Physician Assisted Suicide
(PAS), in Washington state

Year 2008: I-1000. TV misinformation. Hospital
opt-out. I-1000 passed. First suicide. 2009 data.

Sponsored link.

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." ₂

_{(Emphasis ours)}

Yet in the Safeguards part of Initiative 1000, Section 6 defines "Counseling referral" the text of the initiative plainly states:

"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 consulting physician.

We contacted the Coalition Against Assisted Suicide for an explanation. As expected, we received no response.

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

2008: Initiative 1000 passed:

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 ..." ₆

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 law.

2009 Report:

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

References used:

The following information sources were used to prepare and update the above essay. The hyperlinks are not necessarily still active today.

1. "Martin Sheen to appear in ads against I-1000." Yakima Herald, 2008-SEP-29, at: http://www.yakima-herald.com/
2. "Initiative 1000 Opponents Debut Actor Martin Sheen in Commercials," press release, 2008-SEP-29, at: http://www.noassistedsuicide.com/
3. Home page of The Coalition Against Assisted Suicide, at: http://www.noassistedsuicide.com/
4. William Yardley, "A 2nd state lets doctors lend help in suicide," The New York Times, 2009-MAR-04, at: http://www.nytimes.com/
5. William Yardley, "First Death for Washington Assisted-Suicide Law," New York Times, 2009-MAY-22, at: http://www.nytimes.com/
6. Andrew H. Ko, "Cancer of the Pancreas," Cancer Supportive Care Programs, at: http://www.cancersupportivecare.com/
7. "A Careful Reading of State Reports Indicates Oregon and Washington Laws are Safe and Rarely Used," Death with Dignity National Center, 2010-Spring, at: http://www.deathwithdignity.org/

Up-to-date information:

The Death with Dignity National Center tracks bill activity at the state, national and international level. See:  http://www.deathwithdignity.org/

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Last updated 2010-JUL-03
Author: Bruce A Robinson

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