| 1. Carefully evaluate all patients making requests for an assisted death of any kind. Explore their fears, concerns, and what makes their current (or future) situation so unacceptable. Comprehensive palliative care and/or hospice care, where available, should always be offered. Ideally, no end of life options, be they legal or illegal, should be acted upon because of lack of adequate management of pain and other symptoms. |
| 2. Have the patient clarify exactly what he/she is requesting and why. Make sure you understand if he/she is asking about hypothetical future assistance or assistance right now[1]. Regard immediate, intractable suffering as a medical/palliative care emergency. |
| 3. Recognize that pain and suffering do not always coincide. Treating one does not necessarily relieve the other. Explore, understand, and address the root causes of suffering as much as possible. |
| 4. Clinicians should know and respect their own limitations and boundaries, but also do their best to respond to the patient's questions and situation[2]. Articulate what you can do as well as what you cannot do to help. Do not mislead the patient into thinking you will help in ways that you know you cannot. |
| 5. Be aware of the legal options and limits in terms of end of life alternatives in your area[3,4]. Because something is legal in this domain does not mean that you are obligated to provide it. If you cannot provide options that are legal or your patient prefers an option that is illegal, be clear about what your own approach is and what you can do to respond to the patient's situation. |
| 6. If there are legal options for which the patient qualifies that you cannot provide for personal moral reasons, it is generally agreed that you are morally (though not legally) obligated to let the patient know such options are available, how to access them, and to whom the patient can transfer. |
| 7. If you are planning to prescribe a potentially lethal medication under the Death with Dignity Act, be sure you are aware of doses, prices, and availability. |
| 8. Remember that under many death with dignity statutes, "coercion or undue influence" is a felony, so make sure that it is the informed patient's values, preferences, and circumstances that are driving the process. |
| 9. Make sure the patient understands that they can withdraw their request for a medically assisted death at any time or for any reason, and that exploring the request with you does not obligate them to act on their request. Also, make sure that, if you have committed yourself to help, your commitment is sincere. |
