Bill Text: NY A01203 | 2019-2020 | General Assembly | Introduced
Bill Title: Relates to restoring medical futility as a basis for DNR.
Spectrum: Partisan Bill (Democrat 2-0)
Status: (Introduced - Dead) 2020-01-08 - ordered to third reading cal.60 [A01203 Detail]
Download: New_York-2019-A01203-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 1203 2019-2020 Regular Sessions IN ASSEMBLY January 14, 2019 ___________ Introduced by M. of A. GOTTFRIED, ABINANTI -- read once and referred to the Committee on Health AN ACT to amend the public health law and the surrogate's court proce- dure act, in relation to restoring medical futility as a basis for both surrogate consent to a do not resuscitate order and for a do not resuscitate order for a patient without a surrogate The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Legislative findings. Under New York's former do not resus- 2 citate (hereinafter "DNR") law, article 29-B of the public health law, a 3 surrogate could consent to a DNR order if the patient met any one of 4 four clinical criteria, one of which was a finding by two physicians 5 that resuscitation was "medically futile," which was defined to mean 6 that resuscitation "will be unsuccessful in restoring cardiac and 7 respiratory function or that the patient will experience repeated arrest 8 in a short time period before death occurs." The former DNR law also 9 allowed a DNR order to be entered for a patient who did not have a 10 surrogate on that basis. That law applied to all patients, including 11 developmentally disabled patients. 12 In 2010, the former DNR law was superseded by the Family Health Care 13 Decisions Act (hereinafter "FHCDA") which established standards for the 14 withdrawal or withholding of a broad range of life-sustaining treat- 15 ments. Accordingly, the FHCDA did not have a standard specifically 16 relating to medically futile resuscitation. Similarly, Surrogate's Court 17 Procedure Act (hereinafter "SPCA") §1750-b does not have a standard 18 specifically relating to medically futile resuscitation for develop- 19 mentally disabled patients. 20 The legislature finds that the broader FHCDA and SPCA §1750-b stand- 21 ards are difficult to apply to situations in which resuscitation would 22 be medically futile. Accordingly, this bill restores the former DNR EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD03447-01-9A. 1203 2 1 law's medical futility standard as an alternative basis for writing a 2 DNR order under the FHCDA and under SCPA §1750-b. 3 § 2. Subparagraphs (i) and (ii) of paragraph (a) of subdivision 5 of 4 section 2994-d of the public health law, as amended by chapter 430 of 5 the laws of 2017, are amended and a new subparagraph (iii) is added to 6 read as follows: 7 (i) Treatment would be an extraordinary burden to the patient and an 8 attending physician or attending nurse practitioner determines, with the 9 independent concurrence of another physician or nurse practitioner, 10 that, to a reasonable degree of medical certainty and in accord with 11 accepted medical standards, (A) the patient has an illness or injury 12 which can be expected to cause death within six months, whether or not 13 treatment is provided; or (B) the patient is permanently unconscious; 14 [or] 15 (ii) The provision of treatment would involve such pain, suffering or 16 other burden that it would reasonably be deemed inhumane or extraor- 17 dinarily burdensome under the circumstances and the patient has an irre- 18 versible or incurable condition, as determined by an attending physician 19 or attending nurse practitioner with the independent concurrence of 20 another physician or nurse practitioner to a reasonable degree of 21 medical certainty and in accord with accepted medical standards[.]; or 22 (iii) With respect to a decision to enter an order not to resuscitate, 23 an attending physician determines, with the independent concurrence of a 24 second physician, to a reasonable degree of medical certainty, that in 25 the event of a cardiac or respiratory arrest, resuscitation would be 26 unsuccessful in restoring cardiac and respiratory function or that the 27 patient will experience repeated arrest in a short time period before 28 death occurs. 29 § 3. Paragraph (b) of subdivision 5 of section 2994-g of the public 30 health law, as amended by chapter 430 of the laws of 2017, is amended to 31 read as follows: 32 (b) If the attending physician or attending nurse practitioner, with 33 independent concurrence of a second physician or nurse practitioner 34 designated by the hospital, determines to a reasonable degree of medical 35 certainty that: 36 (i) (A) life-sustaining treatment offers the patient no medical bene- 37 fit because the patient will die imminently, even if the treatment is 38 provided; and 39 [(ii)] (B) the provision of life-sustaining treatment would violate 40 accepted medical standards, then such treatment may be withdrawn or 41 withheld from an adult patient who has been determined to lack deci- 42 sion-making capacity pursuant to section twenty-nine hundred ninety- 43 four-c of this article, without judicial approval. This [paragraph] 44 subparagraph shall not apply to any treatment necessary to alleviate 45 pain or discomfort; or 46 (ii) in the event of cardiac or respiratory arrest, resuscitation will 47 be unsuccessful in restoring cardiac and respiratory function or that 48 the patient will experience repeated arrest in a short time period 49 before death occurs, then an order not to resuscitate may be entered for 50 an adult patient who has been determined to lack decision-making capaci- 51 ty pursuant to section twenty-nine hundred ninety-four-c of this arti- 52 cle, without judicial approval. 53 § 4. Subparagraphs (i) and (ii) of paragraph (b) of subdivision 4 of 54 section 1750-b of the surrogate's court procedure act, as amended by 55 chapter 198 of the laws of 2016, are amended to read as follows:A. 1203 3 1 (i) the person who is intellectually disabled has a medical condition 2 as follows: 3 A. a terminal condition[, as defined in subdivision twenty-three of4section twenty-nine hundred sixty-one of the public health law] which 5 shall mean an illness or injury from which there is no recovery, and 6 which can reasonably be expected to cause death within one year; or 7 B. permanent unconsciousness; or 8 C. a medical condition other than such person's intellectual disabili- 9 ty which requires life-sustaining treatment, is irreversible and which 10 will continue indefinitely; [and] or 11 D. in the case of a decision to enter an order not to resuscitate, 12 that in the event of cardiac or respiratory arrest such resuscitation 13 would be unsuccessful in restoring cardiac and respiratory function or 14 that the patient will experience repeated arrest in a short time period 15 before death occurs; and 16 (ii) except in the case of a decision to enter an order not to resus- 17 citate based on clause D of subparagraph (i) of this paragraph, the 18 life-sustaining treatment would impose an extraordinary burden on such 19 person, in light of: 20 A. such person's medical condition, other than such person's intellec- 21 tual disability; and 22 B. the expected outcome of the life-sustaining treatment, notwith- 23 standing such person's intellectual disability; and 24 § 5. This act shall take effect on the ninetieth day after it shall 25 have become a law.