New England Journal of Medicine Looks at Washington’s Death with Dignity Act

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Dr. Remmel with his sons, photo provided to NBC News by Grace Wang
Dr. Remmel with his sons, photo provided to NBC News by Grace Wang

When Washington’s Death with Dignity Act took effect in 2009, medical groups throughout the state took the law’s built-in safeguards as a guide for formulating their own internal policies for honoring their terminally ill patients’ new legal rights. One of these institutions, the Seattle Cancer Care Alliance, just published an analysis of their experience with patients who requested the prescribed medication in the New England Journal of Medicine. Their conclusion: “Overall, our Death with Dignity program has been well accepted by patients and clinicians.”

Echoing what we’ve seen through the Washington Department of Health’s annual reports of usage, this study found the law is used by a small minority of the clinic’s patients and “patients and families were grateful to receive the lethal prescription, whether it was used or not.”

The 114 patients involved in the study inquired about the clinic’s Death with Dignity program between March 5, 2009, and December 31, 2011. Among these patients, 74 either decided not to start the request process or started the process and didn’t complete it. Of the 40 terminally ill people who did receive the medication, 60% of them died after ingesting the medication. One of these people was Dr. Ethan Remmel, whom I had the privilege of working with toward the end of his life in 2011. He was a truly giving and generous individual I’m pleased to have known, and I’m so happy his life is being honored and celebrated in conjunction with this study.

In one of the many news stories about this study, Dr. Elizabeth Loggers, an oncologist and the center’s medical director for palliative care, got to the heart of why the center developed a policy to honor patient’s wishes under Washington’s law stating, “You can’t be an oncologist for very long without honestly facing the fact that not everyone can be cured of their cancer. In this situation, you are ethically obligated to provide exceptional care for people who are dying of their illness.”

In addition to the safeguards already written into the Washington and Oregon Death with Dignity Acts, the Seattle Cancer Care Alliance additionally stipulated only current patients of the clinic could request the prescribed medication, a social worker at the clinic is assigned to each person who requests the medication, and the patients were required to sign an agreement stating they won’t ingest the medication in a public space.

The wide news coverage of this study is encouraging. It further demonstrates the conversation about how we die and the necessity for Death with Dignity Acts are growing on a national scale. All of us here at the Death with Dignity National Center are excited to be such an integral part of these discussions.

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