Polls show Washington voters favor physician-assisted suicide

Oregon's stand as the only U.S. state to provide terminally ill patients with legal access to physician-assisted suicide may come to an end Nov. 4.

Voters in Washington will consider a ballot measure, known as Initiative 1000, to enact a law similar to the one in Oregon. Under I-1000, access to doctor-ordered lethal doses of medication would be limited to adults who live in Washington and who are judged by two physicians to be mentally competent and likely to die of a terminal illness within six months.

The proposal states that doctors must tell patients about options such as hospice and palliative care. The process would require an oral request from the patient and a witnessed written request, followed by another oral request 15 days later.

Fifty-seven percent of Washingtonians polled in early September favored I-1000. A third of registered voters surveyed by Elway Research, a nonpartisan polling firm, opposed the initiative, and 10% were undecided. Another poll, released in late September and conducted on behalf of TV station KING, found that 54% of voters supported the initiative, and 26% opposed it.

But while advocates of legal physician-assisted suicide succeeded on the ballot in Oregon in 1994, actions in other states have failed.

Voters rejected doctor-assisted dying measures in California in 1992, in Michigan in 1998 and in Maine in 2000. Washington voters rejected a 1991 ballot proposal by 54% to 46%. That measure would have allowed doctors to administer lethal medications to patients unable to ingest them. Under the 2008 initiative, patients must self-administer the deadly dose.

The Oregon law's implementation was delayed until 1998 by litigation and a failed 1997 repeal attempt. From 1998 to 2007, 341 terminally ill Oregonians ended their lives early under the state's Death With Dignity Act.

Washington's ballot push has been spearheaded by former Washington Gov. Booth Gardner, who has Parkinson's disease. He has called the I-1000 effort his "final campaign" and has donated $470,000 to the cause, according to the Seattle Post-Intelligencer. Supporters of I-1000 have raised $2.5 million, while opponents have raised more than $1 million, the newspaper reported in late September.

Medical society voices opposition

The Washington State Medical Assn. first adopted policy opposing doctor-aided suicide in 1991 and reaffirmed its policy last year. The group is offering doctors up to 200 free "vote no" brochures each to place in waiting rooms.

"The relationship between physicians and patients is a sacred relationship," said Cynthia Markus, MD, an Everett, Wash., emergency physician who is president of the medical society. "We feel no patient should be forced to choose suicide for fear that they can't get good medical care. ... Our palliative medicine is far better now than it was 17 years ago."

Shane E. Macaulay, MD, agreed.

I-1000 "represents a direct assault on patient welfare," said Dr. Macaulay, a Seattle-area radiologist who is volunteering for the Coalition Against Assisted Suicide. "We have the ability to control pain and other symptoms at the end of life, and that doesn't require that the patient be killed."

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

Retired cardiologist Thomas Preston, MD, is on the other side of the issue. He supports I-1000 and has visited scores of dying patients in Washington to help them access comfort care and make end-of-life choices such as completing advance directives.

"Physicians have two great duties," Dr. Preston said. "One is to cure diseases and prolong life and the other is to prevent suffering. At the end of life, these two intersect. To prolong life and allow life to drag on causes more harm than good. The greater ethical duty is to prevent suffering."

What the surveys say

A 2005 HCD Research nationwide poll of 677 physicians found that 59% supported physician-assisted suicide, while 41% opposed it. A March 2007 e-mail survey of 502 Washington State Medical Assn. physician members showed that 50% supported an Oregon-like law, while 42% opposed it. The survey respondents did not represent a random sample of WSMA membership, according to Elway Research, which conducted the poll for the medical society.

WSMA president Dr. Markus said the poll "was nonscientific, and we do not make policy based on polls."