States with Legal Physician-Assisted Suicide

ABX2-12 End of Life Option Act

Signed into Law: Oct. 5, 2015

Effective Date: June 9, 2016

“(a) Notwithstanding any other law, a person shall not be subject to civil or criminal liability solely because the person was present when the qualified individual self-administers the prescribed aid-in-dying drug. A person who is present may, without civil or criminal liability, assist the qualified individual by preparing the aid-in-dying drug so long as the person does not assist the qualified person in ingesting the aid-in-dying drug.

(b) A health care provider or professional organization or association shall not subject an individual to censure, discipline, suspension, loss of license, loss of privileges, loss of membership, or other penalty for participating in good faith compliance with this part or for refusing to participate in accordance with subdivision (e).

(c) Notwithstanding any other law, a health care provider shall not be subject to civil, criminal, administrative, disciplinary, employment, credentialing, professional discipline, contractual liability, or medical staff action, sanction, or penalty or other liability for participating in this part, including, but not limited to, determining the diagnosis or prognosis of an individual, determining the capacity of an individual for purposes of qualifying for the act, providing information to an individual regarding this part, and providing a referral to a physician who participates in this part. Nothing in this subdivision shall be construed to limit the application of, or provide immunity from.”

California Department of Health

Phone: 916-558-1784

Patient Eligibility:

• 18 years of age or older
• Resident of California
• Capable of making and communicating health care decisions for themselves
• Diagnosed with a terminal illness that will lead to death within six months
• Physically and mentally capable of self-administering the aid-in-dying drug

Physician Protocol:

• The attending physician must be licensed in the same state as the patient and have a current United States Drug Enforcement Administration (USDEA) certificate.
• 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.

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, life, or annuity insurance policies.
• Physicians and health care systems are not obligated to participate.
• Translators should be made available for non-English speakers.
• Pharmacists are also protected from prosecution for filling aid-in-dying prescriptions.

Proposition 106: End of Life Options Act

Voted On: Nov. 8, 2016 (65% in favor)

Effective Date: Jan. 2017

“(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.”

Colorado Department of Public Health & Environment

Phone: 303-692-2000

Email: cdphe.information@state.co.us

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.

DC ACT 21-577 Death with Dignity Act of 2016

Signed into Law: Dec. 19, 2016

Effective Date: Feb. 18, 2017

“To provide procedures and requirements regarding the request for and dispensation of covered medications to qualified patients seeking to die in a humane and peaceful manner, to define the duties of attending physicians and consulting physicians, to provide for counseling of patients and family notification, to require informed decisions-making and waiting periods, to require reporting from the Department of Health, to outline the effect of the act on contracts, wills, insurance, and annuity policies, to provide for immunities, liabilities, and exceptions, to provide an opt-out provision for health care providers, to provide for claims against a qualified patient’s estate for costs incurred by the District government when a qualified patient ingests a covered medication in public, and to establish criminal penalties.”

[Note: DC laws are subject to Congressional oversight. The Death with Dignity Act of 2016 was submitted to Congress for a 30-day review on Jan. 6, 2017. Representative Brad Wenstrup (R-OH) and Senator James Lankford (R-OK) submitted disapproval resolutions to the House and Senate respectively on Jan. 12, 2017 that would bar the law. However, the resolutions did not come up for a full vote of the House or the Senate within 30 working days, making the law effective as of Feb. 18, 2017.]

DC Department of Health

Phone: 202-442-5955

Email: doh@dc.gov

Patient Eligibility:

• 18 years of age or older
• Resident of the District of Columbia
• 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 DC.
• 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.

Patient Request Timeline:

• First oral request to physician
• Written request to physician before second oral request and at least 48 hours before the medication is dispensed
• Second oral request to physician made at least 15 days after the first oral request

Other:

• Use of the law cannot affect the status of a patient’s health, life, or annuity insurance policies.

HB 2739, Hawai’i Our Care, Our Choice Act

Signed into Law: Apr. 5, 2018

Effective Date: January 1, 2019

“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.”

Hawaii Department of Health

Phone: 808-586-4400

Email: webmail@doh.hawaii.gov

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.

HP 948, An Act to Enact the Maine Death with Dignity Act

Signed into Law: June 12, 2019

Effective Date: September 19, 2019

“This bill enacts the Maine Death with Dignity Act authorizing a person who is 18 years of age or older, who meets certain qualifications and who has been determined by the person’s attending physician to be suffering from a terminal disease, as defined in the Act, to make a request for medication prescribed for the purpose of ending the person’s life. The bill establishes the procedures for making these requests, including 2 waiting periods and one written and 2 oral requests and requires a 2nd opinion by a consulting physician. The bill requires specified information to be documented in the person’s medical record, including all oral and written requests for a medication to hasten death.”

[Note: The law indicates that it does not legalize “assisted suicide.” The law states that the act must be referred to as “obtaining and administering life-ending medication” in state reports.]

Maine Department of Health and Human Services

Phone: 207-287-3707

Patient Eligibility:

• 18 years of age or older
• Resident of Maine
• Capable of making and communicating health care decisions for themselves
• Diagnosed with a terminal illness that will lead to death within six months
• Physically and mentally capable of self-administering the aid-in-dying drug

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 Maine residency
• The patient must be referred to a consulting physician to confirm the diagnosis and competency, and that the patient is acting voluntarily
• 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 if appropriate
• The physician must recommend 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:

• Oral request to physician
• Written request to physician, signed at least 15 days after first oral request
• Second oral request to physician at least 15 days after first oral request
• 48-hour waiting period after the written request is signed until the prescription may be written

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 life, health, accident insurance, or annuity policy
• No contract, will, or other agreement may prevent a person from using the law

Montana First Judicial District Court: Baxter v. Montana

Court Ruling Date: 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.

No legal protocol in place.

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 explained 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.”

Bill A1504 Aid in Dying for the Terminally Ill Act

Signed into Law: Apr. 12, 2019

Effective Date: Aug. 1, 2019

“Recognizing New Jersey’s long-standing commitment to individual dignity, informed consent, and the fundamental right of competent adults to make health care decisions about whether to have life-prolonging medical or surgical means or procedures provided, withheld, or withdrawn, this State affirms the right of a qualified terminally ill patient, protected by appropriate safeguards, to obtain medication that the patient may choose to self-administer in order to bring about the patient’s humane and dignified death.”

State of New Jersey Department of Health

Phone: 800-367-6543

Patient Eligibility:

• 18 years of age or older
• Resident of New Jersey
• 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 capable of making and communicating 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 recommend 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:

• Contracts, wills, insurance policies, or other agreements cannot be used to restrict a patient’s ability to request or stop a request for medication.
• 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.

Elizabeth Whitefield End of Life Options Act

Signed into Law: Apr. 8, 2021

Effective Date: June 18, 2021

“The Act is explicit that medical aid in dying is not ‘suicide.’ Physicians, nurses and loved ones who may be present toward the end are protected against prosecution for “assisting suicide.” Further, good faith compliance with the law may not be construed as unprofessional conduct or considered neglect. Medical aid in dying is entirely voluntary for patients, health care providers, and pharmacists. No one is obligated to participate.”

New Mexico Department of Health

Phone: 800-432-2080

Patient Eligibility:

• at least 18 years old
• a New Mexico resident
• mentally capable of making and communicating health care decisions, and
• diagnosed with a terminal disease that will result in death within six months.

Physician Protocol:

• The prescribing health care provider determines that the patient is capable of making health care decisions.
• The prescribing provider affirms either that the patient is enrolled in a hospice program or that one other health care provider has confirmed the patient’s diagnosis and prognosis.
• The prescribing provider confirms that the patient is capable of self-administering the aid-in-dying medication.
• The patient has a psychological examination, if the prescribing health care provider or the consulting health care provider feels the patient’s judgment is impaired.
• The prescribing provider confirms that the patient is not being coerced or unduly influenced by others when making the request.
• The prescribing provider informs the patient of any feasible alternatives to the medication, including care to relieve pain and keep the patient comfortable.
• The prescribing provider offers the patient the opportunity to withdraw the request for aid-in-dying medication before granting the prescription.

Patient Request Timeline:

• The patient gives a written request to their health care provider, signed in front of two qualified, adult witnesses. The law provides the specific form that the patient must use.

Other:

• Contracts, wills, insurance policies, or other agreements cannot be used to restrict a patient’s ability to request or stop a request for medication.
• Physicians and health care systems are not obligated to participate.

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

Voted On: Nov. 8, 1994 (51% in favor)

Effective Date: October 27, 1997

“An adult who is capable… 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.

Mar. 29, 2022 – Oregon Ends Residency Requirement

In a court settlement with Compassion & Choices, the Oregon Health Authority and the Oregon Medical Board agreed to stop enforcing the residency requirement and to ask the legislature to amend the law.

Oregon Health Authority

Phone: 971-673-1222

Email: dwda.info@state.or.us

Patient Eligibility:

• 18 years of age or older
• Oregon stopped requiring residency on Mar. 29, 2022
• 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.

Act No. 39. An Act Relating to Patient Choice and Control at End of Life

Signed into Law: May 20, 2013

Effective Date: May 20, 2013

“A physician shall not be subject to any civil or criminal liability or professional disciplinary action if the physician prescribes to a patient with a terminal condition medication to be self-administered for the purpose of hastening the patient’s death and the physician affirms by documenting in the patient’s medical record [the required information].”

“A patient with a terminal condition who self-administers a lethal dose of medication shall not be considered to be a person exposed to grave physical harm… and no person shall be subject to civil or criminal liability solely for being present when a patient with a terminal condition self-administers a lethal dose of medication or for not acting to prevent the patient from self-administering a lethal dose of medication.”

Vermont Department of Health

Phone: 800-464-4343

Patient Eligibility:

• 18 years of age or older
• Resident of Vermont
• 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.

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.
• Physicians and health care systems are not obligated to participate.

Ballot Initiative 1000: Death With Dignity Act

Voted On: Nov. 4, 2008 (58% in favor)

Effective Date: March 5, 2009

“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.”

Washington State Department of Health

Phone: 360-236-4030

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.