Longtime patients are familiar with filling out forms from physicians and health insurers, but not like this one.
Called a "Request for Medication to End My Life in a Humane and Dignified Manner," the proposed form would be used by terminally ill Washington residents to initiate a specified process that would lead to their deaths.
"I understand the full import of this request and I expect to die when I take the medication to be prescribed," the form states. "I further understand that although most deaths occur within three hours, my death may take longer and my physician has counseled me about this possibility."
On March 5, Washington will become the second state after Oregon to allow physicians to legally prescribe lethal medication to terminally ill patients given six months or less to live. The patients must voluntarily ask for the drug and self-administer it.
The state Department of Health will hold a public hearing Tuesday on the proposed rules to implement the Death With Dignity Act, created after voters approved Initiative 1000 in November. The hearing will cover legal definitions and the steps that patients, witnesses, physicians and pharmacists must take to comply with the new law.
The act replicates Oregon's law of the same name, which took effect in 1998 and has facilitated 341 deaths, or about 34 a year, in its first decade, with a high of 49 in 2007. At least 80 percent of them suffered from cancer and were 55 or older.
The Washington State Medical Association remains opposed to what it calls "physician-assisted suicide" and will advise its members about their responsibilities under the law, spokeswoman Jennifer Hanscom said Monday.
In comments recently sent to the Department of Health, the association called for greater details and disclosure in the forms to better serve all parties.
For instance, the group wants the patient-request form to better show "that the patient is in fact acting voluntarily. For example, the form could require the patient to state that they have not been coerced, influenced (or) pressured in any way throughout this process."
Members of Compassion & Choices of Washington, the state affiliate of the Portland-based group that advocates for what it calls "aid in dying," plan to testify at Tuesday's hearing. They include social worker Arline Hinckley and Dr. Tom Preston, a cardiologist, both of Seattle.
"The procedure for procuring (lethal) medication should not present onerous obstacles for either the patient or the physician," Hinckley said. "Dying patients have very little energy left. That energy should not be spent dealing with burdensome regulations."
Since "most dying patients experience suffering," Preston said, his job is to "help my patients maintain as much control and dignity as they can at the end of life. ... And when I cannot relieve my patients' suffering, I support their right to decide to die at the time of their choosing."
Dr. Paul Buehrens, who practices family medicine in Kirkland, holds an opposing view.
The new law is "damaging to the profession of medicine, the role of healer in society, the conscience of the physician," he said. "And rather than promoting relationship, (it) promotes the autonomy of the patients at the expense of society."
Though the Washington State Hospice and Palliative Care Organization opposed I-1000, "now it will be a legal option," Executive Director Anne Koepsell said.
"Anyone involved in end-of-life care needs to understand that option." On Feb. 23, her group will hold a workshop on the law with the Washington State End of Life Consensus Coalition.
The board of the Washington State Pharmacy Association discussed the law at its annual retreat over the weekend.
"We support the pharmacist's decision to participate or not participate as defined by the law," association Chief Executive Officer Jeff Rochon said Monday.
If Oregon is any example, Washington pharmacists who decline to dispense the "morning-after pill," sold as Plan B, probably would decline to participate in the Death With Dignity Act, said George Eighmey, executive director of Compassion & Choices of Oregon.
"That really doesn't hurt us, because we have so many pharmacists willing to participate," he said.
In late 2007, a federal judge in Seattle issued a preliminary injunction allowing pharmacists to refuse to sell the Plan B pill, provided they referred customers to a nearby source.
That ruling favored Olympia pharmacy owner Kevin Stormans, who had argued in a suit against the state that his constitutional religious rights were being violated.
Asked last week if his pharmacy would dispense a lethal prescription under the Death With Dignity Law, Stormans replied, "That's not been a question that's been contemplated."
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