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Live in Washington State? In a crisis? Suicidal?

Call 911.

Then what?

A dispatcher sends crisis negotiators who, if they follow the suggestions provided at a recent negotiators’ training session, could help you consider “all options.” If you’re eligible, you may be referred to friendly volunteers who will help you find a doctor willing to prescribe a deadly drug overdose.

Just take the prescription to a pharmacy. Have it filled by a pharmacist who hands it to you with instructions to “take this with a light snack and alcohol to cause death.”

But what if the pharmacy has opted out of participation in assisted suicide?

Not to worry.

Washington pharmacies are required to fill your prescription.

And what if you’re not “qualified” for assisted suicide under Washington’s Death with Dignity Act?

No sweat. There’s help for you, too. Exit International, an equal opportunity death facilitator, has just established its North American headquarters in Bellingham, WA.

Enter the twilight zone that is Washington State.

Last November, Washingtonians went to the polls and approved Initiative 1000, the Washington “Death with Dignity Act,” a law that is almost identical to Oregon’s assisted-suicide law. During the campaign, assisted-suicide advocates assured voters that the measure, if passed, would be solely a matter of choice for patients who wanted “aid in dying” and that health care providers would not have to participate in it.

That was Then, This is Now

Soon after the law passed, residents of Mount Vernon, a city north of Seattle, heard that Skagit Valley Hospital was one of many health care institutions that had opted out of assisted suicide. They assumed this meant their local hospital would be an assisted-suicide-free zone.

However, while a hospital’s opting out means there won’t be any patients taking the deadly overdose on the premises, it doesn’t prevent hospital staff from making referrals for help in committing suicide.

Take, for example, a recent program held in the community. Like most jurisdictions, Mount Vernon has a team of experienced commissioned law enforcement officers who are highly trained crisis/hostage negotiators. To continually enhance their life-saving skills, they have periodic training sessions. One routine training that took place in early August indicates how assisted-suicide promotion can permeate activities in unexpected ways.

As part of that recent training session, Amber Ford, a social worker from the hospital’s oncology department, presented a comprehensive two-hour discussion about the suicide risk among cancer patients. According to one of the attendees, her presentation was sensitive and informative. But, at the end, a jarring note was introduced.

Prefacing her comments by explaining that she was aware of I-1000’s controversial nature, Ford explained that assisted suicide, like hospice care, was among the alternatives available to cancer patients.

And, in keeping with providing all options now available in the state, she distributed a brochure from Compassion & Choices (C & C), the assisted-suicide advocacy group (formerly called the Hemlock Society).

The brochure explains: “C & C created the coalition that passed I-1000 into law and now stewards, protects and upholds Washington’s Death with Dignity Act. There is never a fee for any service provided by C & C, and confidentiality is strictly protected.” A toll-free number is provided to make access to assisted suicide only a phone call away. The brochure notes that a C & C volunteer can help patients “locate physicians who support a patient’s choice to use the law” – in other words, to find a doctor willing to prescribe a deadly overdose of drugs.

The irony was not lost on one experienced negotiator in attendance:

“I find it interesting that, as crisis negotiators, we are trying to talk people out of killing themselves. But by the end of the afternoon, we had a social worker from the oncology department of the hospital talking about being able to assist people in killing themselves.”

If, indeed, part of crisis management eventually includes offering suicide assistance, it could lead to a rather bizarre screening process. When a 911 call comes in, will there be an extra step in the screening process? If a person calls, asking for help for a suicidal family member, will the screener ask if the person is terminally ill? If not, crisis negotiators could be dispatched to the scene. But, if the suicidal person is terminally ill, will she be given C & C’s toll free number – so C & C could dispatch assisted-suicide facilitators?

Death from your Friendly Pharmacist

Crisis negotiators aren’t the only professionals faced with changing expectations of their role in the assisted-suicide-friendly state. Washington pharmacists are getting a rude awakening as well. When the campaign for I-1000 was ongoing, C & C assured voters that it would be completely a matter of choice for health care providers. Because of those assurances many in the health professions believed passage of the law would not affect them. They bought the hype but (like members of Congress) didn’t read the bill.

It’s true that the assisted-suicide law defines a health care provider as a person who is licensed to administer health care or dispense medication. And it also provides immunity for those who do not participate. This led those who own pharmacies to assume that they would not have to dispense assisted suicide drugs.

They were wrong.

In the law, “participation” is very narrowly defined. It only refers to those activities that constitute the duties of the attending physician, the consulting physician or the counselor under the law. It does not include dispensing drugs.

Pharmacy owners who assumed they could opt out were very much mistaken.

Not only does the assisted-suicide law not give them the right to refuse to dispense a prescription for assisted suicide, but the Washington Administrative Code positively requires all pharmacies to deliver and distribute all lawfully prescribed drugs or devices to patients. That requirement was affirmed in July when the U.S. Court of Appeals for the Ninth Circuit in Stormans v. Selecky vacated a preliminary injunction preventing its enforcement.

The word games continue even after the patient dies from physician-assisted suicide. If she had taken pills that she stockpiled on her own, her death certificate would reflect that the cause of death was a barbiturate overdose and the manner of death was “suicide.” However, if she is a C & C facilitated death, the state forbids any hint of that on her death certificate.

Instructions from the Washington Department of Health make it crystal clear that doctors, coroners and others must refer to her underlying illness, not the drug overdose, as the cause of death and the manner of death must be listed as “natural.” According to the Washington State Department of Health, “The cause of death section may not contain any language that indicates that the Death with Dignity Act was used.”

Assisted-suicide advocates are well aware that, in Washington, they’ve found a friendly home from which they can expand their operations. The welcoming atmosphere has attracted Exit International’s Dr. Philip Nitschke (sometimes called the Australian Kevorkian).

During the few months in which euthanasia and assisted suicide were legal in Australia, Nitschke was the specialty’s sole practitioner, using his “death by laptop” method. In the past, he received funding for development of a “peaceful pill” – the label used for a quick, sure do-it-yourself death – from the Hemlock Society.

Long a believer in equal suicide opportunity for anyone of any age for any reason, he has said assisted suicide should be available to children and teens.

Recently, Nitschke announced establishment of a North American base in the college town of Bellingham, WA where he plans to hold an “Exit workshop” in the Fall, covering such topics as how to obtain end-of-life barbiturates, how to store and test veterinary Nembutal, and how to use helium and a plastic bag to end your life.

Move over, Holland. Move over, Oregon. Washington State is rapidly taking over first place when it comes to embracing the grim reaper.
[Rita Marker, September 29, 2009 Note: Rita Marker is an attorney and executive director of the International Task Force on Euthanasia & Assisted Suicide. ]


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