Checklist for an Attending Physician
Under the newly enacted Medical Aid in Dying for the Terminally Ill Act, an attending physician – meaning one who has primary responsibility for the treatment and care of a qualified terminally ill patient and treatment of the patient’s illness, disease or condition - is required to “ensure that all appropriate steps are carried out...before writing a prescription for medication that a qualified terminally ill patient may choose to self-administer.”
NOTE: ALL SECTIONS APPEARING IN
PURPLE, REGARDING INTERACTIONS WITH PATIENTS THROUGH THE USE OF TELEMEDICINE, ARE EFFECTIVE FOR THE DURATION OF THE STATE OF EMERGENCY AND PUBLIC HEALTH EMERGENCY RELATED TO COVID-19, WHICH WAS INITIALLY DECLARED PURSUANT TO EXECUTIVE ORDER NO. 103 (MURPHY). IN ALL INSTANCES, TELEMEDICINE MAY ONLY BE UTILIZED IF IT IS CONDUCTED USING AN AUDIO-VISUAL, REAL-TIME, TWO WAY INTERACTIVE COMMUNICATION SYSTEM, AND ONLY IF PROCEEDING BY TELEMEDICINE IS OTHERWISE CONSISTENT WITH THE STANDARD OF CARE.
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THE PHYSICIAN’S DECISION WHETHER TO PARTICIPATE IN A PATIENT’S REQUEST FOR
MEDICAL AID IN DYING (“MAID”) IS VOLUNTARY.
If a physician is unable or unwilling to carry out a patient’s request for MAID, the patient may transfer care to a new health care professional or facility and request a copy of the patient’s relevant records be transferred to the new health care professional or health care facility.
Given the manifest need to act quickly in these circumstances, a physician who declines to participate in the care of a patient seeking MAID should attempt to accommodate a request for transfer of relevant records as quickly as possible - ideally within three business days.
In order to assist attending physicians who elect to prescribe MAID, the Board has prepared a checklist, organized into twelve steps - beginning with a patient’s initial oral request
(Step 1) and ending with the required filing of a Cause of Death form with the Department of Health
(Step 12) For a full explanation of each of the steps and the definitions used in the checklist, click where prompted. The Additional Explanation of Steps includes links to forms available on the Department of Health's MAID website.
It is the Board’s hope that the checklist will be a useful tool to assist and enable licensees to ensure full compliance with all statutory requirements.
DAY 1
THE INITIAL ORAL REQUEST
As an attending physician, your responsibilities commence at the time that a patient makes an initial oral request for MAID which should be made directly to you, either in person, face-to-face, or through a telemedicine encounter, in conjunction with a review of the patient’s history available in medical records.
 Step 1: | | Document the first oral request in the patient chart. |
Step 2: | | Conduct an evaluation to determine whether a patient qualifies to be prescribed MAID. |
Part A: |
| Establish, and document in the patient chart, a qualifying diagnosis and prognosis.
(Click Here)
If you conclude that the patient does not have a qualifying diagnosis or prognosis, the patient is not eligible to be prescribed MAID, and you should not proceed to any of the steps below. |
Part B: | | Establish, and document in the patient chart, whether the patient is or “may not be” capable of making an informed decision to obtain MAID. (Click Here)
If you conclude that the patient “may not be” capable, then you must refer the patient to a qualified mental health professional
(psychiatrist, psychologist or licensed clinical social worker) for an independent evaluation of capacity
(See Step 5, Part B).
The independent mental health capacity evaluation may be conducted by a mental health professional in person, face-to-face, or through a telemedicine encounter.
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Part C: | | Establish, and document in the patient record, that the request is voluntary. (Click Here) |
Part D: | | Establish, and document in the patient record, that the patient has made an “informed decision” and has been apprised of relevant facts to make that decision. (Click Here) |
Step 3: | | Engage in discussions with the patient concerning additional requirements and document in the patient record that these discussions occurred. (Click Here) |
Step 4: | | Establish, and retain in the patient record, proof that the patient is an adult resident of New Jersey. (Click Here) |
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ON
OR AFTER DAY 1:
Generally, all of the referrals and discussions outlined in Steps 5-8 should occur as soon as
possible after the patient makes his or her initial request, but need not occur on Day 1.
Step 5: | | Facilitate the required referrals after the initial oral request is received. |
Part A: | | Make, and document in the patient record, the required referral to a consulting physician for confirmation that the patient is “qualified," that is, that the patient has a qualifying diagnosis and prognosis, is capable, acting voluntarily and has made an informed decision. (Click Here)
The independent consulting physician evaluation may be conducted in person, face-to-face, or through a telemedicine encounter.
A patient cannot be considered to be a qualified terminally ill patient or prescribed or dispensed MAID until the consulting physician corroborates in a written report the required determinations. |
Part B:
| | Make, and document in the patient record, a referral for an independent mental health capacity evaluation, if you determined that the patient “may not be” capable to make an informed decision (see Step 2, Part B). (Click Here) The independent mental health capacity evaluation may be conducted by a mental health professional in person, face-to-face, or through a telemedicine encounter.
In the event a patient is referred for a determination of capacity -regardless whether that referral is made by you or by the consulting physician - no prescription for MAID may be written unless and until the mental health professional concludes the evaluation, affirmatively determines that the patient is capable of making an informed decision, and notifies you in writing of that determination. |
Step 6: | | Obtain from the patient, and retain within the patient record, a written request by the patient for MAID, in addition to the mandatory two oral requests. (Click Here) The written request must be received a minimum of 48 hours prior to the time that you write a prescription for or dispense MAID. |
Step 7: | | Determine if the patient has participated in any consultations concerning concurrent or additional treatment opportunities and whether the patient is currently receiving palliative, comfort or hospice care or pain control treatments, and document that information in the patient record. |
Step 8: | | Ensure that the patient is advised of his or her obligations and the discussion of those obligations is documented in the patient record. (Click Here) |
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NO SOONER THAN DAY 16
A prescription for MAID can ordinarily be issued as early as the 16th day after the
initial oral request if all requirements in Steps 1-8 have been fully completed.
Step 9: | | Receive, and document in the patient record, a second oral request no sooner than 15 days after the initial oral request The second oral request should be made directly to you in person, face-to-face, or through a telemedicine encounter. (Click Here) |
Step 10: | | Write a prescription for, or dispense MAID. |
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AFTER THE DISPENSATION
OR THE WRITING OF THE PRESCRIPTION
Step 11: | | File a record of a MAID dispensation with the Department of Health, not later than 30 days after MAID was dispensed, if applicable.
(Click here to obtain the DoH required form.) |
Step 12: | | File a record of the patient’s death, with the Department of Health whether the medication was prescribed or dispensed, no later than 30 days after the patient’s death.
(Click here to obtain the DoH required form.)
NOTE: You should report the underlying cause of death, not that the death resulted from the ingestion of the medication, suicide, or assisted suicide. |
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