Laws About Death

This week we will be talking about issues related to death and resuscitation. There are two legal and political issues that are important in this discussion: DNR orders and I-1000. Hopefully you have already taken a look at the Physicians Orders for Life Sustaining Treatment (POLST) form linked at the course readings webpage and have had a chance to read the chapter from Bill Colby's book about living wills. I'd encourage everyone to post some thoughts on the blog about DNR and living wills by clicking "New Post" in the upper right corner of the page. (You need to be signed in first.)

There is one other topic that you should be aware of if you think you will practice medicine in Washington or Oregon. The Washington Death with Dignity Act passed by initiative in November 2008. Sometimes it's an interesting challenge to read the original text, but its always helpful to have a digest. I've pasted in information about safeguards of the law from the pro-I-1000 website, below.

There are multiple safeguards in Washington’s death with dignity law. These safeguards include independently witnessed oral and written requests, two waiting periods, mental competency and prognosis confirmed by two physicians, and self-administration of the medication. Only the patient – and no one else – may administer the medication.

Washington’s Death with Dignity safeguards:

1. The patient must be at least 18 years old
2. The patient must be a resident of the state of Washington
3. The patient must be terminally ill - not disabled, but diagnosed as terminally ill
4. The terminally ill patient must have 6 months or less to live, as verified by two physicians
5. Three requests for Death with Dignity must be made (two verbal and one written)
6. Two physicians must verify the mental competence of the terminally ill patient
7. The request must be made voluntarily, without coercion, as verified by two physicians
8. The terminally ill patient must be informed of all other options, including palliative care, pain management and hospice care
9. There is a 15 day waiting period between the first oral request and the written request
10. There is a 48 hour waiting period between the written request and the writing of the prescription
11. The terminally ill patient's written request must be independently witnessed, by two people, at least one of whom is not related to the patient or employed by the health care facility
12. The terminally ill patient is encouraged to discuss their decision with family (not required because of confidentiality laws)
13. Only the terminally ill patient may self-administer the medication
14. The patient may change their mind at any time

The safeguards in Washington's Death with Dignity Act ensure that terminally ill patients are making a voluntary and informed decision. These same safeguards have worked in Oregon for over 10 years. Patients must be terminally ill, must have less than 6 months to live, the patient must make two independently witnessed requests, and every step of the process must be approved by two doctors.

Because this is a political issue (it passed with 58% of the vote), it's important to include the position of the sizable minority. A comprehensive opinion of the opposition is available at noassistedsuicide.com. Specifically, there are lengthy arguments centered on the:

• text of the initiative
• claims of the initiative's supporters and
• a critique of Oregon's law
  

I take the position that when health care issues come up in elections, it's my social obligation as a care provider to become informed about the issue. For one reason or another, there are very few physicians in politics, and only slightly more who advise policy makers. The least we can do as future docs is to be able to provide facts about the issues to patients and our opinions to friends.