Initiative 1000: Terminally ill should have a choice

It's officially "The Washington Death with Dignity Act," and Initiative 1000 has predictably emerged as the most controversial of three ballot issues facing Washington voters Nov. 4. Little wonder since it authorizes state-sanctioned suicide under controlled circumstances.

We have listened to proponents and opponents and conducted extensive research on this sensitive issue. While we respect the views of opponents, we're going to recommend approval of I-1000 -- an issue that in the final analysis is about people making end-of-life choices about themselves.

If the measure is approved, Washington would become the second state -- behind neighboring Oregon -- to authorize planned suicide for the terminally ill. Oregon's law has been on the books 10 years now and has survived a couple of court challenges.

The track record in Oregon shows that after a decade, the number of people actually opting for that final end-of-life decision is low -- 341 over a 10-year period through 2007, out of 545 people requesting the life-ending prescriptions. Opponents challenge the accuracy of those numbers because of what they see as suspect reporting of such deaths. Be that as it may, the numbers show that in a system that offers a dying person an option, there is no evidence of abuse.

Washington voters defeated a broader right-to-die measure in 1991 by 54 percent to 46 percent. That proposal would have allowed doctors to actually administer lethal drugs directly to dying patients. Initiative 1000 differs in that it would give terminally ill, competent adult residents of Washington who have less than six months to live the right to request -- and self-administer-- lethal medication prescribed by a physician.

We think adequate safeguards are in place in the measure to prevent abuse (see accompanying box.) Besides, the flip side of the abuse argument is that without safeguards and a legal procedure, it would be naive to believe that such assisted deaths are not now happening outside the law in the country as a whole.

Our endorsement of I-1000 should in no way be seen as supporting it as a substitute for hospice and palliative care for the terminally ill. To the contrary, those efforts should be continued. Assisted suicide should only be a legitimate alternative for people whose personal and religious beliefs allow them the end-of-life choice when all other care options have been exhausted.

However, critics of the measure draw attention to a couple of areas we also think should be reviewed after passage: The six-month window that triggers the provisions of I-1000 and the requirement that doctors list the cause of death in such instances as the underlying terminal disease as the cause of death, rather than the lethal dose.

The window seems long, arbitrary and leaves too great a chance for patients taking their lives prematurely. The cause-of-death certification smacks of falsifying a death certificate, even though it has been medically determined that the patient is going to die from the terminal disease without the prescription.

If I-1000 is voted into law, the Legislature can revisit it and change it by two-thirds vote within the first two years it is on the books. After that changes can be made by lawmakers with a simple majority vote. So, even if it's approved, the measure is not written in stone and can be changed -- or even taken off the books -- if legislators decide that's necessary.

That being the case, we support the initiative as an option for those who want to have that choice.

• Members of the Yakima Herald-Republic editorial board are Michael Shepard, Sarah Jenkins, Bill Lee and Karen Troianello.

I-1000 requirements and safeguards

Under Washington state's proposed Initiative 1000, to qualify for a lethal prescription, a patient must:

* Be at least 18, declared competent, and a resident of Washington state.

* Have been determined by the attending physician and another, consulting physician, to have a terminal disease from which he or she will die within six months. A person does not qualify solely because of age or disability.

* Make an oral and written request, signed and dated by the patient and witnessed by two other people. One of the witnesses must not be a relative of the patient, entitled to the patient's estate, anyone tied to a health facility where the patient is being treated or is a resident, or the attending physician.

* Repeat the oral request to the attending physician at least 15 days after making the initial oral request. The patient can rescind the request at any time. There must be at least two days between when the patient signs the written request, and when the prescription is written.

Once the request is made, the attending physician:

* Determines whether the patient is competent and has made the request voluntarily.

* Informs the patient of other alternatives, like hospice care and pain control.

* Refers the patient to another physician for confirmation of the terminal diagnosis and to ensure the patient is competent and acting voluntarily.

* Recommends the patient for counseling if the doctor, or the consulting physician, believe the patient is suffering from a psychiatric or psychological disorder, or depression.

* Recommends that the patient notify next of kin, though the patient is not required to do that in order to receive the prescription.

* Dispenses medication directly, or with the patient's consent, contacts a pharmacist to fill the prescription.

* Signs the patient's death certificate, listing the underlying terminal disease as the cause of death.

-- Source: Initiative 1000

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