X-Message-Number: 11823 Date: Wed, 26 May 1999 09:42:48 -0700 From: David Brandt-Erichsen <> Subject: Oregon law amended Changes to the Oregon Death with Dignity Act have passed both the House and Senate in Oregon and are expected to be signed by the Governor. These changes are given below. For a copy of the existing Oregon law, go to: http://www.azstarnet.com/~davidbe/hemlock/oregon.htm OREGON LAW CHANGES 70th OREGON LEGISLATIVE ASSEMBLY--1999 Regular Session NOTE: Matter within { + braces and plus signs + } in an amended section is new. Matter within { - braces and minus signs - } is existing law to be omitted. New sections are within { + braces and plus signs + } . Senate Bill 491 Sponsored by COMMITTEE ON JUDICIARY A BILL FOR AN ACT Relating to Oregon Death with Dignity Act; amending ORS 127.800, 127.805, 127.815, 127.825, 127.830, 127.835, 127.855, 127.860, 127.865, 127.885 and 127.897; and declaring an emergency. Be It Enacted by the People of the State of Oregon: SECTION 1. ORS 127.800 is amended to read: 127.800. s1.01. Definitions. The following words and phrases, whenever used in ORS 127.800 to 127.897, { - 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) '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. + } { - (3) - } { + (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. { - (4) - } { + (5) + } 'Counseling' means { - a consultation - } { + one or more consultations as necessary + } between a state licensed psychiatrist or psychologist and a patient for the purpose of determining { - whether - } { + that + } the patient is { + capable and not + } suffering from a psychiatric or psychological disorder { - , - } or depression causing impaired judgment. { - (5) - } { + (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 provide medication + } 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; { + and + } (e) The feasible alternatives, including, but not limited to, comfort care, hospice care { + , + } { - and - } pain control { + , refusal of nutrition and hydration and discontinuation of life-sustaining treatment + }. (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) 'Resident' means a person domiciled in Oregon. + } { - (12) - } { + (13) + } 'Terminal disease' means an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, produce death within six { - (6) - } months. SECTION 2. ORS 127.805 is amended to read: 127.805. s2.01. 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. + } SECTION 3. ORS 127.815 is amended to read: 127.815. s3.01. 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) Verify that the patient is a resident of Oregon; + } { - (2) - } { + (3) To ensure that the patient is making an informed decision, + } 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; { + and + } (e) The feasible alternatives, including, but not limited to, comfort care, hospice care { + , + } { - and - } pain control { + , refusal of nutrition and hydration and discontinuation of life-sustaining treatment; + } { - . - } { - (3) - } { + (4) + } 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) - } { + (5) + } Refer the patient for counseling { - if appropriate - } pursuant to ORS 127.825; { - (5) - } { + (6) + } { - Request - } { + Recommend + } that the patient notify next of kin; { - (6) - } { + (7) + } 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 ORS 127.840; { - (7) - } { + (8) + } Verify, immediately prior to writing the prescription for medication under ORS 127.800 to 127.897, that the patient is making an informed decision { - : - } { + ; + } { - (8) - } { + (9) + } Fulfill the medical record documentation requirements of ORS 127.855; { - (9) - } { + (10) + } 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 { - . - } { + ; + } { + (11) Indicate on the face of any prescription that the prescription is 'written pursuant to ORS 127.800 et seq.'; and (12) Notwithstanding any other law, complete and sign the patient's death certificate. + } SECTION 4. ORS 127.825 is amended to read: 127.825. s3.03. Counseling referral. { - If in the opinion of the attending physician or the consulting physician - } { + To ensure that + } a patient { - may be - } { + is not + } suffering from a psychiatric or psychological disorder { - , - } or depression causing impaired judgment, { - either - } { + the attending + } 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. SECTION 5. ORS 127.830 is amended to read: 127.830. s3.04. Informed decision. { + (1) + } 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. { + (2) Another adult individual designated by the patient shall be present when the patient takes the medication prescribed pursuant to ORS 127.800 to 127.897. If the patient does not designate such an individual or the individual is unable or unwilling to be present, the attending physician or a health care provider designated by the attending physician shall be present when the patient takes the medication. If the attending physician does not intend to be present when the patient takes the medication, the physician shall ensure that the medication is delivered to the individual who does intend to be present at the location at which the patient intends to take the medication. (3) The patient may take the medication prescribed pursuant to ORS 127.800 to 127.897 at any of the following locations: (a) A health care facility; (b) The patient's home; (c) The private home of an individual who has expressed consent to the attending physician; or (d) The medical office or clinic of the attending physician. + } SECTION 6. ORS 127.835 is amended to read: 127.835. s3.05. Family notification. { + (1) + } The attending physician shall { - ask - } { + recommend that + } the patient { - to - } 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. { + (2) If an Oregon court has appointed a guardian, conservator or other fiduciary on behalf of the patient pursuant to a protective proceeding under ORS chapter 125 prior to the patient's initial request for medication pursuant to ORS 127.800 to 127.897 and the attending physician is aware that the court has appointed such a fiduciary, the attending physician shall notify the fiduciary of the patient's request for medication pursuant to ORS 127.800 to 127.897. + } SECTION 7. ORS 127.855 is amended to read: 127.855. s3.09. 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) 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 (7) 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. SECTION 8. ORS 127.860 is amended to read: 127.860. s3.10. 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. + } SECTION 9. ORS 127.865 is amended to read: 127.865. s3.11. Reporting requirements. (1) The Health Division shall annually review a sample of records maintained pursuant to ORS 127.800 to 127.897. (2) { + (a) + } The Health Division shall make rules to facilitate the collection of information regarding compliance with ORS 127.800 to 127.897. The information collected { - shall not be a public record and may not be made available for inspection by the public - } { + is not a public record and may be made available only to the following: (A) The Board of Medical Examiners; (B) The office of the district attorney; (C) Law enforcement officers; and (D) The State Medical Examiner. (b) Information collected pursuant to this subsection is admissible as evidence in a judicial or administrative proceeding + }. (3) The { - Health - } division shall generate and make available to the public an annual statistical report of information collected under subsection (2) of this section. { + (4) The Assistant Director for Health shall appoint an advisory panel to the division. The advisory panel shall evaluate the information collected pursuant to this section and advise the assistant director regarding the appropriate course of action to be taken in response to evidence of noncompliance with ORS 127.800 to 127.897. The panel shall be composed of representatives of the division, district attorney offices, the Board of Medical Examiners and other representatives as the assistant director may designate. + } SECTION 10. ORS 127.885 is amended to read: 127.885. s4.01. Immunities. 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) Notwithstanding the provisions of this section, a physician or other health care provider may be subject to civil liability, censure, discipline, loss of privileges, loss of membership or other penalty if the physician participates in ORS 127.800 to 127.897 while on the premises of a health care facility that has indicated that it prohibits participation in ORS 127.800 to 127.897 on its premises. + } SECTION 11. ORS 127.897 is amended to read: 127.897. s6.01. 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 { + , refusal of nutrition and hydration and discontinuation of life-sustaining treatment + }. 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; (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. ___________________________________________________ SECTION 12. { + This 1999 Act being necessary for the immediate preservation of the public peace, health and safety, an emergency is declared to exist, and this 1999 Act takes effect on its passage. + } ----------------------------------------------------------------------- This message from Arizonans for Death with Dignity David Brandt-Erichsen, AzDD website manager http://www.hemlock.org/hemlock/arizona or http://www.azstarnet.com/~davidbe/hemlock Rate This Message: http://www.cryonet.org/cgi-bin/rate.cgi?msg=11823