PHYSICIAN AID-IN-DYING: UPDATES FOR GERIATRIC PSYCHIATRISTS: Session 100

Abstract

Abstract At this time, five states (Oregon, Washington, Vermont, Hawaii, and California) and Washington, D.C. have statutes permitting PAD and outlining procedures for this process. One state, Montana, allows PAD under common law. At least thirty-six states have attempted to introduce legislation to legalize PAD. In states with statutes addressing PAD, patients are typically required to make multiple requests, both orally and in writing. They are required to have a terminal illness with a prognosis of six months or less as agreed upon by two physicians. Mental health and/or capacity assessments are typically not mandated unless at least one of the two evaluating physicians suspects a contributory underlying psychiatric illness or incapacitation. All states provide opt-out measures for conscientious objectors or those not wishing to participate. Initial data suggests that patients utilizing PAD are frequently college educated, insured, and engaged in hospice care. Patients requesting PAD are often those with terminal illnesses who are experiencing co-morbid severe pain, discomfort, and deterioration in functional status. Women, African-Americans, and those with cognitive impairments may be more likely to oppose PAD, highlighting the need to maintain protections for vulnerable patients where PAD is permitted. In one survey of physicians who have received requests for PAD (including those practicing in states where PAD has not been legalized), physicians reported a significant amount of co-morbid depression in those requesting PAD. Despite this, no legal requirements for psychiatric and/or capacity assessments exist in any state that has legalized PAD, except for Hawaii. In several European countries, chronic mental illness has been accepted as a terminal diagnosis, which may have significant impact in the United States as PAD is legalized in more states. Finally, as a federal entity, PAD is not permitted at VA facilities, even in states where it has been legalized. This may have major implications for patients and providers within the VA healthcare system.