The following is a plain language explanation of Oregon Death with Dignity Act.
What is permitted under the Act?
The law permits:
1. an eligible person, 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 eligible person 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 eligible person’s family and physician to be present at the time the patient takes the medication.
Who is eligible for the Oregon Death with Dignity Act?
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 may not be 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. During this discussion, the physician may discover 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 judgment, 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 judgment.
What are the safeguards and guidelines in the Oregon Death with Dignity Act?
1. The Act requires the patient give a fully informed, voluntary decision.
2. The Act applies only to the last six months of the patient’s life.
3. The Act makes it mandatory that a second opinion by a qualified physician be given that the patient has fewer than six months to live.
4. The Act requires two oral requests by the patient.
5. The Act requires a written request by the patient.
6. The Act allows cancellation of the request at any time.
7. The Act makes it mandatory that a 15-day waiting period occurs after the first oral request.
8. The Act makes it mandatory that 48-hour (2 days) elapse after the patient makes a written request to receive the medication.
9. The Act punishes anyone who uses coercion on a patient to use the Act.
10. The Act provides for psychological counseling if either of the patient’s physicians thinks the patient needs counseling.
11. The Act recommends that the patient inform his/her next of kin.
12. The Act excludes nonresidents of Oregon from taking part.
13. The Act doctors must be licensed in Oregon.
14. The Act mandates Oregon Health Division Review.
15. The Act does not authorize mercy killing or active euthanasia.
What is not permitted under the Oregon Death with Dignity Act?
1. Does not authorize mercy killing, lethal injection or active euthanasia.
2. Does not allow people suffering from a psychiatric or psychological disorder, or depression causing impaired judgment, to qualify to receive life-ending medication.
3. Does not allow nonresidents of Oregon to participate.
4. Does not allow physicians not licensed to practice in Oregon to participate.
5. Does not allow coercion or undue influence.
What are the definitions as listed in the Oregon Death with Dignity Act?
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:
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.
What are the 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 judgment 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.
What are the ‘timing safeguards’ detailed in the Oregon Death with Dignity Act?
1. The attending physician must document in the patient’s chart the patient’s first oral request to use the Act.
2. The attending physician must wait fifteen (15) calendar days after the patient’s first oral request to write the prescription to hasten death. The attending physician must have the completed Request for Medication form and the Consulting Physician form before writing the prescription.
3. In addition, the attending physician must wait at least forty-eight (48) hours after the patient has signed the Written Request for Medication form to write the prescription.
4. The patient cannot sign the Written Request for Medication form until the consulting physician confirms the terminal illness.
5. The patient must also make the second oral request before the attending physician writes the prescription to hasten death.