Robb Miller has been the Executive Director of Compassion & Choices of Washington—an affiliate of Compassion & Choices—since 2000. He was also one of the leaders of the coalition that passed Initiative 1000, the Washington Death with Dignity Act, with nearly 60% of the vote in 2008.
When the Washington Department of Health issued its third annual report on the Washington State Death with Dignity Act in early May, there was little interest from the media and no good news for opponents of patient autonomy at the end-of-life.
The lack of interest from the media tells us there was nothing sensational and no controversies to report. On the other hand, less media coverage means less awareness about the law.
Only 16 more people received prescriptions for life-ending medication as compared to 2010, and only 10 more died after receiving prescriptions. Of the 94 individuals who died, 70 self-administered medication, and 19 didn’t—32% of patients who acquired prescriptions in 2011 elected not to take the medication. This is bad news for opponents who claimed that people who use the law would be anxious to die and would take the medication prematurely. The report indicates just the opposite.
Other claims by opponents, such as “patients wouldn’t need the option if they had good palliative (comfort) care,” or that “patients will be encouraged to use the law to save money,” have been debunked by Washington’s and Oregon’s annual reports which indicate that the vast majority of patients who use the law were enrolled on hospice at the time of death and had health insurance.
Additionally patients’ concerns about pain control or the financial implications of treatment were both at the bottom of the list of end-of-life concerns of those who died after acquiring medication. As in prior years, their major concerns were loss of autonomy and dignity, and the loss of ability to participate in activities that make life enjoyable.
Prescriptions were written by 80 different physicians in 2011 (up from 68 in 2010) and dispensed by 46 different pharmacies. Participating physicians wrote an average of 1.3 prescriptions in 2011, and pharmacies filled an average of 2.2 prescriptions. This contrasts sharply with claims by opponents that only a few physicians would help the majority of patients who used the law.
An issue not fully addressed by the report is the difficulty that some patients face finding participating physicians in certain regions of the state. While considerable support for the law exists throughout Washington (the ballot measure received majority support in 30 of 39 counties), the 2011 report indicates only five out of 94 patients who died after acquiring—but not necessarily using—life-ending medication lived in Central and Eastern Washington.
Another problem is medical providers putting their values before those of their patients, i.e., practicing organization-centered care rather than patient-centered care. Although the Death with Dignity Act permits medical providers to decline to participate, participation is defined in law as performing the duties of a participating physician, pharmacist, or psychiatric/psychological evaluation provider. Participation does not include providing information about the Death with Dignity Act or referring patients to other physicians or organizations, such as Compassion & Choices of Washington, who will.
Nevertheless, some religiously affiliated providers, such as Providence Hospice of Seattle, a Catholic health care provider, have gone so far as to adopt “gag rules” that expressly prohibit its nurses, social workers, and other staff from discussing Death with Dignity or making referrals. Because a key component of hospice philosophy is patient autonomy, these kinds of policies are antithetical to the practice of hospice. They also violate informed consent, one of the most important principles in medicine.
One of the items the report doesn’t directly address is the peace of mind and comfort the law provides. Because most of the patients who use the law are clients of Compassion & Choices of Washington and work with our client support volunteers, we believe the law is a form of palliative care. Our clients frequently say the peace of mind and control they gain makes it easier to live out their remaining days, or once they’ve acquired the medication, they can “start living again.”
Finally, a major benefit of the Death with Dignity Act is that it allows patients to die at home in familiar surroundings surrounded by their loved ones. 93% of patients who self-administered life-ending medication died at home, most often with two Compassion & Choices of Washington client support volunteers present to support the patient and family through the process.
Like the 2009 and 2010 annual reports, the 2011 report confirms the law is safe and working as intended with no unintended consequences.
Compassion & Choices of Washington stewards, protects, and upholds Washington’s Death with Dignity Act and provides free counseling services to incurably and terminally ill patients statewide. Compassion & Choices of Washington also provides information and medical expertise to participating physicians and other medical providers. All services are free of charge, and confidentiality is strictly protected. For more information: 206.256.1636, 877.222.2816 toll free, info@CompassionWA.org, or www.CompassionWA.org.
The Washington State Department of Health’s 2011 Report on the Death with Dignity Act is available on the Washington Department of Heath website.
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