What Are The Obligations Of An Attending Physician?
Before prescribing an aid-in-dying drug, an attending physician must make an initial determination of whether a patient is a qualified individual and so can receive aid-in-dying drug.
New in 2022, physicians who cannot or will not support patient requests are required to tell the patient they will not support them, document the patient's request and the provider's notice of rejection in the patient's medical record, and transfer the relevant medical record upon request. Providers are also prohibited from engaging in false, misleading, or deceptive practices relating to their willingness to qualify an individual or provide a prescription for an aid-in-dying medication to a qualified individual. Finally, healthcare entities are required to post their current policy regarding medical aid in dying on their internet website.
An individual patient is qualified if he or she:
- Is an adult (18 years of age or older)
- Is a California Resident
- Has an incurable and irreversible terminal disease (6 month prognosis)
- Has the capacity to make medical decisions
- Is making an informed decision
- Is making a fully voluntary request for aid-in-dying drug and the request does not arise from coercion or undue influence
- Is physically and mentally able to self administer aid-in-dying drug, meaning a conscious and physical act of administering and ingesting an aid-in-dying drug to bring about death
- Has submitted the signed, dated witnessed request form
The attending physician must receive, from the patient directly and not through a designee, two oral requests a minimum of 48 hours apart, and a written request. The law does not specify when the written request should be submitted.
All written and oral requests must be recorded in the medical record. (There is no specific language required in the documentation.)
The attending physician must refer the patient to a consulting physician.
The attending physician must refer the patient to a mental health specialist if indicated.
A mental health special assessment is indicated for the purpose of determining that the patient has the capacity to make medical decisions and is not suffering from impaired judgement due to a mental disorder.
The attending physician must counsel the patient about the importance of:
- Having another person present when aid-in-dying drug is ingested
- Not ingesting aid-in-dying drug in a public place or place open to public view or access
- Notifying next of kin of request for aid-in-dying drug (failure to do so is not reason to deny the patient the aid-in-dying drug)
- Participating in a hospice program
- Maintaining aid-in-dying drug in safe and secure location until self-administered
At the time of counseling, the attending physician must remind the patient that he or she may rescind their request for aid-in-dying drug at any time in any manner.
To confirm that the patient is making an informed decision, the attending physician must discuss the following with the patient:
- The patient’s diagnosis and prognosis
- The risks associated with taking the aid-in-dying drug
- Probable result of taking the aid-in-dying drug
- The possibility that the patient may at any time choose not to obtain the aid-in-dying drug or may obtain the drug and choose not to take it
- Feasible alternatives or additional treatment options, e.g., comfort care, hospice care, palliative care, pain control
The attending physician must comply with all documentation requirements and submit all necessary forms.
In addition, the attending physician must:
- Offer the patient an opportunity to withdraw/rescind the request before prescribing the drug
- Verify the patient is making an informed decision immediately before prescribing the aid-in-dying drug
- Confirm all requirements are met and that appropriate steps are carried out before prescribing the aid-in-dying drug
- Fulfill all documentation requirements
- Complete the Consulting Physician Compliance Form and the Attending Physician Checklist & Compliance Form, place the forms in the patient’s medical record, and submit copies of both the Attending and Consulting Compliance forms and the patient’s written request to the California Department of Public Health (CDPH) within 30 days of writing the prescription
The Attending Physician Follow-Up Form must be completed within 30 calendar days of the patient’s death. A copy of the form must also be submitted to CDPH. This form must be completed and signed by the attending physician.