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NM END-OF-LIFE
OPTIONS ACT
Presented to Cancer Support Now
Rep. Debbie Armstrong, Rob Schwartz and Jan Wilson
May 8, 2021
Elizabeth Whitefield End-of-Life Options Act
(HB 47)
New Mexico’s End-of-Life Options Act provides for “medical aid in dying”
which is the medical practice wherein a health care provider prescribes
medication to a qualified individual who may self-administer that medication to
bring about a peaceful death.
The law goes into effect June 18, 2021
Qualified Individual
The individual must be an ADULT at least 18 years old and a RESIDENT of NM.
The prescribing provider must determine that the individual has:
1. CAPACITY to understand and appreciate health care options available, including significant
benefits and risks, and to make and communicate an informed decision.
2. TERMINAL ILLNESS which is a disease or condition that is incurable and irreversible
and that, in accordance with reasonable medical judgement, will result in death within 6
months.
3. VOLUNTARILY makes the request for MAID and is not under duress or undue influence.
4. ABILITY TO SELF-ADMINISTER the MAID medication by taking an affirmative,
conscious, voluntary action to ingest the medications. (Injection or IV administration are NOT
allowed.)
Healthcare Provider
Any of the following individuals licensed in New Mexico and authorized under NM law to prescribe a
medication to be used in MAID:
1. Medical Physician
2. Osteopathic Physician
3. Advanced Practice Nurse
4. Physician Assistant
At least one physician (MD/DO) must determine, after conducting an appropriate examination, that the
individual is qualified. That can be the ”prescribing” provider, a “consulting” provider OR affirmation the
individual is enrolled in Hospice. If the individual is not enrolled in hospice, then two providers must
affirm qualifications, one of which must be an MD/DO.
Capacity
A determination of capacity shall be made only according to professional standards of care and the
provisions of the NM Uniform Health Care Decisions Act, which has an underlying presumption that an
individual has the capacity to make a healthcare decision.
If the prescribing or a consulting provider believes the individual may lack decisional capacity or if the
individual has a current or recent history of mental illness or disability that could impair capacity for end-
of-life decision-making, the individual must be referred to a mental health professional and MAID cannot
proceed until such professional determines the individual has capacity to make end-of-life decisions.
If capacity must be confirmed by a Mental Health Professional, that means a NM-licensed psychiatrist,
psychologist, master social worker, psychiatric nurse practitioner or professional clinical mental health
counselor.
Prescribing MAID
◦ Prior to prescribing, the provider must inform the individual of all available end-of-life care options,
including palliative care and hospice.
◦ The prescribing provider must document all qualifications. The individual’s enrollment in hospice or,
if necessary, affirmation of terminal illness by a consulting provider must also be included.
◦ The form required by law must be completed and signed by the individual requesting MAID and
witnessed by two persons, one of which must be a disinterested party. The prescriber will provide
the form and then include it in the individual’s health record.
◦ The prescription, once written, has a 48-hour hold before it can be filled UNLESS the prescriber
affirms that, within reasonable medical judgement, the individual will not survive the waiting period.
◦ The prescribing provider will also be responsible for reporting required information to State.
Other Provisions
◦ “Right to Know” – Healthcare providers must inform terminally ill patients of all reasonable and
legally available options that meet medical standards for end-of-life care.
◦ By law, “Medical Aid in Dying” is NOT to be considered “suicide” for any purpose (including death
certificate); and, if the law is followed in good faith, it is also not considered “assisted suicide”.
(“Assisting Suicide” remains 4th degree felony)
◦ A person shall not be subject to criminal liability, licensing sanctions or any type of professional or
employment disciplinary actions for participating or refusing to participate in MAID; or for being
present when a qualified patient self-administers the medication.
◦ A health care entity, provider, professional organization, health insurer or managed care organization
shall not subject a person to censure, discipline, suspension, loss/denial of license, credential,
privileges, membership or other penalty for participating in MAID or not.
Other Provisions
◦ If a “health care provider” is unable or unwilling to participate, he/she must inform the
individual, refer to another willing provider OR to an individual or entity who will assist the
individual seeking MAID. No health care provider shall be required to participate.
◦ ”Health Care Entity” is an entity (not individual) licensed to provide any form of healthcare in
NM, including a hospital, clinic, hospice agency, home health agency, pharmacy, group medical
practice, medical home or similar entity.
◦ A health care entity that prohibits MAID on premises or by employees shall provide appropriate public
notice on their website and in relevant materials given to patients.
◦ A health care entity shall not forbid or otherwise sanction a provider who participates off premises, off
hours or outside scope of employment
What you can do now.
◦ Create or review your Advanced Directives/End-of-Life planning documents.
◦ Appoint a surrogate healthcare decision maker and speak with her/him about your wishes.
Even though you cannot include MAID in your Advanced Directives, nor can you delegate
the decision to utilize MAID to a surrogate, it is important to speak with your loved ones
and plan for all other options that may come before a decision to use MAID. If you want
MAID as an option, that may influence the other choices you make about care or providers.
◦ Talk to your provider(s) to see if they will be supportive if/when the time comes you want MAID.
◦ Do they need more information about the law before deciding?
◦ If they will not participate, is it important enough to you to consider another provider?
◦ Before selecting a hospice agency, long-term care or other healthcare facility, ask what their policy is. That
may make a difference to you in your selection.
Resources
END-OF-LIFE OPTIONS NEW MEXICO https://endoflifeoptionsnm.org
Non-profit entity formed to serve as MAID information clearinghouse and referral source for providers and
patients; and to educate and support individuals, healthcare providers, organizations and communities
regarding the full range of end-of-life options for all New Mexicans.
COMPASSION & CHOICES https://compassionandchoices.org
or C&C’s NM Organizer, Jill VonOsten jvonosten@compassionandchoices.org
DEATH WITH DIGNITY https://deathwithdignity.org
Rep. Debbie Armstrong Deborah.Armstrong@nmlegis.gov

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Medical aid in dying

  • 1. NM END-OF-LIFE OPTIONS ACT Presented to Cancer Support Now Rep. Debbie Armstrong, Rob Schwartz and Jan Wilson May 8, 2021
  • 2. Elizabeth Whitefield End-of-Life Options Act (HB 47) New Mexico’s End-of-Life Options Act provides for “medical aid in dying” which is the medical practice wherein a health care provider prescribes medication to a qualified individual who may self-administer that medication to bring about a peaceful death. The law goes into effect June 18, 2021
  • 3. Qualified Individual The individual must be an ADULT at least 18 years old and a RESIDENT of NM. The prescribing provider must determine that the individual has: 1. CAPACITY to understand and appreciate health care options available, including significant benefits and risks, and to make and communicate an informed decision. 2. TERMINAL ILLNESS which is a disease or condition that is incurable and irreversible and that, in accordance with reasonable medical judgement, will result in death within 6 months. 3. VOLUNTARILY makes the request for MAID and is not under duress or undue influence. 4. ABILITY TO SELF-ADMINISTER the MAID medication by taking an affirmative, conscious, voluntary action to ingest the medications. (Injection or IV administration are NOT allowed.)
  • 4. Healthcare Provider Any of the following individuals licensed in New Mexico and authorized under NM law to prescribe a medication to be used in MAID: 1. Medical Physician 2. Osteopathic Physician 3. Advanced Practice Nurse 4. Physician Assistant At least one physician (MD/DO) must determine, after conducting an appropriate examination, that the individual is qualified. That can be the ”prescribing” provider, a “consulting” provider OR affirmation the individual is enrolled in Hospice. If the individual is not enrolled in hospice, then two providers must affirm qualifications, one of which must be an MD/DO.
  • 5. Capacity A determination of capacity shall be made only according to professional standards of care and the provisions of the NM Uniform Health Care Decisions Act, which has an underlying presumption that an individual has the capacity to make a healthcare decision. If the prescribing or a consulting provider believes the individual may lack decisional capacity or if the individual has a current or recent history of mental illness or disability that could impair capacity for end- of-life decision-making, the individual must be referred to a mental health professional and MAID cannot proceed until such professional determines the individual has capacity to make end-of-life decisions. If capacity must be confirmed by a Mental Health Professional, that means a NM-licensed psychiatrist, psychologist, master social worker, psychiatric nurse practitioner or professional clinical mental health counselor.
  • 6. Prescribing MAID ◦ Prior to prescribing, the provider must inform the individual of all available end-of-life care options, including palliative care and hospice. ◦ The prescribing provider must document all qualifications. The individual’s enrollment in hospice or, if necessary, affirmation of terminal illness by a consulting provider must also be included. ◦ The form required by law must be completed and signed by the individual requesting MAID and witnessed by two persons, one of which must be a disinterested party. The prescriber will provide the form and then include it in the individual’s health record. ◦ The prescription, once written, has a 48-hour hold before it can be filled UNLESS the prescriber affirms that, within reasonable medical judgement, the individual will not survive the waiting period. ◦ The prescribing provider will also be responsible for reporting required information to State.
  • 7. Other Provisions ◦ “Right to Know” – Healthcare providers must inform terminally ill patients of all reasonable and legally available options that meet medical standards for end-of-life care. ◦ By law, “Medical Aid in Dying” is NOT to be considered “suicide” for any purpose (including death certificate); and, if the law is followed in good faith, it is also not considered “assisted suicide”. (“Assisting Suicide” remains 4th degree felony) ◦ A person shall not be subject to criminal liability, licensing sanctions or any type of professional or employment disciplinary actions for participating or refusing to participate in MAID; or for being present when a qualified patient self-administers the medication. ◦ A health care entity, provider, professional organization, health insurer or managed care organization shall not subject a person to censure, discipline, suspension, loss/denial of license, credential, privileges, membership or other penalty for participating in MAID or not.
  • 8. Other Provisions ◦ If a “health care provider” is unable or unwilling to participate, he/she must inform the individual, refer to another willing provider OR to an individual or entity who will assist the individual seeking MAID. No health care provider shall be required to participate. ◦ ”Health Care Entity” is an entity (not individual) licensed to provide any form of healthcare in NM, including a hospital, clinic, hospice agency, home health agency, pharmacy, group medical practice, medical home or similar entity. ◦ A health care entity that prohibits MAID on premises or by employees shall provide appropriate public notice on their website and in relevant materials given to patients. ◦ A health care entity shall not forbid or otherwise sanction a provider who participates off premises, off hours or outside scope of employment
  • 9. What you can do now. ◦ Create or review your Advanced Directives/End-of-Life planning documents. ◦ Appoint a surrogate healthcare decision maker and speak with her/him about your wishes. Even though you cannot include MAID in your Advanced Directives, nor can you delegate the decision to utilize MAID to a surrogate, it is important to speak with your loved ones and plan for all other options that may come before a decision to use MAID. If you want MAID as an option, that may influence the other choices you make about care or providers. ◦ Talk to your provider(s) to see if they will be supportive if/when the time comes you want MAID. ◦ Do they need more information about the law before deciding? ◦ If they will not participate, is it important enough to you to consider another provider? ◦ Before selecting a hospice agency, long-term care or other healthcare facility, ask what their policy is. That may make a difference to you in your selection.
  • 10. Resources END-OF-LIFE OPTIONS NEW MEXICO https://endoflifeoptionsnm.org Non-profit entity formed to serve as MAID information clearinghouse and referral source for providers and patients; and to educate and support individuals, healthcare providers, organizations and communities regarding the full range of end-of-life options for all New Mexicans. COMPASSION & CHOICES https://compassionandchoices.org or C&C’s NM Organizer, Jill VonOsten jvonosten@compassionandchoices.org DEATH WITH DIGNITY https://deathwithdignity.org Rep. Debbie Armstrong Deborah.Armstrong@nmlegis.gov