Monday, July 27, 2020

Death with Dignity Act

The term "euthanasia," or mercy killing, refers to the intentional taking of another's life (with their consent) in order to ease the suffering of a terminally ill individual. Euthanasia is technically illegal in all states, although a few states allow physician-assisted suicide in a manner that gives the patient complete control over his or her demise. This remains a very controversial medical and social policy issue, involving several different aspects of medicine, religion, ethics, and law.

Death. “It’s the big elephant in the room. Everyone’s afraid to talk about it,” said Heather Bitar, D.O., a palliative care physician and assistant clinical professor in the Department of Supportive Care Medicine at City of Hope.

But “patients know when they’re not feeling well. They know,” she insisted. And when she is upfront with them about their prognosis, “Many are not surprised.”

Many of the dying don’t fear death as much as they fear how they will die, Bitar said. “It’s the in-between part people fear the most. If you can give them insight on what to expect, that can ease a lot of their concerns.”

No One Wants To Talk About It

However, it is as difficult for physicians to talk about death as patients, Bitar said. “Physicians may think it means they’ve failed their patients.” In addition, she said, oncologists can get overly focused on the tumor and tumor markers, “but I think it’s important to redefine the situation and remember a person is more than their disease.” In the face of incurable disease, instead of hoping for a cure, “You can hope for more time to do something special with your grandchild,” for example.

“We take cardiac arrest and CPR protocols so seriously, yet there is no protocol for people who are dying,” Bitar continued. “It requires an emphasis on compassion, empathy and learning the individual’s needs and that person’s and that family’s grieving process.”

When a person is dying, Bitar said, palliative care physicians focus on treating symptoms rather than the disease, and they let the patient direct the care.

The three main symptoms that need to be managed at end-of-life are pain, delirium and shortness of breath, she said.

In addition, she said, “We get focused on the physical things, when a lot of the stuff is spiritual, such as unresolved family dynamics. It’s amazing how much [physical] pain can be relieved when you address the emotional issues.”

The Dying Process

Since families are often unprepared for the dying process, “They can go into shock when it happens,” Bitar said. But, “no matter how you get there, natural death is similar for everyone.”

It begins with a person no longer wanting to eat. This is a natural reaction to the body starting to shut down and no longer being able to process food. Many families make the mistake of urging the patient to keep eating at this point, which will only make them feel ill, Bitar said. “When you’re dying, your body isn’t working in a way where it can naturally process these things, like intravenous fluids, food. It is no longer absorbed in the same way,” Bitar said.

Many families fear the patient is dying of starvation. “They’re not starving, they’re dying of their disease,” Bitar said. “When they’re entering the active stage of death, it doesn’t bother them that they don’t have an appetite.”

Once the patient has slowed or stopped eating and drinking, they become weaker and weaker, become bedbound and begin to go into kidney failure. When the kidneys stop functioning, toxins build up in the bloodstream. Their level of consciousness goes down at this point, and they go into a “dreamlike state.” The toxins cause their electrolytes to become unbalanced, which causes the heart to go into arrhythmia, and the weakened heart eventually stops.

This “active dying” process generally can take up to two weeks, and the focus should be on comfort and pain control, Bitar said. “In the final hours to days the person may not be able to verbalize their needs, so we have to know by their body language and facial expression what’s going on.”

The patient’s breath may become labored, and they may make a gurgling sound. “’Agonal’ breath is part of the natural dying process,” Bitar said. “It looks like they’re struggling to breathe, but they’re not. Their body is just shutting down. They are too weak to swallow the saliva, so they gurgle. The patient usually isn’t suffering.”

Even if the person can’t speak or they look unconscious, “Never assume they can’t hear,” Bitar said. “Most people fear dying alone. If they still hear their loved ones, that makes a huge difference.”

Many dying patients exhibit delirium, but Bitar emphasized that the patient lacks awareness of their behavior. “It’s possible to be peacefully confused,” she said. “Talk to them and orient them: ‘You’re at home. We’re here.’ Open the blinds and close them at night so they know whether it’s day or night.”

When the patients stops making urine, “You know you’re within 24 to 72 hours of death because the kidneys have failed at that point,” Bitar said.

Natural Death Shouldn’t Hurt

Natural death “doesn’t look pretty, especially if it’s prolonged,” Bitar said. “But in theory, medically speaking, it should be a pleasant way to go. The toxins that build up put you in a dreamlike state that is supposed to be euphoric. It’s not supposed to be uncomfortable.”

We’re a very cure-focused society. Keep going, keep going, keep going, death,” Bitar added. “Sometimes patients are in denial — unwilling to talk about what’s happening. That’s the hardest of them all. That creates a lot of challenges in caring for them at the end of life, for providers and their loved ones. Both are shooting in the dark because we don’t know what the person wants because it was never discussed. That’s a big barrier and it’s tough to overcome. It creates distress and anxiety for everybody.”

Facing a grim prognosis head-on is probably the bravest and most difficult thing a person can do. Bitar said she reminds people that “’Your life is not your disease.’ We try to take a step back and see the whole person. We want to talk about big-picture things, meaningful things. People have to be allowed to be human and talk about what matters most to them at this time.”

There are numerous reasons why someone would want to end their life, ranging from severe depression to terminal illness, and in fact suicide is the tenth leading cause of death in the United States. While there are treatment options available for people with depression, what are the options for those who aren't expected to live much longer, perhaps suffering extraordinary pain? More to the point: is assisting with suicide a crime? If you're not a licensed physician, then assisting someone with suicide is most definitely a crime. But in states that have enacted "right to die" or "death with dignity" laws, eligible patients may request lethal drugs and administer them on their own.

This article lays out the legal parameters for assisted suicide, including what it means to assist someone with ending their life and the policy reasons for its prohibition in most states.

What's Considered Assisted Suicide?

Every state has a slightly different definition of what it means to assist a suicide and some states do not actually define it in their statutes. Generally, someone assists with a suicide when they:

Do some act which causes someone else to die, such as administering lethal doses of drugs;
Provide the drugs or tools necessary for someone else to commit suicide when they know those tools are likely to be used for suicide;
Advise someone else on the way to commit suicide; or
Persuade someone else to commit suicide.

Note that it is not considered assisted suicide to fail to resuscitate someone who is already dying. Individuals who do not wish to be kept alive through artificial means (such as feeding tubes and breathing machines) may state their wishes in a legally binding advance directive.

Why is Assisted Suicide Illegal?

There are two major public policy reasons why assisting with suicide, a crime in most states, is generally frowned upon. First, many states consider the preservation of life the highest priority. Consequently, in those states, anything that ends a human life is considered a crime, such as murder or manslaughter. But while the U.S. Supreme Court reached a similar conclusion -- ruling that there is no constitutional right to physician-assisted suicide -- states are free to enact such laws.

The second policy reason against assisted suicide is that it can be difficult in some cases to distinguish it from murder or manslaughter. States have an interest in ensuring that no one is forced to commit suicide through threats or deception. For this reason, the few states that currently allow physician assisted suicide (including Washington, Oregon, and Montana) have strict requirements and procedures that must be followed before any lethal medication is administered, including the following:

Patient must be a resident of the state.
Patient is mentally competent, terminally ill, and predicted to live only a short while (typically six months).
Patient's request was voluntary.
Patient is given multiple opportunities to change their mind.

Get Professional Legal Help With Your End-of-Life Concerns

While assisting with suicide is a crime in most states, the list of states allowing physician-assisted suicide continues to grow. But if a family member or loved one with a terminal illness doesn't want to be kept alive through artificial means, they have that choice. Regardless, be sure to consult with a health care law attorney if you have any additional questions about end-of-life care.

Created by FindLaw's team of legal writers and editors | Last updated June 20, 2016

Euthanasia Law and the Oregon Death with Dignity Act

Oregon is one of just a few states where terminally ill patients may legally end their own lives if they choose. The Oregon Death with Dignity Act allows terminally ill patients to receive a prescription for lethal medications, which they administer themselves after completing the consent process. To be eligible, patients must be given six months or less to live, be at least 18 years old, and submit three separate doctor requests (two oral, one written).

The Oregon Health Authority provides the necessary forms on its Website, including the Patient Request Form (PDF) and Consulting Physician Form (PDF). See the following chart for more details of Oregon's physician-assisted suicide statute.

Code Section	127.800, et. seq. (The Oregon Death with Dignity Act)
Euthanasia Condoned in Statutes?	Physician-assisted suicide is allowed in limited circumstances: Patient must have been diagnosed with a terminal illness in which he/she is expected to die within 6 months; physician may prescribe a lethal dose of drugs to eligible patients who have provided the necessary consent.
Safeguards and Consent	After confirming presence of a terminal illness, the patient requesting lethal drugs to end their life must be informed of alternatives (including hospice and counseling); referred to another physician to confirm the diagnosis and to confirm the patient's decision to end their life; and be informed of their right to rescind the request for lethal drugs.
Effect of Withholding of Life-Sustaining Procedures	Withholding or withdrawal of life-sustaining procedures or artificially administered nutrition and hydration does not constitute suicide, assisted suicide, homicide, or mercy killing.

Note: State laws are always subject to change, usually through new legislation or higher court decisions. You may want to contact an Oregon health care attorney or conduct your own legal research to verify the state law(s) you are researching.

Oregon Revised Statute: Oregon's Death with Dignity Act

Chapter 127

NOTE: This page reflects the changes to the Death with Dignity Act resulting from the passage of Senate Bill 579 by the 2019 Oregon legislative assembly.

Please browse this page or download the statute for printing.

You can also view the statute on the Oregon State Legislature webpage: https://www.oregonlegislature.gov.

127.800 s.1.01. Definitions.

The following words and phrases, whenever used in ORS 127.800 to 127.897, 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) "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.

(4) "Consulting physician" means a physician who is qualified by specialty or experience to make a professional diagnosis and prognosis regarding the patient's disease.

(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.

(6) "Health care provider" means a person licensed, certified or otherwise authorized or permitted by the law of this state to administer health care or dispense medication in the ordinary course of business or practice of a profession, and includes a health care facility.

(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;

(d) The probable result of taking the medication to be prescribed; and

(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 ORS 127.800 to 127.897 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 judgment, produce death within six months. [1995 c.3 s.1.01; 1999 c.423 s.1]

(Written Request for Medication to End One's Life in a Humane and Dignified Manner)

(Section 2)

127.805 s.2.01. Who may initiate a written request for medication.

(1) 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 ORS 127.800 to 127.897.

(2) No person shall qualify under the provisions of ORS 127.800 to 127.897 solely because of age or disability. [1995 c.3 s.2.01; 1999 c.423 s.2]

127.810 s.2.02. Form of the written request.

(1) A valid request for medication under ORS 127.800 to 127.897 shall be in substantially the form described in ORS 127.897, 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 patient 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 Oregon Health Authority by rule. [1995 c.3 s.2.02]

(Safeguards)

(Section 3)

127.815 s.3.01.Attending physician responsibilities.

(1) The attending physician shall:

(a) Make the initial determination of whether a patient has a terminal disease, is capable, and has made the request voluntarily;

(b) Request that the patient demonstrate Oregon residency pursuant to ORS 127.860;

(A) His or her medical diagnosis;

(B) His or her prognosis;

(D) The probable result of taking the medication to be prescribed; and

(E) The feasible alternatives, including, but not limited to, comfort care, hospice care and pain control;

(d) 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;

(e) Refer the patient for counseling if appropriate pursuant to ORS 127.825;

(f) Recommend that the patient notify next of kin;

(g) Counsel the patient about the importance of having another person present when the patient takes the medication prescribed pursuant to ORS 127.800 to 127.897 and of not taking the medication in a public place;

(h) 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 time the patient makes the patient’s second oral request pursuant to ORS 127.840;

(i) Verify, immediately prior to writing the prescription for medication under ORS 127.800 to 127.897, that the patient is making an informed decision;

(j) Fulfill the medical record documentation requirements of ORS 127.855;

(k) Ensure that all appropriate steps are carried out in accordance with ORS 127.800 to 127.897 prior to writing a prescription for medication to enable a qualified patient to end his or her life in a humane and dignified manner; and

(L)(A) Dispense medications directly, including ancillary medications intended to facilitate the desired effect to minimize the patient's discomfort, provided the attending physician is registered as a dispensing physician with the Board of Medical Examiners, has a current Drug Enforcement Administration certificate and complies with any applicable administrative rule; or

(B) With the patient's written consent:

(i) Contact a pharmacist and inform the pharmacist of the prescription; and

(ii) Deliver the written prescription personally or by mail to the pharmacist, who will dispense the medications to either the patient, the attending physician or an expressly identified agent of the patient.

(2) Notwithstanding any other provision of law, the attending physician may sign the patient's death certificate. [1995 c.3 s.3.01; 1999 c.423 s.3]

127.820 s.3.02. Consulting physician confirmation.

Before a patient is qualified under ORS 127.800 to 127.897, 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. [1995 c.3 s.3.02]

127.825 s.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. [1995 c.3 s.3.03; 1999 c.423 s.4]

127.830 s.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 ORS 127.800 (7). Immediately prior to writing a prescription for medication under ORS 127.800 to 127.897, the attending physician shall verify that the patient is making an informed decision. [1995 c.3 s.3.04]

127.835 s.3.05. Family notification.

The attending physician shall recommend that the patient notify the next of kin of his or her request for medication pursuant to ORS 127.800 to 127.897. A patient who declines or is unable to notify next of kin shall not have his or her request denied for that reason. [1995 c.3 s.3.05; 1999 c.423 s.6]

127.840 s.3.06. Written and oral requests.

(1) 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 15 days after making the initial oral request.
(2) Notwithstanding subsection (1) of this section, if the qualified patient’s attending physician has medically confirmed that the qualified patient will, within reasonable medical judgment, die within 15 days after making the initial oral request under this section, the qualified patient may reiterate the oral request to his or her attending physician at any time after making the initial oral request.
(3) 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. [1995 c.3 §3.06]

127.845 s.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 ORS 127.800 to 127.897 may be written without the attending physician offering the qualified patient an opportunity to rescind the request. [1995 c.3 s.3.07]

127.850 s.3.08. Waiting periods.

(1) No less than 15 days shall elapse between the patient’s initial oral request and the writing of a prescription under ORS 127.800 to 127.897. No less than 48 hours shall elapse between the patient’s written request and the writing of a prescription under ORS 127.800 to 127.897. [1995 c.3 §3.08]
(2) Notwithstanding subsection (1) of this section, if the qualified patient’s attending physician has medically confirmed that the qualified patient will, within reasonable medical judgment, die before the expiration of at least one of the waiting periods described in subsection (1) of this section, the prescription for medication under ORS 127.800 to 127.897 may be written at any time following the later of the qualified patient’s written request or second oral request under ORS 127.840.

127.855 s.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 determinations made during counseling, if performed;

(6) Any medically confirmed certification of the imminence of the patient’s death;

(7) 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 ORS 127.840; and

(8) A note by the attending physician indicating that all requirements under ORS 127.800 to 127.897 have been met and indicating the steps taken to carry out the request, including a notation of the medication prescribed. [1995 c.3 s.3.09]

127.860 s.3.10. Residency requirement.

Only requests made by Oregon residents under ORS 127.800 to 127.897 shall be granted. Factors demonstrating Oregon residency include but are not limited to:

(1) Possession of an Oregon driver license;

(2) Registration to vote in Oregon;

(3) Evidence that the person owns or leases property in Oregon; or

(4) Filing of an Oregon tax return for the most recent tax year. [1995 c.3 s.3.10; 1999 c.423 s.8]

127.865 s.3.11. Reporting requirements.

(1)(a) The Health Services shall annually review a sample of records maintained pursuant to ORS 127.800 to 127.897.

(b) The division shall require any health care provider upon dispensing medication pursuant to ORS 127.800 to 127.897 to file a copy of the dispensing record with the division.

(2) The Health Services shall make rules to facilitate the collection of information regarding compliance with ORS 127.800 to 127.897. Except as otherwise required by law, the information collected shall not be a public record and may not be made available for inspection by the public.

(3) The division shall generate and make available to the public an annual statistical report of information collected under subsection (2) of this section. [1995 c.3 s.3.11; 1999 c.423 s.9]

127.870 s.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. [1995 c.3 s.3.12]

127.875 s.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. [1995 c.3 s.3.13]

127.880 s.3.14. Construction of Act.

Nothing in ORS 127.800 to 127.897 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 ORS 127.800 to 127.897 shall not, for any purpose, constitute suicide, assisted suicide, mercy killing or homicide, under the law. [1995 c.3 s.3.14]

(Immunities and Liabilities)

(Section 4)

127.885 s.4.01. Immunities; basis for prohibiting health care provider from participation; notification; permissible sanctions.

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.

(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 ORS 127.800 to 127.897.

(3) No request by a patient for or provision by an attending physician of medication in good faith compliance with the provisions of ORS 127.800 to 127.897 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 ORS 127.800 to 127.897, 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.

(5)(a) Notwithstanding any other provision of law, a health care provider may prohibit another health care provider from participating in ORS 127.800 to 127.897 on the premises of the prohibiting provider if the prohibiting provider has notified the health care provider of the prohibiting provider's policy regarding participating in ORS 127.800 to 127.897. Nothing in this paragraph prevents a health care provider from providing health care services to a patient that do not constitute participation in ORS 127.800 to 127.897.

(b) Notwithstanding the provisions of subsections (1) to (4) of this section, a health care provider may subject another health care provider to the sanctions stated in this paragraph if the sanctioning health care provider has notified the sanctioned provider prior to participation in ORS 127.800 to 127.897 that it prohibits participation in ORS 127.800 to 127.897:

(A) Loss of privileges, loss of membership or other sanction provided pursuant to the medical staff bylaws, policies and procedures of the sanctioning health care provider if the sanctioned provider is a member of the sanctioning provider's medical staff and participates in ORS 127.800 to 127.897 while on the health care facility premises, as defined in ORS 442.015, of the sanctioning health care provider, but not including the private medical office of a physician or other provider;

(B) Termination of lease or other property contract or other nonmonetary remedies provided by lease contract, not including loss or restriction of medical staff privileges or exclusion from a provider panel, if the sanctioned provider participates in ORS 127.800 to 127.897 while on the premises of the sanctioning health care provider or on property that is owned by or under the direct control of the sanctioning health care provider; or

(C) Termination of contract or other nonmonetary remedies provided by contract if the sanctioned provider participates in ORS 127.800 to 127.897 while acting in the course and scope of the sanctioned provider's capacity as an employee or independent contractor of the sanctioning health care provider. Nothing in this subparagraph shall be construed to prevent:

(i) A health care provider from participating in ORS 127.800 to 127.897 while acting outside the course and scope of the provider's capacity as an employee or independent contractor; or

(ii) A patient from contracting with his or her attending physician and consulting physician to act outside the course and scope of the provider's capacity as an employee or independent contractor of the sanctioning health care provider.

(c) A health care provider that imposes sanctions pursuant to paragraph (b) of this subsection must follow all due process and other procedures the sanctioning health care provider may have that are related to the imposition of sanctions on another health care provider.

(d) For purposes of this subsection:

(A) "Notify" means a separate statement in writing to the health care provider specifically informing the health care provider prior to the provider's participation in ORS 127.800 to 127.897 of the sanctioning health care provider's policy about participation in activities covered by ORS 127.800 to 127.897.

(B) "Participate in ORS 127.800 to 127.897" means to perform the duties of an attending physician pursuant to ORS 127.815, the consulting physician function pursuant to ORS 127.820 or the counseling function pursuant to ORS 127.825. "Participate in ORS 127.800 to 127.897" does not include:

(i) Making an initial determination that a patient has a terminal disease and informing the patient of the medical prognosis;

(ii) Providing information about the Oregon Death with Dignity Act to a patient upon the request of the patient;

(iii) Providing a patient, upon the request of the patient, with a referral to another physician; or

(iv) A patient contracting with his or her attending physician and consulting physician to act outside of the course and scope of the provider's capacity as an employee or independent contractor of the sanctioning health care provider.

(6) Suspension or termination of staff membership or privileges under subsection (5) of this section is not reportable under ORS 441.820. Action taken pursuant to ORS 127.810, 127.815, 127.820 or 127.825 shall not be the sole basis for a report of unprofessional or dishonorable conduct under ORS 677.415 (2) or (3).

(7) No provision of ORS 127.800 to 127.897 shall be construed to allow a lower standard of care for patients in the community where the patient is treated or a similar community. [1995 c.3 s.4.01; 1999 c.423 s.10]

Note: As originally enacted by the people, the leadline to section 4.01 read "Immunities." The remainder of the leadline was added by editorial action.

127.890 s.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 ORS 127.800 to 127.897 limits further liability for civil damages resulting from other negligent conduct or intentional misconduct by any person.

(4) The penalties in ORS 127.800 to 127.897 do not preclude criminal penalties applicable under other law for conduct which is inconsistent with the provisions of ORS 127.800 to 127.897. [1995 c.3 s.4.02]

127.892 Claims by governmental entity for costs incurred.

Any governmental entity that incurs costs resulting from a person terminating his or her life pursuant to the provisions of ORS 127.800 to 127.897 in a public place shall have a claim against the estate of the person to recover such costs and reasonable attorney fees related to enforcing the claim. [1999 c.423 s.5a]

(Severability)

(Section 5)

127.895 s.5.01. Severability.

Any section of ORS 127.800 to 127.897 being held invalid as to any person or circumstance shall not affect the application of any other section of ORS 127.800 to 127.897 which can be given full effect without the invalid section or application. [1995 c.3 s.5.01]

(Form of the Request)

(Section 6)

127.897 s.6.01. Form of the request.

A request for a medication as authorized by ORS 127.800 to 127.897 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 further understand that although most deaths occur within three hours, my death may take longer and my physician has counseled me about this possibility.

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;

(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.

[1995 c.3 s.6.01; 1999 c.423 s.11]

PENALTIES

127.990

[Formerly part of 97.990; repealed by 1993 c.767 s.29]

127.995 Penalties.

(1) It shall be a Class A felony for a person without authorization of the principal to willfully alter, forge, conceal or destroy an instrument, the reinstatement or revocation of an instrument or any other evidence or document reflecting the principal's desires and interests, with the intent and effect of causing a withholding or withdrawal of life-sustaining procedures or of artificially administered nutrition and hydration which hastens the death of the principal.

(2) Except as provided in subsection (1) of this section, it shall be a Class A misdemeanor for a person without authorization of the principal to willfully alter, forge, conceal or destroy an instrument, the reinstatement or revocation of an instrument, or any other evidence or document reflecting the principal's desires and interests with the intent or effect of affecting a health care decision. [Formerly 127.585]

Hari's Random Thoughts by Hariharan Ramamurthy