The Eugene Oregon Request for Medication to End Life — Statutory form is a legal document used by individuals in the state of Oregon who are seeking to exercise their right to obtain medication for the purpose of ending their own life in a humane and dignified manner. The use of this form is governed by the Oregon Death with Dignity Act, which allows terminally ill adults with a prognosis of six months or less to request a prescription for medication to self-administer and bring about a peaceful death. This request form is an essential component of the end-of-life decision-making process and is designed to ensure compliance with the specific requirements set forth by the state law. It must be completed and signed by the patient, who must be mentally competent and capable of making informed decisions about their medical treatment. The Eugene Oregon Request for Medication to End Life — Statutory form includes several important sections that must be carefully filled out. These sections often include: 1. Personal Information: The form typically begins with a section for the patient to provide their full legal name, date of birth, and contact details. 2. Diagnosis and Prognosis: This section requires the patient's attending physician to provide a detailed account of the patient's medical condition, confirming that they have a terminal illness and that their life expectancy is within the prescribed six-month timeframe. 3. Competency: A statement affirming that the patient is mentally competent, not under any kind of undue influence, and fully understands the consequences of their decision. 4. Request for Medication: The patient is required to make a clear and explicit request for medication to end their lives and indicate that this request is voluntary. 5. Witness Statements: The form typically requires two witnesses who are not related to the patient by blood or marriage, nor eligible to inherit any portion of their estate, to attest that the patient is acting voluntarily and is of sound mind. It's important to note that while the Eugene Oregon Request for Medication to End Life — Statutory form is the most commonly utilized form in Oregon, different variations or revisions of the form may exist over time due to legal updates or changes in specific requirements. It is crucial for individuals considering this option to consult with an attorney or healthcare professional to ensure they are using the most up-to-date and legally compliant form for their specific circumstances.
Para su conveniencia, debajo del texto en español le brindamos la versión completa de este formulario en inglés. For your convenience, the complete English version of this form is attached below the Spanish version.