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.
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 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.
There are no exceptions to these requirements.
Residency in Oregon, Washington, or Vermont is a requirement under Death with Dignity laws. You may prove residency in one of these states 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 or other programs for participation in these laws. However, departments of health in each state enforce compliance with the law, including all requests and prescriptions under these laws.
Participation in Death with Dignity laws is voluntary. You or your physician are not obligated to participate in 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, they must refer you for a psychological examination.
If your first oral request is authorized, you must wait at least 15 (fifteen) days to make the second oral request.
Second Oral Request
Following the 15-day waiting period, you may make your second oral request at any time.
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 physician who agreed to participate in the law and submit their respective paperwork. Keep a copy of the written request for your records.
The written the request must be witnessed by two individuals, at least one of whom is not related to you, entitled to any portion of your estate, 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 all the requests are made and requirements are met, your physician writes the prescription. You must wait 48 hours before you can pick up your medications from the pharmacy.
Your decision to end your life under a Death with Dignity statute has no effect on your life, health, or accident insurance or annuity policy.
Talking to Your Doctor About Death with Dignity
Information in this section has been adopted from a handout by End of Life Washington.
It is important to discuss your end-of-life wishes with your doctor as early as possible. Though Death with Dignity laws provide peace and comfort by merely offering the option of requesting life-ending medication, it’s important to seek treatment from a physician who shares your values and who can confirm that they would support your decision to use the option.
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 ask only your doctor and that you ask in person; do not ask their office staff, nurse, or assistant or leave a request on voice mail. Above all, avoid demanding your physician’s assistance or approaching her with a sense of entitlement. 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 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 Death with Dignity itself, ask her if she would be willing to participate as the consulting physician, who would confirm your diagnosis, prognosis, and mental capacity.
Common responses from physicians include:
- “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,” “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.” Give your physician the toll-free number of End of Life Washington, 877.222.2816, where she 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,” “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 are terminally ill and reside in a state without a Death with Dignity law, you have other options.
Do you have any additional questions? Call us at (503) 228-4415.