Introduction to Oregon’s Death With Dignity Act (DWDA)
The DWDA allows terminally ill adult Oregonians to control the manner and timing of their death by ingesting a lethal medication prescribed by an Oregon-licensed DO or MD. The Act specifies conditions to protect physicians when they aid a dying patient by writing a lethal prescription. Patients ingest the medication as they would take any other medication. The patient’s family members and friends are protected, because the DWDA clearly states that these deaths are not suicides.
ORS 127.880 s.3.14 states:
Nothing in ORS 127.800 to 127.897 shall be construed to authorize a physician or any person to end a patient’s life by lethal injection, mercy killing or active euthanasia. Actions taken in accordance with ORS 127.800 to 127.897 shall not, for any purpose, constitute suicide, assisted suicide, mercy killing or homicide, under the law.
And ORS 127.885 s.4.01 states:
Except as provided in ORS 127.890: (1) No person shall be subject to civil or criminal liability or professional disciplinary action for participating in good faith compliance with ORS 127.800 to 127.897. This includes being present when a qualified patient takes the prescribed medication to end his or her life in a humane and dignified manner.
In the DWDA, the prescribing physician is called the attending physician.
The consulting physician verifies that the person is eligible.
Physician Aid in Dying
The terms for this procedure are “physician aid in dying” or “aid in dying.” We do not use the word “suicide” to describe medical practices such as allowing patients to withdraw or withhold medical treatment. Current medical practice allows physicians to prescribe medication that sedates a patient into unconsciousness to relieve refractory symptoms in palliative sedation.
The distinction is more than linguistic. The word “suicide” demeans people who desire a choice in the timing and manner of their imminent deaths. People using the DWDA and those who wish to commit suicide are opposites:
- The suicidal person is generally healthy but does not wish to live; the person who uses the DWDA wishes to live but is dying.
- Suicides are often impulsive and violent; dying under DWDA allows planning for a peaceful death.
- Suicide is an expression of despair and futility; a DWDA death is an empowering act.
In order to qualify for the DWDA, a person must be terminally ill as determined by two doctors; an Oregon resident; at least 18 years of age; and be mentally capable of making their own healthcare decisions.
If your terminally ill patient asks you about DWDA, respect them as you do all your patients by listening to their concerns. These patients will have symptoms that you can sometimes relieve with medications and modification of their living situation. Hospice teams are great resources. Even if your patient requests your assistance in using physician aid in dying, a likelihood exists that he or she will not complete the process. Sometimes repeated conversations are necessary to understand the meaning of the request. You can explore the social context of the request and suggest the patient discuss the decision with close relatives.
The Oregon law requires two Oregon-licensed physicians (the prescriber and the consultant) certify the patient has decision-making capacity and has intact judgment. Consider whether the request is compatible with other critical decisions this person has made. This is routine for physicians caring for critically ill patients. The law allows someone who is clinically depressed to use DWDA if she or he has intact judgment.
Both the attending and consulting physicians must verify the person’s diagnosis, prognosis, and understanding of the requested procedure. If either physician is unsure of the patient’s capability or judgment, DWDA requires you to refer your patient for a mental health evaluation by a psychologist or psychiatrist. If a referral is made, you must have your patient’s judgment deemed intact on a completed Psychiatric/Psychological Consultant’s compliance form or other written format.
The DWDA established the Oregon Health Authority (OHA) to monitor the healthcare provider’s compliance by collecting confidential records. This information is compiled for the State of Oregon’s annual report.
The OHA provides forms for healthcare professionals to document compliance and return to OHA. All legal requirements are present on each compliance form. These forms and instructions for completing them are on our website.
A feeding tube is not a contraindication of DWDA, if your patient can pour liquid into the barrel of a 60 cc syringe used as a funnel inserted in the end of the tube.
An implanted cardioverter defibrillator must be turned off before the patient ingests the lethal medication in order to prevent violent shocks. A pacemaker will not cause problems.
Patients who are unable to swallow 4 oz. of a bitter liquid in 2 minutes, who have any bowel obstruction, uncontrolled vomiting or poor absorption of medication and nutrients should be offered other options. These options include voluntary stopping eating and drinking (VSED) or palliative care with hospice. End of Life Choices Oregon can provide information to your patient about VSED.
If your patient wants you to be present, the decision is up to you. If your patient wishes their presence, our experienced volunteers are available to be with your patient at the time of ingestion.