The Aid in Dying Bill: The Physician’s Roles and Responsibilities

By: Mark Pancrazio
June 27, 2014

Physicians – whether they be attending or consulting – have an enormous role to play in this proposed legislation.  That includes psychiatrists, psychologists and pharmacists as well.

Beginning with the attending physician, after she is presented with a patient’s first written request for aid in dying, she must make a threshold determination that the patient is an adult, has a terminal illness, is competent and has voluntarily requested the aid.  The next thing she must do is require the patient to demonstrate that he or she is a resident of the State of Connecticut.  Any one of the following four methods of identification will suffice in this regard: a Connecticut driver’s license; a valid voter registration record authorizing the patient to vote in the State of Connecticut; a recorded deed to property in the State (or a written lease); or any other government issued document that the physician reasonably believes demonstrates that the patient is a current resident of Connecticut.  It does not end there however.  The physician must also ensure that the patient is making an informed decision by advising her patient of the following: his or her medical diagnosis; his or her progress; the potential risks associated with self-administering aid in dying medication; the likely result of administering that medication; and feasible options and treatment, including but not limited to, palliative care.  Finally, the attending physician would have a legal duty to refer the patient to a consulting physician for confirmation of the attending physician’s diagnosis, prognosis and most importantly, a determination that the patient is competent and acting voluntarily by requesting aid in dying medication.  It’s important to know that a consulting physician is defined to be a physician who is qualified by specialty or experience to make a diagnosis/prognosis regarding a patient’s terminal illness.

Now let’s shift gears and look at palliative care … one of the options to self-administering aid in dying medication.  Under House Bill 5326, “palliative care” is defined to mean health care centered on a terminally ill patient and that patient’s family.  This so-called palliative care is designed to achieve several purposes.  The first, is to optimize a patient’s quality of life by anticipating, preventing and treating the patient’s suffering throughout their terminal illness.  Another, is to address the physical, emotional, social and spiritual needs of the patient.  Still another is to facilitate autonomy, access to information and of course, offer the patient choices as to their care.  Finally, a significant part of palliative care includes facilitating discussions between the patient and his or her doctors with respect to goals for treatment, various treatment options, possibly hospice care and of course, pain management.

Yet, the physician’s responsibilities do not end there.  Section seven of the proposed legislation puts the burden on the consulting physician to go even further, when determining whether a patient is a “qualified” patient.  That means that the consulting physician has to examine the patient and his or her relevant medical records, confirm – in writing – the attending physician’s diagnosis of the patient’s terminal illness, verify that the patient is competent, is acting voluntarily, has made an informed decision regarding his or her request for aid in dying medication and the consulting physician must refer the patient for counseling if – in her opinion – the patient is suffering from a psychiatric or psychological condition (or even depression), that is causing the patient to have impaired judgment.  If a psychiatrist or psychologist determines that the patient is not suffering from a psychiatric or psychological condition (or depression) that would cause his judgment to be impaired, then the patient can have aid in dying medication provided to him.

There are various and sundry other legal requirements imposed upon the attending physician, most of which have to do with recommending that the patient notify their next of kin, counseling the patient about how to administer the aid in dying medication, dispensing medication to make the patient as comfortable as possible and signing the patient’s death certificate.  The attending physician also has certain documentation and filing obligations pursuant to the proposed legislation.  Noteworthy is that when the attending physician signs the death certificate she must list the underlying terminal illness as the cause of death, rather than state that the cause of death was due to the aid in dying medication.  It’s not difficult to conclude that the proposed legislation goes to great lengths to insure that if a patient is requesting aid in dying, that it be done properly and with as many safeguards as possible.  It’s also obvious that a great deal of responsibility is placed on the physician to insure that this medication is dispensed correctly.

If you have any questions related to the Aid in Dying bill – House Bill 5326 – please feel free to call me at (203) 744-0004 or email me at mpancrazio@mixgoldman.com.

-Mark Pancrazio