Frequently Asked Questions
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Q: Qualified Provider: Who is a Qualified Healthcare Provider?
A: A qualified healthcare provider is defined as:
- a physician licensed pursuant to the Medical Practice Act;
- an osteopathic physician licensed pursuant to the Osteopathic Medicine Act;
- a nurse licensed in advanced practice pursuant to the Nursing Practice Act; or
- a physician assistant licensed pursuant to the Physician Assistant Act or the Osteopathic Medicine Act.
Q: In addition to doctors, I understand physician assistants and nurse practitioners can also perform aid in dying. Can they determine if the person qualifies or is that up to a doctor?
A: All of those qualified providers in the above answer can prescribe the medication. But every MAID patient must have a MD or DO
1) confirm the terminal illness (except: Individuals enrolled in hospice are considered terminal based on the standard of care and do not require a second confirmation if the prescribing provider is a physician);
2) assess the patient’s mental capability to make end-of-life care decisions; and
3) assess their ability to self-administer aid-in-dying medication before a prescription can be written.
EOLONM worked with our national partner Compassion & Choices to produce this downloadable PDF fact sheet on our law
Q: Provider Support: What Can I Do to Make Sure My Provider Will Support Me if I Ever Want to Access Medical Aid in Dying?
A: Ask your healthcare providers now whether they will support your end-of-life options, including medical aid in dying. This will encourage your providers to listen to your priorities and become prepared to provide you with the treatment you may want in the future. If your providers are unable or unwilling to support your end-of-life choices, you have the option to change your care to a healthcare team that puts your wishes first.
Q: Provider Training: My Healthcare Providers Want to Better Understand Medical Aid in Dying; Where Can They Learn More?
A: Clinicians can write to firstname.lastname@example.org to inquire about upcoming trainings or 1:1 support here in New Mexico. They may reach out and join the list serve ACAMAID.org of the American Clinicians Academy on Medical Aid in Dying, or check our website for upcoming training at: endoflifeoptionsnm.org.
Finally, they may call Compassion & Choices’ Doc2Doc consultation line at 800.247.7421 for a free, confidential consultation and information on end-of-life care with our medical directors who have extensive medical aid-in-dying experience.
Q: Can a person with an Alzheimer/Dementia diagnosis access medical aid in dying?
A: With regard to whether an Alzheimer or dementia patient is eligible for medical aid in dying, one of the qualifications of the law is that the prescribing health care provider must determine that the individual has capacity and can make and communicate informed health care decisions. This determination is made by the individual’s NM licensed prescribing health care provider and according to professional standards of care and provisions of Section 24-7A-11 NMSA 1978. If an individual is deemed to not have capacity, there are other end of life options to consider such as palliative care, hospice, not starting or stopping treatment, VSED (voluntary stopping eating and drinking) and palliative sedation to name a few.
Click to read about these and other end of life options.
Or to gain a better understanding of how to help an individual prepare and plan for the end of life upon receiving a diagnosis of Alzheimer or Dementia, please click here.
A: No. A mental health referral is only necessary if the prescriber or consulting provider has a question or concern about the individual’s capacity. The Act states that a healthcare provider must determine that the person is terminally ill, can self-administer the medication, and is mentally capable of making an informed decision. If there is any doubt about capacity, the provider must refer the patient for an evaluation to a licensed mental health professional (see FAQ for who is capable of making a mental health assessment). Furthermore, “determination of capacity shall be made only according to professional standards of care and the provisions of The NM Uniform Health-Care Decisions Act (Section 24-7A-11 NMSA 1978)” which presumes an individual has capacity to make their own healthcare decisions.
Q: Mental Health Assessment: Who is capable of completing the mental health assessment? (does it have to be a psychiatrist or can it be a mental health provider who is independently licensed?)
A: If deemed necessary by their prescribing provider, the law provides that a state-licensed psychiatrist, psychologist, master social worker, psychiatric nurse practitioner or professional clinical mental health counselor can complete a mental health assessment.
Q: Do prescribers need to see and assess a patient in person? Or does tele-health work?A: Telehealth can be utilized in accordance with accepted medical standards of care. The NM MAID law has no requirement that the prescriber must see the patient in person, although it is recommended if at all possible. The decision is left to the discretion of the provider.
As long as the patient is enrolled in a Medicare certified hospice program and the prescribing physician makes the various findings required by statute, and that provider has also “provided medical care to the patient in accordance with accepted medical standards of care,” there is no requirement that the prescriber do a physical exam of the patient or see the patient in person. If the patient is not enrolled in hospice, at least one of the two physicians must “conduct an appropriate examination,” but even then it does not have to be in person, that decision is left to the discretion of the provider.
Q: What Cause of Death Should be Listed on the Death Certificates of Individuals Who Have Accessed Medical Aid in Dying?
A: The law specifies that a death resulting from self-administering aid-in-dying medication is not suicide. The underlying illness should be listed as the cause of death.
Q: If a patient is not on hospice and a medical provider does not attend the death, how is the death reported?
A: In these cases where the prescribing clinician is not present at the death and a healthcare provider (physician, nurse practitioner, hospice doc, hospice nurse, etc.) is not present to pronounce the time of death, the family/friends/surrogate of the person utilizing MAID should
- notify the prescribing clinician of the death; and
- contact EMS or mortuary/funeral home to pick up the body.
The individual MAID patient can arrange for this themselves prior to death.
In these cases specifically, it is strongly recommended that the individual requesting MAID, or their family/friends/surrogate retain a signed copy of the Request to End My Life Peacefully Form in their home and make it available to substantiate the death. It is likely that the NM Office of the Medical Investigator will investigate the death if it is unattended and having this completed form which includes the signature of witnesses and the optional attestation of the prescribing clinician can be used to validate that the individual utilized medical aid in dying.
Q: What If The MAID Death Is Unattended But The Individual Utilizing MAID Is On Hospice?
A: Families should call hospice and the mortuary to notify them of the death. Hospice will pronounce their patient’s death and provide appropriate medical certification of cause of death to the funeral service practitioner at the mortuary. Hospice will also offer a nursing visit for support after a loved one dies. Finally, hospice offer ongoing bereavement support of many types, free of charge.
Mortuaries commonly come within 30 to 90 minutes to collect remains, and will need basic information (name, address, birth date, weight, height, stairs into the home, name of hospice).
Q: Where do healthcare providers pick up the end-of-life medications – how does that process work?
A: The prescription must be sent directly to a compounding pharmacist by the qualified clinician, not by the patient, family or friend. The pharmacy may need time to order the medication.
Some pharmacies will prepare the medication before it is picked up if the qualified clinicians adds this instruction to the prescription. Once the prescription is written, the patient may choose to keep it on file at the pharmacy if and until they choose to take the medication. They need not pay for the medication until the prescription is filled. The medication can be picked up by the patient, prescribing clinician, family/friends or it can be overnighted by mail.
If the terminally ill person decides to pick up the medication themselves, they will need to designate a person responsible for its safe disposal, if they end up not taking it.
What is the cost of the Aid in Dying Medication?
A: In most cases, the patient will be responsible for the cost of the medication, which are likely to cost around $700.
Q: How does the New Mexico law differ from other states who have passed medical aid in dying?
A: Nine states (OR, WA, MT, VT, CA, CO, HI, NJ, ME) and the District of Columbia have authorized medical aid in dying. Since the first Oregon law was passed by ballot initiative in 1994 and actually went into effect in the fall of 1997, we’ve learned a lot. Oregon’s experience and that of the other authorized states, now constitutes more than 40 years of combined experience covering more than 22% of the U.S. population. In writing the 2021 Elizabeth Whitefield End-of-Life Options Act, bill drafters applied those lessons learned to the bill’s provisions.
Here are four major differences in our New Mexico law:
Shorter waiting period – Other states that have authorized medical aid in dying have extended waiting periods that can require multiple visits to providers and generally takes at least 2-3 weeks or more to become qualified for the medications. This has created barriers for people who urgently need to access the law. Several states have or are looking to amend their law with emergency exceptions or to reduce these wait times. Our law reduces that barrier from the start. The Elizabeth Whitefield End of Life Options Act has only a 48-hour waiting period before the aid in dying prescription can be filled for qualified individuals, and even that wait period can be waived if deemed urgent.
Mid-level healthcare providers – The Act permits not only physicians but also recognizes Advance Practice Nurses and Physician Assistants as providers authorized to prescribe aid in dying medication.
Because 32 of New Mexico’s 33 counties are designated “primary care health professional shortage areas” this is an important provision for expanding access to the state’s population, especially for those living in rural areas where a choice in healthcare providers may not be an option.
Hospice Eligibility – Under the New Mexico law, an eligible individual needs two health care providers to confirm a terminal prognosis of six months or less to live as a requirement for qualification. However, the NM Act does not require confirmation from a (second) consulting clinician if the prescribing clinician affirms that the individual is enrolled in a Medicare certified hospice program. Hospice enrollment requires a terminal prognosis of 6 months or less to live. Since approximately 90% or more of those who utilize these laws in other states are in hospice at the time they request medical aid in dying, we think this change will really help reduce some barriers.
Minimizing paperwork – The NM Act has minimized the required paperwork for all parties. There are some basic reporting requirements included but not the onerous provisions included in some other state’s laws.
How did the 2021 NM Senate Floor amendments affect the Elizabeth Whitefield End-of-Life Options Act?
A: The Elizabeth Whitefield End-of-Life Options Act was amended a few times during the 2021 legislative session. None of the Senate floor amendments actually changed the way that the law will work.
- NAME of ACT – One amendment changed the name of the law from the “Elizabeth Whitefield End-of-Life Options Act” to the “Elizabeth Whitefield End-of-Life Options Act or the End-of-Life Options Act.” The rest of the adopted amendments were part of a package designed to streamline the law by making it shorter and simpler, usually because they are already part of New Mexico law.
- DEATH CERTIFICATE – The provision declaring that the cause of death in the case of someone who has taken a lethal dose under the law shall be the underlying terminal illness is simply not necessary; the law already provides that choosing to make use of this law is not suicide, and no state with a similar law has faced any problem in listing the underlying illness as the cause of death for purposes of the death certificate.
Similarly, a couple of insurance and contract provisions that were removed are simply not required.
- INSURANCE PROVISION – While the Senate removed a provision that outlaws contract, will or insurance provisions that might affect a person’s decisions regarding medical aid in dying, there simply are no such provisions that are generally used – or that have ever been used – in New Mexico, or anywhere else.
- ABUSE/NEGLECT PROVISIONS – The sponsors decided that the part of the law that says that requesting aid in dying, or providing it, is not evidence of neglect or elder abuse, was also a solution in search of a problem. No one has ever made such a claim. There is no reason to complicate New Mexico law by addressing problems that do not exist.
- CONSCIENCE CLAUSE – Finally, the part of the law that protected the conscientious decisions of providers to engage in aid in dying – or to refuse to do so – originally included a section that if an institution punished a provider for violating institutional policy, that would not be considered a punishment based on “quality of care,” and thus would not be reported to the National Practitioner Data Bank. By the time the law made it to the Senate floor, though, with the fully intact conscience clause offering protection to those who choose to offer aid in dying as well as to those who refuse to do so, it was clear this provision was not necessary.
- CIVIL LIABILITY –
Q: An amendment to the Elizabeth Whitefield End of Life Options Act removed civil liability from the list of forms of liability which providers were immune. Does that mean providers who participate in medical aid in dying are opening themselves to civil liability?
A: The amendment on Civil Liability has no bearing at all on a provider who chooses either to participate or not to participate in medical aid in dying. As with any other medical practice or procedure, if there is negligence in the case of medical aid in dying, then the same four elements of civil liability would have to be proven: (1) that the provider-patient relationship be established, (2) that the provider take some act that no reasonable provider would ever take, (3) that the patient be injured, and (4) that the injury be actually caused by the act in question. Unless all four of these elements are proven, the provider has no civil liability.
In the end, the amendments added on the Senate floor made the law simpler, shorter and stronger.