Compassion & Choices of Oregon - The Oregon Law
Compassion and Choices of Oregon has guided more than 1400 terminally ill Oregonians through Oregon’s aid-in-dying process.
Each of the 1400 plus clients who died during the past almost 12 years left a lasting impression on all of us at Compassion. More than 340 of them chose to use Oregon's Death with Dignity Act by taking the medication legally prescribed to them under the law. An over whelming number of their surviving family members and friends have expressed appreciation to Compassion for guiding their loved ones through the process and for making certain their loved ones had the opportunity to die according to their wishes.
To address the concerns of Oregon residents and others interested in end of life care, Compassion is participating in a study being conducted by Linda Ganzini, MD at the Oregon Health & Sciences University. The study includes more than 150 of Compassion’s present clients and family members. The study was released in 2008. It involves in depth interviews with our clients and their family members to determine their views on aid-in-dying.
During the past almost twelve years Compassion has gathered useful and informative information on those who seek to use Oregon’s law that is not included in the Oregon Department of Human Services’ annual report. Such facts as:
1. 40% self identify as Republican, 44% as Democrat & the remainder having no political preference or indentify as being Independent.
2. 87% believe in a higher being. Of the total who gave a religious preference 14% identified with a Protestant Church, 6% to the Catholic Church, 2.2% to a Jewish Synagogue, 2.2% to a Unitarian Church and 1% to a Buddhist Temple.
3. The ages ranged from 20 to 109 with 70 the average.
4. The average length of time from a client's first contact with Compassion to his or her death (from any cause) is 208 days.
5. We believe the most significant statistic that reflects the effectiveness of our law is the prevention of violent sucides. Oregon's law has prevented at least 155 terminal Oregonians from committing a violent suicide.
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The following is a plain language explanation of Oregon's aid-in-dying law.
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What is permitted under the Act?
The law permits:
1. a qualified patient, suffering from a terminal disease, to voluntarily request from his/her attending (primary) physician a prescription for medication to end his or her life in a humane and dignified manner,
2. the patient to rescind (take back) his or her request at any time or in any manner,
3. doctors and other health care providers to refuse to participate
4. the patient’s family and physician to be present at the time the patient takes the medication.
Who is a Qualified Patient?
The law requires that the patient:
1. be an adult - 18 years of age or older,
2. be capable - meaning that in the opinion of a physician, a patient has the ability to make and communicate health care decisions to health care providers,
3. be an Oregon resident,
4. have a terminal illness with fewer than six (6) months to live, which is the same requirement to become eligible for hospice.
5. Make his/her request for assistance voluntarily.
There are many different reasons a patient might request to hasten his or her inevitable death. The patient's physician must explore all of the physical, psychological, and spiritual reasons for the request and explain all of the options available. The physician should ask about the patient’s social and financial issues and if there has been any coercion used to make the patient ask to hasten his/her death. The physician may discover, after discussing these matters with the patient, that there are symptoms or other conditions which need to be addressed promptly with medications, counseling or other measures.
If either attending/prescribing or consulting physician is unsure of the patient's competency or judgement, the patient should be referred to a psychiatrist or psychologist, as the law requires. If a psychological evaluation is needed it should be done early in the process because the attending physician may not write the prescription to hasten death until the psychiatrist or psychologist determines that the patient is competent and does not have impaired judgement.
Are there Safeguards and Guidelines in the Act? YES!
The Act:
a. Requires the patient give a fully informed, voluntary decision
b. Applies only to the last six months of the patient's life
c. Makes it mandatory that a second opinion by a qualified physician be given that the patient has fewer than six months to live
d. Requires two oral requests by the patient
e. Requires a written request by the patient
f. Allows cancellation of the request at any time
g. Makes it mandatory that a 15-day waiting period occurs after the first oral request
h. Makes it mandatory that 48-hour (2 days) elapse after the patient makes a written request to receive the medication
i. Punishes anyone who uses coercion on a patient to use the Act
i. Provides for psychological counseling if either of the patient's doctors thinks the patient needs counseling
k. Recommends that the patient inform his/her next of kin
l. Excludes nonresidents of Oregon from taking part
m. Doctors must be licensed in Oregon
n. Mandates Health Division Review
o. Does not authorize mercy killing or active euthanasia
What is not permitted under the Death with Dignity Act?
The Act:
a. Does not authorize mercy killing, lethal injection or active euthanasia
b. Does not allow people suffering from a psychiatric or psychological disorder, or depression causing impaired judgment, to qualify to receive life-ending medication
c. Does not allow nonresidents of Oregon to participate
d. Does not allow physicians not licensed to practice in Oregon to participate
e. Does not allow coercion or undue influence
Definitions
The "Attending Physician" is the physician who takes primary responsibility for end-of-life care and will write the prescription to hasten an inevitable death.
The "Consulting Physician" is the physician who confirms that the patient is capable, acting voluntarily, has a terminal illness, and has fewer than six months to live.
Legal Requirements of the Attending Physician
The attending physician must recommend that the patient discuss his/her intentions with close relatives. In doing so, the physician may discover unresolved family conflicts that should be addressed.
Even though it is not legally required, the physician is encouraged to ask the patient about the existence of an Advanced Directive for healthcare and encouraged to fill out a Physician Orders for Life Sustaining Treatment (POLST) form, which is a straight-forward Do or Do Not Resuscitate order.
The physician must document the elements of an informed decision in the patient's medical chart as follows:
1. diagnosis,
2. prognosis,
3. potential risks associated with taking the medication,
4. result of taking the medication,
5. and the feasible alternatives, which include but are not limited to comfort care, hospice, and symptom control.
The physician must document all reminders to the patient of his or her "Right to Rescind" the request to hasten death and document the physician’s recommendation to take the medication with another person in attendance in a non-public site. The physician must also obtain a consultation from another physician (the "consulting physician") to confirm the diagnosis and prognosis.
Legal Requirements of the Consulting Physician
Similar to the duties of the attending physician, the consultant must explore all the issues that are the basis for the patient's request. The consultant must document that the patient has a terminal illness with fewer than six months to live, is capable, is acting voluntarily, and has made an informed decision. If there is a question about the patient's capability or judgement the consultant must request a referral to a psychiatrist or psychologist. The consultant must document the above on the Oregon Health Division (OHD) Consulting Physician's Compliance Form and deliver this form to the attending physician.
Timing Safeguards of the Act
• The attending physician must document in the patient's chart the patient's first oral request to use the Act.
• The attending physician must wait fifteen (15) calendar days after the patient's first oral request to write the prescription to hasten death.
• In addition, the attending physician must wait at least forty-eight (48) hours after the patient has signed and delivered the Written Request for Medication form to write the prescription.
• The patient cannot sign the Written Request for Medication form until the consulting physician confirms the terminal illness.
• The patient must also make the second oral request before the attending physician writes the prescription to hasten death.
If you wish to read the text of Oregon’s aid-in-dying dying law (ORS 127.800-127.897).CLICK HERE. |
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| Directors |
Patrick G. Boylston, JD
Portland, OR
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Nick Drakos, MD
Portland, OR
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Nina Ford, NP
Portland, OR
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Peter Goodwin, MD
Portland, OR
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Kirsten Leonard
Portland, OR
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Julie McMurchie, JD, Chair
Portland, OR
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Jeffrey I Menashe, MD
Portland, OR
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Derianna Mooney, RSN, RN
Immediate Past Chair
Portland, OR
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Bobbie Regan, BA
Vice Chair
Portland, OR
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Brian Ruess, JD
Secretary/Treasurer
Portland, OR
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| Advisors |
JoAnn Bowman
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Nancy Bragdon
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Mary Gay Broderick
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Ron Cease
Former State Senator
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Gwyneth Gamble-Booth
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Lynne Gazzola
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Nicholas Gideonse, MD
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Chris Helmer, JD
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Renée Holzman
President Holzman Foundation
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John Howieson, MD
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Harriett Dixon Kazzimir
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Marianne Leipzig
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Marc Lintner
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Dolorosa Margulis
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Laurie B. Marx
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Sally McCracken
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Carolyn McMurchie
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Fred Miller
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Laura Murray
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Christina Nicholaidis, MD
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Cheryl Perrin
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Peter Rasmussen, MD
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Barbara Roberts
Former Governor
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Rabbi Emanuel Rose
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Rabbi Kim I. Rosen
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Rev. Robert Schaibly
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Donna Schuurman
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Rabbi Joshua Stampfer
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Rabbi Ariel C. Stone
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Kate Swindell
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Charles Swindells
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Robert Trotman
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Miranda Wellman
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Stacie White
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Dara Wilk
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