OLYMPIA, Wash. — Terminally ill patients with less than six months to live will soon be able to ask their doctors to prescribe them lethal medication in Washington state.
But even though the "Death with Dignity" law takes effect Thursday, people who might seek the life-ending prescriptions could find their doctors conflicted or not willing to write them.
Many doctors are hesitant to talk publicly about where they stand on the issue, said Dr. Tom Preston, a retired cardiologist and board member of Compassion & Choices, the group that campaigned for and supports the law.
"There are a lot of doctors, who in principle, would approve or don't mind this, but for a lot of social or professional reasons, they don't want to be involved," he said.
But Preston said discussions about end-of-life issues between doctor and patient will increase because of the new law, and he thinks that as time goes on more and more doctors who don't have a religious or philosophical opposition will be open to participating.
"It will be a cultural shift," he said.
The U.S. Supreme Court ruled in 2006 that it was up to states to regulate medical practice, including assisted suicide, and Washington's Initiative 1000 was passed by nearly 60 percent of state voters in November.
It became the second state, behind Oregon, to have a voter-approved measure allowing assisted suicide.
In December, a Montana district judge ruled that doctor-assisted suicides are legal. That decision, which was based on an individual lawsuit, is before the Montana Supreme Court. While Montana doctors are allowed to write prescriptions pending the appeal, it's unknown whether any actually have because there's no reporting process.
Docs, pharmacists not required to participate
Under the Oregon and Washington laws, physicians and pharmacists are not required to write or fill lethal prescriptions if they are opposed to the law. Some Washington hospitals are opting out of participation, which precludes their doctors from participating on hospital property.
Dr. Stu Farber, director of the palliative care consult service at the University of Washington Medical Center, voted against the measure and doesn't plan to prescribe lethal medication to his patients for now.
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"I am not here to tell people how they should either live their life or the end of their life," Farber said. "There's possibly a story out there, in the future, that's so compelling that maybe I would write a prescription."
Farber said he would refer patients to Compassion & Choices of Washington, the state's largest aid-in-dying advocacy group, after talking about how they came to their decision.
The advocacy group is compiling a directory of physicians who aren't opting out of the law, as well as pharmacies willing to fill the prescriptions, said executive director Robb Miller.
"Physicians don't understand yet exactly how the law works," Miller said. "Whenever there's lack of understanding, there tends to be some reluctance."
Dr. Robert Thompson, an internist and cardiologist at Swedish Medical Center in Seattle who voted for the measure, said that in his 32 years of practice he has treated patients who would have benefited from this law.
"I believe for the sake of compassion, and for a person's own individual rights, that this should be an option for them," he said.
Washington's law is based on Oregon's measure, which took effect in late 1997. Since then, more than 340 people — mostly ailing with cancer — have used that state's measure to end their lives.
Under the Washington law, any patient requesting fatal medication must be at least 18 years old, declared competent and a state resident. The patient would have to make two oral requests, 15 days apart, and submit a written request witnessed by two people, one of which must not be a relative, heir, attending doctor, or connected with a health facility where the requester lives.
Six months or less to live
Two doctors must certify that the patient has a terminal condition and six months or less to live.
Some doctors who opposed the measure have argued that a six-month terminal diagnosis is never a sure thing.
"There is no question in my mind that, if this is too easy of a task, people will die prematurely," said Dr. Linda Wrede-Seaman, a family physician and palliative care specialist in Yakima.
Health care providers writing a prescription or dispensing medication also must file a copy of the record with the state Department of Health, which is required to create an annual report on how the law is used.
The University of Washington health system and Group Health Cooperative chose not to opt out.
That decision was made easier by the law's clear option that physicians could opt out if they wanted to, said Dr. Larry Robinson, vice dean for clinical affairs at the UW School of Medicine.
"We're not forcing anyone to do anything," he said.
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