2015 ORS 127.897¹
Form of the request

§6.01. Form of the request. A request for a medication as authorized by ORS 127.800 (Definitions) to 127.897 (Form of the request) shall be in substantially the following form:

______________________________________________________________________________

I, ______________________, am an adult of sound mind.

I am suffering from_________, which my attending physician has determined is a terminal disease and which has been medically confirmed by a consulting physician.

I have been fully informed of my diagnosis, prognosis, the nature of medication to be prescribed and potential associated risks, the expected result, and the feasible alternatives, including comfort care, hospice care and pain control.

I request that my attending physician prescribe medication that will end my life in a humane and dignified manner.

INITIAL ONE:

______I have informed my family of my decision and taken their opinions into consideration.

______I have decided not to inform my family of my decision.

______I have no family to inform of my decision.

I understand that I have the right to rescind this request at any time.

I understand the full import of this request and I expect to die when I take the medication to be prescribed. I further understand that although most deaths occur within three hours, my death may take longer and my physician has counseled me about this possibility.

I make this request voluntarily and without reservation, and I accept full moral responsibility for my actions.

Signed: _______________

Dated: _______________

We declare that the person signing this request:

(a) Is personally known to us or has provided proof of identity;

(b) Signed this request in our presence;

(c) Appears to be of sound mind and not under duress, fraud or undue influence;

(d) Is not a patient for whom either of us is attending physician.

______________Witness 1/Date

______________Witness 2/Date

NOTE: One witness shall not be a relative (by blood, marriage or adoption) of the person signing this request, shall not be entitled to any portion of the person’s estate upon death and shall not own, operate or be employed at a health care facility where the person is a patient or resident. If the patient is an inpatient at a health care facility, one of the witnesses shall be an individual designated by the facility.

______________________________________________________________________________ [1995 c.3 §6.01; 1999 c.423 §11]

Notes of Decisions

Series violates Equal Protec­tion Clause under federal Constitu­tion because defined class is overinclusive and therefore not ra­tionally related to state purpose. Lee v. State of Oregon, 891 F. Supp. 1429 (D. Or. 1995)

United States Attorney General's rule punishing physicians who issue prescrip­tions under Oregon Death with Dignity Act was invalid intrusion on right of state to determine legitimate medical practices. Oregon v. Ashcroft, 368 F3d 1118 (9th Cir. 2004)

Law Review Cita­tions

74 OLR 449 (1995); 31 WLR 601 (1995); 77 OLR 1027 (1998); 37 WLR 691 (2001); 81 OLR 505 (2002); 41 WLR 863 (2005); 43 WLR 399 (2007); 45 WLR 91, 137 (2008); 91 OLR 457 (2012)


1 Legislative Counsel Committee, CHAPTER 127—Powers of Attorney; Advance Directives for Health Care;, https://­www.­oregonlegislature.­gov/­bills_laws/­ors/­ors127.­html (2015) (last ac­cessed Jul. 16, 2016).
 
2 Legislative Counsel Committee, Annotations to the Oregon Revised Stat­utes, Cumulative Supplement - 2015, Chapter 127, https://­www.­oregonlegislature.­gov/­bills_laws/­ors/­ano127.­html (2015) (last ac­cessed Jul. 16, 2016).
 
3 OregonLaws.org assembles these lists by analyzing references between Sections. Each listed item refers back to the current Section in its own text. The result reveals relationships in the code that may not have otherwise been apparent.