STATE . DEPARTMENT OF - OPERATING PROCEDURE 8 AFFAIR 400.600 - WSVH TITLE: DEATH WITH DIGNITY EFFECTIVE February 1, 2017 DATE: AUTHORITY: General authority of the Washington State Department of Veterans Affairs (WDVA) Deputy Director, as delegated by WDVA Policy 100.100 to manage and direct the activities of Washington State Veterans Homes (WSVH). PURPOSE: To provide information on the agency?s response to a resident APPLICABILITY: DEFINITIONS: PROCEDURE: who chooses to exercise his or her right under the Washington Death with Dignity Act (ROW 70.245). Residents and staff within a WSVH. Quali?ed adult: a competent adult who is a Washington resident with a terminal illness who has less than 6 months to live. 1. It is the policy of the WDVA to allow residents the freedom to exercise their rights under the Washington Death with Dignity Act. This act allows terminally ill qualified adults seeking to end their life to request lethal doses of medication from a physician. WDVA staff shall refer to this act as ?obtaining and self? administering life ending medication?, and not refer to this as ?suicide or assisted suicide?. WDVA supports 8. respects this very private end of life decision between a resident and their physician. 2. Staff shall not: A. Serve as a witness to any written request by a resident for medication that the resident may self? administer to end his or her life under the Act. B. Attend or othenNise be present during and after the ingestion of a lethal dose of medication, except in the delivery of comfort care services outlined in the Page 2 .. . .W.SVH.. 0?3 resident?s care plan. C. Take possession of the medication for storage'or delivery. 7 . If a staff member becomes aware of a resident?s intent to exercise his/her rights under the Act, the staff person shall notify his/her supervisor who shall notify the facility DNS or Superintendent . The DNS and/or Superintendent will assure the resident?s physician is contacted and request that the physician meet with the resident to review state guidelines for the Act. if the physician is already aware and the resident has completed the required paperwork, the DNS will review for compliance with state guidelines and attend the initial care conference. . If a staff member is asked for any information about the Death with Dignity Act, the staff member shall refer the resident to his or her social worker. The social worker will notify the DNS or SUperintendent of the resident?s request. . Social work staff may provide a resident with copiesof state requirements for-the Death with Dignity Act and/or offer. to refer to Compassion Choices of Washington. A. If a member of the social work department is uncomfortable with this, they shall engage another' member of the social work department or other member of the resident?s care team to provide. the information and referral. B. The request for information and referral shall be . documented in the resident?s health record. . The law requires that the resident make an initial oral request, then wait 15 days before a 2nd oral request. The physician must then wait 48 hours after the resident signs the written request before writing the prescription. If a resident is making a written request for medication under the Death with Dignity Act, the Act requires thatthey must have at least two witnesses who, in the presence of the resident, must attest that the resident is competent, acting voluntarily and is not being coerced. A. For resident?s residing in a WSVH at the time the Page 3 request is made, one of the witnesses must be designated by the same WSVH. . The resident care team shall meet and designate as a witness an individual who is personally known to the resident or has provided proof of identity. Witnesses can be, but are not limited to a social worker or chaplain, as long as they are not employees of WDVA. . Under no circumstances shall the facility designate a relative of the resident by blood, marriage, or adoption, or any individual who under any will or by operation of law would be entitled to inherit any portion of the resident?s estate. . Under no circumstances shall any employee or agent of the facility serve as .a witness to any written request by a resident for medication thatthe resident may self- administer to end his or her own life under the Act. 8. Once the written request is signed by the resident, and 2 physicians have affirmed that the resident meets the qualifications under 70.245, the facility shall conduct an immediate care plan review with the resident and the resident?s designated representative or family member to discuss the following: A. Options to involve a hospice agency, Compassion Choices of Washington orthe local Ombudsman. . Limitations of the facility?s involvement in all aspects of the Act. ReqUirement that the lethal dose of medication, once obtained, must be secured in a locked drawer in the resident?s room at all times. The lethal dose of medication shall only be accessible to the resident, his or her designated representative or- family member or attending physician, who is not an employee of the facility. - Update of the resident?s CPR status and POLST form to reflect the Death with Dignity request. Where dying process will occur (will the resident wish to discharge to home, etc.) Page Who the resident has designated to be present when the ingestion of the medication occurs and how that notification process will be accomplished. G. The facility request (not required) that the resident notify nursing staff of immediate or impending self- administration of the lethal dose of medication or immediately after ingesting such medication to assure that staff are able to carry out the resident's wishes. H. Facility staff will not be allowed under any circumstances to be designated or othenNise present, except for the delivery of comfort care services as outlined in the care plan. 9. The residents care plan will be updated by the care team to reflect the following; A. Resident?s desire to exercisethe right to utilize the Act. The name and contact information of the individual designated by the resident to be present during the dying process. C. Resident? 3 preferred comfort measures during the dying process (warm blanket music or other comfort measures). 10.A member of the care team will request and add to the resident's file a copy of the following documents: A. The resident?s signed request for medications to end his or her own life if such request is made while resident is in the facility. B. The consulting physician's written confirmation that the resident is suffering from a terminal conditiOn and that the resident meets Washington Death with Dignity Act criteria. 11.A member of the care team will ensure that the lethal dose of medication, once obtained, is secured in a locked drawer in the resident?s room. The lethal dose of medication shall only be accessible to the resident, his or her designated . representative or family member or attending physician, who REVIEW: REFERENCES: SUPERSESSION ATTACHMENTS: Page 5 WSVH OP 400.600 is not an employee of the facility. Staff shall not take possession of the medication for storage or delivery and the lethal dose of medication may not be filled by the WSVH Pharmacy. 12. If at any time following the ingestion of the lethal dose of medication, medical treatment is requested by the resident, the facility will call 911 on behalf of the resident or his or her representative or family member. 13. Under no circumstances will staff be allowed or required to attend or otherwise be present during and after the ingestion of a lethal dose of medication, except for the delivery of comfort care services as outlined in the care plan. 14.Any staff member who wishes to be re-assigned from a resident's care team because of the resident?s decision to follow the Death with Dignity Act, shall make that request to his or her supervisor and will be assigned to a different resident. 15.Any staff member who is also the Power of Attorney for a resident wishing to exercise their rights under the Death with Dignity Act shall be re-assigned from the resident?s care team. This procedure will be reviewed annually and updated as needed. Chapter 70.245 RCW, WAC 388-597-0180 and 0240, 42CFR 48310, and 380FR 51.70. WDVA Policy 400.600 dated May 20, 2014. None. zo/ Gary Condra, Deputy Director Date