Physician-assisted Suicide

Ongoing Challenges for Pharmacists

Jennifer Fass and Andrea Fass

Disclosures

Am J Health Syst Pharm. 2011;68(9):846-849. 

In This Article

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.[1] 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.[1]

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.[1] 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.[1] The physician must also recommend that the patient notify his or her next of kin.[1] 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.[1]

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.[1] 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.[2]

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