Opinion - Whatcom View

POSTED: Monday, Feb. 02, 2009

After passage of I-1000, now what?

In the wake of Washingtonians’ overwhelming support for Initiative 1000, what comes next? The law will become effective on March 4. But that doesn’t mean nothing will happen until then. There is much to be done in the meantime. Patients, physicians, family members, state health officials and others can begin preparing now.

Washington’s Death with Dignity Act will give qualified, terminally ill patients the right to ask their physician for medication that a patient may choose to self administer to escape an unbearable dying process and bring about a peaceful death. It will provide peace of mind and comfort to many who suffer from incurable forms of cancer and other deadly diseases. The Washington State Department of Health will develop regulations to implement the law. Although the law is not yet in effect, advance planning for a more peaceful death is still important.

The act’s benefits will extend well beyond the terminally ill. In Oregon, the law spurred conversation, education and improvements in end-of-life care across the board. Oregon experienced dramatic increases in those who died at home rather than in hospitals — something almost all of us prefer. More patients were referred to, and entered, hospice care, and did so earlier, receiving benefits that are helpful to all facing the end of life. Better use of pain medication resulted from more open and frequent conversations with physicians about end-of-life care.

We want all those same benefits for all Washingtonians.

Compassion & Choices of Washington is ready and able, with professional and volunteer staff, to serve as an expert resource to patients, families, physicians, hospice providers and others throughout Washington. Our expertise is based upon 20 years of providing counseling, education and support to patients exploring end-of-life options. Our expertise also comes from close association with our sister organization, Compassion & Choices of Oregon, which has served as steward of that state’s Death with Dignity Act and a resource to patients, families and professionals for 11 years.

Patients asking how to begin a request under the law and physicians asking how to respond are encouraged to contact C&C of WA (206-256-2636, 1-877-222-2816 toll-free, or info@CandCofWA.org) for information and guidance.

People interested in volunteering to become client support advocates are also encouraged to call. Our goals are access for all eligible patients and thorough compliance with the law’s requirements.

One key question for patients and families to ask their doctors are, “Would you support my choice to use the Death with Dignity Act?” The time to ask this question is well in advance of seeking to use this new choice.

Some religious-based health care providers will not honor this choice but will require the physicians they employ to adhere to the church’s religious directives and forbid them from participating in the law. This is particularly true of the Catholic health care facilities, which subscribe to the Ethical and Religious Directives. These rules strictly prohibit any form of aid in dying, including standard medical practices such as the removal of a feeding tube from a person in a persistent vegetative state.

Patients and family members should investigate their health care providers’ policies in advance. Many patients have found they did not have options they thought they had, and did not learn of the restrictions until it was too late.

Fortunately, many Washington physicians will be willing to support patients who are eligible to use the Dignity Act. The American Medical Women’s Association; the American Public Health Association and its Washington affiliate; and the American College of Legal Medicine all support the option made legal by the new law. Physicians who are members of these organizations will likely look to the policies of these organizations to guide their participation.

The Death with Dignity Act promises great improvements in end-of-life care for all Washingtonians. Now is the time for learning, planning and preparing for implementation of our new law.

Robb Miller is the Executive Director of Compassion & Choices of Washington, www.CandCofWA.org. He can be reached by e-mail at info@CandCofWA.org.