FAQs
WHAT IS AID-IN-DYING LEGISLATION?
End of Life options, or medical aid-in-dying, statutes allow certain terminally ill adults to request and obtain a prescription for medication to end their lives in a peaceful manner. The acts outline the process of obtaining such medication, including safeguards to protect both patients and physicians.
In states where physician-assisted dying is legal, there is no state program for participation in the existing aid-in-dying laws and people do not apply to state health departments. It is up to eligible patients and licensed physicians to implement the act on an individual, case-by-case basis.
As of September 2019, physician-assisted dying statutes are in effect in eight states and the nation’s capital:
- Oregon since 1997 (the law had been passed in 1994 at the ballot)
- Washington since 2009 (2008; ballot)
- Vermont since 2013 (legislature)
- California since 2016 (2015; legislature))
- Colorado since 2016 (ballot)
- District of Columbia since 2017 (2016; City Council)
- Hawaii since 2019 (2018; legislature)
- New Jersey since 2019 (legislature)
- Maine since 2019 (legislature)
HOW DO AID-IN-DYING LAWS PROTECT PATIENTS?
- Patients must meet stringent eligibility requirements, including being an adult, state resident, mentally competent, and having a terminal diagnosis with a 6-month prognosis as confirmed by two licensed physicians.
- Only the patient him or herself can make the oral requests for medication, in person. It is impossible to stipulate the request in an advance directive, living will, or any other end-of-life care document.
- The patient must make two oral requests, at least 15 days apart.
- The written request must be witnessed by at least two people, who, in the presence of the patient, attest that to the best of their knowledge and belief the patient is capable, acting voluntarily, and is not being coerced to sign the request. One of the witnesses cannot be a relative of the patient by blood, marriage or adoption; anyone who would be entitled to any portion of the patient’s estate; an owner, operator or employee of a health care facility where the eligible patient is receiving medical treatment or is a resident or the patient’s attending physician.
- The patient must be deemed capable to take (self-administer and ingest) the medication themselves, without assistance.
- The patient may rescind the request at any time.
- Two physicians, one of whom is the patient’s attending physician, familiar with the patient’s case, must confirm the diagnosis. Each physician must be licensed by the state to practice medicine and certified to prescribe medications.
- If either physician determines the patient may be suffering from a psychiatric or psychological disorder or depression causing impaired judgment, they must refer the patient for evaluation by a state licensed psychiatrist or psychologist to determine their mental competency. Medication cannot be prescribed until such evaluation determines the patient is mentally competent.
- The attending physician must mail or hand-deliver the prescription to the pharmacy.
- The patient must wait 48 hours from their written request to fill their prescription.
- The request process must be stopped stop immediately if there is any suspicion or evidence of coercion.
- The physicians must meet strict reporting requirements for each request.
- Anyone who falsifies a request, destroys a rescission of a request or who coerces or exerts undue influence on a patient to request medication under the law or to destroy a rescission of such a request commits a Class A felony. The law also does not limit liability for negligence or intentional misconduct, and criminal penalties also apply for conduct that is inconsistent with it.
WHO USES PHYSICIAN-ASSISTED AID-IN-DYING LAWS? WHAT ARE THEIR DEMOGRAPHICS?
People who access physician-assisted dying laws tend to be well educated and have excellent health care, good insurance, access to hospice, and financial, emotional, and physical support. Two out of three are aged 65 years or older; the median age at death is 72 years.
Most patients have cancer (77.9 percent in Oregon) or ALS (7.8 percent). Most people die at home (93.1 percent) and are enrolled in hospice care (90.2 percent).
The three most frequently mentioned end-of-life concerns are loss of autonomy (90.9 percent of patients cited this concern), decreasing ability to participate in activities that made life enjoyable (89.5 percent), and loss of dignity (75.7 percent); the least important concerns are being a burden on family/friends/caregivers (43.7 percent), inadequate pain control or concern about it (25.8 percent), and financial implications of treatment (3.7 percent).
WHAT ARE THE BENEFITS OF PHYSICIAN-ASSISTED AID-IN-DYING LAWS FOR TERMINALLY ILL PEOPLE AND THEIR FAMILIES?
Medical aid in dying legislation yields numerous direct and indirect benefits.
For the terminally ill, the greatest comfort these laws provide is having the freedom to control their own ending. Most people who obtain medications under these laws value being able to make their own decisions, including the where and when of their death. We know this because people using the law cite loss of autonomy as their chief end-of-life concern.
In addition, if you are terminally ill the option to die a peaceful death at a time and place of your choosing provides you with invaluable peace of mind, which is especially important at the end of life. In fact, so many people get reassurance from simply filling the prescription that one in three choose not to use it.
Most people who are dying wish to die at home. While on the national level only about 20 percent of people die at home, almost 95 percent of people accessing the Oregon Death with Dignity Act do. The stringent safeguards in these laws also protect patients from possible abuse, coercion, and wrongful medical practice.
WHAT ARE THE BENEFITS OF MEDICAL-ASSISTED AID-IN-DYING LAWS FOR PHYSICIANS?
For physicians, medical aid-in-dying laws codify and bring to light the common practice of giving life-ending medications to their patients. Medical aide in dying legislation protects physicians by stipulating the steps they must follow and, provided they follow the law, providing them with immunity from civil and criminal liability as well as professional disciplinary action.
WHAT IS THE CURRENT STATE OF PHYSICIAN-ASSISTED DYING IN AMERICA?
With a history of more than 100 years, and accelerated development beginning in the early 1990’s, the aid-in-dying movement enjoys more momentum than ever.
While before 2015, only two or three states at the time considered physician-assisted dying bills, in the 2015 legislative session no fewer than 25 states considered such bills. In 2016, 20 jurisdictions, in 2017, 30 jurisdictions, in 2018, 25 jurisdictions, and in 2019, 21 jurisdictions considered such bills.
We saw our greatest victories in California where the End of Life Option Act went into effect on June 9, 2016; District of Columbia, where the Death with Dignity Act went into effect on June 6, 2017; in Hawaii, where the Our Care, Our Choice Act went into effect on January 1, 2019; and in Maine where the Death with Dignity Act went into effect on September 19, 2019.
Though elsewhere aid in dying bills failed, that’s the way progress happens: victories beget more victories, and even our losses teach us the lessons we need to advance. With polls showing up to 7 in 10 Americans favoring right-to-die legislation, every day we are closer to the day when a large majority of Americans will have what they are asking for: more freedom and control at the end of life.
