Health-care facilities scrambling to deal with Death with Dignity Act

With just a month before the Death with Dignity Act takes effect in Washington, hospitals and other health-care institutions are racing to learn the details of the law, decide if they will participate and put together policies that address the law's many nuances and complexities.

Statewide, many health-care systems and hospice programs have not yet come up with final policies on whether, or how, they will participate.

"It's a very short time" between the law's passage last November and when it takes effect March 5, said Dr. Hope Wechkin, medical director of Kirkland-based Evergreen Hospice Services.

For starters, "No physicians have been trained in how to evaluate for requests like this and prescribe life-ending doses of medication," said Wechkin, whose organization has not determined its policy. "This isn't something we have classes on in medical school."

The Death with Dignity Act, modeled on a decade-old Oregon law, permits terminally ill patients with less than six months to live to request and self-administer lethal medication prescribed by a physician. It allows institutions and individual doctors, pharmacists and other health-care providers to opt out of participating.

Some organizations — including the University of Washington Medicine health system and Group Health Cooperative — have already decided to participate.

But there are still questions, such as: Should hospitals require a mental-health evaluation before giving a prescription? If there's an on-site pharmacy, would the pharmacist be willing to fill the prescription?

Even Catholic health-care systems and other organizations that decided early to opt out are still grappling with practical and ethical issues: If a system opts out, how would its staff deal with a patient who wants to use this law? Could its caregivers be present when a patient takes the medication?

"One reason I think this is taking a while for people to sort through is it's a huge issue," said Cassie Sauer, spokeswoman for the Washington State Hospital Association.

"You talk to someone about: 'Is it time to get a knee replaced,' and there are numerous questions. Imagine how many more questions would accompany a discussion about ending a patient's life."

Some opting out

In the Seattle area, the UW Medical Center and Harborview Medical Center are participating, though making clear that individual physicians can opt out.

The area's other two largest hospitals — Swedish Medical Center and Virginia Mason Medical Center — haven't made their decisions yet.

Many hospice programs statewide also have not decided, though most seem to be leaning toward not participating, said Anne Koepsell, executive director of the Washington State Hospice and Palliative Care Organization.

For the most part, that would mean their physicians would not provide the medication and staff members would not be in a home at the time a patient ingested it, Koepsell said.

But hospice-care providers still could work with the patient and family before and after the actual act, helping a patient manage pain, and later, helping the family with grief counseling and funeral planning.

Catholic health-care organizations determined early on they wouldn't participate. In general, that means any caregiver operating within their facilities or on their behalf is forbidden from participating in activities that hasten a patient's death. And they will not make referrals to physicians who do.

What worries advocates of the Death with Dignity Act is that in some parts of the state, Catholic health-care organizations are one of only a few health-care options, if not the only one.

Dr. Tom Preston, a retired cardiologist who serves on the board of right-to-die organization Compassion & Choices of Washington, is concerned that people in those areas "would have to go elsewhere."

That's significant because in Oregon, 40 of the 341 people who used the law over the past decade were under the care of a Catholic health-care system or a physician working in one, said George Eighmey, executive director of Compassion & Choices of Oregon. The doctors prescribed the medications off-duty and off-premises, he said.

Furthermore, 88 percent of those who used the Oregon law were in hospice care at the time, Eighmey said. And in Washington state, the two largest hospice programs are run by Catholic organizations.

Still, based on the Oregon data, the fact that Catholic health systems aren't participating may not be a big obstacle to patients seeking aid in dying, said Sauer, of the hospital association.

That's because in Oregon, only about 45 doctors statewide wrote the approximately 85 prescriptions given in 2007.

"Even outside the Catholic system, it will be a small group of physicians willing to provide the life-ending medications" in this state, Sauer believes.

"But through a handful of physicians, people will get the prescriptions."

Janet I. Tu: 206-464-2272 or jtu@seattletimes.com