**11.7 A more detailed look at USA states in which PAS is protected**

USA states that permit physician assisted suicide have very similar laws, all based on the same core template espoused by advocates in Oregon. Montana is an exception, as its protection is based on a court ruling in 2009 which held that consent could be a defense against a charge of homicide in a case of PAS. No legislative or regulatory steps have been completed there (**Table 2**).

All states require that candidates be at least 18 and diagnosed with a terminal illness that limits life expectancy to 6 months or less. All states require two oral and one written request for services except for New Mexico. All states protect patients' insurance and contracts. Mental health consultation is required in Hawaii and Colorado and is left up to screening physicians elsewhere. All states require a second "consultant" physician who confirms the diagnosis and the patient's capability of giving their own consent.


Montana, on the other hand, having arrived at assisted suicide by a court decision, has no legislative framework to follow, and no reporting structure.

#### **Table 2.**

*States of the USA in which physician-assisted suicide is protected.*

A recent report, from 2019, says that 4249 prescriptions for lethal medication have been written since 1998 in US states, and that 66.3% of these patients have used the drugs to end their lives. Of note for this chapter, 63.1% of these patients had cancer [40].

#### *11.7.1 California*

**ABX2-12 End of Life Option Act [41], was signed into Law** Oct. 5, 2015, and became effective June 9, 2016.

**Contact** California Department of Health, **Phone:** 916-558-1784.

**Patient eligibility:** As with other states, candidates must be 18 or older, residents of the state, and able to make their own decisions and communicate them. A patient must have a terminal illness with a life expectancy of 6 months or less but must still be physically and mentally capable of self-administering the prescribed lethal medication without assistance. **Physician requirements:** The doctor must diagnose a terminal illness with a life expectancy of 6 months or less. This must be confirmed by a second consulting doctor, who is also expected to certify that the patient can make and communicate health care decisions. If either doctor questions the patient's ability to make judgments, the patient must be referred for a psychological examination. The attending doctor must inform the patient of alternatives, including hospice, palliative care, and pain management options. **Patient request timeline:** First oral request to doctor, 15-day waiting period, second oral request to doctor along with written request. **Other:** Patient's insurance is protected from being affected by patient's decision to "use law." Doctors and health care systems have choice about whether to participate. Non-English speakers are to have translators available. Pharmacists cannot be prosecuted for filling lethal prescriptions.

#### *11.7.2 Colorado*

**Proposition 106: End of Life Options Act [42], came from voters** Nov. 8, 2016 (65% in favor), became **Effective:** Jan. 2017.

Colorado Department of Public Health & Environment **Phone:** 303-692-2000; **Email:** cdphe.information@state.co.us

**Patient eligibility:** As with other states, candidates must be 18 or older, residents of the state, and able to make their own decisions and communicate them. They must have made requests voluntarily. A patient must have a terminal illness with a life expectancy of 6 months or less. **Physician requirements:** The doctor must diagnose a terminal illness with a life expectancy of 6 months or less, confirm the patient's capacity to make and communicate medical decisions, and confirm residency. Diagnosis must be confirmed by a second consulting doctor, who is also expected to confirm competency. The doctor must refer the patient to a licensed mental health professional. The doctor must discuss diagnosis, prognosis, feasible alternatives, and risks of taking lethal medication, as well as possibility of choosing not to use it. The doctor should tell the patient to notify next of kin, and request that medication not be taken in a public place. **Patient request timeline:** First oral request to doctor, 15-day waiting period, second oral request to doctor along with written request. **Other:** Patient's insurance is protected from being affected by patient's decision to "use law." Doctors and health care systems have choice about whether to participate.

#### *11.7.3 District of Columbia*

**DC ACT 21-577** *Death with Dignity Act of 2016* [43], **Signed into Law** Dec. 19, 2016, **Effective Date:** Feb. 18, 2017.

DC Department of Health **Phone:** 202-442-5955 **Email:** doh@dc.gov

**Patient eligibility:** As with other states, candidates must be 18 or older, residents of the District, and able to make their own decisions and communicate them. A patient must have a terminal illness with a life expectancy of 6 months or less. **Physician requirements:** The doctor must diagnose a terminal illness with a life expectancy of 6 months or less. This must be confirmed by a second consulting doctor, who is also expected to certify that the patient can make and communicate health care decisions. If either doctor questions the patient's ability to make judgments, the patient must be referred for a psychological examination. The attending doctor must inform the patient of alternatives, including palliative care, hospice, and pain management options. **patient request Timeline:** First oral request to doctor, 15 day waiting period, second oral request to doctor along with written request before second request, then 48-hour waiting period before drugs dispensed. **Other:** Patient's insurance is protected from being affected by patient's decision to "use law."

#### *11.7.4 Hawaii*

HB 2739, Hawai'i Our Care, Our Choice Act [44] **signed into Law** Apr. 5, 2018, **effective Date** January 1, 2019.

Hawaii Department of Health **Phone:** 808-586-4400, **Email:** webmail@doh. hawaii.gov

Highlights of the law (use Hyperlink to see entire law):

**Patient eligibility:** As with other states, candidates must be 18 or older, residents of the state, and able to make their own decisions and communicate them. A patient must have a terminal illness with a life expectancy of 6 months or less. **Physician requirements:** The doctor must diagnose a terminal illness with a life expectancy of 6 months or less. This must be confirmed by a second consulting doctor, who is also expected to certify that the patient can make and communicate health care decisions. A counselor must confirm that the patient is capable and not suffering from depression or impaired decision-making ability. The attending doctor must inform the patient of alternatives, including palliative care, hospice, and pain management options. **Patient request timeline:** First oral request to doctor, 20-day waiting period, second oral request to doctor along with witnessed written request before second request; 48 h to prescription. **Other:** The patient can withdraw request at any time and is not required to fill the prescription. Patient's insurance is protected from being affected by patient's decision to "use law."

#### *11.7.5 Maine*

HP 948, An Act to Enact the Maine Death with Dignity Act [45] **signed into Law** June 12, 2019, **effective Date** September 19, 2019.

**Note**: Maine's law indicates that it does not legalize "assisted suicide," but states that the act must be referred to as "obtaining and administering life-ending medication" in state reports. Note that this does not alter the action for which the physician is protected.

Maine Department of Health and Human Services **Phone:** 207-287-3707.

#### *Leaving Early: The Reality of Assisted Suicide and Euthanasia in 2022 DOI: http://dx.doi.org/10.5772/intechopen.105989*

**Patient eligibility:** As with other states, candidates must be 18 or older, residents of the state, and able to make their own decisions and communicate them. A patient must have a terminal illness with a life expectancy of 6 months or less but must still be physically and mentally capable of self-administering the prescribed lethal medication without assistance. **Physician requirements:** The doctor must diagnose a terminal illness with a life expectancy of 6 months or less and judge the patient mentally capable of making an informed, voluntary decision. This must be confirmed by a second consulting doctor, who is also expected to certify that the patient can make and communicate health care decisions and is acting voluntarily. If either doctor questions the patient's ability to make judgments, the patient must be referred for a psychological examination. The attending doctor must discuss diagnosis and prognosis, and inform the patient of alternatives, including palliative care, hospice, and pain management options, as well as risks of taking lethal medication and possibility of not taking it. Patient is to be requested to notify next of kin, and not take medication in a public place. **Patient request timeline:** First oral request to doctor, 15-day waiting period, second oral request to doctor along with written request signed at least 15 days after first request; 48 h to prescription. **Other:** The patient may withdraw the request at any time and is not required to fill the prescription. Patient's insurance is protected from being affected by patient's decision to "use law." No will, contract, or other agreement can interfere with patient's use of law.

#### *11.7.6 Montana*

#### **Montana First Judicial District Court:** *Baxter v. Montana* [46]

**Court ruling date:** Dec. 5, 2008, in favor of plaintiffs.

Plaintiffs (four physicians and a dying patient) asked court to establish constitutional right "to receive and provide aid in dying." Judge ruled that a terminally ill, competent patient has a legal right to die with dignity under Article II, Sections 4 and 10 of the Montana Constitution, including a right to "use the assistance of his physician to obtain a prescription for a lethal dose of medication that the patient may take on his own if and when he decides to terminate his life." Judge further held that this right "includes protection of that patient's physician from liability under the State's homicide statutes."

#### State Supreme Court: **Baxter v. Montana**

Decided: Dec. 31, 2009, in favor of plaintiffs 5-4.

The Attorney General of Montana appealed the ruling above to the Montana Supreme Court, which said, "we find no indication in Montana law that physician aid in dying provided to terminally ill, mentally competent adult patients is against public policy." Therefore, the physician who assists is shielded from criminal liability *by the patient's consent*.

#### **No legal protocol is in place.**

Despite multiple legislative attempts since 2009, neither laws nor regulations dealing with assisted suicide have been put in place in Montana.

#### *11.7.7 New Jersey*
