Washington Adopts “Death With Dignity” Act Legalizing Assisted Suicide

Assisted suicide occurs when an individual, typically someone suffering from chronic intense pain or an incurable illness, intentionally kills himself with the help of another person. For instance, a doctor may prescribe drugs with the understanding that the patient plans to use them to fatally overdose. Or a doctor may insert an intravenous needle into the arm of a patient, who then triggers their own fatal injection. The United States has long outlawed assisted suicide, charging people who help others kill themselves with murder, manslaughter, and other offenses. For many years, right-to-die groups attempted to change the laws, but were unsuccessful until 1994 when Oregon voters approved the Death With Dignity Act allowing physician-assisted suicide. Although the act was blocked for three years by critics who challenged its constitutionality in the U.S. Supreme Court, it was finally enacted in 1997. Since then, Oregon has stood alone and under great pressure as the only state in the country to allow assisted suicide—but not any longer.

On March 5th, Washington state will enact Initiative 1000, which will allow terminally ill patients with less than 6 months to live to ask their doctors for a life-ending prescription. As with Oregon’s measure, Washington’s law will require any patient requesting fatal medication to be at least 18 years old, declared competent, and they must be a state resident. Two doctors must certify that the patient has a terminal condition and six months or less to live. The patient will have to make two oral requests, fifteen days apart, and submit a written request witnessed by two people, one of which cannot be a relative, heir, attending physician, or connected with the health facility where the patient is being treated or is a resident. Health care providers writing a prescription or dispensing medication must also file a copy of the record with the state Department of Health, which is required to create an annual report on how the law is used.

However, neither the Oregon nor Washington law requires physicians, hospitals, or pharmacists who have ethical objections with the law to write or fill lethal prescriptions. Some Washington hospitals are opting out, which precludes their doctors from participating on hospital property. Others won’t allow patients to take lethal drugs on their premises or their pharmacies to dispense them, but won’t try to stop its doctors from prescribing the drugs or from being present when a patient takes them. Compassion and Choices of Washington, the state’s largest aid-in-dying advocacy group, is compiling a directory of physicians who aren’t opting out of the law, as well as pharmacies willing to fill the prescriptions. “Physicians don’t understand yet exactly how the law works,” said executive director Robb Miller. “Whenever there’s lack of understanding, there tends to be some reluctance.”

Dr. Tom Preston, a retired cardiologist and board member of Compassion and Choices, said many doctors are hesitant to talk publicly about where they stand on the issue. “There are a lot of doctors, who in principal, would approve or don’t mind this, but for a lot of social or professional reasons, they don’t want to be involved,” he said. But Preston thinks that, because of the new law, discussions about end-of-life issues between doctors and patients will increase and as time goes on, more and more doctors who don’t have philosophical or religious opposition will be open to participating. “It will be a cultural shift.”

Barbara Coombs Lee, president of Compassion and Choices, said having the law available means “people will get referred to appropriate palliative care and hospice care earlier and will be able to avoid highly technical care when that’s not what they want.” She hopes the new law will encourage people to stop referring to the practice as suicide. “That’s like calling people who jumped from the World Trade Center, with flames at their back, suicidal,” Lee said. “They’re not suicidal, they don’t want to die, but they are dying. They are hoping to choose the least-worst way.” Lee also suggests that you “find out now if your doctor shares your values, because when you are terminally ill, when you’re close to your death, that’s not the time to find out.”

The U.S. Supreme Court ruled in 2006 that it was up to states to regulate medical practice, including assisted suicide. Washington's Initiative 1000 was passed by nearly 60 percent of state voters in November. In December 2008, a Montana judge overturned that state’s law prohibiting doctor-assisted suicide in a ruling on a case involving a man with terminal cancer. That decision is currently before the Montana Supreme Court. Montana doctors are allowed to write prescriptions pending the appeal, but because there’s no reporting process, it’s unknown whether any actually have. Legislators in California introduced a bill based on the Oregon law. The Compassionate Choices Act was first introduced in 2005 and reintroduced in February 2007, but was shelved in June 2007.

The “Death With Dignity” law is very controversial, as it delves into ethical issues. Advocates for the law believe that individuals should be able to control the time and circumstances of their own death. Some argue that actively causing one’s own demise is no different than refusing life-saving treatment. Dr. Robert Thompson, an internist and cardiologist at Swedish Medical Center in Seattle who voted for the measure, said that in his 32 years of practice he has treated patients who would have benefited from this law. “I believe for the sake of compassion, and for a person’s own individual rights, that this should be an option for them,” he said.

On the other hand, opponents fear that vulnerable patients may be coerced into assisted suicide to ease the financial burden of caring for them. Some also argue that six-month terminal diagnosis is never a sure thing and that offering them the opportunity to kill themselves is unethical. Dr. Stu Farber, director of the palliative care consult service at the University of Washington Medical Center, voted against the measure and doesn’t plan to prescribe lethal medication to his patients for now. “I am not here to tell people how they should either live their life or the end of their life,” Farber said. “There’s possibly a story out there, in the future, that’s so compelling that maybe I would write a prescription.”

Currently, only three places besides Oregon and Washington openly and legally authorize assisted suicide: the Netherlands, Belgium and Switzerland. The Netherlands introduced specific legislation to legalize assisted suicide and active euthanasia in 2002, but the country’s courts have permitted them there since 1984. The patient, who must be suffering unbearably and have no hope of improvement, must ask to die, must clearly understand the condition and prognosis, and a second doctor must agree with the decision to help the patient die.

Belgium legalized euthanasia in 2002, but the laws seem to encompass assisted suicide as well. Two doctors must be involved, as well as a psychologist if the patient’s competency is in doubt. The doctor and patient negotiate whether death is to be by lethal injection or prescribed overdose. Switzerland has allowed physician and non-physician assisted suicide since 1941, but prohibits euthanasia. Three right-to-die organizations in the country help the terminally ill by providing counseling and lethal drugs, but death by injection is banned.

Elsewhere, many countries seem to show slow movement toward legalizing assisted suicide and euthanasia, including Luxembourg, where legislation that would have permitted euthanasia was lost by a single vote in March 2003 and Britain, where legislation that would have legalized assisted suicide for the terminally ill was defeated in the House of Lords in May 2006.