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Originally published September 21, 2008 at 12:00 AM | Page modified September 22, 2008 at 4:55 PM

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Initiative 1000 would let patients get help ending their lives

As the Nov. 4 election approaches, voters' experiences and fears about death are triggering powerful emotions as they consider I-1000, which would allow doctors to prescribe lethal doses of medication for terminally ill patients seeking to hasten their deaths.

Seattle Times health reporter

Information

Read the initiative: www.secstate.wa.gov/elections/initiatives/people.aspx

Yes on 1000: www.yeson1000.org

Coalition Against Assisted Suicide: www.noassistedsuicide.com

Initiative 1000

This measure would permit terminally ill, competent adult Washington residents, who are medically predicted to have six months or less to live, to request and self-administer lethal medication prescribed by a physician.

I-1000's provisions

The patient

A patient requesting a lethal dose of medication to end his life must:

• Be a terminally ill, mentally competent adult state resident expected to die within six months.

• Be free of depression and able to muster sound judgment.

• Request the prescription verbally and in writing, and again verbally after a 15-day waiting period.

• Have two witnesses to his or her request. One of those witnesses must not be an heir, related or employed by the health-care facility caring for the patient. No witness is required to be present when the patient takes the drugs.

The doctor

Any doctor can opt out of providing the lethal prescription to a patient. A willing doctor must:

• Determine that the patient is competent and acting voluntarily.

• Inform the patient of the medical diagnosis, prognosis and the risks and probable result of taking the lethal dose.

• Offer alternatives, including pain control, comfort care and hospice.

• Inform the patient of the right to rescind the request at any time.

• Refer the patient to a second, consulting doctor who must verify that the patient has a terminal disease, is competent, acting voluntarily and making an "informed decision."

• Refer the patient for counseling if patient is depressed or otherwise not competent.

• Recommend that the patient notify next of kin.

• Document in the medical record all the steps required by the law.

The pharmacist

• Must dispense medications directly to the patient, the doctor or a chosen representative of the patient.

Source: Initiative 1000

One woman shudders and chokes back tears as she recounts the agony of her husband's slow death. Another recalls with wonder and affection the many precious months she and her husband shared before he finally succumbed.

After intimate encounters with death, these two came to opposite conclusions about Initiative 1000, which would allow doctors to prescribe lethal doses of medication for terminally ill patients seeking to hasten their deaths.

Oregon is the only state that allows the dying to get medical help explicitly to end their lives. No other such proposals are on the ballot this fall in other states.

As the Nov. 4 election approaches, voters' experiences and fears about death are triggering powerful emotions as they consider I-1000.

Dr. Jack Leversee, an 81-year-old retired family doctor from Seattle supporting the initiative, has seen enough — up close and gritty — to know what he doesn't want.

"The last thing I want is to be in an intensive-care unit in some hospital and being declared alive because I'm artificially on a breathing machine, keeping my heart going with a defibrillator, unconscious so I can't communicate with my family in any way," he said. "I don't want that at all."

Opponent Duane French, paralyzed since age 14 after a carefree dive off a bridge, recalls all the times people have confessed they'd rather be dead than like him — unable to move without his electric wheelchair.

"They see me as helpless, someone whose life isn't worth living," said French, a 54-year-old who is married and working for the state. "That's what this campaign is all about."

A law offering physician assistance to die might first apply only to terminal patients, but it wouldn't stop there, French says, given the "deep prejudice" against the disabled. And that frightens him.

What frightened Sherri Jones — enough to volunteer to gather signatures for the initiative — was coming across the body of a man who had shot himself in his car.

Jones, a 47-year-old Snohomish woman who was driving her preteen daughter home from a gymnastics class several years ago, later learned that the man had terminal cancer. He had killed himself in the car, alone, to spare his wife and granddaughter the trauma of finding his body.

"That was such a selfless, beautiful action, for such a sad, horrible thing," said Jones, who sought counseling after sleepless nights. "It just made me feel like, 'Why is there no option for people?' "

Initiative redux

This is the second time around for a physician-assistance-in-dying initiative in Washington. In 1991, after one of the most expensive initiative campaigns ever at that time, Initiative 119 was narrowly defeated.

Initiative 119 would have allowed a doctor to prescribe and administer lethal drugs, such as with a lethal injection.

I-1000 is substantially different. Under this measure, closely modeled on Oregon's law, patients must self-administer — defined as "ingest" — a lethal dose of medication. Doctors could prescribe the drugs, but not administer them, without running afoul of a state law against assisting a suicide.

The current campaign began in early 2006, when former Gov. Booth Gardner, who has Parkinson's disease, unexpectedly announced at a speaking event that he planned to head an effort to legalize doctor assistance in dying.

The U.S. Supreme Court had just cleared the way for such legislation by upholding Oregon's law.

Gardner's bombshell took many choice-in-dying advocates by surprise, but the former governor, in an interview soon afterward, said he'd been thinking about it for some time.

"When the day comes when I can no longer keep busy, and I'm a burden to my wife and kids, I want to be able to control my exit," he said at the time.

As the campaign geared up, advocates struggled with a thorny question: What to call it?

A judge, considering a ballot-title challenge by French, who heads the local chapter of disability-rights group Not Dead Yet, refused to allow the ballot title to refer to I-1000 as "assisted suicide," because "suicide" is not a neutral term. Nor, the judge added, is "death with dignity," the term preferred by advocates.

Instead, the language voters will see on their ballots is starkly clinical, stating that terminally ill adults would be allowed to "request and self-administer lethal medication prescribed by a physician."

A very personal issue

For many people, the battle lines are exceedingly personal. Even those who endure a similar experience — the death of a cherished spouse, for example — can end up on different sides.

There's Nancy Niedzielski, who watched her husband, Randy, die a lingering, painful death from brain cancer in 2006.

Randy knew what was coming, she said, because many close friends from a support group had died. "He knew the ugliness his death was going to cause him, the pain and the suffering," Niedzielski said.

When hospice workers told him laws prevented them from helping him hasten his death, her gentle husband became uncharacteristically angry, she recalled.

"He said, 'They don't have a right to tell me how long I have to suffer.' "

Nancy promised Randy she would help change the law.

"Nobody knows what they're going to want in the future," said Niedzielski, who gathered more than 1,700 signatures for the initiative. "This is about giving people options and choice, because none of us knows how we're going to die."

Rheba de Tornyay, former dean of the University of Washington's school of nursing, came to a different conclusion after her husband of 53 years, Rudy, died last year after a long illness.

A believer in self-determination, she supported I-119. More than most, she had seen the emotional and financial costs to families as patients died slowly, and often painfully, with skimpy pain medication.

"We were very worried about them getting addicted — we had all kinds of screwy viewpoints about it," she said.

But times have changed, she says now. Patient-administered pain medication, pain teams and "an enormous change in attitude" mean providers can now control "bad symptoms."

She cherished the "extra" months with Rudy. "I'm really grateful he was able to live out his life — it was a beautiful time," she said. "There's no question that it changed me."

Now 82, she's on the stump against I-1000. "I just don't think it's necessary."

Deliverance or danger?

In Washington, patients can voluntarily stop life-sustaining machines or treatment, including food and water. If they're in pain, their doctor may agree to give enough pain medication that it eventually causes death, which is legal because the intent is pain relief — not ending life.

But an initiative backer, Dr. Thomas Preston, a retired cardiologist who has attended to more than 100 patients in their final days, says such strategies don't always work. "Even in the best of hands, there is still pain and suffering."

I-1000 says patients must be free of depression, able to exercise sound judgment and have less than six months to live in order to obtain a lethal prescription. But advocates and opponents differ as to whether the measure contains adequate safeguards to screen out patients who don't qualify.

Chris Carlson, the 61-year-old volunteer chairman of the opposition coalition, says doctors are often wrong when they predict life expectancy. In late 2005, he was told he would be dead in six months from cancer.

Opponents, backed by recommendations from a task force from Oregon Health & Science University, argue that I-1000 should require every patient to get a psychological evaluation and order an independent review of all cases to ferret out abuses.

In Oregon, opponents charge, some patients have been depressed or pressured by family members to take their own lives.

Margaret Dore, a Seattle attorney who handles probate and guardianship disputes, argues the initiative wouldn't protect against a patient being pressured — or even forced to swallow lethal drugs — by a "greedy son."

Advocates argue that Oregon's 10-year experience proves few people use the law — on average about 30 a year — and that there have been few problems.

Faith and finances

While right-to-die organizations have provided heavy funding for the initiative campaign, donations to the opposition have come in large part from dozens of dioceses, parishes and Catholic organizations around the country.

The Archdiocese of Seattle and the Catholic Health Association each gave $50,000.

That's raised a dispute over whether a religious group is seeking to impose its beliefs on the general public, or simply following the dictates of its faith.

The opposition, which was seriously underfunded earlier this year, says it's relieved.

"Well, if the Catholic Church wasn't heavily involved in this, I would be disappointed," Carlson said. "We have for some time been hoping that religiously affiliated groups would recognize the danger to patients presented by Initiative 1000."

Once, while she gathered signatures in support of the initiative at Seattle Center, Sherri Jones recalls, a man berated her for her "sinful" actions.

"I said: 'I don't have the same belief system you do, so to me it's not a sin,' " Jones said.

For others, it's not about faith as much as their vision of the future.

Leversee, the retired family doctor, says it's time for patients to wrest control from the medical system.

"I think what's happened with our high-tech world is that we are not only doing some wonderful lifesaving things, we're also greatly prolonging dying," he said.

Doctors have long surreptitiously helped patients hasten death, he said, but "nothing is ever said." Over the years, he maintains, he's noticed that doctors themselves have a considerably shorter period of time between illness onset and death. "Obviously, physicians were getting some help."

Recently diagnosed with leukemia, Leversee is getting treatment and expects to feel better soon. But for him this debate, as it has for many, has become more personal.

For Duane French, the disabled opponent of I-1000, it's been personal for a long time.

When he was first paralyzed, French was suicidal. But "you come through that," he said. "Every moment is precious. Let's not send people to an early grave."

Carol M. Ostrom: 206-464-2249 or costrom@seattletimes.com

Copyright © 2008 The Seattle Times Company

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