ANALYSIS: Taking a closer examination of I-1000

On Nov. 4, Washington voters will vote on Initiative 1000, Washington’s Death with Dignity initiative. Having followed the development of this initiative, as well as the 10 years of empirical research on Oregon’s Death with Dignity law (upon which I-1000 is based), it seems that the public is not well-informed about this initiative to allow choice near the end of life.

What is important to know about I-1000?

The law restricts eligibility to terminally ill patients who are diagnosed with less than six months to live, as verified by two physicians. Thus, a disabled, but otherwise healthy person, or individuals with chronic or progressive diseases cannot qualify to use this law.

The law requires patients to be mentally competent as verified by two physicians. A depressed patient whose judgment is impaired in any way cannot qualify to use this law.

The law mandates numerous safeguards including:

• Only the patient can request and administer the medication. I-1000 prohibits anyone but the patient to self-administer oral medication.

• Decisions must be made voluntarily by a mentally competent patient.

• Two oral and one written request, a waiting period and objective witnesses are required.

• Two physicians must determine that the criteria are met.

• Patients must be informed of feasible alternatives and must be able to self-administer the medication. Ten years of published, peer-reviewed scientific research has been conducted on Oregon’s Death with Dignity law with NO evidence of abuse or of patients being coerced in any way.

Other Questions:

Q: Can’t modern medicine and pain management insure that all patients will live pain-free in their final days?

A: Unfortunately, even the most aggressive pain and symptom management fails to alleviate suffering in 5-20% of terminally ill patients.

Q: Isn’t death with dignity just a euphemism for suicide?

A: Local and national organizations such as the Washington State Psychological Association (WSPA), the American Public Health Association, the American Academy of Hospice and Palliative Medicine, and many others, clearly distinguish choices made by mentally competent, terminally ill individuals for physician-aid-in-dying from “suicide.”

According to WSPA, profound psychological differences distinguish suicide from patient-directed dying.

The term suicide is traditionally used to refer to medically well individuals who wish to end their lives because of severe emotional and/or psychiatric disorders. Typically, they do not consult with or have the support of others, often choosing violent means, acting alone, and causing suffering to those they leave behind.

Mentally competent, terminally ill individuals who wish for a humane and dignified death that is patient-directed, in a situation in which death is inevitable, differ from such suicidal individuals. A person with a terminal illness is going to die even with, or despite the best medical treatment available. The designation of suicide, WSPA notes, is disrespectful to individuals with terminal illness who wish to have choice regarding their dying processes and can be distressing and problematic for families and loved ones. Thus, terms such as aid-in dying, patient-directed dying, or a terminally ill individual’s choice to bring about a peaceful death, are more accurate.

Should mentally competent, terminally ill patients be allowed to have “choice” near the end of life?

Should a dying patient have the right to control the time and manner of his or her death in order to alleviate suffering and bring about a peaceful death?

No matter what one’s personal beliefs about choice near the end of life, it is important to accurately understand the terminology and the facts of this initiative.

Renee S. Katz is clinical psychologist and fellow in Thanatology: Death, Dying and Bereavement. For over 25 years she has worked with the bereaved and with those living with life-limiting and terminal illness. She is co-editor of When Professional’s Weep: Emotional and Countertransference Responses in End-of-Life Care.