Physician Assisted Suicide
(PAS), in Washington state
I-1000. TV misinformation. Hospital
opt-out. I-1000 passed. First suicide. 2009 data.
Misinformation in TV ads:
Martin Sheen was featured in a number of TV ads in opposition to Initiative
1000. It was part of a $750,000 advertising campaign. 1 In one ad which appears on the
Coalition Against Assisted Suicide's web site, he says that:
"Initiative 1000 tells doctors its OK to give a lethal drug overdose to a
seriously ill person even if they are suffering from depression." 2
This seems to be a serious misrepresentation of
Initiative 1000 on at least three levels:
It is definitely not OK for doctors to prescribe a
lethal drug overdose in almost all cases. Two doctors and their patient must
follow specific procedures before drugs are given. Above all, the initiative
must come from the patient.
Drugs are not given freely to seriously ill patients;
the person must be terminally ill with less than six months to live.
Giving drugs to a depressed patient is specifically
prohibited by the law.
The Coalition's website appears to have reinforced Sheen's statement
concerning depression, and goes even
further. It said, on 2009-MAR-06:
"According to [Eileen] Geller, [the Coalition's campaign coordinator] ...
the ads point out some of the little known, major flaws of the proposed law.
... Persons suffering from depression can be given a lethal overdose without
any psychological counseling or treatment -- nothing in the Initiative
requires an assessment of potential depression by a qualified professional."
Yet in the Safeguards part of Initiative 1000,
Section 6 defines "Counseling referral" the text of the initiative plainly
"If, in the opinion of the attending physician or the consulting physician,
a patient may be suffering from a psychiatric or psychological disorder or
depression causing impaired judgment, either physician shall refer the patient
for counseling. Medication to end a patient's life in a humane and
dignified manner shall not be prescribed until the person performing the
counseling determines that the patient is not suffering from a psychiatric or
psychological disorder or depression causing impaired judgment." 3
To a casual observer, the statement by Sheen and its confirmation by Geller
would seem to be simply untrue. But, as is common with ballot initiatives of
this type, it is impossible to know whether statements were:
Intentional lies to strike fear into the electorate, misrepresent the
Initiative, and motivate them to vote no, or
An accidental mistake, misinterpretation, or oversight, or
Valid if considered by an unusual interpretation that would not be
immediately apparent to the casual observer. It may be that both Sheen and
Geller were referring to an unusual circumstance where a patient was actually
clinically depressed but did not appear depressed to both the attending and
We contacted the
Coalition Against Assisted Suicide for an explanation. As expected, we received no
Hospital opt out:
The law contains an opt-out provision for those hospitals who do not want to
meet the needs and wishes of dying terminal patients. Hospitals can chose to participate,
to not participate, or to allow the doctors with privileges at the hospital, but
who are not employed by it, to write prescriptions on their own time, as long as
it is not for a patient admitted at the hospital. However, they must allow staff
members to refer a patient to another health care provider if they do opt-out.
This clause was included partly to handle those hospitals controlled by the
Roman Catholic Church.
Terry Barnett, president of the board of Compassion and Choices of
Washington State -- the group that led the campaign to pass Initiative 1000
-- said that a hospital's decision "doesn't make any difference." In Oregon,
nearly all of the 401 people who have used their death with dignity law over the
11 years of its existence have died at home. 4
The initiative was added to the 2008-NOV ballot where it passed by a vote of
58% to 42%. Washington State became the second state in the U.S. to approve PAS
for its citizens. It went into effect four months later on 2009-MAR-05.
2009-MAY-21: First suicide completed under the state assisted suicide law:
Linda Fleming, 66, of Sequim, WA had received a diagnosis of Stage 4
pancreatic cancer in April. 5 This
is the final stage, when the cancer has metastasized -- spread to other organs.
According to Compassion and Choices of Washington, the advocacy group
that promoted the law, "She was told that she was actively dying."
This is one of the worst types of cancer to have. According to Cancer
Supportive Care Programs:
"... the annual mortality rate almost approximates the annual incidence rate,
which reflects the generally short survival time associated with pancreatic
cancer, most often less than one year. On a stage for stage basis, cancer of the
pancreas is met with the shortest median survival time out of all cancer types.
"For patients with advanced pancreatic cancer, pain is often the major
problem and needs to be treated aggressively. This may require escalating doses
of narcotics, which can be given as pills, oral solution, or as transdermal
patches (placed on the skin). In general, long-acting narcotics should be given
to provide a baseline degree of round-the-clock pain control, with more short,
immediate-acting narcotics on hand for use as needed for breakthrough
pain. These narcotics can cause a fair amount of drowsiness, confusion
(particularly in older patients), and constipation ..."
She decided to seek assistance in committing suicide. She said:
"I am a very spiritual person, and it was very important to me to be
conscious, clear-minded and alert at the time of my death. The powerful pain
medications were making it difficult to maintain the state of mind I wanted to
have at my death." 6
Her two children and her former husband were involved in her decision. All supported her. She died
after taken a lethal dose of oral medication prescribed by her doctor in
accordance with the
The state reported that during 2009, 53 physicians issued a total of 63 prescriptions for a fatal dose of barbituates to their patients. Of these, 36 used them to commit suicide. 7