How Death with Dignity program is implemented
Following referral to the Death with Dignity program, each patient is assigned a social worker to serve as an advocate who assists the patient, family, physicians and other health care providers through the multi-step process, which includes:
• describing the process to the patient and family (including offering alternatives such as palliative care and hospice)
• conducting a preliminary medical chart review to confirm a diagnosis of terminal disease
• identifying a physician who will write the prescription
• verifying legal residency
• completing a psychosocial assessment
• monitoring compliance with required documentation
Upon completion of these steps, formal documents are given to the patient, who is required to sign them. The patient and family then meet with both the prescribing and consulting physicians, who review the diagnosis, prognosis and medication risks. Alternatives to lethal medication are again discussed. After the mandatory 15-day waiting period, if all legal requirements are met, a written prescription is sent to the SCCA pharmacy. A pharmacist then meets with the patient and family to educate them about using the prescribed medication.
Assessing the program
The authors reported no unexpected complications except for a patient who died a day after taking the lethal medication, which caused caregiver and clinician distress. Similar cases have been reported by other Washington and Oregon institutions.
“Anecdotally, families describe the death as peaceful (even when death has taken longer than the average of approximately 35 minutes),” the authors wrote. “We have not received complaints from family members or caregivers regarding our process or the manner of death of any patients.”
None of the patients who chose to obtain a prescription were found to have current or historical depression or decision-making incapacity. None were deemed to need a mental health evaluation, which the law requires if physicians believe the patient may be suffering from a psychiatric or psychological disorder or depression causing impaired judgment.
The authors attribute the acceptance of the Death with Dignity program to the professionalism of the patient advocates, the care provided by clinicians when interacting with patients and families, the overall low profile of the program, and the willingness by SCCA leadership to allow significant upfront debate. Some physicians who initially were strongly opposed to the policy eventually joined the program, which further supported its acceptance, according to the authors.
About Seattle Cancer Care Alliance
Seattle Cancer Care Alliance (SCCA) is a cancer treatment center that unites doctors from Fred Hutchinson Cancer Research Center, UW Medicine and Seattle Children’s. Our goal, every day, is to turn cancer patients into cancer survivors. Our purpose is to lead the world in the prevention and treatment of cancer. SCCA has three clinical care sites: an outpatient clinic on the Hutchinson Center campus, a pediatric inpatient unit at Seattle Children’s, and an adult inpatient unit at UW Medical Center. For more information about SCCA, visit www.seattlecca.org.
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