Mental Health Consultation
Before accepting the responsibility of evaluating a patient’s judgment to use Oregon’s Death with Dignity Act, determine if you can be objective. If not, please decline the request.
The Death with Dignity Act – Oregon Revised Statute 127.825 s.3.03 – mandates a “counseling referral” to an Oregon licensed psychologist or psychiatrist:
If in the opinion of the attending [prescribing] 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.
In ORS 127.800 s 1.01 (5)
“Counseling” means one or more consultations as necessary between a state licensed psychiatrist or psychologist and a patient for the purpose of determining that the patient is capable and not suffering from a psychiatric or psychological disorder or depression causing impaired judgment.
In ORS 127.800 s 1.01 (3)
“Capable” means that in the opinion of a court or in the opinion of the patient’s attending physician or consulting physician, psychiatrist or psychologist, a patient has 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.
Be aware that the patient might be on medication and fatigued, which may compromise the length of the interview. A distinction must be made between a mental or cognitive disorder and the effects of illness and its treatment.
The patient’s medical records can be used, plus an in-person interview. Since most of these patients are on hospice, with their permission, you may interview other members of their healthcare team. Some mental health care practitioners suggest caution in using standardized test instruments, since patients may not have stamina to fully participate.
During the interview, consider gathering information about factors regarding judgment, such as reasons for the DWDA request, long-held values, family issues, financial issues, and previous experience with others who have died.
Submit a report with your conclusions to the prescribing physician.
Ethics Guidebook for Download
For further discussion of the psychologist or psychiatrist role in the DWDA, refer to the OHSU Center for Ethics document –The Oregon Death with Dignity Act: A Guidebook for Health Care Professionals (2008). Refer to chapter 9, “Mental Health Consultation,” page 62.