Analysis of Washington Assisted Suicide Initiative (I-1000)

Initiative 1000, called the “Death with Dignity Act,” will appear on the 2008 Washington State general election ballot. The assisted-suicide proposal is virtually identical to Oregon’s assisted-suicide law.

Former Governor Booth Gardner is the initiative’s prime spokesperson.  According to The New York Times Magazine (12/2/07), “Gardner’s campaign is a compromise; he sees it as a first step.  If he can sway Washington to embrace a restrictive law, then other states will follow.  And, gradually, he says, the nation’s resistance will subside, the culture will shift and laws with more latitude will be passed…”

The Death with Dignity Act would classify a lethal drug overdose as a medical treatment option. It would permit a doctor to help a patient commit suicide if the patient has a condition that is expected to cause death within six months.

The Assisted Suicide Initiative does not require that family members be notified when a doctor is going to help a loved one commit suicide.

Family notification is not required, only suggested. [Sec. 8] The patient’s family might not be notified until after the patient is dead.

The Assisted Suicide Initiative has no safeguards for the patient after the prescription is written.

As with Oregon’s law, physicians aren’t required to keep track of patients who have received assisted-suicide prescriptions. According to one Oregon official who was the lead author of most of Oregon’s official reports, “The law itself only provides for writing the prescription. not what happens afterwards.” [Dr. Katrina Hedberg, 12/9/04, published 4/4/05]

There are no provisions to insure that the patient is competent at the time the overdose is taken, that the patient is not pressured into taking the prescribed drugs, or that the fatal dose was not given to the patient against his or her will.

The only provision related to taking the prescription for assisted suicide is a recommendation that another person be present when the prescription is taken and that it not be done in a public place. [Section 4 (g)] If the patient does take the drugs in a public place, any governmental entity can make a claim against the dead person’s estate to recover costs related to the death (moving the body, cleaning up, etc.) and also to recover attorneys’ fees related to enforcing the claim. [Sec. 21]

The Assisted Suicide Initiative would give government health programs, managed care programs and HMOs the opportunity to approve prescriptions for suicide to cut costs.

In Oregon (the only state with a law permitting assisted suicide), Medicaid pays for assisted suicide for poor residents under the category of “comfort care.” The drugs for assisted suicide cost less than $100 – far less than medications and treatments to make patients comfortable.

In California, Sen. Joe Dunn (D-Santa Ana) cast the deciding “No” vote on an assisted-suicide measure based on Oregon’s law because the “power of money” would influence HMO’s, health insurers and the state. [SF Chronicle, 6/27/06] To save money, assisted suicide would expand while patient care would be cut back.

The Assisted Suicide Initiative does not allow anyone to “coerce” or use “undue influence” to obtain a request for assisted suicide. [Sec. 20 (2)] However, nothing in the Assisted Suicide Initiative prohibits physicians, or others from suggesting assisted suicide to a patient or encouraging a patient to request assisted suicide.

The Assisted Suicide Initiative would permit doctors to help mentally ill or depressed patients commit suicide.

A referral for counseling is only necessary “if, in the opinion of the attending or consulting physician, a patient may be suffering from a psychiatric or psychological disorder or depression causing impaired judgment.” [Sec. 6 emphasis added] If the counselor determines that the patient’s judgment is not impaired from the mental illness or depression, the prescription for assisted suicide may be issued. In the last year for which reports are available, physicians in Oregon reported referring only 4% of assisted-suicide patients for counseling. [Ninth Official Report, 3/8/07]

Even if a patient were found to have “impaired judgment,” the Assisted Suicide Initiative does not prohibit a health provider, family member or other person from arranging for the patient to be evaluated by other counselors until one is found who would declare the patient capable of choosing assisted suicide. This has already occurred in Oregon where it has been noted that “a psychological disorder — senility, for example — does not necessarily disqualify a person.” [Oregonian, 10/17/99]

A woman died of assisted suicide under Oregon’s “Death with Dignity Act,” even though she was suffering from early dementia. Her own physician had refused to provide a lethal prescription for her. When counseling to determine her capacity was sought, a psychiatrist determined that she was not eligible for assisted suicide since she was not explicitly pushing for it. Rather, is was her daughter who seemed to be coaching her to do so. She was then taken to a psychologist who determined that she was competent but possibly under the influence of her daughter who was “somewhat coercive.” Finally, she was assessed by a managed care ethicist who determined that she was qualified for assisted suicide, and the lethal dose was prescribed. [Oregonian, 10/17/99]

The Assisted Suicide Initiative does not insure that abuse or the number of deaths from assisted suicide would ever be known.

As with the Oregon “Death with Dignity Act,” the Assisted Suicide Initiative requires that information on assisted suicide be collected [Sec. 15], but there are no penalties for incomplete or inaccurate reports nor even for not reporting.

The Assisted Suicide Initiative does not require that requests for assisted suicide be made in person.



As with Oregon’s assisted-suicide law, under the Assisted Suicide Initiative, a patient must make two oral requests and one witnessed, written request for assisted suicide. [Sec. 9] Nothing prevents the two oral requests (which need not be witnessed) from being made by phone, nor does the initiative prevent the written request from being mailed to the doctor.

Following receipt of the requests, the doctor could fax the prescription to a pharmacy where the patient or someone designated as the patient’s agent could pick it up. [Sec. 4 (l)(i)(B)

The Assisted Suicide Initiative would require all state agencies to refer to assisted suicide as “obtaining and self-administering life-ending medication.” [Sec. 18]

Assisted suicide by any other name is still assisted suicide. The new label for assisted suicide is the result of polling done by Compassion & Choices (formerly known as the Hemlock Society). Polls indicated that the public was far more likely to oppose measures called “assisted suicide” than identical proposals or actions called by another name. [Gallup News Service, 5/17/05 and Californians for Compassionate Choices Act Press Kit, 9/28/05]

The Assisted Suicide Initiative would require that death certificates not list assisted suicide as the cause of death.

The Assisted Suicide Initiative would require that the cause of death for assisted-suicide be listed on death certificates as the terminal disease with which the patient was diagnosed before receiving the assisted-suicide prescription. [Section 4, (l)(ii)(B)(2).

The Assisted Suicide Initiative could victimize minorities, people with disabilities and poor people.

According to the Washington State Office of Financial Management, one in 11 Washingtonians lack health insurance. [11/06] How many poor and uninsured Washingtonians would choose the “option” of assisted suicide because they could not receive adequate medical care?

Back to main Washington page.