DC READY TO APPROVE DEATH WITH DIGNITY ACT

​“Can’t someone just shoot me? That is what we do with horses,” asked my client in earnest when we were designing her Advance Healthcare Directive.  I informed her that at the time the District of Columbia did not permit physician-assisted suicide.  However, that may soon change, as the City Council is currently considering the Death with Dignity Act (“DwDA”), which the Council Committee on Health and Human Services Committee has already approved on a vote of 3 to 2.  In order for the DwDA to become law, the full City Council must approve the legislation before the Council adjourns this year on December 16, and then the Council-approved legislation is subject to the approval of the Mayor.  Below I provide a description of the legislation. 
 
PATIENT’S REQUESTS
Under the DwDA, a patient has to observe a procedure of oral and written requests in order for a doctor to prescribe medication that will result in death of the patient.  Specifically, the patent has to make two oral requests, no less than 15 days apart from each other, and in the period between the requests, the patient must also submit a written request. 
 
WRITTEN REQUEST
In the written request the patient must acknowledge:
     

• 2nd Opinion The attending physician has diagnosed the patient with a terminal disease and that a consulting physician has confirmed the diagnosis. 
  • Terminal disease is defined as an incurable and irreversible disease  . . . and will, within reasonable medical judgment, result in death within six months.
• Fully Informed  Patient is fully informed of "the diagnosis, 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.
• Death likely in 3 hours  Patient will die from taking the medication, and the death may take more than 3 hours.
•  Right to Rescind  Patient has right to rescind the request at any time.
• Notice to the Family Patient must indicate one the following (i) informed the family of the decision and taken their opinion into consideration; (ii) decided not inform the family of the decision or (iii) does not have any family to inform.

WITNESSES TO THE WRITTEN REQUEST
Two witnesses must attest that (i) the patient signed the request in their presence; (ii) the patient appeared to be of sound mind and not under duress, fraud, or undue influence (iii) the witness is not the attending physician to the patient.
One witness must also be able to declare that the witness is (i) not related to the patient by blood, marriage or adoption; (ii) not entitled to the estate of the patient upon the patient’s death; and (iii) not employed at the patient’s health care facility.

If the patient is at a health care facility, then one witness has to be a representative of the health care facility.

PHYSICIAN RESPONSIBILITIES
The attending physician must determine the patient (i) has a terminal disease; (ii) is able to make and communicate health care decisions; (iii) has made the request voluntarily and (iv) is a resident of the District of Columbia.  The attending physician must also inform the patient of the terminal disease and the same information above which would make the patient “fully informed.” 

The attending physician must also counsel the patient that that patient should inform his or her next of kin of the request to die and that the medication should not administer the medication alone nor administer the medication in a public place.

SAFEGUARDS
Consulting Physician  The attending physician must refer the patient to the consulting physician.  The consulting physician must examine the patient and review the patient’s medical records.  The consulting physician must confirm in writing

• the attending physician’s diagnosis that the patient has a terminal disease.  
• the patent is able to make and communicate health care decisions;
• the patient has made an “informed” decision (i.e., based on an appreciation of all the facts after being “fully informed”. 

Mental Counseling  The attending physician or consulting physician must refer the patient for psychological counseling if the physician believes that that the patient is suffering from psychiatric or psychological condition impairing the patient’s judgment.   No medication that would cause death can be prescribed until the counseling determine that the patient is NOT suffering from a condition that is impairing the patient’s judgment.
48 Hours Before Prescribing Medication Before a physician can prescribe the medication that will result in the patient’s death, 48 hours must have already passed from the point of the written request.   

​IMMUNITY FROM LIABILITY 
A person cannot be subject to civil or criminality liability or subject to professional  disciplinary action for good faith compliance with the Act or for being present at the end of life for a patient who has died pursuant to the Act.