For Medical Professionals

Participating Physician Guidelines

The Death with Dignity Act Requires 2 licensed Oregon Physicians to qualify terminally ill patients for MAID. The responsibilities of these physicians are divided into two roles: the Attending Physician and the Consulting Physician.

The Attending Physician has the most responsibility in the qualifying process; they oversee the process and provide the life-ending Rx. The Consulting Physician provides the second determination of eligibility that is required by the law. These roles are described in detail further on this page.

By law, each Oregon physician can determine if they want to participate in the qualification process for the Death with Dignity Act. Participation only includes the duties of the Attending Physician, Consulting Physician and psychiatrist or psychologist.

If a physician chooses not to participate they can still:

  • Make an initial determination that the patient has a terminal disease and inform the patient of the medical prognosis.

  • Provide information and referrals about Oregon’s Death with Dignity Act.

  • Provide referrals for qualifying physicians.

  • Document the first oral request in the patient’s medical chart.

  • Share medical records with qualifying physicians.

Attending Physician Responsibilities

  • Determine if the patient has a terminal disease with a 6 months or less prognosis.

  • Determine if the patient is capable of making and communicating their own healthcare decisions. 

  • Determine if the patient is making the request to use MAID voluntarily.

  • Ensure the patient is making an informed decision, an informed decision must include informing the patient about:

    • Their medical diagnosis.

    • Their terminal prognosis.

    • The potential risks associated with taking the MAID medication.

    • The probable result of taking the MAID medication.

    • Alternative end-of-life options, including, but not limited to, comfort care, hospice care, pain management and VSED.

  • Refer the patient to an Oregon licensed psychologist or psychiatrist if there is any question about their judgement or ability to make healthcare decisions and collect the The Psychiatric/Psychological Consultant’s Compliance Form.

    • The MAID Rx may not be written until it is determined by a mental health expert that the patient is not suffering from a psychological disorder or depression causing impaired judgment.

  • Recommend the patient notify next of kin.

  • Counsel the patient about the importance of having another person attend the patient’s planned death, who can:

    • Mix the MAID medication. 

    • Help position them to take the MAID medication.

    • Report time to sleep.

    • Report time to death.

    • Report complications.

  • Inform the patient that it is illegal to take the MAID medication in a public space. 

  • Inform the patient that the request for MAID can be rescinded at any time, in any manner. 

  • Take the second oral request and document it in the patient’s medical chart.

    • Offer the patient the opportunity to rescind their request at this time. 

  • Submits all Documentation to the Oregon Health Authority. 

  • Ensure all appropriate steps are carried out under the law before writing the MAID Rx.

  • Immediately, before writing the MAID Rx, verify the patient is making an informed decision. 

  • Deliver the MAID Rx directly to the pharmacy via in-person, courier, or mail. 

  • If needed, sign the death certificate.

Consulting Physician Responsibilities

  • Confirm the patient has a terminal illness with a 6 months or less prognosis.

  • Confirm the patient is capable of making and communicating their own healthcare decisions. 

  • Confirm the patient is making the request to use MAID voluntarily.

  • Ensure the patient is making an informed decision by informing them about:

    • Their medical diagnosis.

    • Their terminal prognosis.

    • The potential risks associated with taking the MAID medication.

    • The probable result of taking the MAID medication.

    • Alternative end-of-life options, including, but not limited to, comfort care, hospice care, pain management and VSED.

  • Refer the patient to an Oregon licensed psychologist or psychiatrist if there is any question about the patient’s judgement or ability to make healthcare decisions.

  • Complete the Consulting Physicians Compliance Form and submit it to the Attending Physician.

Psychologist / Psychiatrist Responsibilities

It is important to be aware that the patient may be on sedative medication and fatigued from their illness, which may affect the length of the interview.

  • A distinction must be made between a mental or cognitive disorder and the effects of an illness and treatment.

  • The patient’s medical records can be used, plus an in-person interview.

  • With the patient’s permission, you may interview other members of their healthcare team, such as hospice.

  • Caution is suggested for using standardized testing and tools, since patients may not have the stamina to fully participate.

  • During the interview, gather information about judgment, such as reasons for using Medical Aid In Dying, beliefs and values, family dynamics, finances, and previous experience with others who have died.

Submit a report with your conclusions to the Attending Physician: download required form

Hospice Support

  • Hospice enrollment is strongly recommended for all patients considering MAID. 

  • Besides providing effective pain and symptom management, they can often help with the DWDA’s required paperwork, medical record transfers to participating physicians, and medical support during planned deaths. 

  • A patient supported by hospice does not have to involve emergency services, coroners, or medical examiners for their planned death.

The Oregon Hospice & Palliative Care Association takes a neutral stance regarding MAID, however, each hospice has their own policies and procedures when it comes to MAID. Some hospices may limit their physicians and staff from participating on their premises or as a function of their employment. Others may allow their staff to be present in the home on the day of the planned death, but not be in the room when the MAID medication is taken. While others allow staff to be present as long as they do not handle the MAID medication. 

Lawful Protections

The Oregon Death with Dignity Act specifies protections for physicians who write the MAID Rx, preventing civil or criminal liability or professional disciplinary action for participating in good faith compliance with the law. 

Employed Physicians

An employer may prohibit DWDA participation on the employer’s premises if the employer has informed the employed physician of their non-participatory DWDA policy in writing. However, any physician may make direct arrangements with their patient to act outside the scope of employment and off the premises of the employer, acting independently as a participating physician. No doctor may be compelled to participate. If they choose not to, they should note any request in the patient’s medical chart, inform the patient that they will not participate, and refer them to a colleague.

Contact EOLCOR if you need help connecting your patient with participating physicians. 

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