In 2008, voters in 30 of the 39 Washington counties approved the Death with Dignity Act, allowing terminally ill, competent adults with six months or less to live to request lethal doses of medication from a physician. They can then decide to take the medication to end their life.
In 2018, the most recent year for which data is available, 267 Washington residents received the medication. Of those, 251 were known to have died — 203 after taking the medication, 29 without taking it. Ingestion status was unknown for 19.
Some who have seen the law operate firsthand say it includes unnecessary obstacles for people who are suffering.
In her testimony, Zosia Stanley, associate general counsel with the Washington State Hospital Association, said she gets one or two calls per month from patients, family members, and providers looking for information on the law. Several family members have shared how challenging the process is, she said.
This year, the state Legislature is considering adjusting the law to ease access.
“Washingtonians who want a dignified death without pain and suffering deserve a bill that helps them by removing unnecessary barriers contained in the existing law,” Bob Free, board president of End of Life Washington said in a prepared statement.
Rep. Skyler Rude, R-Walla Walla, said he came to the issue by way of an article in the Walla Walla Union-Bulletin. The 2019 article details the plight of one of his constituents who battled Parkinson’s disease.
The man ultimately died due to “VSED,” or Voluntary Stopping Eating and Drinking, over 12 days, the article reads. It says he could no longer swallow — the law requires the fatal medication be self-administered. Plus, Providence St. Mary Medical Center didn’t allow it, according to the article, and he was too sick to move to another hospital.
Rude sponsored a bill last year that would’ve directed the University of Washington to study and report on barriers for residents who want to use the law. It passed the full Legislature but was ultimately vetoed by Gov. Jay Inslee after COVID-19 changed the state’s budget outlook.
So, in the interim, Rude said he engaged with stakeholders, including a group of eight physicians who’ve used the law with patients. The bill, HB 1141, is a result of looking at concerns and proposing policy changes that have minimal fiscal impact.
Washington, D.C., and eight states, including Washington state, currently allow the practice of medical aid in dying, according to the National Conference of State Legislatures. A bill passed the Legislature in New Mexico this year and awaits the governor’s signature.
What the Bill Does
More than a dozen Democrats signed on to Rude’s bill, which makes a series of changes to the Death with Dignity Act.
A patient who wants to use the Death with Dignity Act currently has to make an oral request to a physician, then a written request, then a second oral request, which can’t happen until 15 days have passed since their first. The bill would reduce that waiting period between the first and second oral request from 15 days to 72 hours, or less if they’re not expected to survive so long.
Rude said the 15-day waiting period was a chief concern for the physicians he talked to — patients will decide they want to use the law at the very end of their lives, he said, and then often pass away before those two weeks are over.
The bill also would allow medications to be delivered by mail, which is currently prohibited. The House approved a floor amendment that would require the signature of the addressee or an authorized person.
Another change: One of the two providers that have to sign off on a patient’s requests could be a physician’s assistant or advanced registered nurse practitioner, rather than requiring both providers be physicians.
In public testimony, Dr. Roy Graves, a retired physician and volunteer with End of Life Washington, said that primary care and hospice care is increasingly being provided by ARNPs and PAs, especially in rural areas.
“These providers have ongoing relationships with their patients and continuity of care is important to quality of care,” Graves said.
The bill also expands the providers who can provide patients counseling to include social workers, mental health counselors, and psychiatric advanced registered nurse practitioners. And it prohibits health care providers from contractually keeping employees from participating in the Act if they’re out of the scope of their employment and not on the provider’s premises.
Nothing about who’s eligible for the Act would change, and providers still wouldn’t be required to participate.
Objections
“I think reasonable people can disagree on the fundamentals of the Death with Dignity Law,” Rep. Rude said in floor debate. “And, oftentimes, there are religious objections to the underlying law that has existed in our state for 10 years.”
Among critics who testified in opposition to the bill in the House were Bishop Daniel Mueggenborg with the Archdiocese of Seattle and the Washington State Catholic Conference; and Richard Doerflinger with the de Nicola Center for Ethics and Culture at the University of Notre Dame.
A repeated concern was that it represents a shift from the law as originally approved by voters. The conference opposed the 2008 initiative voters passed, Mueggenborg said, and he called the bill a “significant expansion.”
“Why are we in such a rush to encourage people to kill themselves?” he said. “Are we afraid that they might change their minds?”
Sharon Quick, physician and state director for the American Academy of Medical Ethics, wrote an op-ed last month in the Spokesman-Review critiquing the bill as “lowering or eliminating already minimal safeguards without reliable evidence that such changes are warranted.”
“I strongly urge Washington legislators to concentrate on improving palliative care instead of expanding access to assisted suicide,” she wrote. “Let HB 1141 die instead of patients.”
Disability Rights Washington also submitted written testimony against the bill, writing with concern that “people with disabilities will be pushed into assisted suicide” and listing unanswered questions. Instead, the organization advocated for a thorough study such as was proposed last year.
Rep. Joe Schmick, R-Colfax and ranking member on the House Health Care and Wellness Committee, explained his no vote in floor debate.
“This is not what the people passed,” Schmick said. “And I go by that. I have sat with my parents, cared for them as they end their life naturally. Death is a natural process. And … I value life. Time will take its course — is there suffering in the end? Absolutely, no one would deny that. But to make it easier to take one’s life I struggle with.”
Not Quite Partly Line
The bill passed out of the House on a 60-37 vote last month. It was mostly along party lines, with Democrats approving and Republicans voting against it.
“If, like me, you have sat with a family member — cared for, physically and emotionally, a family member with a terminal illness, you understand how deeply personal this is,” Rep. Nicole Macri, D-Seattle, said in floor debate.
Five Republicans voted for it, including sponsor Rep. Rude. One Democrat, Rep. Dave Paul of Oak Harbor, voted no.
Rude, a Libertarian-leaning Republican, told McClatchy he weighs restricting people’s rights with the public good and how others are impacted. He sees most arguments in opposition to his bill as aimed at the underlying law rather than the proposed adjustments.
If the initiative were on the ballot with the changes proposed in his bill, he’d expect it to pass with even stronger support today.
“I think this is really an issue of individual liberty,” Rude said in floor debate. “The decision, when someone is suffering to end that suffering a little bit early, earlier than it would naturally happen, is something that I feel is completely reasonable. And for those who don’t want to participate, due to the safeguards in the law, they don’t have to.”
