York State, to create the law my concern is we will have all of a sudden we will have a doctor, a physician, a mental health provider and someone else come together team up and say look this is what' happening in New York why don't we get some of that money and we are going to create this agency that says one-eight 100 help me whatever they want to call it and an individual can call them and say look we can help you get to where you need to be. Are there any is there anything there that could stop that from happening?

[Amy Paulin (Member, bill sponsor)]: No, I would imagine that some doctors are going to feel comfortable with this whole process sooner than others or generally. And there could be doctors who are used to write the prescriptions when someone doesn't want to and they could be known. So I'm not going to call that a cottage industry because I don't believe cause that has a negative connotation. I would say that we would be lucky if there were doctors out there that we could rely on for our end of life patients.

[Brian D. Manktelow (Member)]: Okay, thank you Madam.

[Amy Paulin (Member, bill sponsor)]: I was hoping you would ask me about death certificates. You spent a lot of time on that and I researched it, so offline.

[Brian D. Manktelow (Member)]: Go ahead. Can you tell me about death certificates?

[Amy Paulin (Member, bill sponsor)]: That's okay.

[Sam Pirozzolo (Member)]: Please do.

[Crystal D. Peoples-Stokes (Majority Leader)]: Go ahead.

[Amy Paulin (Member, bill sponsor)]: So I did get a copy of the New York State death certificate. It wasn't easy, but I got a copy of it. And there's two categories. One for the illness and then one for the manner of death. So the manner of death is where suicide would be or not. And so I actually said to the health department, where do you put medical aid in dying? And they're thinking about what would be appropriate. So I just want you to know that in the debate you caused me to look at it and now the health department is considering what would be appropriate for the manner of death for this circumstance.

[Brian D. Manktelow (Member)]: Would there be another box on the death certificate I

[Amy Paulin (Member, bill sponsor)]: think there could be. Or they could deem one of the other categories. You know, because we say obviously it's not suicide, the matter of death. Nor is suicide when you know, when morphine kills you and the doctor kind of gives you too much. Or you don't eat or drink at the end of your illness. Those are all not indicated. And so I would say whatever those are, this should be. But I'm letting the health department, I raised it because of you.

[Brian D. Manktelow (Member)]: Just want to know. Well, you for clarifying that. Madam Speaker, on the bill.

[Presiding Officer (Acting Speaker/Chair)]: On the bill.

[Brian D. Manktelow (Member)]: Definitely a tough bill a tough amendment to vote on again and there are a lot of questions a lot of gray areas out there I think many of us across this chamber have concerns and thought processes on this Not only in this chamber but across this whole state hearing from our church groups to senior citizens to family members that have dealt with family members that were dying of cancer or dying from diabetes. I just comfortably cannot say, yeah, this is okay, because I really believe that it's not. And I think that we need to hold firm to that. And remember, we talk about morphine. When you take morphine at the end of life, you may be taking the morphine to comfort you, but you really don't know that that morphine will kill you. You don't know that. If you take these three pills, you know after you take the third one, your life will be stopped. So I'm asking you, let' hold this process up a little bit let' talk to our people back home to our churches and make sure that before we bring this forward in the state we can answer many of the questions that were brought to the floor today by my colleagues and some of the colleagues across the aisle that I' talked with over the time. Thank you Madam Speaker for allowing me to ask a few questions.

[Presiding Officer (Acting Speaker/Chair)]: Thank you. Mr. Norber.

[Unidentified Assemblymember ('Mr. Norber')]: Thank you, madam speaker. Would the sponsor yield?

[Presiding Officer (Acting Speaker/Chair)]: Will the sponsor yield? Yes. Sponsor yields.

[Unidentified Assemblymember ('Mr. Norber')]: Thank you, Amy. Thank you for your time. Just a few questions regarding the decision making capacity regarding this bill. Just some things that came up while I was reading about it. And you said a little bit earlier to during the debates that it's really under extraordinary pain in which a patient would request this type of medication. Correct? Like

[Amy Paulin (Member, bill sponsor)]: I think it's the fear of the extraordinary pain.

[Unidentified Assemblymember ('Mr. Norber')]: The fear?

[Amy Paulin (Member, bill sponsor)]: The fear of the pain at the end of life that would probably be a big factor for someone. I know from talking to people who are dying.

[Unidentified Assemblymember ('Mr. Norber')]: Alright. So a person who has actually not suffering from any pain, let's say, a person like me just walks in, I say, a doctor tells me I have six months to live but I'll just say I'm scared of the end of life within six months to the dot because it can't be six months in a day, and so I'm allowed to take this prescription?

[Amy Paulin (Member, bill sponsor)]: Yes, it's going to take a while and we have now five extra waiting days. But yes, they could get a prescription. And I would say that the third of the people who don't take it die peacefully or more peacefully. Or decide that they can suffer through the pain because they want to be alive longer. The two thirds that do take it are likely to take it because of the breakout pain. Eighty three point three percent, according to scientific studies, say that people, even when they get a high dose of the morphine that's given typically can't they feel pain. That You said

[Brian D. Manktelow (Member)]: the high

[Unidentified Assemblymember ('Mr. Norber')]: dose what? Couldn't hear you.

[Amy Paulin (Member, bill sponsor)]: What?

[Unidentified Assemblymember ('Mr. Norber')]: The high dose of morphine?

[Amy Paulin (Member, bill sponsor)]: Of morphine.

[Unidentified Assemblymember ('Mr. Norber')]: Okay.

[Amy Paulin (Member, bill sponsor)]: You know or fentanyl. You know, or other drugs. Remember our colleague Corinus Reyes talking about all these other drugs that they administer to people. So, you know, and they suffer breakout pain. Twenty four percent say the pain is so severe that no medication helps them at So I know with my sister the breakout pain was very severe. But she also didn't want to be so drugged that she couldn't have a conversation. So breakout pain is real and that's what people hear about and what people are afraid of. And they're afraid they may suffer from that. So they might request the medication earlier so that they have it just in case.

[Unidentified Assemblymember ('Mr. Norber')]: Thank you for that. Alright, so a person who is within decision making capacity, is that the same thing as having unimpaired judgment, would you say?

[Amy Paulin (Member, bill sponsor)]: Decision making capacity is usually the term that's used for medical decision. Doctors make that all the time. You know, when you go in for a flu shot, they're not going to give it to you if they think you might have had five flu shots because you're a little bit you know, a little bit out there, right? So doctors are making decisions all the time on your capacity for the treatment that they're providing.

[Unidentified Assemblymember ('Mr. Norber')]: Right. Okay, good. Understood. So let's walk through this. So a person is terminally ill and he has either you said it's sixty something percent cancer or could be renal failure, ALS, could be other types of conditions, but it's usually cancer. Correct?

[Presiding Officer (Acting Speaker/Chair)]: Mhmm.

[Unidentified Assemblymember ('Mr. Norber')]: And they are pretty much immediately put on, like you said, morphine or fentanyl or

[Amy Paulin (Member, bill sponsor)]: When the pain gets bad. When

[Unidentified Assemblymember ('Mr. Norber')]: gets Let's the say they haven't made the decision yet about whether to go through medical aid in dying, prescribe anything like that. But first of all, of course, they would start off with morphine, high doses, hydromorphone or something similar. Correct?

[Amy Paulin (Member, bill sponsor)]: Right.

[Unidentified Assemblymember ('Mr. Norber')]: Alright. So when you're taking these drugs, let's say high doses, for an ongoing amount of time, let's say they started chemotherapy, they're suffering, let's say it's a year, even more. They haven't even visited the idea yet of prescribing medicating and dying, but they are on high doses of morphine, and I'm just asking if that would affect their judgment in any way.

[Amy Paulin (Member, bill sponsor)]: Usually their judgment or their request for it is before they're that sick on morphine. But that would be a conversation between the patient and the provider. Again, they'd have to go through two providers, the attending and the consulting. Each would be evaluating their own mental capacity toward the patient. And then they have a third visit with a psychologist or psychiatrist. So if all three providers decided this person had the mental capacity, then they could go ahead. If somehow because of morphine or something else they felt they didn't, then they couldn't.

[Unidentified Assemblymember ('Mr. Norber')]: Okay. So in New York State, it's illegal to drive due to impaired judgment while on morphine or hydro morphine or fentanyl. Correct?

[Amy Paulin (Member, bill sponsor)]: Yes, that's impaired judgment. Again, the term that's used I think commonly in the law for that circumstance. This is mental capacity for treatment. Little different.

[Unidentified Assemblymember ('Mr. Norber')]: Well, they say in medical law that a patient cannot make informed decisions about their medical treatment while, due to impaired judgment. So there is some type of law that connects

[Amy Paulin (Member, bill sponsor)]: And again, it would be evaluated. Right.

[Unidentified Assemblymember ('Mr. Norber')]: I mean, I I don't believe there there's that too many things more consequential than making that decision about a person's life. So my question is, is there any type of way to maybe the doctors who would prescribe or evaluate the person's mental situation to maybe wean them off morphing to make sure that they are just not very much emotionally charged due to the or depressed or maybe also coerced or treated in a certain way due to these psychiatric, psychotropic drugs?

[Amy Paulin (Member, bill sponsor)]: You know that's between the provider and the patient. The provider is putting their license on the line if they're not evaluating the patient for their ability to make a decision. So they're going to be very careful in making those decisions as will the psychiatrist and the psychologist. So if they feel that this particular drug needs to be not used for the time period where they're making those decisions, then they'll make that decision.

[Unidentified Assemblymember ('Mr. Norber')]: Yeah, that was pretty much what I was trying to get to. I mean, how could a doctor actually evaluate a person's mental capacity while they are on fentanyl on a long term basis?

[Amy Paulin (Member, bill sponsor)]: Usually, the fentanyl and morphine are at the end of life, not in not in the six months prior.

[Unidentified Assemblymember ('Mr. Norber')]: Okay. So there is no way of looking at that? The doctor there was no consideration

[Amy Paulin (Member, bill sponsor)]: There's there's no specific language in the bill.

[Unidentified Assemblymember ('Mr. Norber')]: Understood. Alright. Thank you very much.

[Presiding Officer (Acting Speaker/Chair)]: Thank you. Mister McDonald?

[Crystal D. Peoples-Stokes (Majority Leader)]: On the bill?

[Presiding Officer (Acting Speaker/Chair)]: On the bill.

[John T. McDonald III (Member)]: I just wanted to clarify a couple things. Rightfully, I've heard from a few colleagues concerns about unused medications. And to be honest with you, and I know some of the members have been here for a bit of time, but some members have not been here for a

[Brian D. Manktelow (Member)]: bit of

[John T. McDonald III (Member)]: time, unused medications, irrespective of this piece of legislation, has been a concern of this body before and remains to be. Do want to, you know, first of all, our junior pharmacist did a good job of mentioning the drugs, amitriptyline digoxin. Those are very common medications. They actually are sitting in probably some of your family members households right now, whether they have a cardiac issue, whether they have depression. Phenobarbital, if you have somebody who has seizure issues, sits in your households. And technically, if somebody grabbed a month's supply of that medication and took it, they probably would die, in all fairness. So it's an issue all the time before this bill even came to existence. We have, through legislation, done two things I think is important for you to know. I admit it's probably not going to change some people's minds. Number one, on any controlled substance, whenever a pharmacist dispenses a prescription, they are required to give out a document that explains the warnings and concerns of controlled substances and how to properly dispose of the medication. So technically, in reality, a patient gets a prescription for morphine or diazepam or phenobarbital, one of those drugs, they will get information on how to dispose of that medication. That's happening. It's been going on for about eight to ten years in this state. The second thing that you should also be reminded of, because it's a good thing that you all support, is that community pharmacies are required to take back medications. I don't work the bench all day long anymore because I get to spend my time with you guys. But I can tell you on Saturday mornings, hey, my mother just died this past week, what do I do with these medications? Bring it in, we got a box. And by the way, the state pays for that. So congratulations to all of you and thank you for your support of making sure we don't have these medications, household medications, building up in our communities. But the reality is as it relates to this bill, these medications individually on their own can be problematic And it's something that we should all be very mindful of. That's why we always encourage patients when you're not taking a medication, not just because you may have passed away, when you're not taking a medication, get them out of your cabinets, get them out of your households, make your community a little bit safer. Thank you.

[Presiding Officer (Acting Speaker/Chair)]: Thank you. Read the last section.

[Reading Clerk]: This act shall take effect immediately.

[Presiding Officer (Acting Speaker/Chair)]: A party vote has been requested. Ms. Walsh.

[Mary Beth Walsh (Member)]: Thank you, Madam Speaker. The minority conference will be in the negative on the chapter amendment and but if there is anybody that wishes to vote in the affirmative, they would be able to do so now at their seats. Thank you.

[Presiding Officer (Acting Speaker/Chair)]: Thank you. Mr. Fall.

[Carl E. Heastie (Speaker of the Assembly)]: Thank you Madam Speaker. The majority conference will be in the affirmative on this piece of legislation. For those that would like to vote in a different direction, they could do so at their desk.

[Presiding Officer (Acting Speaker/Chair)]: Thank you. The clerk will record the vote. Mister Szampolinsky to explain his vote.

[Unidentified Assemblymember ('Mr. Szampolinsky')]: Thank you, madam speaker. I I, you know, debated this bill last time and expressed my concerns with surround you know, my daughter has got a developmental disability and has a congenital heart defect. I think, hopefully, much later rather than sooner, you know, that heart defect will get her. And I think there's too much faith in the system and faith in the process in this bill where, you know, where the sponsor says we're not gonna have coercion, you know, because we outlawed coercion. We're gonna have witnesses do the right thing because, you know, they'll have a form to fill out. Well, the problem is the victim is dead. The victim's gone. I don't I don't see how and this was the point I brought up during the first debate. You know, I don't see how there's going to be the teeth there that's gonna prevent any sort of coercion and just because you videotape coercion doesn't mean you're not being coerced, which is one of the big changes here. So my concern remains with the manipulation and the coercion of folks in the intellectual and developmental disability space and I'm therefore compelled to vote no.

[Presiding Officer (Acting Speaker/Chair)]: Mister Stempelinsky, the negative. Mister Fitzpatrick, explain his vote.

[Michael J. Fitzpatrick (Member)]: Thank you madam speaker. Explain my vote. Morally, I object to this legislation. But what I'm very concerned about is the slippery slope and how in other states the rules have been changed, have been loosened. More people want the opportunity to take advantage of this when they shouldn't do so. For that reason, I will be voting no. And I think we need to be very careful when we do something like this. I am sensitive to the cases that we've heard about. They are very sad. No one wants to see anyone suffer, but as a previous speaker during debate said, we need to spend more and put more resources into palliative care to help those people cope with suffering. Suffering is a part of life. It's unfortunate, but it is a fact of life. And our obligation is to help them manage that suffering and deal with that suffering and not provide a way for them to kill themselves. It's unfortunate that people would go to that extreme and I do find it morally objectionable to create an opportunity for people to take advantage of that. So for that reason, I am voting no. Thank you.

[Presiding Officer (Acting Speaker/Chair)]: Mister Fitzpatrick in the negative, mister Cashman to explain his vote.

[Unidentified Assemblymember ('Mr. Cashman')]: Madam speaker, as a newest member or one of the newest members of this body, I rise today to explain my vote in support of Medical Aid in Dying Act. The agreement before us, which will finally make this option available to terminally ill New Yorkers, This moment reflects years of careful deliberation and powerful testimony from patients, families, advocates, and medical professionals. At its core, this legislation and amendments is about compassion. It is about dignity, respect for patient autonomy at the end of life. My support for medical aid in dying long predates my election to this body. And for years, I have traveled to Albany to advocate for this legislation because I have seen firsthand why it is needed. My stepfather endured a battling and devastating brain cancer, And he should have been afforded the opportunity to make this deeply personal choice himself. No patient should be denied control over their own final days. I also have a background in counseling and have walked alongside individuals and families during the most difficult times and moments of their lives. Those experience have shaped my belief that policies must be guided by empathy, respect, and trust. I appreciate this agreement and amendments include guardrails to ensure the integrity of the process, protect against coercion, and respect medical professionals and faith based providers. These safeguards reaffirm that this legislation is about preserving dignity and easing suffering at the end of life. For these reasons, with care and conviction, I proudly cast my vote in favor.

[Presiding Officer (Acting Speaker/Chair)]: Thank you, mister Cashman in the affirmative. Mister Polonia to explain his vote.

[Sam Pirozzolo (Member)]: Thank you, madam speaker. I just come back to the unused drugs portion of this and think that the difference between a bottle of aspirin and these substances in conjunction is that these are used for the expressed purpose of ending life. And the fact that these will be out in homes and we're relying on essentially grieving estates or grieving families to return them properly and dispose of them properly gives me great concern. In addition to which, I think we could probably all acknowledge that there is a mental health crisis, especially, you know, with our youth and our young adults in this country and state today. Because of that, I have strong fears that someone who is struggling may try to take advantage of these drugs being available in a home and do something they can' reverse or cannot undo. For those reasons I remain in the negative on this because these concerns were not addressed in the chapter amendment. Thank you.

[Presiding Officer (Acting Speaker/Chair)]: Mr. Polonian the negative and Mr. Jensen to explain his vote.

[Josh Jensen (Member)]: Thank you Madam Speaker to explain my vote I certainly appreciate the sponsors answering our questions today as well as the recognition both on the sponsor and both houses part and the governor to take some steps to address some of the concerns that were brought up on the original bill in chief. Like many of my colleagues who have spoken to explain their vote I still do have concerns about what has not been addressed or further clarified from our debate a year ago. Certainly, think the biggest blind spot that's contained in this very critically and emotional issue is the aspect of coercion. It's not just about in person coercion, societal coercion, self coercion, familiar coercion. And I think that until we put stronger guardrails on this legislation, on this statute, there is the potential for New Yorkers who are extremely vulnerable to be preyed upon. Additionally, this was brought up in last year's debate that with the state's new amendment on guaranteeing certain rights, we do extend that right based on disability and age. My concern is that the courts could act outside the legislative process to expand this legislation in a way that members who are voting for it may not be comfortable with. All of those things are why while I'm very appreciative of the work and the advocacy that has gone into crafting what is believed to be a very safe measure and in the best interest of all New Yorkers, there is a concern that there's still more work to be done. With that, I'll be voting nay. Thank you, Madam Speaker.

[Presiding Officer (Acting Speaker/Chair)]: Mr. Jensen in the negative, Mr. Ra to explain his vote.

[Edward P. Ra (Member)]: Thank you, Madam Speaker. So, this issue is one that has been emotional for so many of us. We obviously had a very emotional debate last year about this. And I understand where people are coming from and and how so many people have come to the conclusions they have on on this particular issue. But I always wanna note that those of us who have had the experience of having a loved one suffering and watching them die, there are people who have had that experience and come down on the side of being a supporter of this bill. There And are also people who have had that experience and are not a supporter of this bill. I firmly believe that it's a gift to exist. Our lives are are are a gift, and unfortunately, sometimes people end up in a situation where they have a terrible illness and and they're suffering, and, you know, I I understand the want to alleviate that suffering. But on this particular piece of legislation, there was no chapter amendment that could make it palatable to me. So I'm gonna be voting in the negative because that's what my conscience and my heart tells me is the right thing to do on this piece of legislation. I thank all of my colleagues who have, you know, shared their journeys with regard to this bill. But again, I don't think there is any chapter amendment that can fix the concerns that so many of us have in in adopting this piece of legislation. Thank you, madam speaker.

[Presiding Officer (Acting Speaker/Chair)]: Thank you, mister Ron. Negative mister Norber to explain his vote.

[Unidentified Assemblymember ('Mr. Norber')]: Thank you, madam speaker. Last year, when we're debating this, I mentioned briefly about my own personal situation, which my dad suffered through renal failure, and he ultimately was fined after even though the doctors and nephrologists told him, you have six months to live. So I told him about this bill, of course, like I would, and I I asked him, so what would you have done? And he's told me, of course, I would have taken the bills. I was suffering so much that I would not even think twice about it. He was already 78 years old. He just was old enough. He wanted to retire. That's it. People give up so easily sometimes in these situations. So I'm glad this was not available back then, but I'm just saying that people are sometimes in these situations are going through so much emotional charge with themselves, so so much difficulty and so much pain that to give them this option, people will jump the gun. And that's what's sad about it. Instead of fighting, we should not even give them this option because we cannot play God in this point. Thank you so much, and I'll be avoiding the negative.

[Presiding Officer (Acting Speaker/Chair)]: Mister Norber in the negative, miss Pollan to explain her vote.

[Amy Paulin (Member, bill sponsor)]: Thank you, madam speaker. Today is a historic day for New York State. Today we reaffirm the principle that in New York, individuals confronting terminal illness can approach the end of life with dignity, supported by thoughtful law, and compassionate care. I stand here alongside my amazing colleagues in the assembly who partnered with me and who fought alongside me for this bill. Together, we got it done. I am so, so, so grateful. To the speaker who gave me a path to make this happen, thank you for your leadership, your persistence, your polling, your support and your fortitude. This issue has always been deeply personal for me. My sister died a horrific death from ovarian cancer. And in her final days, she was in so much pain, she begged for death. When am I going to die already? She shouted out in excruciating pain. Her words continue to haunt me. Her experience is tragically the story of so many others. Most people will never choose medical aid in dying. But they want the reassurance of having it as a compassionate safeguard that offers comfort even if it's never used. More recently, my former Chief of Staff, who helped persuade me to take on this issue, was diagnosed with an incurable cancer. She said to me, she's not sure if she'll ever take the medication. But she wants to know it's available to her if she suffers with debilitating pain as she nears her death. Reaching this moment has taken more than a decade of work. For ten years, advocates, individuals facing death, families, health professionals, and legislators returned to this bill and legislation again and again and again and again. Sometimes in grief, sometimes in frustration, always with determination A and shout out to the advocates. Thank you. We couldn't have done this without you. Today is about honoring choice, easing suffering, and affirming that no one in New York State will ever again have to face the end of life without dignity, autonomy, support, and compassion. Thank you to all who made this possible.

[Presiding Officer (Acting Speaker/Chair)]: Thank you, Ms. Pollan. Ms. Pollan in the affirmative. Are there any other votes? I'm gonna answer the results.

[Reading Clerk]: Ayes, 85. Noes, 60.

[Presiding Officer (Acting Speaker/Chair)]: The bill is passed.

[Presiding Officer (Acting Speaker/Chair)]: Miss Peoples Stokes.

[Crystal D. Peoples-Stokes (Majority Leader)]: Do you have any further housekeeping or resolutions?

[Presiding Officer (Acting Speaker/Chair)]: Yes. We do have a piece of housekeeping. An amendment's been received at the desk. Miss Kellis? On a motion by miss Kellis, the amendment has been received and adopted. We have a number of resolutions before the house. Without objection, these resolutions will be taken up together. On the resolutions, all those in favor signify by saying aye.

[Crystal D. Peoples-Stokes (Majority Leader)]: Aye.

[Presiding Officer (Acting Speaker/Chair)]: Opposed, no. The resolutions are adopted. Miss People Stokes.

[Crystal D. Peoples-Stokes (Majority Leader)]: Madam speaker, would you call on miss Clark for the purposes of an announcement?

[Presiding Officer (Acting Speaker/Chair)]: Miss Clark for the purpose of an announcement.

[Sarah Clark (Member, AD 136)]: Figure, I am here to announce that there will be majority conference immediately following session in Hearing Room C. Majority conference immediately following session. Thank you.

[Presiding Officer (Acting Speaker/Chair)]: Immediate majority conference at the conclusion of session in Hearing Room C, miss Peoples Stokes.

[Crystal D. Peoples-Stokes (Majority Leader)]: I move that the assembly stand adjourned and that we reconvene at 10AM, Thursday, February 5. Tomorrow will be in a session day.

[Presiding Officer (Acting Speaker/Chair)]: On miss Peoples Stokes' motion, the house stands adjourned.