WASHINGTON — A growing number of terminally ill residents have chosen to die on their own terms since the Death With Dignity Act went into effect in 2009. However, a recent report suggests that few minority, lower-income and rural Washington residents have taken advantage of the law. It may be more difficult for residents in rural parts of the state, including Pacific County, to participate because they don’t have easy access to participating doctors and pharmacists.
Washington is one of just four states where “aid in dying” (sometimes called “physician-assisted suicide”) is legal. Under state law (which is modeled after Oregon’s 1997 Death With Dignity Act) a mentally-sound person who is within six months of dying from a terminal condition can request a lethal dose of medication. The process requires approval from two physicians as well as a pharmacist who is willing to dispense the lethal drugs. In some cases, a psychological evaluation is also required to ensure the person is competent to make the decision.
The number of people who received the lethal doses of medication has increased each year, from 65 in 2009, to 176 in 2014, according to an annual report published by the state Department of Health. DOH is responsible for making sure that participating patients, doctors and pharmacists comply with the requirements of the DWD Act.
As of March 15, about 170 of the 2014 participants, ranging age from 21 to 101, had died. At least 126 of those patients actually took the medication. In all, 109 Washington physicians and 57 pharmacists helped patients end their lives during 2014.
A spokesman for DOH would not say how many Pacific County residents have participated in the program, saying that the number of participants in rural counties is so small that providing even anonymous data could reveal patients’ identities.
The program appears to work well for those who win approval to take the medication. In 2014, the approval process generally took somewhere between two weeks and six months. The majority of patients were able to take the medication at home. Most died within two hours of taking the medication. About 96 percent of patients did not experience any complications, and none called for intervention after taking the medication.
The people who participate seem to have many things in common: 73 percent of the 170 who died had some form of cancer, and 13 percent had neuro-degenerative conditions such as Lou Gehrig’s Disease. Most patients cited the same reasons for requesting aid-in-dying: concerns about losing their independence, losing their dignity, and losing the ability to participate in the activities that make life enjoyable.
According to the report, 92 percent of the participants were white, 93 percent had some form of insurance, and 76 percent had at least some college education. More than half were married, and 95 percent lived west of the Cascades.
Currently, experts don’t have enough information to determine whether the lack of diversity among participants is due to cultural or religious factors, financial concerns, difficulty accessing services, or some combination of factors.
“There would be really no way for us to know that information,” DOH epidemiologist Phyllis Reed said on Nov. 1. She explained that DOH researchers don’t start collecting patient information until the prescription has been written. In other words,the state only finds out when the approval process goes right.
“We don’t have definite answers on that. I know for Eastern Washington, it can be more of an access issue,” said John Eric Rolfstad, executive director of End of Life Washington (formerly Compassion and Choices). His non-profit group offers counseling and assistance to terminally ill patients who are exploring end-of-life options.
According to Rolfstad, one common challenge is that people who don’t live in major cities may have to travel out of their area to have the two required consultations and pick up the medication. That can be a serious hardship for people who are low-income, don’t have transportation, or are too sick to travel.
Another issue is that it can be hard for rural patients to get accurate, helpful information about aid-in-dying.
That is especially true in places like Pacific County, where hospitals have adopted policies that ban practitioners from assisting patients who seek DWD services.
“Some of the health care systems prohibit even their doctors and staff from giving information about Death With Dignity,” Rolfstad said. “Not only can they not participate, they can’t even give referrals. That becomes a real barrier for people.”
Changes in the medical and insurance industries have forced all but very few doctors to affiliate with larger healthcare systems. With so few independent practitioners, the philosophy of each community’s dominant medical system tends to dictate whether residents there have access to DWD counseling and services, Rolfstad said.
In 2009, the boards of both Willapa Harbor Hospital and Ocean Beach Hospital adopted policies that prohibited their employees and facilities from providing DWD services.
Additionally, since 2012, Ocean Beach Hospital has operated under a management contract with the non-profit, Catholic PeaceHealth hospital system. PeaceHealth does not allow its employees or facilities to provide aid in dying. Two of the closest large hospitals, St. John Medical Center in Longview, and Southwest Medical Center in Vancouver are also PeaceHealth facilities.
Rolfstad said he’s “quite sure” End of Life has served people from this region, but he can’t provide more specific information for confidentiality reasons.
“We do work with those folks to find someone who will work with them,” Rolfstad said, adding that although a few participating doctors do make house calls, people here would probably have to travel at least as far as Chehalis or Olympia for their consultations.
“When your health is poor, that may be quite an effort, just to take a trip for an hour or two to see a doctor,” Rolfstad said.