Washington ushers in era of "Death with Dignity"

March 20, 2009

In November, 57.8 percent of Washington voters said yes to a ballot initiative that permits physicians to offer terminally ill patients prescriptions for a lethal dose of barbiturates, which patients may self-administer to end their own lives.

Key Points

Randy Niedzielski of Lynnwood, Washington, did not want to die the way he did in 2006. "It was a very ugly death, very painful and difficult," says Nancy, his widow. In his last few months of suffering from brain cancer, he couldn't control his arms and legs, developed double vision, was incontinent, and couldn't stop drooling.

Washington law at the time rendered Niedzielski's physicians helpless to offer assistance. In light of this, he wanted to move to neighboring Oregon-the only state where a physician could legally write a prescription that could end Niedzielski's life. But he died before establishing residency there. (Read more about Randy's battle as below "Lynnwood, Washington, Randy Niedzielski.")

Supporters say they would target states that have narrowly rejected physician-assisted suicide: California, Vermont, Maine, and Hawaii. In Montana, a judge in December ruled that physician-assisted suicide is legal in that state, holding that the state constitution's right to privacy allows it. The state has appealed the ruling to the Montana Supreme Court.

Polls show that physicians and the American public are closely divided on the issue.

The American College of Physicians does not support the legalization of physician-assisted suicide, concluding that, among other things, making it legal raises "serious ethical, clinical, and social concerns and that the practice might undermine patient trust and distract from reform in end-of-life care."

The American Academy of Family Physicians does not take a direct position on physician-assisted suicide, though one of its core principles for end-of-life care is to respect the right to refuse treatment.

Cynthia A. Markus, MD, president of the Washington State Medical Association, which actively opposed the ballot initiative, says she doesn't expect a groundswell of support for similar initiatives in other states. However, she couldn't rule out that possibility.

"Maybe, as other states see it works well in Oregon, and perhaps it will work well in Washington, it could lead to passage [in other states]," she says. "I hope it works well here, because it's now the law."

A major question is how many Washington physicians and pharmacists, at least initially, will agree to help patients with their death requests-particularly in the rural central and eastern parts of the state. That was an issue at first in Oregon as well, though Compassion & Choices in Oregon says it now has 750 physicians participating around the state.

Thomas Preston, MD, a retired Seattle cardiologist who was a leader in the ballot initiative campaign, predicts that Washington physicians will be slow to step forward at first. He already has a confidential list of about 90 physicians who backed the initiative and believes most of the state's doctors privately support it.