The Maine Death with Dignity Act provides a structured, legal process by which qualified patients may request and receive life-ending medication from their attending physician under specific circumstances.
It is essential that healthcare providers of all kinds know how to respond to patient inquiries with correct information about the Maine Death with Dignity Act and how a patient can access it.
The law states:
“A patient has a right to information regarding all treatment options reasonably available for the care of the patient, including, but not limited to, information in response to specific questions about the foreseeable risks and benefits of medication, without a physician’s withholding requested information regardless of the purpose of the questions or the nature of the information.”
This includes a patient asking for information about the Maine Death with Dignity Act. Patients have a right to make an informed decision. The law defines “informed decision” thus:
“Informed decision” means a decision by a qualified patient to request and obtain a prescription for medication that the qualified patient may self-administer to end the qualified patient’s life in a humane and dignified manner that is based on an appreciation of the relevant facts and that is made after being fully informed by the attending physician of:
(1) The qualified patient’s medical diagnosis;
(2) The qualified patient’s prognosis;
(3) The potential risks associated with taking the medication to be prescribed;
(4) The probable result of taking the medication to be prescribed; and
(5) The feasible alternatives to taking the medication to be prescribed, including palliative care and comfort care, hospice care, pain control and disease-directed treatment options.
The law goes on to define what it means to participate in the Act, and what kinds of activities are specifically NOT participating in the Act:
“Participating, or entering into an agreement to participate, in activities under this Act” means doing or entering into an agreement to do any one or more of the following:
(a) Performing the duties of an attending physician as specified in this Act;
(b) Performing the duties of a consulting physician as specified in this Act;
(c) Performing the duties of a state-licensed psychiatrist, state-licensed psychologist, state-licensed clinical social worker or state-licensed clinical professional counselor, in the circumstance that a referral to one is made pursuant to subsection 8;
(d) Delivering the prescription for, dispensing or delivering the dispensed medication pursuant to this Act; or
(e) Being present when the qualified patient takes the medication prescribed pursuant to this Act.
“Participating, or entering into an agreement to participate, in activities under this Act” does not include doing, or entering into an agreement to do, any of the following: diagnosing whether a patient has a terminal disease, informing the patient of the medical prognosis or determining whether a patient has the capacity to make decisions; providing information to a patient about this Act; or providing a patient, upon the patient’s request, with a referral to another health care provider for the purposes of participating in the activities authorized by this Act.
The Maine Death with Dignity Act is a codified medical standard of care for end-of-life options and, as such, is available for patients who qualify. Physicians and other providers who withhold information or refuse to provide timely referral when asked by a patient inhibit the right of a patient to make a fully informed decision regarding their own end-of-life care.
In order to qualify, a patient must:
- Be an adult (18 yrs or older) resident of Maine.
- Be diagnosed with a terminal disease and have a six month prognosis, confirmed by attending and consulting physicians.
- Be of sound mind.
- Be making an informed decision (as defined in statute).
- Be capable of ingesting the medication on their own without assistance.
- Submit two verbal requests separated by a minimum of 15 days.
- Submit a witnessed, written request (which may be submitted with the second verbal request).
Forms and More Info
Physicians willing and able to support a patient’s decision under the Maine Death with Dignity Act have specific procedural requirements codified in the law. Physicians may have additional policy guidelines depending on their employer.
A physician check-sheet is available to help guide the process (click here).
All required physician forms may be found on the Maine Department of Health and Human Services website under forms for vital statistics (click here).
The Maine Death with Dignity Act is silent on death certificates, as are the laws in three other aid-in-dying states. Physicians are encouraged to identify the underlying disease as cause of death. Patient, family, and provider privacy is important, and public documents, such as a death certificate, should not disclose specific healthcare decisions made by a patient. Just as “declined further treatment” or “palliative sedation” is generally not identified as a cause of death, neither should medical aid-in-dying be identified as such.
NOTE: If the physician is not attending the ingestion and the patient is not on enrolled in hospice, physicians should advise patients and their families to notify them when death occurs in order to facilitate initiation of the death certificate to avoid confusion with funeral homes, who may or may not be familiar with medical aid-in-dying as an expected death.
Read the full text of the Maine Death with Dignity Act (click here).
Maine’s law on opiate prescribing, authorized exceptions to exceed 100mg limitation (click here), and waivers for electronic prescription submission.
Generally speaking, compounded formulas known as DDMA or DDMP, which contain morphine, are the most commonly used prescriptions under the Maine Death with Dignity Act.
If needed, a waiver request form for electronic prescribing may be submitted if the attending physician does not have access to electronic prescribing (click here). More information about this may be obtained by contacting the prescription monitoring program team via email at SAMHS.PMP[at]maine[dot]gov or by phone at 207.287.2595, option 2.
Emergency Rules for data reporting and collection were put in place by executive order of Governor Janet Mills on September 19, 2019, making the law completely accessible upon it’s effective date.
NOTE: 10-146 CMR Chapter 15, Death with Dignity Act Reporting Rule, has been adopted and is effective August 30, 2020. Access major substantive rules for the Maine Death with Dignity Act in the Rule Chapters for the Department of Health and Human Services under section 10 146 Office of Data, Research and Vital Statistics, Chapter 15 (or download here).
If you are a physician, pharmacist, other heath care provider, or funeral director and have additional questions about implementing the Maine Death with Dignity Act or about obtaining general training for your group, please contact us.
The Maine Death with Dignity Act does not require physicians or other providers to participate in supporting patients’ decisions to hasten their own death:
“Nothing in this Act requires a health care provider to provide medication to a qualified patient to end the qualified patient’s life. If a health care provider is unable or unwilling to carry out the qualified patient’s request under this Act, the health care provider shall transfer any relevant medical records for the patient to a new health care provider upon request by the patient.”
For physicians and providers who do not participate, the Maine Death with Dignity Act does require a physician to provide a referral to a physician who will support the patient’s decision to qualify, when the patient requests the referral. Referring a patient to another physician for the purpose of accessing the Maine Death with Dignity Act is not considered “participating in the Act.”
For more information on the legal definition for “participating” and “not participating” in the Maine Death with Dignity Act, refer to Section 20 of the statute.