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The Washington Death with Dignity Act

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The Washington Death with Dignity Act: Initiative Measure 1000.

http://wei.secstate.wa.gov/osos/en/Documents/I1000-Text%20for%20web.pdf.

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News Reports etc.

20081027@amednews. com@American Medical News
@Polls show Washington voters favor physician-assisted suicide
http://www.ama-assn.org/amednews/2008/10/27/prsb1027.htm
20081031@New York Times Online
@On Washington State's Ballot: Doctor-Assisted Suicide
http://www.nytimes.com/2008/10/31/us/31death.html
20081104@The Seattle Times
@Wash. voters approve assisted suicide initiative
http://seattletimes.nwsource.com/html/localnews/2008352565_apwaassistedsuicide2ndldwritethru.html
20081106@Bioethics Forum Diverse Commentary on Issues in Bioethics
@Washington's New Suicide Law Reflects Unfair Prejudices
http://www.thehastingscenter.org/Bioethicsforum/Post.aspx?id=2712
20081211@NEJM@ Volume 359:2513-2515 December 11, 2008 Number 24
@Physician-Assisted DeathFFrom Oregon to Washington State
http://content.nejm.org/cgi/content/full/359/24/2513?query=TOC

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Citation of Articles etc.

20081027@amednews. com@American Medical News
@Polls show Washington voters favor physician-assisted suicide
http://www.ama-assn.org/amednews/2008/10/27/prsb1027.htm
If passed, a state ballot measure would be the first doctor-assisted suicide law to receive voter approval since Oregon's Death With Dignity Act.

By Kevin B. O'Reilly, AMNews staff. Oct. 27, 2008.

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.

@EVoters in 4 states have rejected ballot initiatives on doctor-assisted suicide.

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.

@EMedical 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."

@ESince 1998, 341 terminally ill Oregonians ended their lives early under the state's Death With Dignity Act.

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."

@EWhat 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."


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20081031@New York Times Online
@On Washington State's Ballot: Doctor-Assisted Suicide
http://www.nytimes.com/2008/10/31/us/31death.html

By WILLIAM YARDLEY@Published: October 30, 2008

SEATTLE \\ In the 11 years since Oregon became the first state to allow physician-assisted suicide, the worst fears have never been realized, even some of the lawfs staunchest opponents say. Large numbers of people have not moved to Oregon to take advantage of the measure; through last year, 341 people had used it to hasten their death. And yet no other state has followed Oregonfs lead.
On Tuesday, however, its neighbor to the north, and in many ways its cultural reflection, will decide whether to adopt its own assisted-suicide law, the Washington Death With Dignity Act. The ballot initiative, modeled on Oregonfs, would let mentally competent, terminally ill adults obtain a doctorfs prescription for a lethal dose of medication.
Polls have shown that more Washington voters support the initiative than oppose it, but, like the Oregon measure, it is controversial and closely contested. Religious groups, along with some advocates for the disabled and some doctors, aggressively oppose it, raising questions about ethics and the way the Oregon law has been carried out.
Oregonfs measure has withstood legal challenge; in 2006, the United States Supreme Court rejected an effort by the Justice Department to stop doctors from writing lethal prescriptions. Yet Oregonfs experience has not created clear political momentum for assisted-suicide measures in other states, a circumstance that both sides say reflects the issuefs political tenderness.
gItfs a murky issue for politicians on either side, to be for it or against it,h said Peg Sandeen, executive director of the Death With Dignity National Center, based in Portland, Ore. An earlier incarnation of the group led the push for the Oregon law, and it is now helping, along with a second organization, Compassion and Choices, to promote the Washington measure.
Since Oregon narrowly approved its ballot initiative in 1994 ea court injunction prevented the measure from taking effect until voters rejected a repeal effort in 1997 ' similar initiatives have failed in at least two states. In 1998, Michigan voters overwhelmingly rejected an assisted-suicide proposal, though supporters say that drive was poorly organized. In 2000, voters in Maine narrowly defeated a better organized campaign for a measure modeled on the Oregon law.
Voters in California had rejected a similar initiative before Oregon passed its measure, and Washington itself rejected such an initiative in 1991.
(In addition to referendums, all but a few legislative efforts in several states have run out of steam before a full floor vote.)
Supporters of the Washington measure say a variety of factors make this year different. Unlike the failed 1991 proposal, the current one would not allow doctors to administer the lethal drugs. Like the Oregon law, it would permit them only to prescribe the drugs, which patients would give themselves, orally.
Further, supporters note that the Washington initiative is the first such effort since the 2006 Supreme Court ruling, a factor that may make voters more comfortable about backing it.
It also has a prominent, and popular, supporter in a former Democratic governor, Booth Gardner, 72, who suffers from Parkinsonfs disease. Mr. Gardnerfs condition would not qualify him to invoke the proposed law, but he has said he hopes it will one day be extended to people with certain debilitating conditions not considered terminal.
Both Washington and Oregon have become increasingly Democratic, a factor leading the initiativefs opponents to make a point of saying that support for it should not be the presumed Democratic position. They say the measure could threaten vulnerable groups, including women (who, they say, are more likely than men to feel like a burden to others if incapacitated) as well as minorities, the elderly and the poor, who may be tempted to end their lives because they cannot afford health care.
Under the Washington proposal, two doctors, each making an assessment independent of the otherfs, would have to determine that a patient had less than six months to live before that patient could receive a lethal prescription.
But Chris Carlson, chairman of the Coalition Against Assisted Suicide, the main opposition group, said he was found to have terminal carcinoid cancer in 2005 and was told then that he most likely had less than six months. Now Mr. Carlson, 61, describes his cancer as gdormant.h
gYoufre encouraging people to prematurely give up hope, and I think thatfs wrong,h he said. gI donft think the state should be encouraging people to give up hope.h

@A version of this article appeared in print on October 31, 2008, on page A14 of the New York edition.


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20081104@The Seattle Times
@Wash. voters approve assisted suicide initiative
http://seattletimes.nwsource.com/html/localnews/2008352565_apwaassistedsuicide2ndldwritethru.html
Originally published Tuesday, November 4, 2008 at 10:45 PM

Voters approved Initiative 1000 on Tuesday, making Washington the second state to give terminally ill people the option of medically assisted suicide.

By CURT WOODWARDiAssociated Press Writerj

OLYMPIA, Wash. \\
Voters approved Initiative 1000 on Tuesday, making Washington the second state to give terminally ill people the option of medically assisted suicide.
The ballot measure, patterned after Oregon's "Death with Dignity" law, allows a terminally ill person to be prescribed lethal medication, which would be self-administered.
With about 43 percent of the expected vote counted Tuesday in unofficial returns, I-1000 was being approved by a margin of about 58 percent to about 42 percent.
Supporters, led publicly by Democratic former Gov. Booth Gardner, said the initiative would provide a compassionate way for terminally ill people to die.
Gardner has Parkinson's disease, an incurable disorder that causes tremors and stiff or frozen limbs. Gardner, who would not be eligible under I-1000 because Parkinson's is not considered fatal, said he pushed the measure in his "last campaign" because he understood why other ill people would want the option.
Opponents, including the Catholic church, said assisted suicide is a dangerous step that devalues human life. Critics also said the assisted suicide measure could exploit depressed or vulnerable people who worry they've become a burden on their families.
The measure involved a multimillion-dollar campaign, including TV advertisements featuring actor Martin Sheen, who urged a "no" vote. But polling before Election Day showed I-1000 with significant support.
Outside of Oregon, advocates of similar laws haven't fared well. California, Michigan and Maine voters rejected the idea, and bills have failed in statehouses around the country. In Washington, voters rejected physician-assisted suicide in 1991.
This year's proposal differs from the earlier Washington measure - it doesn't allow doctors to administer lethal drugs on behalf of patients who can't do so themselves. Any patient requesting the fatal medication must be at least 18, declared competent and a resident of Washington state.
The patient would have to make two oral requests, 15 days apart, and submit a written request witnessed by two people, including one person who is not a relative, heir, attending doctor, or connected with a health facility where the requester lives. Two doctors also would have to certify that the patient has a terminal condition and six months or less to live.

Forty-nine people died in Oregon last year under that state's assisted suicide law, according to a report by the Oregon Department of Human Services. Since it went into effect, more than 340 Oregon patients have used the law to end their lives.
Most suffered from cancer, and the most common reasons reported for choosing assisted suicide were loss of autonomy, loss of dignity and a decreasing ability to participate in activities they enjoyed.
The decision on I-1000 was a personal one for 82-year-old Jean Hoggarth of Yakima. She battled breast cancer and the disease now has spread to her bones, but voted against the initiative.
"I've had experience with people dying, but I believe it can be done peacefully," Hoggarth said. "And we have doctors today who give the best care. They should be allowed to do that all the way to the end."
Mike Dingus, a 39-year-old long-term care worker in Yakima, voted "yes." "You don't get much choice coming in, so you should get some choice going out," Dingus said.

AP Writer Shannon Dininny contributed to this report from Yakima.


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20081106@Bioethics Forum Diverse Commentary on Issues in Bioethics
@Washington's New Suicide Law Reflects Unfair Prejudices
http://www.thehastingscenter.org/Bioethicsforum/Post.aspx?id=2712
Bioethics Debate 2008
Ben Mattlin, 11/06/2008

The passage of Washington state's Initiative 1000, the "death-with-dignity act," saddens and scares me. It saddens me because I have serious concerns about legalizing physician-assisted suicide. It scares me because laws like this are direct threats against people like me.
Don't get me wrong. I am not a right-to-lifer. I am not particularly religious. Rather, my opposition stems from my lifelong experience as a person with a severe, progressive disability.
Born with spinal muscular atrophy, I have never walked or stood. I use a motorized wheelchair and am almost completely unable to move my extremities. I've had, however, the good fortune to graduate with honors from Harvard, get married, have two children and forge a career as a freelance journalist. I turn 46 this month, and I wasn't supposed to live past my teens.
Yet none of these accomplishments matters to those who only see my disability. What I've achieved--the very quality of my life--may mean nothing if I'm judged the way Initiative 1000 seems to judge people. Stripped of the accoutrements of my high-tech wheelchair, voice-recognition computer, family and the rest, as I might be in a doctor's office or on a hospital gurney, what's left of me is an emaciated, immobile rag doll. My diagnosis alone tells very little about who I am. But it makes me a good candidate for a poison prescription under Washington's new law and the similar one in Oregon.
Granted, these laws are only for those with no more than six months to live. But spinal muscular atrophy is frequently a terminal condition. To be sure, in my case it progresses very slowly. By anyone's measure I have more than six months to live. Yet what happens when something goes wrong? I recently recovered from a three month stay in the ICU at the UCLA Medical Center, where I had internal bleeding, multiple pneumonias, scattered blood clots and other complications from routine surgery. I was on a ventilator, unable to speak and at times unconscious. It's the closest I've ever been to death. Whether I would live another six months was not always clear. My wife was asked if attempts to save my life should even be tried. I'm grateful she was there to say yes.
The problem with physician-assisted suicide is that it presumes euthanasia is a rational choice for someone in dire straits, based solely on that person's diagnosis. If, on the other hand, a healthy, able-bodied person requests a doctor's aid in death, what happens? Antidepressant medication or psychological counseling will likely be prescribed.
Don't ill and disabled people, even those with less than six months to live, deserve the same?
Not that I have anything against suicide. It is a personal choice. I'm pro-choice. Like many people with disabilities, I don't want others deciding my fate, telling me what I can and cannot do. Yet if we're going to legalize medically aided suicide, let's legalize it not solely on the basis of diagnosis. Let's legalize it for everyone! Why should the terminally ill have the exclusive privilege of a death with dignity? (This, by the way, is the true, secret agenda of Compassion & Choices, the organization formerly known as the Hemlock Society, which was the chief backer of I-1000 and other euthanasia laws.)
To me, free choice can only be rendered when there's full disclosure about the options available. It's not a free and fair choice if the deck is stacked. So until it's clear and true that there is life after a terminal diagnosis, that an ill person's (remaining) life can be good and full and worthwhile, there is no free and fair choice. Why the rush to mandate death alternatives without equal time for maximizing life-enhancing choices? As an advocate for people with disabilities, I believe we need to do a better job of ensuring equal access to all society has to offer, not just welcoming but valuing people with all sorts of medical diagnoses as viable, worthwhile contributors to our society. Measures like I-1000 reinforce an old stereotype that one is better off dead than severely disabled. It's hard enough to live a good life as a person with a hefty diagnosis in this youth-cherishing, athletics-venerating world--to maintain a healthy dose of self-esteem--without the promulgation of such an outmoded prejudice.

iBen Mattlin is a contributing editor at Institutional Investor and Dealmaker and a commentator on NPR. j

EComments
Mr. Mattlin seems to have overlooked the very essence of the newly-passed law in Washington, the requirement that the decision to seek and receive aid-in-dying be freely chosen by the terminally ill person. Neither this nor the Oregon law, upon which it is modeled, even permits a surrogate to act for a patient without decision-making capacity. We respect persons most when we fully respect their rights to make these important decisions for themselves.


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20081211@NEJM@ Volume 359:2513-2515 December 11, 2008 Number 24
@Physician-Assisted DeathFFrom Oregon to Washington State
http://content.nejm.org/cgi/content/full/359/24/2513?query=TOC

Robert Steinbrook, M.D.

@The text is left out.

References

The Washington Death with Dignity Act: Initiative Measure 1000. (Accessed November 18, 2008, at http://wei.secstate.wa.gov/osos/en/Documents/I1000-Text%20for%20web.pdf)
@Quill TE. Legal regulation of physician-assisted death -- the latest report cards. N Engl J Med 2007;356:1911-1913.

@Ganzini L, Goy ER, Dobscha SK. Why Oregon patients request assisted death: family members' views. J Gen Intern Med 2008;23:154-157.

@The Task Force to Improve the Care of Terminally-Ill Oregonians. The Oregon Death with Dignity Act: a guidebook for health care professionals. Portland: Oregon.gov, 2007. (Accessed November 18, 2008, athttp://www.oregon.gov/DHS/ph/pas/publications.shtml)

@Ganzini L, Goy ER, Dobscha SK. Prevalence of depression and anxiety in patients requesting physicians' aid in dying: cross sectional survey. BMJ 2008;337:973-975.

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