X-Message-Number: 3409
Date: Mon, 14 Nov 94 20:17 EST
From: David Brandt-Erichsen <>
Subject: CRYONICS Text of Oregon Measure 16
THE OREGON DEATH WITH DIGNITY ACT
SECTION 1: GENERAL PROVISIONS
1.01 DEFINITIONS
The following words and phrases, whenever used in this Act, shall have
the following meanings:
(1) "Adult" means an individual who is 18 years of age or older.
(2) "Attending physician" means the physician who has primary
responsibility for the care of the patient and treatment of the patient's
terminal disease.
(3) "Consulting physician" means a physician who is qualified by
specialty or experience to make a professional diagnosis and prognosis
regarding the patient's disease.
(4) "Counseling" means a consultation between a state licensed
psychiatrist or psychologist and a patient for the purpose of determining
whether the patient is suffering from a psychiatric or psychological
disorder, or depression causing impaired judgment.
(5) "Health care provider" means a person licensed, certified, or
otherwise authorized or permitted by the law of this State to administer
health care in the ordinary course of business or practice of a profession,
and includes a health care facility.
(6) "Incapable" means that in the opinion of a court or in the opinion
of the patient's attending physician or consulting physician, a patient
lacks the ability to make and communicate health care decisions to health
care providers, including communication through persons familiar with the
patient's manner of communicating if those persons are available. Capable
means not incapable.
(7) "Informed decision" means a decision by a qualified patient, to
request and obtain a prescription to end his or her life in a humane and
dignified manner, that is based on an appreciation of the relevant facts
and after being fully informed by the attending physician of:
(a) his or her medical diagnosis;
(b) his or her prognosis;
(c) the potential risks associated with taking the medication to be
prescribed;
(d) the probable result of taking the medication to be prescribed;
(e) the feasible alternatives, including, but not limited to, comfort
care, hospice care and pain control.
(8) "Medically confirmed" means the medical opinion of the attending
physician has been confirmed by a consulting physician who has examined the
patient and the patient's relevant medical records.
(9) "Patient" means a person who is under the care of a physician.
(10) "Physician" means a doctor of medicine or osteopathy licensed to
practice medicine by the Board of Medical Examiners for the State of
Oregon.
(11) "Qualified patient" means a capable adult who is a resident of
Oregon and has satisfied the requirements of this Act in order to obtain a
prescription for medication to end his or her life in a humane and
dignified manner.
(12) "Terminal disease" means an incurable and irreversible disease that
has been medically confirmed and will, within reasonable medical judgement,
produce death within six (6) months.
SECTION 2: WRITTEN REQUEST FOR MEDICATION TO END ONE'S LIFE IN A
HUMANE AND DIGNIFIED MANNER
2.01 WHO MAY INITIATE A WRITTEN REQUEST FOR MEDICATION
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 in accordance with this Act.
2.02 FORM OF THE WRITTEN REQUEST
(1) A valid request for medication under this Act shall be in
substantially the form described in Section 6 of this Act, signed and dated
by the patient and witnessed by at least two individuals 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.
(2) One of the witnesses shall be a person who is not:
(a) A relative of the patient by blood, marriage or adoption;
(b) A person who at the time the request is signed would be entitled
to any portion of the estate of the qualified person upon death under any
will or by operation of law; or
(c) An owner, operator or employee of a health care facility where
the qualified patient is receiving medical treatment or is a resident.
(3) The patient's attending physician at the time the request is signed
shall not be a witness.
(4) If the patient is a patient in a long term care facility at the time
the written request is made, one of the witnesses shall be an individual
designated by the facility and having the qualifications specified by the
Department of Human Resources by rule.
SECTION 3: SAFEGUARDS
3.01 ATTENDING PHYSICIAN RESPONSIBILITIES
The attending physician shall:
(1) Make the initial determination of whether a patient has a terminal
disease, is capable, and has made the request voluntarily;
(2) Inform the patient of:
(a) his or her medical diagnosis;
(b) his or her prognosis;
(c) the potential risks associated with taking the medication to be
prescribed;
(d) the probable result of taking the medication to be prescribed;
(e) the feasible alternatives, including, but not limited to, comfort
care, hospice care and pain control.
(3) Refer the patient to a consulting physician for medical confirmation
of the diagnosis, and for a determination that the patient is capable and
acting voluntarily;
(4) Refer the patient for counseling if appropriate pursuant to Section
3.03;
(5) Request that the patient notify next of kin;
(6) Inform the patient that he or she has an opportunity to rescind the
request at any time and in any manner, and offer the patient an opportunity
to rescind at the end of the 15 day waiting period pursuant to Section
3.06.
(7) Verify, immediately prior to writing the prescription for medication
under this Act, that the patient is making an informed decision;
(8) Fulfill the medical record documentation requirements of Section
3.09;
(9) Ensure that all appropriate steps are carried out in accordance with
this Act prior to writing a prescription for medication to enable a
qualified patient to end his or her life in a humane and dignified manner.
3.02 CONSULTING PHYSICIAN CONFIRMATION
Before a patient is qualified under this Act, a consulting physician
shall examine the patient and his or her relevant medical records and
confirm, in writing, the attending physician's diagnosis that the patient
is suffering from a terminal disease, and verify that the patient is
capable, is acting voluntarily and has made an informed decision.
3.03 COUNSELING REFERRAL
If in the opinion of the attending physician or the consulting physician
a patient may be suffering from a psychiatric or psychological disorder, or
depression causing impaired judgment, either physician shall refer the
patient for counseling. No medication to end a patient's life in a humane
and dignified manner shall be prescribed until the person performing the
counseling determines that the patient is not suffering from a psychiatric
or psychological disorder, or depression causing impaired judgment.
3.04 INFORMED DECISION
No person shall receive a prescription for medication to end his or her
life in a humane and dignified manner unless he or she has made an informed
decision as defined in Section 1.01(7). Immediately prior to writing a
prescription for medication under this Act, the attending physician shall
verify that the patient is making an informed decision.
3.05 FAMILY NOTIFICATION
The attending physician shall ask the patient to notify next of kin of
his or her request for medication pursuant to this Act. A patient who
declines or is unable to notify next of kin shall not have his or her
request denied for that reason.
3.06 WRITTEN AND ORAL REQUESTS
In order to receive a prescription for medication to end his or her life
in a humane and dignified manner, a qualified patient shall have made an
oral request and a written request, and reiterate the oral request to his
or her attending physician no less than fifteen (15) days after making the
initial oral request. At the time the qualified patient makes his or her
second oral request, the attending physician shall offer the patient an
opportunity to rescind the request.
3.07 RIGHT TO RESCIND REQUEST
A patient may rescind his or her request at any time and in any manner
without regard to his or her mental state. No prescription for medication
under this Act may be written without the attending physician offering the
qualified patient an opportunity to rescind the request.
3.08 WAITING PERIODS
No less than fifteen (15) days shall elapse between the patient's initial
oral request and the writing of a prescription under this Act. No less
than 48 hours shall elapse between the patient's written request and the
writing of a prescription under this Act.
3.09 MEDICAL RECORD DOCUMENTATION REQUIREMENTS
The following shall be documented or filed in the patient's medical
record:
(1) All oral requests by a patient for medication to end his or her life
in a humane and dignified manner;
(2) All written requests by a patient for medication to end his or her
life in a humane and dignified manner;
(3) The attending physician's diagnosis and prognosis, determination that
the patient is capable, acting voluntarily and has made an informed
decision;
(4) The consulting physician's diagnosis and prognosis, and verification
that the patient is capable, acting voluntarily and has made an informed
decision;
(5) A report of the outcome and determination made during couseling, if
performed;
(6) The attending physician's offer to the patient to rescind his or her
request at the time of the patient's second oral request pursuant to
Section 3.06; and
(7) A note by the attending physician indicating that all requirements
under this Act have been met and indicating the steps taken to carry out
the request, including a notation of the medication prescribed.
3.10 RESIDENCY REQUIREMENT
Only requests made by Oregon residents, under this Act, shall be granted.
3.11 REPORTING REQUIREMENTS
(1) The Health Division shall annually review a sample of records
maintained pursuant to this Act.
(2) The Health Division shall make rules to facilitate the collection of
information regarding compliance with this Act. The information collected
shall not be a public record and may not be made available for inspection
by the public.
(3) The Health Division shall generate and make available to the public
an annual statistical report of information collected under Section 3.11(2)
of this Act.
3.12 EFFECT ON CONSTRUCTION OF WILLS, CONTRACTS AND STATUTES
(1) No provision in a contract, will or other agreement, whether written
or oral, to the extent the provision would affect whether a person may make
or rescind a request for medication to end his or her life in a humane and
dignified manner, shall be valid.
(2) No obligation owing under any currently existing contract shall be
conditioned or affected by the making or rescinding of a request, by a
person, for medication to end his or her life in a humane and dignified
manner.
3.13 INSURANCE OR ANNUITY POLICIES
The sale, procurement, or issuance of any life, health, or accident
insurance or annuity policy or the rate charged for any policy shall not be
conditioned upon or affected by the making or rescinding of a request, by a
person, for medication to end his or her life in a humane and dignified
manner. Neither shall a qualified patient's act of ingesting medication to
end his or her life in a humane and dignified manner have an effect upon a
life, health, or accident insurance or annuity policy.
3.14 CONSTRUCTION OF ACT
Nothing in this Act shall be construed to authorize a physician or any
other person to end a patient's life by lethal injection, mercy killing or
active euthanasia. Actions taken in accordance with this Act shall not,
for any purpose, constitute suicide, assisted suicide, mercy killing or
homicide, under the law.
SECTION 4: IMMUNITIES AND LIABILITIES
4.01 IMMUNITIES
Except as provided in Section 4.02:
(1) No person shall be subject to civil or criminal liability or
professional disciplinary action for participating in good faith compliance
with this Act. This includes being present when a qualified patient takes
the prescribed medication to end his or her life in a humane and dignified
manner.
(2) No professional organization or association, or health care provider,
may subject a person to censure, discipline, suspension, loss of license,
loss of privileges, loss of membership or other penalty for participating
or refusing to participate in good faith compliance with this Act.
(3) No request by a patient for or provision by an attending physician of
medication in good faith compliance with the provisions of this Act shall
constitute neglect for any purpose of law or provide the sole basis for the
appointment of a guardian or conservator.
(4) No health care provider shall be under any duty, whether by contract,
by statute or by any other legal requirement to participate in the
provision to a qualified patient of medication to end his or her life in a
humane and dignified manner. If a health care provider is unable or
unwilling to carry out a patient's request under this Act, and the patient
transfers his or her care to a new health care provider, the prior health
care provider shall transfer, upon request, a copy of the patient's
relevant medical records to the new health care provider.
4.02 LIABILITIES
(1) A person who without authorization of the patient willfully alters or
forges a request for medication or conceals or destroys a rescission of
that request with the intent or effect of causing the patient's death shall
be guilty of a Class A felony.
(2) A person who coerces or exerts undue influence on a patient to
request medication for the purpose of ending the patient's life, or to
destroy a rescission of such a request, shall be guilty of a Class A
felony.
(3) Nothing in this Act limits further liability for civil damages
resulting from other negligent conduct or intentional misconduct by any
person.
(4) The penalties in this Act do not preclude criminal penalties
applicable under other law for conduct which is inconsistent with the
provisions of this Act.
SECTION 5: SEVERABILITY
5.01 SEVERABILITY
Any section of this Act being held invalid as to any person or
circumstance shall not affect the application of any other section of this
Act which can be given full effect without the invalid section or
application.
SECTION 6: FORM OF THE REQUEST
6.01 FORM OF THE REQUEST
A request for a medication as authorized by this act shall be in
substantially the following form:
REQUEST FOR MEDICATION
TO END MY LIFE IN A HUMANE AND DIGNIFIED MANNER
I, ____________________, am an adult of sound mind.
I am suffering from ____________________, which my attending physician
has determined is a terminal disease and which has been medically confirmed
by a consulting physician.
I have been fully informed of my diagnosis, prognosis, the nature of
medication to be prescribed and potential associated risks, the expected
result, and the feasible alternatives, including comfort care, hospice care
and pain control.
I request that my attending physician prescribe medication that will
end my life in a humane and dignified manner.
INITIAL ONE:
___ I have informed my family of my decision and taken their opinions
into consideration.
___ I have decided not to inform my family of my decision.
___ I have no family to inform of my decision.
I understand that I have the right to rescind this request at any
time.
I understand the full import of this request and I expect to die when
I take the medication to be prescribed.
I make this request voluntarily and without reservation, and I accept
full moral responsibility for my actions.
Signed: ____________________
Dated: ____________________
DECLARATION OF WITNESSES
We declare that the person signing this request:
(a) Is personally known to us or has provided proof of identity;
(b) Signed this request in our presence;
(c) Appears to be of sound mind and not under duress, fraud or undue
influence;
(d) Is not a patient for whom either of us is attending physician.
____________________________________________ Witness 1 / Date
____________________________________________ Witness 2 / Date
NOTE: One witness shall not be a relative (by blood, marriage or adoption)
of the person signing this request, shall not be entitled to any portion of
the person's estate upon death and shall not own, operate or be employed at
a health care facility where the person is a patient or resident. If the
patient is an inpatient at a health care facility, one of the witnesses
shall be an individual designated by the facility.
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