On February 27, the Washington state senate decided to subject many more of its residents to the risk of being hastened toward death by drug overdose.
The senators did this by approving Senate Bill 5179, promoted as legislation to “expand access” to the state’s Death With Dignity Act (DWDA). The bill actually expands “access” to the lethal drugs themselves, by weakening or eliminating the “safeguards against coercion and abuse” that persuaded Washington voters to support the current Act in November 2008.
The DWDA allows physicians to prescribe “lethal medication” so terminally ill patients expected to have less than six months to live can take their own lives. The safeguards include agreement by a second physician, informed consent procedures, and referral for mental health evaluation if either physician thinks depression or other mental disturbance is impairing the patient’s judgment. A first oral request for the drugs is followed by a 15-day waiting period to reconsider, then a formal written request signed by the patient — and witnessed by two people swearing that the patient is of sound mind and not acting under coercion or undue influence. Another 48 hours must elapse between that final request and the lethal prescription.
Finally, physicians must submit the patient’s request form and their own “compliance form” to the state Department of Health within 30 days of writing the prescription. Otherwise they are subject to professional discipline, civil liability, and criminal liability for assisting a suicide, which remains a felony.
This may seem strict. Supporters of 5179 say it is so strict as to exclude many eligible patients from acting on their “right” to the lethal drugs. But the facts tell another story.
The Department of Health’s annual reports show that the 400 Washingtonians obtaining the lethal drugs in 2021 are six times as many as in 2009, the Act’s first year; and the 291 known to have died from the drugs that year are eight times the number then. Medical studies show that a great many terminally ill patients asking for death suffer from treatable depression; yet almost none of these patients receive a psychological evaluation before taking the drugs. While supporters say Washington is “lagging behind” states like California with more permissive laws, a Washington resident in 2021 was nearly three times more likely to obtain the lethal prescription than a Californian.[1]
And in hundreds of cases since 2009, physicians have not bothered to report that they complied with any of the safeguards. In 219 cases they have not filed their legally required report on the patient’s terminal illness, life expectancy, informed consent, or mental competency. In 257 cases there is no report that a second physician confirmed such findings. And in 264 cases, the Department of Health never received a request for the drugs signed by the patient. These abuses of patients and the law have become more common, with half of them occurring in the last three years. Yet the Department’s annual reports, having documented these figures, list them as cases where lethal medication was provided “under the terms of the law.”
In practice, then, the “death with dignity” process may be taking the lives of many people who are not terminally ill or expressing a desire for the drugs. So Washington state legislators think the law needs “expanding.”
SB 5179 would shorten the waiting period from 15 days to 7 days; allow physical and psychological assessments by non-physicians; and allow the lethal drugs to be sent by mail or messenger to persons other than the patient. As introduced the bill allowed even the 7-day period to be waived at the discretion of one non-physician; that provision for what critics call “same-day suicide” was deleted on the Senate floor to ensure the bill’s passage. Now the House of Representatives, which has shown stronger support for “expansion” in the past, is poised to vote.
This drive in Washington is not due to any restriction specific to our state. The national assisted suicide advocacy group, Compassion & Choices, has been pushing that agenda in every state that previously legalized the practice, scoring successes in Oregon and California.
What lessons can we learn from this situation? The lesson in Washington is that this agenda is by no means finished. The prime sponsor of the “expansion” bills in recent years, Rep. Skyler Rude, has expressed concern about “barriers to access” posed by the continued ban on lethal injections by third parties (that is, on homicide), and by the Act’s permission for objecting physicians and hospitals to opt out of participating. The lesson for other states considering legalization is simple: The proposal in your state will not be the last time you are asked to place vulnerable patients at risk of an early death. It is only the first time.
Richard M. Doerflinger, M.A. is an associate scholar with Charlotte Lozier Institute.
[1] California’s population is over five times that of Washington, yet California residents received 772 lethal prescriptions and Washington residents received 400, according to their respective health department annual reports. See California census data (2020) available at https://www.census.gov/library/stories/state-by-state/california-population-change-between-census-decade.html; See California End of Life Option Act: 2021 Data Report (July 2022), available at https://www.cdph.ca.gov/Programs/CHSI/CDPH Document Library/CDPH_End_of_Life _Option_Act_Report_2021_FINAL.pdf. See Washington census data (2020), available at https://www.census.gov/library/stories/state-by-state/washington-population-change-between-census-decade.html; See Washington’s 2021 Death with Dignity Act Report (July 15, 2022), available at https://doh.wa.gov/sites/default/files/2022-11/422-109-DeathWithDignityAct2021.pdf?uid=640a2d9d16d42.
