Can a Washington Physician Help Me End My Life?
A Washington physician can prescribe a lethal dose of medication for a patient (RCW 70.245.020), under conditions described below:
1. The physician must provide primary care for the patient, including the patient’s terminal disease. This person is the patient’s “attending physician.”
2. The patient must be at least eighteen years of age and a resident of the State of Washington. Factors demonstrating residence in Washington include, but are not limited to, possession of a Washington driver’s license, registration to vote in Washington, or ownership of property or leases of property in Washington. RCW 70.245.130.
3. The patient must suffer a terminal disease, that is, an incurable and irreversible disease that will within six months, in reasonable medical judgment, cause the patient’s death.
4. The patient must make a written request to her attending physician, which written request must be in substantially the form described at RCW 70.245.220, signed and dated by the patient, and witnessed by two individuals who can attest that the patient is competent, acting voluntarily and without coercion. At least one of these two witnesses cannot be a relative of the patient, a person who will receive a gift from the patient’s estate, a person involved with a health facility at which the patient is receiving medical treatment or where she resides. The patient’s attending physician cannot be a witness. If the patient lives in a long term care facility, one of the witnesses must be an individual designated by the facility. RCW 70.245.030. The patient’s written request must be signed by the patient and witnesses at least forty-eight hours before the attending physician writes the prescription for the lethal dose of medication. RCW 70.245.110.
5. In addition to the written request on the form described by the statute, the patient must make two oral requests for a self-administered lethal dose of medication. The second such oral request must be at least fifteen days after the initial oral request. When the second request is made, the attending physician must offer the patient an opportunity to rescind her request. RCW 70.245.090, 70.245.100. If the patient does not rescind her request and forty-eight hours have elapsed since the written request was received, the attending physician may write the prescription for the lethal dose of medication. RCW 70.245.110.
6. A consulting physician, who is an expert or specialist in the terminal disease suffered by the patient, must concur in writing in the attending physician’s decision to prescribe the lethal drug dose, and confirm that the patient is acting voluntarily with informed consent. RCW 70.245.050.
7. The patient must attend counseling if either the attending physician or consulting physician believes that the patient suffers from depression or a psychiatric or psychological disorder that impairs the patient’s judgment. If counseling is required, no lethal prescription shall be issued until the counselor determines that the patient’s judgment is not impaired. RCW 70.245.060.
8. The patient must be competent, having the ability to make an informed decision about ending her life in a humane and dignified manner, which information must include her medical diagnosis, her prognosis, the risks of taking the lethal prescribed medications, the probable result of taking the prescribed medications, and the alternatives to taking the prescribed medications. RCW 70.245.040, 70.245.070.
9. The lethal dose of medication must be self-administered. RCW 70.245.020. Medications dispensed but not self-administered shall be disposed in a lawful manner. RCW 70.245.140.
10. The terminal patient may not make agreements with any other person or suffer any changes to an existing contract that might induce or prevent the patient from using the Death with Dignity Act provisions. Any such agreement or change is invalid. RCW 70.245.160. Life, health, and accident insurance coverages cannot be affected by use of the Death with Dignity Act. RCW 70.245.170.
11. The physician must recommend that the patient notify her family (RCW 70.245.080), advise the patient not to take the lethal medication prescribed alone or in a public place (the patient’s estate is subject to government claims for expenses incurred if the death occurs in a public place [RCW 70.245.210]), inform the patient that she may rescind her request at any time or in any manner, and offer the patient an opportunity to rescind her request at the end of the fifteen day waiting period. The physician must verify, immediately before writing the lethal prescription, that the patient still gives her informed consent (RCW 70.245.070), make full medical documentation (RCW 70.245.120), and ensure that all the steps required by this statute are followed. RCW 70.245.040.
12. The physician shall dispense or, with the patient’s consent, cause a pharmacist to dispense, the lethal medications. This prescription may not be filled by mail or courier. RCW 70.245.040.
13. The physician may sign the patient’s death certificate and indicate the cause of death as the underlying terminal disease.
14. The Death with Dignity Act does not authorize a physician or any other person to end a patient’s life by lethal injection, mercy killing, or active euthanasia. RCW 70.235.180.
15. Acts taken under the Death with Dignity Act are not suicide, or assisted suicide. RCW 70.235.180. The Act authorizes obtaining and self-administering life-ending medication.
16. Use or attempted use of the provisions of the Death with Dignity Act shall not subject a person to civil or criminal liability or professional disciplinary action, and shall not serve as a basis for requesting guardianship of the patient. RCW 70.245.190.
17. No health care provider shall be compelled to participate in prescribing under the Death with Dignity Act. The patient of an unwilling doctor may seek another doctor. RCW 70.245.190.
18. Entire health care organizations may prohibit physicians practicing on their premises from prescribing lethal medications under the Death with Dignity Act, provided the organization requires this of all physicians and the organization notifies the public. RCW 70.245.190. Physicians may contract with patients outside the course of their normal employment duties for services required under the Death with Dignity Act. RCW 70.245.190.
19. A person who forges a patient request or destroys a rescission of a patient request, coerces or exercises undue influence over a patient request shall be guilty of a class A felony. Such a person shall also be liable for civil damages caused to the patient. RCW 70.245.200.
USE OF THE DEATH WITH DIGNITY ACT.
Physicians must report their prescriptions under the Death with Dignity Act, and a summary of that information is publicly available. RCW 70.245.150.
In 2009, the first year of the statute’s operation, medication was dispensed to sixty-three individuals, of whom forty-seven died, thirty-six by ingesting the medication, seven without ingesting the medication, and four whose means of death is not known.
In 2010, medication was dispensed to eighty-seven individuals, of whom seventy-two have died, fifty-one by ingesting the medication, fifteen without ingesting the medication, and six whose means of death is not known.
Of those utilizing the Death with Dignity Act, they are divided approximately equally by sex, most are over fifty years of age, most live west of the Cascades, and most suffered cancer or neurodegenerative diseases.
The most-often-cited concerns of those using the Death with Dignity Act were loss of autonomy, inability to do enjoyable activities, loss of dignity, loss of control of bodily functions. Smaller percentages of patients were concerned about being a burden on family and caregivers, inadequate pain control, and the financial implications of possible treatments.