Eligibility and Counseling
The legal foundation of physician- assisted suicide is Death with Dignity Act (DWDA) legislation, which has been enacted by Oregon and Washington; in 2008, a supreme court judge in Montana ruled in favor of legalized physician-assisted suicide. Oregon enacted its DWDA in 1994, and the law became effective in 1997. Oregon's DWDA permits a terminally ill patient to request a prescription for a self-administered lethal dose of medication to end his or her life. The patient must be at least 18 years of age, a legal resident of Oregon, capable of making and communicating health care decisions, and diagnosed with a terminal illness that will lead to death within six months.[1,2] The patient must make two oral requests to a physician for a lethal medication dose, at least 15 days apart, and provide a written request to an attending physician, the person with the primary responsibility for the patient's care and treatment of the terminal illness; the request must be signed before two witnesses.
The attending physician must refer the patient to a consulting physician to confirm the diagnosis and prognosis and determine whether the person is capable of making health care decisions. If either physician suspects the patient may be suffering from a psychiatric or psychological disorder that could impair judgment, the individual must be referred for a mental health evaluation. The psychiatrist or psychologist should evaluate the patient for mental disorders, including depression and delirium, and decision-making abilities.[1,2]
After those steps are completed, the prescribing physician must notify the patient of alternatives to suicide, including comfort care, hospice care, and pain management. The physician must also recommend that the patient notify his or her next of kin. Also, the patient may rescind the expressed desire for a lethal medication dose at any time, and the physician must explicitly offer an opportunity to rescind upon the second oral request.
A physician is permitted to dispense the medication directly to patients provided he or she is registered as a dispensing practitioner with the Oregon Medical Board and maintains a current Drug Enforcement Administration certificate.[1,2] Physicians issuing prescriptions to be dispensed at a pharmacy must notify the pharmacist in advance. The physician must either deliver the written prescription personally or mail it to the pharmacist. Once the prescription is filled, it may be obtained by the physician, the patient, or an agent of the patient (e.g., family member).[1,2] Oral medication counseling must be offered to the patient or patient's agent and provided in person, whenever practical, and in a private area; the pharmacist can offer to provide counseling over the telephone.
Am J Health Syst Pharm. 2011;68(9):846-849. © 2011 American Society of Health-System Pharmacists, Inc.
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Cite this: Physician-assisted Suicide - Medscape - May 01, 2011.