By STEPHEN GROVES and LISA MASCARO

WASHINGTON (AP) — The House Ethics Committee on Friday told Rep. Alexandria Ocasio-Cortez to make additional payments for her attendance at the 2021 Met Fashion Gala, where she drew attention for wearing a dress adorned with the message “tax the rich.”

NEW ORLEANS — Louisiana is poised to adopt new measures that watchdogs warn raise barriers to holding public officials accountable via the state’s ethics board. The legislation was drafted by the personal attorney of Republican Gov. Jeff Landry, who faces charges brought by the board for violating state ethics laws.

Proponents say the measures give those accused of ethics violations more opportunities to respond to allegations, increases transparency and limits abuses of a process they claim is often unjust. But watchdog groups — and the Board of Ethics — warn the changes will undermine the board’s ability to hold public officials accountable.

While the changes would not apply to Landry’s current charges, the legislation further bolsters the governor’s power over a state board largely made up of his own appointees. Having overwhelmingly passed in the House and Senate this week — only three lawmakers voted against it — the bill awaits Landry’s signature.

Republican Rep. Gerald “Beau” Beaullieu, who sponsored the bill, said it was brought forth after officials complained that the board’s investigation process was “more like being investigated by the Gestapo.”

Landry’s office declined to comment.

Another bill would share the names of complainants with officials they are accusing of wrongdoing, as well as limit the board’s ability to launch investigations.

Landry’s private attorney, Stephen Gelé, drafted the legislation, which the governor supports.

Gelé is defending Landry against ethics charges brought in 2023 for undisclosed free plane rides to Hawaii when he served as the state’s attorney general. Gelé said negotiations are progressing to “amicably resolve the charges.”

Last year, Gelé warned lawmakers that the ethics board’s investigatory powers are “dangerous, unwarranted, and threaten well-established fundamental constitutional rights” and he has sought to rein them in with new legislation.

The bill’s supporters say it gives the board more discretion about whether to pursue investigations and bring charges, cuts down on waste of taxpayer dollars and strengthens due process rights for the accused.

Yet these changes are raising red flags.

In a letter to lawmakers, the Board of Ethics warned that the bill’s requirement to share copies of all subpoenas with officials under investigation allows them to “influence a witness’s documents or responses.”

Critics say the bill undercuts the board’s authority by granting local courts the power to quash investigations, gives officials opportunities to run out the clock on the board’s one-year timeline to bring charges and prevents the board from investigating violations that were disclosed by public officials seeking the board’s advisory opinion.

The bill also requires a two-thirds board vote to approve an investigation into a sworn complaint and another two-thirds vote on whether to file charges. Current policy requires only majority votes.

Barry Erwin, president of the Council for a Better Louisiana, a nonpartisan government accountability group, said the bill’s two-thirds vote requirements constitute a “high bar to overcome” for a board of political appointees.

“I just think in real life, in very political situations, it’s hard for some of these board members to act with the independence in the system we had before,” Erwin said.

The other bill under consideration — which Gelé said he did not craft and Landry has not publicly supported — would require anyone bringing an ethics complaint to disclose their name and file the complaint in person at the ethics board offices in Baton Rouge. The bill passed in the House with only seven lawmakers opposed and is pending final passage in the Senate.

In a legislative committee hearing, David Bordelon, general counsel for the ethics board, warned that the bill would enable officials “to intimidate a witness or potentially alter information that’s requested.” Bordelon said the measure would “drastically reduce the number of complaints.”

The legislation’s sponsor, Republican Rep. Kellee Hennessey Dickerson, said her bill is part of a fight for “truth” and “justice.”

“For those of us who have been through it, it helps develop peace of mind, knowing who your accuser is, especially when you are spending thousands upon thousands of dollars to try and clear your good name,” said Dickerson, who was fined $1,500 for an ethics violation in 2023.

She argued people frequently file complaints to harass their political opponents. Bordelon countered that the board dispassionately evaluates complaints and provides the accused with the opportunity to defend themselves if charges are brought.

The bill also prevents the ethics board from launching investigations based on non-governmental sources such as media reports.

Following legislation passed last year, the governor directly appoints nine of the board’s 15 members, with the Legislature appointing the rest.

Officials with the legislative and executive branches now have more control over those who may be tasked with investigating them, watchdogs note.

“It’s gone from a process that was as much arm’s length away from politics as we could make it, and we had it that way for many years, to a process now that is very much more political than we’ve ever seen it,” Erwin said. “It’s going to be very difficult for the board to act in a way that guarantees that kind of oversight we want to have.”

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This story has been corrected to show that the bill has already passed the House and Senate, not that it is awaiting approval in the House.

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Brook is a corps member for The Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues.

An attorney representing two women who testified before the House Ethics Committee told ABC News in an interview that former Rep. Matt Gaetz paid both his adult clients for sex.

Florida attorney Joel Leppard told ABC News’ Juju Chang that one of his clients also witnessed Gaetz having sex with a third woman — who was then 17 years old — at a house party in Florida.

“She testified [that] in July of 2017, at this house party, she was walking out to the pool area, and she looked to her right, and she saw Rep. Gaetz having sex with her friend, who was 17,” Leppard said.

The Justice Department spent years probing the allegations against Gaetz, including allegations of obstruction of justice, before informing Gaetz last year that it would not bring charges. Gaetz has long denied any wrongdoing related to the allegations investigated during Justice Department probe.

“Matt Gaetz will be the next Attorney General. He’s the right man for the job and will end the weaponization of our justice system,” Trump transition spokesperson Alex Pfeiffer told ABC News regarding all the allegations involving Gaetz. “These are baseless allegations intended to derail the second Trump administration. The Biden Justice Department investigated Gaetz for years and cleared him of wrongdoing.”

Leppard, who has called for the House Ethics Committee to release its report amid Gaetz’s nomination to serve as President-elect Donald Trump’s attorney general, told ABC News that the former congressman paid both of his clients for sex using Venmo.

“Just to be clear, both of your clients testified that they were paid by Rep. Gaetz to have sex?” Chang asked Leppard.

“That’s correct. The House was very clear about that and went through each. They essentially put the Venmo payments on the screen and asked about them. And my clients repeatedly testified, ‘What was this payment for?’ ‘That was for sex,'” Leppard said.

Leppard also told ABC News that his client testified to House Ethics Committee that, based on her knowledge, Gaetz stopped having sex with the minor after he learned she was underage.

“Her understanding was that Matt Gaetz did not know that she was a minor, and that when he learned that she was a minor, that he broke off things and did not continue a sexual relationship until she turned 18,” Leppard said.

Leppard’s interview with ABC News comes days after he publicly called for the House Ethics Committee to be released.

“As the Senate considers former Rep. Gaetz’s nomination for attorney general, several questions demand answers,” Leppard said. “What if multiple credible witnesses provided evidence of behavior that would constitute serious criminal violations?”

The House Ethics Committee is expected to meet on Wednesday and discuss its report on Gaetz and potentially vote on its release, despite the fact that the investigation ended when Gaetz resigned from the House, multiple sources told ABC News.

The development comes after Leppard on Friday first told ABC News that one of his clients had witnessed Gaetz having sex with a minor — amid mounting pressure on the House Ethics Committee to release its report on its probe into the former Florida congressman.

The two witnesses, who ABC News is not naming, both allegedly attended parties with the then-congressman and testified in both the DOJ and House Ethics investigations.

Gaetz’s one-time friend Joel Greenberg is currently serving an 11-year prison sentence after reaching a deal with prosecutors in May 2021 in which he pleaded guilty to multiple federal crimes including sex trafficking of a woman when she was a minor and introducing her to other “adult men” who also had sex with her when she was underage.

Attorney John Clune, who represents the former minor at the center of the probe, called for the release of the Ethics Committee’s report on Thursday.

“Mr. Gaetz’s likely nomination as Attorney General is a perverse development in a truly dark series of events. We would support the House Ethics Committee immediately releasing their report. She was a high school student and there were witnesses,” Clune said in a statement.

Sources said the woman, who is now in her 20s, testified to the House Ethics Committee that the now-former Florida congressman had sex with her when she was 17 years old and he was in Congress, ABC News previously reported.

Gaetz faces an increasingly uphill nomination process in the Senate, with at least five Republican senators signaling skepticism that he could get enough support to be confirmed.

President-elect Trump has repeatedly urged GOP leadership to bypass the traditional confirmation process through recess appointments, whereby Trump could appoint his cabinet while Congress is out of session.

LONDON — Details of a proposed law to legalize assisted dying in England and Wales have been published, rekindling debate on the controversial topic ahead of a vote in Parliament later this month.

The draft bill, published Monday, proposes allowing terminally ill adults expected to have less than six months to live to ask for and be provided with help to end their own life, subject to safeguards and protections.

Opponents have voiced concerns that the bill would mean people could become pressured to end their lives.

But Labour lawmaker Kim Leadbeater, who proposed the bill, said the law has robust safeguards built into it and contains “three layers of scrutiny” — two doctors and a High Court judge will have to sign off on any decision.

A debate and first vote on the bill is expected to take place on Nov. 29.

Prime Minister Keir Starmer said Tuesday he will study the details of the bill and “will not be putting pressure on any MP (Member of Parliament) to vote one way or the other.”

Here’s a look at what’s in the Terminally Ill Adults (End of Life) Bill and the next steps:

Under the draft legislation, only those over 18-years-old in England and Wales and who are expected to die within six months can request assisted dying.

They must have the mental capacity to make a choice about the end of their life and will be required to make two separate declarations about their wish to die. Two independent doctors have to be satisfied the person is eligible and a High Court judge will need to approve the decision.

Anyone found guilty of pressuring, coercing or dishonestly getting someone to make a declaration that they wish to die will face up to 14 years in prison.

Assisted suicide is currently banned in most parts of the U.K. It is not a specific criminal offense in Scotland, but assisting the death of someone can result in a criminal charge.

The patient must self-administer the life-ending medication themselves. No doctor or anyone else can give the medication.

No health professional is under any obligation to provide assistance to the patient.

Doctors who do take part would have to be satisfied the person making their declaration to die has made it voluntarily. They also must ensure the person is making an informed choice.

The bill will be debated in Parliament and lawmakers will be able to vote on it according to their conscience, rather than along party lines.

Opinion among lawmakers appears to be divided, though some senior ministers including Health Secretary Wes Streeting has said he intended to vote against the bill. Starmer has previously supported assisted dying, but the government says it will remain neutral on the issue.

If the bill passes the first stage in the House of Commons, it will face further scrutiny and votes in both Houses of Parliament. Leadbeater suggested that any new law is unlikely to come into effect within the next two to three years.

One argument supporting the bill is that wealthy individuals can travel to Switzerland, which allows foreigners to go there to legally end their lives, while others have to face possible prosecution for helping their loves ones to die.

Other countries that have legalized assisted suicide include Australia, Belgium, Canada and parts of the United States, with regulations on who is eligible varying by jurisdiction.

Assisted suicide is different to euthanasia, allowed in the Netherlands and Canada, which involves healthcare practitioners killing patients with a lethal injection at their request and in specific circumstances.

TORONTO — A homeless man refusing long-term care, a woman with severe obesity, an injured worker given meager government assistance, and grieving new widows. All of them requested to be killed under Canada’s euthanasia system, and each sparked private debate among doctors and nurses struggling with the ethics of one of the world’s most permissive laws on the practice, according to an Associated Press investigation.

As Canada pushes to expand euthanasia and more countries move to legalize it, health care workers here are grappling with requests from people whose pain might be alleviated by money, adequate housing or social connections. And internal data obtained exclusively by AP from Canada’s most populous province suggest a significant number of people euthanized when they are in unmanageable pain but not about to die live in Ontario’s poorest and most deprived areas.

Some doctors fear moving forward even with cases that meet Canada’s legal requirements, which allow euthanasia for people with “irremediable suffering” from serious but nonfatal medical conditions and disabilities. On private forums, doctors and nurses have expressed deep discomfort with ending the lives of vulnerable people whose deaths were avoidable, according to messages provided to AP by a participant on condition of anonymity due to their confidentiality.

Some of the requests from the forums were approved and acted upon. Others were denied. But the discourse about patients who are poor, disabled or lonely shows a fraught process where medical professionals test the limits of what conditions warrant euthanasia. The controversial cases in the forums have never been disclosed through Canada’s oversight system, even in an anonymized manner.

When Canada legalized assisted dying in 2016, officials said they wanted to reduce suffering and support individual autonomy and freedom of choice — and polls have consistently shown public approval. Prime Minister Justin Trudeau promised then that safeguards would prevent vulnerable people from being euthanized “because you’re not getting the support and care you actually need.”

But experts tasked with delivering euthanasia to people who aren’t dying have called it “morally distressing” and say the legal provisions are too vague to be protective, obliging doctors and nurses to at times end the lives of people they believe might otherwise be saved.

“I don’t want (euthanasia) to become the solution to every kind of suffering out there,” a physician wrote to colleagues on one of the private forums.

Canada has the world’s fastest-growing program for euthanasia, the practice of doctors and nurse practitioners killing patients with an injection of drugs at their request. Medically assisted suicide — patients themselves taking prescribed, lethal medication — also is legal.

But virtually all of Canada’s MAiD cases — as it’s widely known here, for medical assistance in dying – are euthanasia, with a doctor or nurse practitioner giving the fatal injection.

Unlike many other countries, Canada doesn’t require that patients exhaust all medical treatments before seeking death.

After legalizing euthanasia in 2016, Canada broadened its law in 2021 to allow people with incurable, but not terminal, conditions – including disability alone – to seek a way to die. This vastly expanded the number of people eligible, and medical groups in some territories and provinces require doctors to inform, offer or help provide euthanasia to any patients who might qualify.

Adults with serious, incurable conditions must have a written request approved by two independent doctors or nurse practitioners. Those with nonterminal cases must be informed of other ways to relieve their suffering, among other requirements, and there’s a minimum 90-day assessment period.

As the eligibility pool has grown, so has criticism among academics, disability advocacy groups and religious communities.

Doctors and nurses “do not treat MAiD as an option of last resort,” said an August report published by the Christian think tank Cardus.

The nonprofit organization Inclusion Canada regularly hears from people with disabilities who are offered euthanasia, including one disabled woman whose physiotherapist suggested it when she sought help for a bruised hip, said executive vice president Krista Carr.

“Our response to the intolerable suffering of people with disabilities is: ‘Your life is not worth living,’” she said. “We’ll just offer them the lethal injection, and we’ll offer it readily.”

When euthanasia was legalized, doctors and nurse practitioners set up email discussion groups as confidential forums to discuss potentially troubling cases, with limited patient details for privacy. They’re now run by the Canadian Association of MAiD Assessors and Providers.

Association President Dr. Konia Trouton told AP via email that providing euthanasia for vulnerability or financial reasons alone is “completely forbidden.” Trouton said doctors and nurse practitioners consult with one another on the forums “to gain insights and learn from the experiences of others.”

The participant who shared some of the email discussions with AP provided dozens of messages raising questions about the medical and ethical complexities of euthanasia requests from people nationwide who weren’t terminally ill.

A middle-aged worker whose ankle and back injuries made him unable to resume his previous job told his doctor that the government’s measly support was “leaving (him) with no choice but to pursue MAiD.” His doctor told forum participants the patient met legal criteria, with severe pain, strained social relationships and inability to work. Others agreed and assured the doctor the man was clearly in pain. But the doctor was hesitant because the man cited reduced government payments as a key factor.

Cases of homelessness appear regularly and spark some of the most heated debate.

One doctor wrote that although his patient had a serious lung disease, his suffering was “mostly because he is homeless, in debt and cannot tolerate the idea of (long-term care) of any kind.” A respondent questioned whether the fear of living in the nursing home was truly intolerable. Another said the prospect of “looking at the wall or ceiling waiting to be fed … to have diapers changed” was sufficiently painful.

The man was eventually euthanized.

One provider said any suggestion they should provide patients with better housing options before offering euthanasia “seems simply unrealistic and hence, cruel,” amid a national housing crisis.

Physicians said keeping their opinions out of assessments was difficult — and painful, given patients’ emotions and desperation.

Experts not linked to the forums said that while doctors and nurses need private space for discussion, the lack of transparency about controversial cases is alarming.

“The question about who gets euthanasia is a societal question,” said Kasper Raus, a researcher at Ghent University’s Bioethics Institute in Belgium. “This is a procedure that ends people’s lives, so we need to be closely monitoring any changes in who is getting it.

“If not, the entire practice could change and veer away from the reasons that we legalized euthanasia.”

Critics have long warned that Canada’s policies have led to euthanasia among disadvantaged people whose deaths weren’t imminent. Despite publicized cases of people asking to be killed because of insufficient support, government officials have largely refuted the idea that socially disadvantaged people are being euthanized.

But in Ontario, more than three quarters of people euthanized when their death wasn’t imminent required disability support before their death in 2023, according to data from a slideshow presentation by the province’s chief coroner, shared with AP by both a researcher and a doctor on condition of anonymity due to its sensitive nature.

Of people killed when they weren’t terminally ill, nearly 29% lived in the poorest parts of Ontario, compared with 20% of the province’s general population living in the most deprived communities, the data show.

People euthanized with nonterminal conditions were “more likely to live in neighborhoods where there’s higher levels of residential instability, higher material deprivation and greater dependency on government support,” Ontario Chief Coroner Dr. Dirk Huyer said during his May presentation.

The figures suggest poverty may be a factor in Canada’s nonterminal euthanasia cases.

But Huyer told AP that the data was only an early analysis and “it’s tough to know exactly what it means,” saying that his job was only to present the statistics.

Poverty doesn’t appear to disproportionately affect patients with terminal diseases who are euthanized, according to the leaked data. And experts say no other country that has legalized euthanasia has seen a marked number of deaths in impoverished people.

Overall for Ontario, the data show, nonterminal patients account for a small portion of all euthanasia cases: 116 of 4,528 deaths last year. But the presentation and discussion among Ontario officials and medical professionals show rising awareness of euthanasia deaths for social reasons.

Health Canada, the government agency responsible for national health policy, publishes yearly reports of euthanasia trends but hasn’t released any review of cases that triggered ethical concerns.

Marie-Pier Burelle, a spokeswoman for Health Canada, said in an email that “lack of access to social supports or to health services is not and would never be part of eligibility criteria” for euthanasia. Burelle cited “stringent safeguards to affirm and protect the inherent and equal value of every person’s life.”

In private, though, Canadian officials have examined worrisome cases.

A document from the Ministry of the Solicitor General in Ontario sent to all euthanasia providers in the province in May noted two cases of “lessons learned” in nonterminal cases. The document was shared with AP by a doctor on condition of anonymity because it wasn’t authorized for release.

In one, a 74-year-old patient who’d suffered high blood pressure, a stroke and blindness, among other difficulties, was increasingly dependent on their spouse and “expressed their interest in MAiD to their family physician, due to their vision impairment and loss of hope for improvement of their vision and quality of life.”

The report cited three instances where legally mandated safeguards were not met. Among them: No assessor or expert versed in the nonterminal condition was involved, and efforts to discuss alternatives to death were “limited.”

The report also said the procedure was scheduled “based on the spouse’s preference of timing.” Officials questioned whether “the patient’s death was genuinely voluntary and free of coercion.” Independent legal experts said those breaches could constitute violations of criminal law.

Polls show that expanding access to euthanasia has long been supported across Canada. But the country appears to be pushing the boundaries of what’s socially acceptable, experts say, and that could have global implications, as countries including Britain and France move towards legalization.

“Canada seems to be providing euthanasia for social reasons, when people don’t have the financial means, which would be a big taboo in Europe,” said Theo Boer, professor of health care ethics at Groningen University in the Netherlands. “That may be what Canadians want, but they would still benefit from some honest self-reflection about what is going on.”

Some of that reflection is happening in the confidential providers’ forums.

They’ve debated whether it’s valid to euthanize people for obesity in several cases. One woman with severe obesity described herself as a “useless body taking up space” — she’d lost interest in activities, became socially withdrawn and said she had “no purpose,” according to the doctor who reviewed her case. Another physician reasoned that euthanasia was warranted because obesity is “a medical condition which is indeed grievous and irremediable.”

When a health worker inquired whether anyone had euthanized patients for blindness, one provider reported four such cases. In one, they said, an elderly man who saw “only shadows” was his wife’s caregiver when he requested euthanasia; he wanted her to die with him. The couple had several appointments with an assessor before the wife “finally agreed” to be killed, the provider said. She died unexpectedly just days before the scheduled euthanasia.

Providers on the forum were divided over ending the lives of people in mourning. One case involved a woman in her 80s who required dialysis and lost her husband, sibling and cat in a six-week period. Her assessor said her suffering and request to die were tied to her husband’s death rather than any medical conditions.

Some doctors said because she lost her husband — the protective factor that would make the other losses and suffering bearable — she qualified. Others recommended grief counseling instead.

A provider referenced a similar case, in which a widow requested euthanasia within weeks of her husband’s death: “Her whole life system crashed. I felt much ease in providing for her and had no pushback from the coroner.”

Dr. Ellen Wiebe, who has euthanized more than 400 people in Canada, told AP that while poverty inevitably exacerbates suffering, improved housing and social situations have never changed a patient’s mind.

“The idea that because I’m disabled, I should lose my rights that undisabled people have is outrageous,” said Wiebe, who suffers from heart disease and uses a wheelchair.

She predicted legal consequences if officials introduce more safeguards for euthanasia: “We’ll just be back in court with somebody saying, ‘You interfered with my basic human rights.’”

The government already faces challenges to its euthanasia laws on all sides. The advocacy group Dying with Dignity filed an August lawsuit in Ontario, alleging it’s “discriminatory” to exclude mentally ill people from euthanasia. A coalition of disability-rights organizations in a lawsuit last month argued that euthanasia legislation has resulted in premature deaths of people with disabilities.

On euthanasia forums, doctors and nurses continue to struggle with cases of patients who aren’t fatally ill, lamenting that Canada’s health and social services can seem woefully inadequate.

“I have great discomfort with the idea of MAiD being driven by social circumstances,” one provider said. “I don’t have a good solution to social deprivation either, so I feel pretty useless when I receive requests like this.”

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. This story also was supported by funding from a Pulitzer Traveling Fellowship grant. The AP is solely responsible for all content.