Death with Dignity laws allow certain terminally-ill adults to voluntarily request and receive a prescription medication to hasten their death. As of today, Oregon, Washington, and Vermont have Death with Dignity statutes; California‘s law has yet to go into effect, likely in 2016. In Montana, physician-assisted dying is legal by State Supreme Court ruling.
To qualify for a prescription of medication under Death with Dignity laws, you must be
- a resident of Oregon, Washington, or Vermont
- 18 years of age or older
- mentally competent, i.e. capable of making and communicating your health care decisions;
- diagnosed with a terminal illness that will, within reasonable medical judgment, lead to death within six months.
You must also must be able to self-administer and ingest the prescribed medication. You will not qualify under Death with Dignity laws solely because of age or disability.
Two physicians must determine whether all these criteria have been met.
Since residency in Oregon, Washington, or Vermont is a requirement under their respective Death with Dignity laws, you may prove it with
- a state issued identification card or driver’s license; or
- documents showing you rent or own property in the state; or
- a state voter registration; or
- a recent state tax return.
The attending physician must decide whether you have adequately established residency.
There is no minimum length-of-residency requirement. You must simply be able to prove you are a current, bona fide resident of Oregon, Washington, or Vermont.
Death with Dignity laws clearly outline the process by which qualified individuals may obtain life-ending medications.
It is up to qualified patients and licensed physicians to implement these laws on an individual basis; there are no government programs that will provide assistance. However, the Department of Health in each state enforces compliance with the law. Compliance with the law protects you, your family members, and your physician from criminal prosecution.
Participation in Death with Dignity laws is voluntary. Neither you nor your physician are obligated to use the Death with Dignity laws. Compliance with the law protects you, your family members, and your physician from criminal prosecution.
There are no lists of physicians who prescribe medications under Death with Dignity laws.
First Oral Request
You may make an oral request for medication under Death with Dignity laws at any time. The attending physician to whom you make the request must be licensed in the state in which you are making the request. You can rescind the request at any time in the process.
Your attending physician must confirm you meet all of the eligibility criteria. Your physician must also inform you of alternatives, including palliative care, hospice and pain management options, and ask that you notify your next-of-kin of the prescription request. A second, consulting physician must confirm the diagnosis, prognosis, and your mental competence.
If either physician determines that your judgment may be impaired in any way, e.g. by a mental illness or depression, they must refer you for a psychological or psychiatric examination.
If your first oral request is authorized, you must wait a minimum of 15 (fifteen) days to make the second oral request.
Second Oral Request
You may make your second oral request any time after the 15 day waiting period.
You can make the written request to your attending physician at any time following the first oral request, using the statutory form included in your state’s Death with Dignity law. It is recommended that you only complete and sign the written request after seeing both the attending and consulting physicians after they have submitted their respective paperwork. Keep a copy of the written request for your records.
The written request must be witnessed by two individuals, at least one of whom is not related to you, or entitled to any portion of your estate, or your physician, or an employee of a health care facility caring for you.
As with both oral requests, you can rescind the written request at any time.
After you complete all of the above steps, your physician will write the prescription. You must wait 48 hours before you can pick it up from the pharmacy.
Talking to Your Doctor About Death with Dignity
Information in this section has been adopted from an End of Life Washington handout.
It is important to discuss your end-of-life wishes with your doctor as early as possible (the benefit of doing this even if you are still healthy is that if you ascertain that your doctor does not share your values on this subject, you will have the chance to look for a willing physician while you still have the energy and time to do so).
The best time for this conversation is when you provide your physician with a copy of your advance directives or discuss the use of the Physician Orders for Life-Sustaining Treatment (POLST) form, a non-hospital medical order for people with serious illnesses. If you raise the issue after receiving a terminal diagnosis, your physician may be less receptive.
It is important to have this discussion with your doctor in person. Do not ask their office staff, nurse, or assistant or leave a request on their voice mail. Above all, avoid demanding your physician’s assistance. Under Death with Dignity laws your physician is not required to participate and may have valid reasons for declining.
First, explain to your physician that you believe in being prepared, that you wish to avoid unnecessary suffering at the end of life, and that you would like to make sure that both of you would be on the same page in an end-of-life situation. Then, ask your physician for a yes or no answer to this question: “If I were terminally ill and wanted to use our state’s Death with Dignity law, would you be willing to write me a prescription for life-ending medication?”
If your physician seems reluctant to prescribe but seems unopposed to the concept of Death with Dignity itself, ask if the physician would be willing to participate as the consulting physician, i.e. the doctor who confirms your diagnosis, prognosis, and mental capacity.
Common responses from physicians and what they may indicate:
- “I will help you,” or “I will be there for you when the time comes.” This may mean “I will refer you to hospice and palliative care,” or “I will be sure you are kept comfortable, but I may not write a prescription for life-ending medication.”
- “Let’s talk about that when the time comes.” or “We can talk later.” or “For now, let’s focus on treatment.” Physicians who make these kinds of statements are stalling or trying to change the subject. More often than not, these physicians will elect not to participate when the time comes.
- “I don’t know anything about Death with Dignity.” Send your physician to this website, DeathwithDignity.org or give them the toll-free number of End of Life Washington, 877.222.2816, where they can seek more information. (Though Death with Dignity laws vary from state to state, End of Life Washington can provide the necessary basic information.)
- “My employer will not allow me to participate.” Some physicians work for Catholic or other faith-based health care providers that prohibit participation in Death with Dignity Acts. Although the law permits providers to prohibit physicians from participating while on their employer’s premises, nothing prevents a physician from participating off the premises. The law also prevents a provider from punishing a physician who does. Many physicians are unaware of these provisions of the law, and even those who are aware may not be comfortable participating under these circumstances.
- “I don’t believe in that.” or “I would never do that.” or “I’m against that.” If your physician declines to participate, you should evaluate your relationship with that doctor. While it is your physician’s right to opt out of participating in your state’s Death with Dignity law, these kinds of statements are a possible red flag that she may not practice patient-centered care or be less willing to provide you with adequate pain medication or provide an early referral for hospice or palliative (comfort) care. You have the option of switching doctors or continuing treatment while seeking out another physician willing to honor your end-of-life decisions regardless of their personal beliefs.
- Vermont Department of Health
- Vermont Ethics Network
- Patient Choices Vermont
- Forms for patients and physicians
Other Options to Hasten Death
Death with Dignity is a humane, dignified, and compassionate option to hasten your death, if you meet the criteria. There are other options to hasten your death, whether or not your state allows physician-assisted dying.
Do you have any additional questions? Call us at (503) 228-4415.