Oregon Public Broadcasting

Starting Thursday, medicine in Washington state will never be the same. Terminally ill patients with less than six months to live will be able to ask a doctor for a lethal prescription.

Washington joins Oregon as only the second state in the nation to enact a voter-approved, so-called Death with Dignity Law.

Last December, a judge in Montana ruled that assisted suicide is legal there too.

So how are Washington doctors feeling about this new reality? Olympia correspondent Austin Jenkins re-introduces us to one physician who last fall was struggling with how to vote on Washington’s Initiative 1000.

Last October, Kevin Martin – a family practice physician in Auburn, Washington – was agonizing about I-1000.

Dr. Kevin Martin and his dog Champ visit with a patient at an Auburn, WA nursing home.

Dr. Kevin Martin: “Most of the doctors I know don’t want to play god, they don’t want to give the appearance of playing god and I think that a lot of the discomfort that I feel in a very real sense this initiative puts physicians in that position.”

At the time, Martin didn’t know how he would vote on the initiative - modeled after Oregon’s Death with Dignity Act. Then Election Day rolled around. Martin still couldn’t make up his mind. So he abstained from voting either way.

Flash forward to today. Doctor Martin is doing rounds at an Auburn nursing home where he’s part-time medical director. In the sun room, he checks up on a wheelchair bound patient named Jesse.

Dr. Kevin Martin: “You hurting anywhere?

He’s got a persistent cough.

Dr. Kevin Martin: “Take some nice, deep breaths for me.”

In the nursing home setting, end-of-life issues are ever present. That’s why Dr. Martin wonders and worries when the day will come that a patient asks him to prescribe a lethal dose of medication under Washington’s new assisted suicide law.

Dr. Kevin Martin: “It’s going to be something that I am going to have to wrestle with my own conscience and if I decide that this is somebody that I think it appropriate at that point I’m going sit down and figure out what the options are that are available to the patient.”

Martin will also have to consider the policies of his employers. Hospitals and nursing homes can opt-out of the law and forbid their physicians from participating on the premises. Regardless Martin says he doesn’t even know what drug he’d prescribe or how much of it to ensure a patient died quickly and painlessly. That knowledge is available in Oregon, but he says it’s not something they teach you in medical school.

Dr. Kevin Martin: “It all comes down to compassion, but there are limits to how far compassion can take you. I remember a professor in medical school who said compassion without competence is crap and I think that that may be the position this initiative has put us in.”

Since the law requires two physicians to sign-off on a patient’s request to die, Martin imagines he would bring in a consulting doctor - someone with more knowledge who could provide that second opinion and write the prescription. That’s exactly what retired Oregon oncologist Peter Rasmussen would advise.

Dr. Peter Rasmussen: “It’s just like any other new procedure. It’s always helpful to have a mentor.

Over the years, Rasmussen wrote dozens of prescriptions under Oregon’s Death with Dignity law. Almost every time he was bedside when the patient took the drugs. He remembers at first it was very stressful.

Dr. Peter Rasmussen: “I had difficulty sleeping before and after, it was a real stretch for me and I think that’s what it should be. I think anybody for whom participating and aiding a death would be simple probably shouldn’t be doing it.”

In Washington – as is the case in Oregon - both patients and doctors will have a resource in Compassion and Choices. It’s an end-of-life organization that was a major financial backer of I-1000.

Terry Barnett: “We are ready and able to help people anywhere in the state with whatever needs and concerns they have surrounding the law.”

Retired lawyer Terry Barnett is President of the Board of the Washington Chapter of Compassion and Choices. The organization will serve as a referral service – as it has in Oregon. Barnett  says his group has already started compiling a list of doctors willing to participate in the law. And Barnett offers the organization’s medical director can educate other physicians on how to fulfill a patient’s request to die. Barnett expects a flurry of interest in these initial weeks.

Terry Barnett: “I think we’ll start to get lots of calls in large part because of the media attention to the law becoming effective and we’ll provide whatever support people need.”

Austin Jenkins: “How soon do you think we’ll see someone die under this law?”

Terry Barnett: “That’s very hard to say. I would just be speculating.”

In Oregon, the first death came five months after the law took effect. The Oregon law had been held up for several years because of legal wrangling. So far opponents in Washington have not filed suit to block the law. But they’ve planned protests and continue to argue the law is unnecessary and dangerous.

Eileen Geller is a hospice nurse who’s leading the opposition. She argues there aren’t enough safeguards in place to protect against abuses of the law.

Eileen Geller: “I’m receiving for physical therapy for a knee injury and the consent form for my physical therapy is much more detailed than the consent form for life-ending lethal prescriptions being given to vulnerable terminally ill and depressed and elderly people in our state.”

Geller says the focus should be on making dying people comfortable in their final days, not hastening their death. In Oregon end-of-life experts reported improvements in comfort care after the law took effect.

Supporters of I-1000 say they’re confident that will happen in Washington too.