Death with Dignity

Purpose

To comply with the Washington State Death with Dignity Act that became effective March 5, 2009.

Definition of the Act

The “Washington State Death With Dignity Act” affects terminally ill, competent, adult Washington residents who are medically predicted to die within six months. It allows the individual to request and self-administer a lethal medication prescribed by a physician. The measure requires that the individual make two oral and one written request for the prescription of a lethal medication.   It further requires that two physicians determine that the individual has a terminal and incurable illness and is competent.  The individual must have the opportunity to rescind his or her request. Only the individual may administer the drugs to him or herself. Physicians, patients and others acting in good faith compliance have criminal and civil immunity.

Definitions

Adult means an individual who is 18 years of age or older
Competent 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 an informed decision to health care providers including communication through persons familiar with the patient’s manner of communication if those persons are available
Self Administer means a qualified patient’s act of ingesting medication to end his or her life in a humane and dignified manner.
Qualified Patient means a competent adult who is a resident of Washington state and has satisfied the requirements of this chapter in order to obtain a prescription for medication that the qualified patient may self-administer to end his or her life in a humane and dignified manner.
Terminal Disease means an incurable and irreversible disease that has been medically confirmed and will within reasonable medical judgment produce death within six months.
Medically Confirmed means the medical opinion of the attending physician has been confirmed by a consulting physician who has examined the patient and the patients relevant medical records.

To view the Act in its entirety refer to RCW 70.122.100; RCW 42.56.360

Legal Options for Terminally Ill Patients

There are a number of options available to patients when they are considering their end of life care, to include hospice, palliative care, comfort care, pain management, the right to refuse or withdraw treatment, and the right to request a prescription for a lethal dose of medication to end their life.

Policy for Kittitas Valley Healthcare

In accordance with the Washington Death with Dignity Act, KVH recognizes the patient’s right to request a prescription for a lethal dose of medication to end his or her life.  The Death with Dignity Act involves the self-administration of a medication in the person’s home environment. In support of this intent, KVH will not endorse the self administration of a lethal dose of medication within the hospital. Further, because the KVH pharmacy does not fill take home or outpatient prescriptions, prescriptions authorized by the Act will not be filled at the KVH pharmacy.  However, there may be occasions when patients will want to discuss the “Death With Dignity Act” with their personal physician who is an employee of Kittitas Valley Healthcare, a tenant of KVH, or a member of its Medical Staff.  Hospital employees may, within the framework of the Act, respond to patient’s questions regarding the Act and provide the patient with any hospital approved literature regarding the Act.  (See Patient Care Services Division Policy on “Approved Literature for Death with Dignity Act”)  It is the policy of KVH that it respects the right of both the physician, the patient and all other care providers to determine whether they wish to participate in and/or witness this end of life decision and takes no action to either compel or prohibit physicians from participating in actions under the Death With Dignity Act apart from the hospital.  If a physician elects to participate, it is expected that he or she will fully comply with all aspects of the Act and will ensure that the appropriate standard of care is followed.

If any KVH employed physician elects to participate in the “Washington State Death with Dignity Act” with a patient of KVH, that physician must immediately notify the KVH Clinics’ Medical Director for collaborative review of the attending physician’s adherence to the Act’s legal compliance standards. It is the physician’s responsibility to ensure the correct procedures are followed and the correct documentation is completed in accordance with the Act and hospital policy.  The steps included in the attached checklist are to be followed carefully and documented appropriately.

References

RCW 70.122.100, RCW 42.56.360, State of Washington Department of Health, Kittitas Valley Healthcare Ethics Committee.

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