EDITOR’S NOTE: This is the first of a two-part series on the decision made or facing hospitals and health care providers before the Death with Dignity Act, approved by the state’s voters, goes into effect on March 5.
Eleven days from now, a state law will go into effect that allows terminally ill patients the option of hastening their death with lethal doses of self-administered drugs.
Individual doctors and health-care institutions statewide are scrambling to decide whether or not to participate in Initiative 1000 — the Death with Dignity act — approved by 58 percent of voters in last November’s election.
Under the law, which takes effect March 5, competent adults with six months or less to live can submit a series of formal requests for life-ending medication prescribed by a doctor.
Hospitals, clinics and hospice care centers must give notice they decide not to “opt in,” and participate in the process.
If an institution prohibits participation, it must give notice to all health care providers on its premises, and the general public through posting it, the state Hospital Association said.
Individual doctors and pharmacists do not have to declare their status, but cannot be forced to follow the decision of the institutions that employ them.
A health-care institution can participate, but cannot require a doctor or pharmacist to take part. By the same token, if an institution decides against it, doctors and pharmacists can decide otherwise.
Olympic Medical Center
Olympic Medical Center’s ethics advisory committee unanimously recommended that the Port Angeles hospital and its satellite clinics participate in I-1000.
The committee cited the county’s strong support for the ballot initiative, the need for more information on end-of-life care and the fact that only willing health care providers will participate in the law.
The OMC Board of Commissioners will vote on whether or not to participate on March 4.
Clallam County voters approved the statewide initiative in November by 60.7 percent.
“One thing we should take away from this [vote] is that people want their health care providers to help them die with dignity,” said Dr. Sandra Tatro, OMC Ethics Advisory Committee chairwoman, in a hospital commissioners meeting on Wednesday.
“Palliative care, comfort measures, pain management hospice care — that’s really what I think the public is asking for.”
Jefferson Healthcare
Jefferson Healthcare in Port Townsend has decided to participate. The Jefferson Healthcare commissioners opted in to I-1000 by 4-0 vote on Wednesday.
“As an organization, we’re very supportive of what our community wants,” said Keri Johns, home and community services director for Jefferson Healthcare, which includes hospice care.
“We will be reflective of our county’s desire to participate.”
Washington will become the second state in the nation to enact a right-to-die law. I-1000 was modeled on Oregon’s 1998 Death with Dignity act. It garnered considerable support on the North Olympic Peninsula.
In Jefferson County, 72.15 percent of those who voted in the November election approved I-1000. Only San Juan County approved it by a wider margin, with 75.3 percent voting in favor of it.
Clallam County’s yes vote of 60.67 percent was the ninth-highest approval percentage out of 39 counties in the state.
Forks Community
On the West End, Forks Community Hospital Executive Assistant Tomi Gingell said the board will discuss I-1000 on Tuesday before deciding whether or not to implement it.
“We have not made a decision yet,” Gingell said.
Assistant Administrator Joshua Gilmore said the vote could come as early as this week, but would “hesitate to say we’ll have a decision by then.”
In Seattle, University of Washington Medicine, Group Health Cooperative and Harborview Medical Center have announced plans to participate.
Volunteer Hospice
Port Angeles-based Volunteer Hospice of Clallam County has not come to a decision, director Rose Crumb said.
“We are gathering all the information we can right now,” Crumb said.
“Two of our board members are going to a seminar that is going to be dealing with this issue. The board is discussing it and gathering information.”
The Washington State End of Life Coalition and Washington State Palliative Care Organization is co-sponsoring a seminar on I-1000 in Sea-Tac on Monday, Crumb said.
The state Department of Health on Friday finalized the forms that patients will use to order lethal prescriptions.
Oregon became the first state to enact a right-to-die law in 1998.
Seventeen percent of terminally-ill Oregonians have considered taking life-ending medication, survey data shows, but just one-tenth of one percent have actually used it.
Since the Oregon law was enacted, 45 doctors have signed prescriptions for the lethal medication. There are 10,260 doctors in Oregon, OMC Administrative Director Donna Davison said.
“Bottom line, in Oregon, is if you average it out, about 30 or 31 patients a year have used this,” Davison said, during a presentation to the hospital board on Wednesday.
In most of those cases, the lethal drugs were administered in the patient’s home.
“In Oregon, one person has ever utilized it in a hospital,” said Johns, who manages Jefferson Healthcare’s hospice program. “Really, it’s an at-home thing for the most part.”
Procedure
An adult Washington resident with six months or less to live can apply for the lethal drugs by submitting two verbal requests 15 days apart, followed by a written request with a 48-hour waiting period.
Two witnesses must sign the written application, one of which cannot be a relative, heir, physician or employee of a health-care facility.”
“Informed consent is huge,” Davison said.
“The doctor has to provide so much information to ensure that the patient understands their diagnosis, prognosis, the risks involved, the alternatives that could be used.”
If a doctor believes an applicant has mental health condition, medication cannot be dispensed.
A mental health condition is defined under the law as “psychiatric or psychological disorders causing depression or impaired judgment.”
For life insurance purposes, the patient’s terminal disease is listed as the cause of death. It is not considered a suicide by law.
“It’s a very personal decision,” Johns said. “It’s between you, your physician and your family. I don’t think anybody enters into this lightly.”
ON MONDAY: Ethical decisions facing health care providers.
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Reporter Rob Ollikainen can be reached at 360-417-3537 or at rob.ollikainen@peninsuladailynews.com
