Skip Ribbon Commands
Skip to main content
Sign In
Skip to main content Open accessibility information page

Medical Aid in Dying for the Terminally Ill Act

Additional Explanation of Steps

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.


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.

(DoH form for use by a patient making such a request, click here.)

Step 2:

 
  

Conduct an evaluation to determine whether a patient qualifies to be prescribed MAID.

You must conduct an evaluation to make a four-part determination whether the patient making a request for MAID is a “qualified terminally ill patient.”

        Part A:

 
  

Establish, and document in the patient chart, a qualifying diagnosis and prognosis.

To do so, you should (1) conduct a physical examination of the patient and (2) review the patient’s history in available medical records. The patient must be diagnosed to have an irreversibly fatal illness, disease or condition, and must be found to be in the terminal stage thereof meaning that, with reasonable medical certainty, the patient has a life expectancy of six months or less.

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.

(DoH form for use by Attending Physician, click here.)

        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.
“Capable” is defined as “having the capacity to make health care decisions and to communicate them to a health care provider.” You should engage the patient in conversation sufficient to allow you to determine that the patient understands the decision that he or she is making. In some instances, it may be necessary to involve persons familiar with the patient’s manner of communicating, if those persons are needed in order to facilitate communication with the patient.

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 can be conducted by a mental health professional in person, face-to-face, or through a telemedicine encounter.

        Part C:

 
  Establish, and document in the patient record, that the request is voluntary.
In making a determination of “voluntariness,” you need to establish that the patient is acting on his or her own will, and that the patient is not being intimidated or coerced by any other person(s) to request MAID. You may consider asking the patient how he or she arrived at the decision to request MAID; whether the decision was made independently; whether the patient consulted other people before making the decision; and/or whether the patient had been intimidated or threatened by anyone to request MAID.

         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.

At a minimum, you must inform the patient of:

  • His or her medical diagnosis and prognosis;

  • The potential risks with taking the medication to be prescribed, including, the risks that could occur if the medication were to be ingested but not cause death, to include, for example, the possibility of further disability resulting from brain anoxia;

  • The probable result of taking the medication; and

  • The feasible alternatives to taking the medication including, but not limited to, concurrent or additional treatment opportunities, palliative care, comfort care, hospice care, and pain control.

Step 3:

 
  Engage in discussions with the patient concerning additional requirements and document in the patient record that these discussions occurred.

You are required, at the time of the initial oral request, to:

  • Recommend that the patient participate in a consultation concerning concurrent or additional treatment opportunities, palliative care, comfort care, hospice and pain control options.

  • Provide the patient with a referral to a health care professional qualified to discuss these options with the patient.

  • Inform the patient that he or she has the opportunity to rescind the request at any time and in any manner.

Step 4:

 
  Establish, and retain in the patient record, proof that the patient is an adult resident of New Jersey.
The proof can take the form of: a driver’s license or non-driver identification card issued by the NJMVC; proof of voter registration; a New Jersey resident gross income tax return filed for the most recent tax year; or any other government record that you reasonably believe demonstrates the individual’s current residency in this State.

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.  

You should facilitate the process by providing the consulting physician access to the patient’s relevant medical records and be readily available to discuss the patient’s relevant medical history, if the consulting physician requests additional information. Upon completion of the consulting physician’s evaluation, you must obtain a copy of a written report confirming that the patient is qualified, which should be retained in the patient chart.

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.

(DoH form for use by Mental Health Professional Physician, click here.)

        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).

The independent mental health capacity evaluation may be conducted by a mental health professional in person, face-to-face, or through a telemedicine encounter.

(DoH form for use by Consulting Physician, click here.)

In this event, the Board suggests that the referral to a consulting physician be delayed pending the conclusion of the independent capacity evaluation. The mental health professional’s written report must be retained in the patient record. If the consulting physician determines that the patient may not be capable to make a decision (i.e., in instances where you find the patient to be capable, and thus do not independently refer the patient for a capacity evaluation), the consulting physician must refer the patient for an independent capacity evaluation by a mental health professional. The consulting physician must advise you in writing of that referral. You must then secure a copy of the mental health professional’s written report and retain that report in the patient record.

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.

The written request should substantially be in the form specified in the statute, signed and dated by the patient, and witnessed by at least two individuals who, in the patient’s presence, attest that, to the best of their knowledge and belief, the patient is capable and is acting voluntarily to sign the request.

(DoH form for use by Patient, click here.)

As an attending physician, you may not serve as a witness to the written request.

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.

You must:

  • Advise the patient about the importance of having another person present if and when the patient chooses to self-administer prescribed MAID, and of not taking the medication in a public place.

  • Recommend that the patient notify the patient’s next of kin of the patient’s request for medication, although a patient who declines to do so, or is unable to do so, shall not have a request for MAID denied for that reason.

  • Urge the patient to designate a person who shall be responsible for the lawful disposition of the medication.

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.

At the time that the patient makes the second oral request, you must offer the patient an opportunity to rescind the request, and document that offer in the patient record.

Step 10:

 
 

Write a prescription for, or dispense MAID.

If MAID is prescribed, you must contact a pharmacist to inform the pharmacist of the prescription; and must transmit the written prescription personally, by mail, or by electronic communication to the pharmacist. You must include a note in the medical record indicating the specific medication prescribed or dispensed.

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.

NOTE: You should report the underlying cause of death, not that the death resulted from the ingestion of the medication, suicide, or assisted suicide.

(Click here to obtain the DoH required form.)


Last Modified: 8/28/2020 8:06 AM

Division

Department

State

Legal

RSS

Sign up for New Jersey Division of Consumer Affairs RSS feeds to get the latest information. You can select any category that you are interested in, and any time the website is updated you will receive a notification.

More information about RSS feeds.

Copyright © 2022 State of New Jersey.

OPRA Logo