New Law Aids Dying Patients Seeking to Hasten Death

Ruby de Luna
03/04/2009

Washington's Death with Dignity Act becomes law tomorrow (Thursday). Doctors and hospitals are still trying to understand how the measure is going to be implemented. To get some perspective, we look to Oregon where voters there approved a similar measure more than a decade ago, and what Washington can learn from that experience.

Washington's Death with Dignity Act is modeled after Oregon's measure. Patients who want to use Washington's law to end their lives must be at least 18 years old, a Washington state resident, and declared mentally competent. Two doctors must also certify that the patient is terminally ill, with 6 months or less to live.

Eighmey: "Compassion of Oregon, George Eighmey."

In Oregon, people looking for information about the process and the law call up compassion and choices of Oregon. George Eighmey is the non–profit's executive director. He says callers typically ask how to become Oregon residents, which he discourages. People also want to know how this would affect their insurance, and what happens when they take the lethal medication.

Eighmey: "We don't run the process. We're just there to make sure that everybody has access to it, and knows the law."

And it's not just patients who call for information. Doctors call, too.

Eighmey: "They want to know what to prescribe, they want to know how the instructions are written for taking the medication, and where they can find a pharmacy that will agree to fill the prescription. I tell them of course you have to check for the mental capacity for the person, competency, they know that, they're very, very aware of that."

Since the Oregon Act took effect in 1997, 341 people have used the law to end their lives. Eighmey says 9 people out of 10 who start the process never complete it because they die as a result of their illness. Eighmey says doctors and some hospice facilities initially resisted the law. But over time they started to see things a little differently.

Eighmey: "After about 3, 4 years, the hospices in particular, learned that in addressing their patients' concerns about end of life and also addressing their concerns about hastening their death, they could improve the quality of life for the individual for the remaining days that they had on this earth."

Eighmey credits the law for improving patients' end of life care. He points to Oregon's hospice enrollment, which has gone up considerably in the last decade. Also, the percentage of people who die in hospital is the lowest in the nation. The percentage of those who die at home is the highest. Eighmey expects Washington residents to see similar effects.

Eighmey: "They're going to see more people having an honest, open relationship with their physician when they can talk overtly about maybe ending their life instead of covertly."

Toffler: "No, the solution to pain is to relieve pain, not to kill the person. Introducing that paradigm into medicine is a dangerous slope. Where do you stop?"

William Toffler teaches family medicine at Oregon Health and Science University. He remembers the day when voters approved the measure in his state.

Toffler: "We were really shocked that a majority of Oregonians accepted the idea that the solution to suffering at the end of life was to eliminate the sufferer."

Toffler is also national director of physicians for compassionate care, which started as a support group for doctors who oppose the Oregon Act. One of the first things that members did was put on a conference about pain relief and other end of life issues. Toffler says the law goes against the profession's ethic of "do no harm."

Toffler: "It's absolutely impossible to protect the drift toward essentially assisted suicide on demand. And that's why we were so well served by the previous ethic which is that all human life is inherently valuable and doctors should not be ones to ever deliberately do harm, that is, to end the life of patients just because someone believed that it was no longer worthwhile."

Toffler says doctors should give supportive care so terminally ill patients live well until they die naturally. It's normal to be afraid when facing death. And depression is not uncommon.

Toffler: "We've tried to tell the state of Washington to do a better job of being sure that doctors as about depression and what screening test did they use, doctors ask about mental competency, what screening test? How do they determine the person is mentally competent? Was it simply saying the person said so?"

Washington doctors and pharmacists that don't want to participate may opt out. There's no question that Washington is about to enter a new chapter in medical care. Personal principles will be tested, both publicly and privately. George Eighmey of compassion and choices of Oregon says once everyone understands how the law works, providers will be less reluctant to participate.

Eighmey: "In the beginning the resistance was pretty strong in some of the religiously run hospices, our name and telephone number could be orally given, but not written down. Eventually you could write it down, and now they hand out our brochures."

Meanwhile, the debate continues in other states. In December a Montana judge ruled that terminally ill patients who are mentally competent have a right to seek lethal medications to hasten their death. That ruling is being appealed before the Montana Supreme Court. I'm Ruby de Luna, KUOW News.

© Copyright 2009, KUOW