From Prognosis to Prescription: Six Simple Facts About Medical Aid in Dying
Under medical aid-in-dying laws, the attending physician writing a prescription must be the licensed physician with primary responsibility for the care of an individual. Most frequently, that doctor is a family-practice or palliative-care physician, a hospice medical director, or other specialist who is qualified to confirm a diagnosis and prognosis of terminal illness, and routinely addresses serious and terminal illnesses.
Two doctors need to confirm the terminal diagnosis, prognosis and patient’s mental capability to make healthcare decisions. A terminally ill adult may only receive a prescription for medical aid in dying if two doctors determine the person is suffering from a terminal illness, has less than six months to live and is mentally capable of making their own healthcare decisions.
In 23 years of experience in Oregon and 40 years of combined experience in other jurisdictions that authorize the practice, there has been no evidence of any doctors prescribing aid-in-dying medication inappropriately. There has never been a documented instance of abuse. State medical boards are responsible for reviewing alleged failures to comply with the law; no board has found that a physician has engaged in inappropriate conduct under any medical aid-in-dying law in the country. A physician not legally qualified to fulfill the role of an attending physician who nonetheless provides a prescription is subject to discipline by the state medical board.
Physicians are experts at determining their patients’ mental capability. Doctors are specially trained and required on a daily basis to assess whether patients have the mental capacity to make informed healthcare decisions — including life and death decisions. If either the attending or consulting physician is concerned about the patient’s mental capacity, evaluation by a mental health specialist is required before a prescription for aid-in-dying medication can be written.
Doctors tend to overestimate how much time their patients have left, making fears that patients will prematurely take aid-in-dying medications unfounded. To be referred to hospice a person must have a prognosis of six months or less to live, a time frame that has thus become a guide to end-of-life care decisions. As one study published in the November 2005 issue of Mayo Clinic Proceedings found, the vast majority of physicians overestimate how long a person has to live after being diagnosed with a terminal illness.
Studies indicate that the availability of medical aid in dying in authorized states is improving physician training in end-of-life care. Studies in Oregon and Washington, along with a host of national surveys published in the New England Journal of Medicine, JAMA and other medical journals, link the availability of medical aid in dying as a palliative care option to a number of positive end-of-life care outcomes, including better physician training.