States with Legal Physician-Assisted Suicide

Proposition 106: End of Life Options Act

Voted on Nov. 8, 2016

“(1) An adult resident of Colorado may make a request, in accordance with sections 25-48-104 and 25-48-112, to receive a prescription medical aid-in-dying medication if:

(a) The individual’s attending physician has diagnosed the individual with a terminal illness with a prognosis of six months or less;

(b) The individual’s attending physician has determined that the individual has mental capacity; and

(c) The individual has voluntarily expressed the wish to receive a prescription for medical aid-in-dying medication;

(2) The right to request medical aid-in-dying does not exist because of age or disability.”

[Note: Colorado’s law took effect in Jan. 2017]

Patient eligibility:

• 18 years of age or older
• Resident of Colorado
• Capable of making and communicating health care decisions for themselves and has made the request voluntarily
• Diagnosed with a terminal illness that will lead to death within six months

Physician protocol:

• The physician’s diagnosis must include a terminal illness with six months or less to live and that the patient is mentally capable of making an informed decision and is making that decision voluntarily.
• The physician must request that the patient demonstrate Colorado residency.
• The patient must be referred to a consulting physician to confirm the diagnosis and competency.
• The physician must discuss with the patient his or her medical diagnosis and prognosis of six months or less to live; feasible alternative or additional treatment; the risks of taking aid-in-dying medication; and the possibility that a patient may fill the aid-in-dying medication prescription but choose not to use it.
• The physician must refer the patient to a licensed mental health professional.
• The physician must request that the patient notify his or her next of kin about the prescription request.
• The patient must be informed that the medication should be taken in a private place with another person present.

Patient request timeline:

• First oral request to physician
• 15-day waiting period
• Second oral request to physician
• Written request to physician

Other:

• Use of the law cannot affect the status of a patient’s health or life insurance policies.
• Physicians and health care systems are not obligated to participate.

Signed into law: Apr. 5, 2018

“The legislature concludes that adult, terminally ill residents of the State can determine their own medical treatment as they near the end of life and should have a full complement of support services available, including palliative care, hospice care, aggressive medical care, and the right to choose to avoid an unnecessarily prolonged life of pain and suffering. The choice elected by an individual must be fully informed, including about options for care that are presented and discussed with health care providers in a values-neutral manner.

The purpose of this Act is to allow qualified patients in this State with a medically confirmed terminal illness with less than six months to live and possessing decisional capacity to determine their own medical care at the end of their lives.”

Patient eligibility:

• 18 years of age or older
• Resident of Hawaii
• Capable of making and communicating health care decisions for themselves
• Diagnosed with a terminal illness that will lead to death within six months

Physician protocol:

• The physician’s diagnosis must include a terminal illness with six months or less to live.
• The diagnosis must be certified by a consulting physician, who must also certify that the patient is mentally competent to make and communicate health care decisions.
• A counselor must confirm that the patient is capable, is not suffering from undertreatment or non treatment of depression or other conditions that would impair the ability to make informed decisions.
• The attending physician must inform the patient of alternatives, including palliative care, hospice and pain management options.

Patient request timeline:

• First oral request to physician
• 20-day waiting period
• Second oral request to physician
• Written request witnessed by two people, of whom one may not be a relative, a healthcare professional, or anyone who could gain from the estate of the patient
• 48-hour waiting period between written request and the writing of the prescription

Other:

• The patient retains the right to rescind her/his request at any time and is under no obligation to fill the prescription.
• Use of the law cannot affect the status of a patient’s health, life, or annuity insurance policies.
• Physicians and health care systems are not obligated to participate.

Montana First Judicial District Court: Baxter v. Montana

Decided: Dec. 5, 2008 in favor of plaintiffs

The plaintiffs (four Montana physicians, Compassion and Choices, and Robert Baxter, a 76 year old truck driver from Billings dying of lymphocytic leukemia) asked the court to establish a constitutional right “to receive and provide aid in dying.”

Judge Dorothy McCarter ruled that a terminally ill, competent patient has a legal right to die with dignity under Article II, Sections 4 and 10 of the Montana Constitution. That includes a right to “use the assistance of his physician to obtain a prescription for a lethal dose of medication that the patient may take on his own if and when he decides to terminate his life.” It further held “[t]he patient’s right to die with dignity includes protection of that patient’s physician from liability under the State’s homicide statutes.”
State Supreme Court: Baxter v. Montana

Decided: Dec. 31, 2009 in favor of plaintiffs 5-4

The Attorney General of Montana appealed the ruling of Judge McCarter to the Montana Supreme Court. The Court found that “we find no indication in Montana law that physician aid in dying provided to terminally ill, mentally competent adult patients is against public policy” and therefore, the physician who assists is shielded from criminal liability by the patient’s consent.

[Editor’s Note: Calls to the Montana Department of Public Health and Human Services on July 9 and July 11, 2012 to clarify Montana’s physician-assisted suicide protocol were not returned.]

On Feb. 17, 2011, the Montana legislature tabled two proposed physician-assisted suicide bills. According to the Billings Gazette, “one would have banned the practice altogether (LC0041 – Republican Senator Greg Hinkle), while the other (LC0177 – Democratic Senator Dick Barrett) would have required a doctor to diagnose a patient as being terminally ill and the patient to make voluntary oral and written requests for a lethal prescription of medication. The request would have had to be signed by two witnesses and the patient also would have had to get a second doctor’s opinion.”

Death With Dignity National Center, on its website at deathwithdignity.org, explains that “existing Montana state law provides immunity for physicians for withholding or withdrawing life-sustaining treatment for a terminally-ill patient,” but “does not specifically address physician-assisted suicide.”

Ballot Measure 16: Allows Terminally Ill Adults to Obtain Prescription for Lethal Drugs (Death With Dignity Act)

Decided: Nov. 8, 1994 (51% for)

“An adult who is capable, is a resident of Oregon, and has been determined by the attending physician and consulting physician to be suffering from a terminal disease, and who has voluntarily expressed his or her wish to die, may make a written request for medication for the purpose of ending his or her life in a humane and dignified manner.”

Ballot Measure 51: Repeals Law Allowing Terminally Ill Adults To Obtain Lethal Prescription

Decided: Nov. 4, 1997 (60% against)

Supreme Court of the United States: Gonzales v. State of Oregon

Decided: Jan. 17, 2006 (6-3 in favor of the State of Oregon)

According to the court’s majority opinion, the Controlled Substances Act does not empower the Attorney General of the United States to prohibit doctors from prescribing regulated drugs for use in physician-assisted suicide under state law permitting the procedure. The court’s ruling upheld the Death With Dignity Act.

SB 579

On July 24, 2019, Governor Kate Brown signed SB 579 into law, changing the Death with Dignity Act. The Act now allows patients with fewer than 15 days to live to submit the second oral request for life-ending medication at any time after the first oral request, bypassing the 15-day waiting period.

Patient eligibility:

• 18 years of age or older
• Resident of Oregon
• Capable of making and communicating health care decisions for themselves
• Diagnosed with a terminal illness that will lead to death within six months

Physician protocol:

• The attending physician must be licensed in the same state as the patient.
• The physician’s diagnosis must include a terminal illness, with six months or less to live.
• The diagnosis must be certified by a consulting physician, who must also certify that the patient is mentally competent to make and communicate health care decisions.
• If either physician determines that the patient’s judgment is impaired, the patient must be referred for a psychological examination.
• The attending physician must inform the patient of alternatives, including palliative care, hospice and pain management options.
• The attending physician must request that the patient notify their next of kin of the prescription request.

Patient request timeline:

• First oral request to physician
• 15-day waiting period for patients with more than 15 days to live
• Patients with fewer than 15 days to live may bypass the 15-day waiting period
• Second oral request to physician
• Written request to physician
• 48-hour waiting period before picking up prescribed medications.
• Pick up prescribed medications from the pharmacy

Other:

• Use of the law cannot affect the status of a patient’s health or life insurance policies.
• The Department of Human Services – Health Services enforces compliance with the law. Compliance requires physicians to report all prescriptions to the state. Physicians and patients who comply with the law are protected from criminal prosecution.
• Physicians and health care systems are not obligated to participate.

Ballot Initiative 1000: Death With Dignity Act

Decided: Nov. 4, 2008 (58% for)

“An adult who is competent, is a resident of Washington state, and has been determined by the attending physician and consulting physician to be suffering from a terminal disease, and who has voluntarily expressed his or her wish to die, may make a written request for medication that the patient may self-administer to end his or her life in a humane and dignified manner.”

Patient eligibility:

• 18 years of age or older
• Resident of Washington
• Capable of making and communicating health care decisions for themselves
• Diagnosed with a terminal illness that will lead to death within six months

Physician protocol:

• The attending physician must be licensed in the same state as the patient.
• The physician’s diagnosis must include a terminal illness, with six months or less to live.
• The diagnosis must be certified by a consulting physician, who must also certify that the patient is mentally competent to make and communicate health care decisions.
• If either physician determines that the patient’s judgment is impaired, the patient must be referred for a psychological examination.
• The attending physician must inform the patient of alternatives, including palliative care, hospice and pain management options.
• The attending physician must request that the patient notify their next of kin of the prescription request.

Patient request timeline:

• First oral request to physician
• 15-day waiting period
• Second oral request to physician
• Written request to physician
• 48-hour waiting period before picking up prescribed medications.
• Pick up prescribed medications from the pharmacy

Other:

• Use of the law cannot affect the status of a patient’s health or life insurance policies.
• The Department of Health enforces compliance with the law. Compliance requires physicians to report all prescriptions to the state. Physicians and patients who comply with the law are protected from criminal prosecution.
• Physicians and health care systems are not obligated to participate.