Washington's Death with Dignity Act. In 2008, voters approved initiative 1000 which established The Death with Dignity Act (act). The act allows terminally-ill adult Washington residents with six months or less to live to request medication they may self administer to end their life. The patient's attending physician is responsible for determining if the patient has a terminal condition. This determination must be confirmed by a consulting physician. If either physician determines the patient may have a behavioral health disorder that impairs the patient's judgment, the patient must be referred for counseling.
To receive the medication, the patient must first make an oral request to a physician, followed by a written request, followed by a second oral request. A 15-day waiting period is required between the time of the first oral request and the second request. At least 48 hours must pass between the patient's written request and writing the prescription. The patient has the option to rescind the request at any time. Once the request has been processed and fulfilled, the medication may be self-administered. Health care providers are not required to participate in the provisions of the act and may prohibit others from participating on their premises. Health care providers may sanction other health care providers for participating, unless the participation occurs outside of the course of employment or involves a provider with independent contractor status. A health care provider participating in good faith compliance with the act is not subject to civil or criminal liability, or professional disciplinary action. The act requires the Department of Health (DOH) to collect and report on certain information about participation in the act. According to the most recent report, in 2018, 267 individuals were dispensed the medication and 203 of these individuals died as a result.
Access to Care Policies. Hospitals must submit to DOH their policies on admissions, nondiscrimination, and reproductive health care along with a form created by DOH in consultation with the Washington State Hospital Association and patient advocacy groups. The form must provide the public with specific information about which reproductive health care services are and are not performed at each hospital. Submitted policies and the form must be posted on the hospital's and DOH's website.
The health care providers authorized to perform the duties of the act are expanded to include advanced registered nurse practitioners, physician assistants, and osteopathic physician assistants. Patients may select which type of attending or consulting health care provider they prefer, as long as a physician or osteopathic physician serves in one of those roles. A patient's attending health care provider and consulting health care provider may not have a supervisory relationship with each other. The types of providers who may provide counseling to patients under the act are expanded to include independent clinical social workers, advanced social workers, mental health counselors, and psychiatric advanced registered nurse practitioners.
The 15-day waiting period between the first and second oral request for a prescription for medications is reduced to 72 hours. The 72-hour waiting period may be further reduced if the attending health care provider determines the patient is not expected to survive for 72 hours. The 48-hour waiting period between the patient signing the written request and writing the prescription is eliminated.
The prohibition on dispensing medications by mail or courier is eliminated. Medications may be delivered by personal delivery, messenger service, or the United States Postal Service or a similar private parcel delivery entity. The addressee or an authorized person must sign for the medications upon receipt. In addition to filing by mail, the prescribing health care provider may file prescribing information with DOH by fax or email.
An employing health care provider may not contractually prohibit an employee health care provider from participating in the act while outside of the employment relationship and not on the employing health care provider's premises, including property owned, leased, or under the control of the employing health care provider. The authority for a health care provider to participate in the act while outside of the scope of employment of an employing health care provider who prohibits participation in the act also requires the employee to be at a location not on the employer's premises, including property owned, leased, or under the control of the employing health care provider.
In addition to other access to care policies, hospitals must submit to DOH their policies regarding access to end-of-life care and the act. DOH must post the policies on its website. By November 1, 2021, DOH must develop a form for hospitals to use to provide the public with specific information about which end-of-life services are and are not generally available at each hospital.