Washington State’s Death With Dignity Act: A Gratefully Received But Rarely Used Prescription

By the end of 2011, most of the 255 Washington residents who received a prescription for lethal medication to end their lives under the state’s Death with Dignity Act had been diagnosed with terminal cancer. Of those, 40 were patients at Seattle Cancer Care Alliance, part of the Pacific Northwest’s only National Cancer Institute-designated Comprehensive Cancer Center.

Photograph: Seattle Cancer Care Alliance Clinic Building, Seattle, Washington

Because several states are considering similar Death with Dignity laws, and because such legislation disproportionately affects cancer patients and their families, SCCA conducted a study to describe the institution’s implementation of the Washington state law and its experience with patients who chose to participate. The study’s findings are published in the April 11, 2013 issue of The New England Journal of Medicine.

The study found that overall, SCCA’s Death with Dignity program was rarely used, but in those cases where it was, the program was well-accepted by patients and physicians. “Qualitatively, patients and families were grateful to receive the lethal prescription whether or not it was used,” the authors wrote.

The study found the most common reasons for participating included loss of autonomy, an inability to engage in enjoyable activities and loss of dignity.

“People who pursue Death with Dignity tend to be individuals who want to be independent and want to have control over the conditions and timing of their final moments of life,” said Elizabeth Trice Loggers, M.D., Ph.D., corresponding author and medical director of SCCA’s Supportive and Palliative Care Service.

Washington was the second state, after Oregon, to enact a Death with Dignity law. It was passed in November 2008 after a voter-approved referendum and enacted in March 2009. Under Washington law, competent adults residing in the state with a life expectancy of six months or less due to a diagnosed medical condition may request and self-administer lethal medications prescribed by a physician. Prescribing physicians do not assist patients to ingest the medicine.

SCCA patient participants
A total of 114 patients inquired about the institution’s Death with Dignity program between March 5, 2009 and Dec. 31, 2011. Of these, 44 did not pursue the program; 30 others initiated the process but either elected not to continue or died before completing the steps necessary to obtain a prescription for lethal medicine. Forty patients received a prescription and 24 died after ingesting the medication, which was secobarbital, a barbiturate. The average time from ingestion to death was 35 minutes. The remaining 16 patients did not use the drug and eventually died of their disease.

For this study, SCCA patients were characterized as participants if they completed the steps required for a physician to prescribe lethal medication.

The participants were mostly Caucasian men with more than a high school education, married and ranged in age from 42 to 91.

Policy debate and decision
Loggers said that while SCCA’s goals are to cure cancer and save lives, providers also must be prepared to help patients with terminal disease by offering palliative care and other end-of-life services.