Washington becomes 2nd state to allow physician-assisted suicide

Fourteen years after a slight majority of Oregon voters made their state the first to allow physician-assisted suicide, a Washington ballot initiative nearly identical to Oregon's law was approved with 58% of the vote.

"It was a resounding win," said Peg Sandeen, executive director of the Portland-based Death With Dignity National Center, whose political action committee raised more than $615,000 for the ballot fight. "That's a trouncing any sort of politician would be glad to win anyplace."

The group's board plans to meet in November and December to analyze which state to target next.

"We really believe this is a people's movement," Sandeen said. "The legislatures are still afraid" of physician-assisted suicide. She predicted it will take two to three years to mount another state ballot drive. Planning for Washington's physician-assisted suicide ballot measure, Initiative 1000, began in 2005.

I-1000 supporters brought a big financial edge to their campaign. They raised more than $5.5 million, while opponents brought in $1.6 million, the Seattle Post-Intelligencer reported.

The Washington win ended a decade and a half of losses for aid-in-dying advocates eager to find a state willing to follow Oregon's lead. More than three dozen bills in 13 states were stymied, with none ever reaching a governor's desk. Ballot initiatives in Michigan and Maine failed -- the former by a wide margin, thanks to the specter of Jack Kevorkian, MD, and his suicide machine. Maine's failed by a 51% to 49% margin.

Oregon's law has been continually challenged. It was put on hold until a 1997 repeal attempt was defeated at the polls. Then, in 2001, U.S. Attorney General John Ashcroft issued a directive stating that physicians who wrote lethal prescriptions under the Oregon Death With Dignity Act were in violation of the Controlled Substances Act. The U.S. Supreme Court ruled in January 2006 that Ashcroft's order exceeded his authority.

From 1998 to 2007, 341 Oregonians with terminal illnesses ended their lives early with the help of deadly medications prescribed by their doctors. Another 35 people had taken life-ending drug doses by Nov. 5, according to Compassion & Choices of Oregon, a group that helps patients use the Death With Dignity Act.

As in Oregon, the Washington law makes physician-assisted suicide available only to patients who have been judged terminally ill by two doctors. Patients must make an oral request and a witnessed written request. Another oral request must be made 15 days later. Physicians must tell patients about options such as hospice and palliative care.

If either physician believes the patient has a psychiatric disorder impairing judgment, the patient must be referred for counseling. Doctors ordering deadly prescriptions will have to comply with reporting requirements to be set by the state health department. The information doctors report will not be publicly available, but the health department is required to release an annual statistical report. The law takes effect March 4, 2009.

The Washington State Medical Assn. opposed the ballot measure and offered physicians free "vote no" brochures for their waiting rooms. The organization's leadership decided before the election to respect the voters' decision and has "no plans to actively fight or try to repeal the initiative," a WSMA spokeswoman said.

The AMA "strongly opposes any bill to legalize physician-assisted suicide" because the practice is "fundamentally inconsistent with the physician's role as healer."

Seattle-area radiologist Shane E. Macaulay, MD, said I-1000's victory represents a misguided view of how to care for dying patients.

"The approach that the advocates of assisted suicide bring to end-of-life care represents a failure on their part of vision and understanding the options that exist in end-of-life care," said Dr. Macaulay, a WSMA delegate who volunteered for the Coalition Against Assisted Suicide, a group that opposed I-1000. A physician's duty is to offer patients with terminal illnesses good pain control and access to hospice, "to stand with patients, not help them die," he said.

Mitchell Kahn, MD, voted for the Washington ballot initiative. He said he would be willing to prescribe a lethal dose of medication for a terminally ill patient under the new law, noting he already is committed to helping dying patients experience as little pain as possible. "It's a small step to make sure the patient has enough meds to do himself in if that's what he wants to do," said Dr. Kahn, a Bellingham, Wash., internist. "Some people say there's an ethical divide there. I see it as a continuum."

Linda Ganzini, MD, MPH, is the leading expert on Oregon's decade-long experience with aid in dying. She said there are ways to help patients avoid physician-assisted suicide.

"The key issue is to make sure patients in Washington have access to hospice and access to good palliative care," said Dr. Ganzini, professor of psychiatry and medicine at Oregon Health and Science University. "Our research shows that's the single intervention most likely to cause people who have requested lethal prescriptions to change their minds."

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