米国ワシントン州法律に基づく：包括的がんセンター・安楽死プログラム

death with dignityとは、尊厳死、この場合は、より積極的な安楽死のはずだが、そういう法律名なのでしかたがないのか、medpage解説でも、原著でも、この２つが混在している。混乱のもとになるかも・・・

http://www.medpagetoday.com/PublicHealthPolicy/Ethics/38384

Implementing a Death with Dignity Program at a Comprehensive Cancer Center
Elizabeth Trice Loggers, et. al.
N Engl J Med 2013; 368:1417-1424 ;April 11, 2013


Seattle Cancer Care Allianceでのプログラムについて質問した１１４名の患者で、４０名がスクリーニング検査を受け、secobarbitl処方を受けたが、実際に使用したのは２４名
処方を受けた後、その処方で薬剤を取得したかどうかに関わらず、患者、家族は謝意を示している。

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Essential Elements and Safeguardsは参考になるだろう

Essential Elements and Safeguards of the Washington State Death with Dignity Law

The patinet must make both an initial oral and written reques
After the inital oral request, the patient must wait 15 days to make a second oral reques
Before prescribing the lethal medication, the prescribing physician must:

make an inital determination of the terminal nature of the disease

Determine the patien's competency and the voluntary nature of the request, with referral to a state-licensed phychiatrist or psychologist, if necessary , to ensure competency and the absence of a mental health disorder causing impaired judgment

Confirm Washington State residency (defined as possession of a Washington State driver's license, registration to vote, or of lease or ownership of property in Washington State)

Assess informed consent on the basisi of the patient's awareness of the medical diagnosis, the prognosis, the risks of the medication, the result of the medication (death), and the alternatives (palliative care, hospice, and pain control)

Recommend that the patient notify next of kin, have someone present at ingestion, and not take the medication in a public place

The consulting physician confirms the diagnosis, the patient's competency, and the voluntary nature of the request
At the time of prescribing, the prescribing physician must:
Offer the patient an opportunity to rescind the request
Verify that the patient is making an informed decision at the time of prescription
Delicer the prescription directly to the pharmacist